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Objective: To evaluate the effects of the COVID-19 pandemic on the pain experienced by patients with CIRD and to analyze the associated factors. Methods: A cross-sectional study was conducted amongst patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Patients were asked to assess the level of pain they had experienced before and during the pandemic, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain). Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data. We performed univariate multivariate analysis to search for any related factors to pain perception during the COVID-19 pandemic. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric tests (Mann–Whitney U) when the measures were not normally distributed (the Kolmogorov–Smirnov test was used to test normality). Results: Amongst the 350 patients who answered the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3%, and undifferentiated CIRD 3.4%. CIRD-related pain was reported by 79.1% of the patients The level of pain, using the VAS of Pain, increased significantly during the COVID-19 pandemic (4,6 ± 2,8 and 5,4 ± 3 before and during the pandemic; p In the multivariate analysis, the factors causing the pain were: the negative impact of the coronavirus on accessing rheumatology care, the discontinuation of treatment, the disturbed sleep, and the negative psychological impact. Conclusion: This survey showed that the COVID-19 pandemic had increased CIRD-related pain in patients. Factors influencing this pain should be considered to help patients cope with their chronic rheumatism in this global health crisis.

To investigate Organochlorine (OC) in Moroccan water samples, two different methods of extraction being the solid phase micro extraction (SPME) and the liquid-liquid extraction (LLE) are exploited. The gas chromatography with an electron capture detector (GC-ECD) and the gas chromatography coupled to a mass spectrum (GC-MS) are elaborated. In order to get the best extraction, different process parameters are cheeked and optimized. The relevant results are obtained using a time of unspecific binding properties of 30 minutes’ duration and mode of agitation for 30 min with agitation by a magnetic stirrer and a temperature of 30 °C. In particular, a comparative study between the results of SPME and LLE coupled to (GC-ECD) and (GC-MS), respectively, are given. Concretely, it has been found that the SPME extraction technique is a very useful method to analyze the pesticide residues in water samples controlled by local laboratories.

Introduction La nephropathie diabetique (ND) est une des premieres causes d’insuffisance renale terminal dans le monde et est associee a une mortalite cardiovasculaire elevee. L’objectif de notre etude est de determiner le profil des nephropathies non-diabetiques (NND) chez les diabetiques. Description Etude retrospective des donnees clinicobiologiques et histologiques des diabetiques ayant eu une (PBR) devant la suspicion clinique de (NND). Entre janvier 2009 et decembre 2020 au sein de notre service de nephrologie. Methodes Elle a porte sur un ensemble des 66 patients diabetiques ayant beneficies de PBR devant suspicion de NND. Critere d’exclusions : 6 patients exclus PBR interessant la medullaire. Resultats Sexe-ratio 1,85 (39 hommes, 21 femmes). L’âge moyen 47,9 ans (15–84 ans). Diabete de type I retrouve chez (30 %) et diabete type II chez (70 %) des patients. Une NND a ete mise en evidence dans 28 cas (46,6 %) ; isolee chez 22 patients (36,6 %), et associe a une ND chez 6 patients (10 %). La duree moyenne de l’evolution du diabete etait 8 ans (1–20 ans). La PBR est indiquee devant : insuffisance renale (IR) 60,7 % dont IR rapidement progressives dans 14,3 %, hematurie chez 50 % une proteinurie isolee chez 12 %, syndrome nephrotique 35,7 %, absence de retinopathie diabetique 95 % du groupes de NND. Les nephropathies trouvees : LGM (21,43 %), lupus (14,28 %), GNMP (10,74 %) GEM (7,14 %), amylose (7,14 %), NTA (7,14 %), HSF (7,14 %), NTI (7,14 %), parenchyme renale normale (7,14 %), GNA (3,57 %), Goodpasture (3,57 %) et tuberculose renale (3,57 %). Conclusion Une PBR chez le diabetique a permis de diagnostiquer un grand nombre de NND associees ou non a la ND. La PBR chez le diabetique doit etre indiquee devant toute presentation atypique faisant suspecter une NND.

Objectives: To evaluate oral hygiene status in Rheumatoid arthritis (RA) patients, to analyse possible related factors, and to investigate the role of the rheumatologist in information about importance of adequate oral hygiene status in RA patients. Methods: A cross-sectional study that included 100 consecutive RA patients (89% female, mean age 46.7 ± 11.7 years). For each patient, we recorded oral symptoms, oral hygiene status and role of rheumatologist in information on the oral hygiene status. Factors associated with regular brushing (≥2/day) were also analysed. Results: Median disease duration was 8 years (4;2). Dental pain was reported by 74% of patients and bleeding by 51% of them. Regular brushing was noted in 45% of patients. The use of a correct brushing method was noted in 14% of cases. Two patients reported visiting a dentist regularly. Information explaining that poor oral hygiene has a negative impact on RA was delivered by rheumatologist to 11 patients. Regular brushing of teeth was recommended by rheumatologist to 8 patients and 10 patients were advised by their rheumatologist to consult a dentist. Regular brushing was more important in women (48,3% vs 18,2%; p=0.05) and in the literate patients (57,6 vs 31,2%, p

