Search

Objectives The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. Methods A 4-week prospective study of 387 outpatients suffering from chronic rheumatic diseases was carried out. Pain level was evaluated using a 0–100 mm visual analog scale. An anchoring method based on patient's opinion was used. The PAccSS was defined as the 75th percentile of the score for patients who considered their state satisfactory. Pearson's chi-square and binary logistic regression were used to analyze the data. Results The underlying disease of the patients (mean age 50 ± 13 years; female sex 70%) was rheumatoid arthritis (N = 102), ankylosing spondylitis (N = 100), peripheral osteoarthritis (N = 100), and degenerative back pain (N = 85). The mean disease duration was 7.4 ± 6.7 years. At the time of the study, the level of pain was 44 ± 23 mm. One hundred ninety (49%) patients considered their state as satisfactory, and the PAccSS threshold was 50 mm. Significant contributors to PAccSS were high educational level, high socioeconomic status, higher functional status scores, and shorter term disease duration. Conclusion Half of patients were satisfied of their disease state, while the PAccSS threshold of pain was unexpectedly high. This could be explained by an overestimation of the pain intensity or a Moroccan patients' high tolerance to pain. The main protective factors that contribute to achieving the PAccSS were high educational level, high socioeconomic status, higher functional status, and shorter term disease duration.

Osteoporosis is a common complication of chronic liver disease, from cholestatic disorders to autoimmune, alcoholic, and posthepatitic cirrhosis. Osteoporosis appears more striking in patients with primary biliary cirrhosis (PBC) because the disease usually affects elderly women, who are naturally prone to osteoporosis. Our aims were (1) to compare the prevalence of osteoporosis (T-score-2.5 SD) between PBC patients and a group of age-and sex-matched controls consisting of healthy subjects from the general population; and (2) to identify the main risk factors for the development of bone loss. Thirty-three women with PBC (mean age, 47.3 +/- 10.4 years) and 66 healthy subjects were enrolled in the study. Bone mineral density (BMD) was assessed at the lumbar spine by dual-photon X-ray absorptiometry. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin, 25-hydroxyvitamin D (25-OH vit D), parathyroid hormone, and osteocalcin. Vertebral fractures were analyzed using vertebral fracture assessment (VFA). The mean T-score was lower in the PBC group compared to healthy controls, with a significant statistical difference (-2.39 +/- 0.93 and -1.47 +/- 0.99 in lumbar spine and total hip, respectively, in the PBC group versus -0.99 +/- 0.51 and -0.56 +/- 1.14 in healthy controls (P0.001). The prevalence of osteoporosis was 51.5% in the PBC group versus 22.7% in healthy controls with a statistically significant difference (P = 0.004). BMD of the PBC group was significantly correlated positively with body mass index (BMI) and 25-OH vit D, and negatively with menopausal status, duration of disease, and parathyroid hormone (PTH) levels. Vertebral fractures were present in 9% of the patients. We found that osteoporosis is more prevalent in women with PBC than in the general population. BMI, menopausal status, duration of the disease, and vitamin D deficiency are the main risk factors for osteoporosis in this liver disease.

Osteoporosis has become an increasingly recognized complication among patients with chronic liver disease (CLD). The aim of the present study was to assess the prevalence and risk factors of osteoporosis in patients with CLD (primary biliary cirrhosis and chronic viral hepatitis B or C patients) in comparison with a group of age- and sex-matched controls. Sixty-four patients with CLD (mean age 51.66 ± 11.54 years), 48 females and 16 males were included. Age- and sex-matched individuals from the general population served as controls. Osteoporosis was evaluated by dual energy X-ray absorptiometry (bone mineral density below −2.5 T score) at the lumbar spine (LS) and total hip (TH). Vertebral fractures were established by densitometric morphometry (vertebral fracture assessment). Bone turnover was assessed by intact parathyroid hormone, osteocalcin and C-telopeptides of type I collagen in the serum. Prevalence of osteoporosis in either the LS or the TH was 45.3%, twice as high as in the controls (19.6%) (RR 2.31, 95% CI 1.42–3.75, P < 0.001). Age, menopausal status, cirrhosis and advanced histological stage are not determinant factors for developing osteoporosis in patients with CLD. However, female sex, cholestasis, lower weight and height but not body mass index seem to play predominant role. Three (5.3%) patients had dorsal and LS fractures. It was concluded that osteoporosis is effectively a complication of CLD. Cholestasis in addition to female sex and lower weight and height are risk factors of osteoporosis in CLD.

Background The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with Ankylosing Spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients. Methods A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index. Results The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%. Conclusions This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research.