The aim of the study was to estimate the annual direct costs of biological therapies in rheumatoid arthritis (RA), and to establish possible factors associated with those costs. The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry). We included patients with available 1-year data. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Differences in costs across groups were tested by Mann–Whitney and Kruskal–Wallis tests. Correlations analysis was performed in search of factors associated with high costs. We included 197 rheumatoid arthritis patients. The mean age was 52.3 ± 11 years, with female predominance 86.8%. Receiving one of the following therapies: rituximab (n = 132), tocilizumab (n = 37), or TNF-blockers (n = 28). Median one-year direct costs per patient were €1665 [€1472–€9879]. The total annual direct costs were € 978,494. Rituximab, constituted 25.7% of the total annual budget. TNF-blockers and tocilizumab represented 27.3% and 47% of this overall budget, respectively. Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation. A positive correlation was found between the annual direct cost and body mass index (r = 0.15, p = 0.04). In Morocco, a developing country, the annual direct costs of biological therapy are high. Our results may contribute to the development of strategies for better governance of these costs.

Background Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare. Case presentation We report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution. Conclusions To avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.

Rheumatoid arthritis may be associated with an increased risk of hematological malignancy. Increased lympho-proliferative malignancy in rheumatoid arthritis is often described; however an increased risk of leukemia is not a common finding. A few cases of rheumatoid arthritis have been documented associated with chronic myeloid leukemia in the literature. We report a new case. Case presentation A 36-year-old Moroccan female diagnosed as rheumatoid arthritis eight years ago, was on remission under Methotrexate and prednisone. This therapy was stopped one year before her admission at our hospital because of thrombopenia and anemia. She had polyarthritis flare. The physical examination found splenomegaly, hepatomegaly, and skin lesions at the trunk and limbs. Peripheral blood findings, peripheral smear and bone marrow aspiration diagnosed myeloid leukemia in a blastic accelerated phase with negative Philadelphia chromosome. The skin lesions were diagnosed as pyoderma gangrenosum (skin biopsy). She received oral prednisone and chemotherapy (Cytarabine and 6-Mercaptopurine). She had a complete response on the skin lesions, partial regression of splenomegaly, and improvement of her hematologic disorders. Unfortunately the patient died from septic shock after two weeks of post-chemotherapy pancytopenia. Conclusion We report an unusual case of rheumatoid arthritis complicated by chronic myeloid leukemia associated with pyoderma gangrenosum. It is unclear whether the development of chronic myeloid leukemia in the patient with rheumatoid arthritis occurs by chance alone, is due to the underlying disease, or is facilitated by drugs. Whatever the cause is, it should be kept in mind that chronic myeloid leukemia may develop in the course of rheumatoid arthritis.

L’hormonotherapie constitue un des piliers principaux de la prise en charge medicale du cancer du sein chez les patientes hormonosensibles. Les antiaromatases (AI) representent le traitement de reference chez les patientes menopausees. Cette therapeutique n’est pas depourvue d’effets secondaires notamment les manifestations osteoarticulaires. La prise en charge des manifestations osteoarticulaires des patients sous AI doit etre multidisciplinaire incluant notamment oncologues medicaux et rhumatologues. La rotation des AI peut constituer une alternative possible dans certaines circonstances. La perte osseuse peut etre prevenue et traitee conformement aux recommandations internationales en se basant essentiellement sur les biphosphonates.

Juvenile idiopathic arthritis (JIA) is defined as arthritis of unknown cause that starts before 16 years of age and lasts at least 6 weeks. It is the most common chronic inflammatory disease in childhood and often persists through adulthood and can lead to severe disability. Biologics are an important therapeutic option for treating patients with JIA. The efficiency of rituximab has not been proven for this indication. Its use has rarely been reported in the literature. We report two new cases of severe and refractory polyarticular JIA with positive rheumatoid factor affecting two African females aged 17 and 18 years successfully treated with rituximab. According to our experience, the use of rituximab in the treatment of JIA, especially in severe polyarticular forms with positive rheumatoid factor, might be a good alternative. Larger therapeutic trials should be conducted in this direction in order to prove the effectiveness of this biotherapy for this indication.

Joint manifestations in scleroderma (Scl) and polymyositis (PM) are dominated by inflammatory arthralgia. Arthritis is less common and preferentially affects the hands, wrists, knees, and ankles. Involvement of the hip has been rarely reported in the literature. We report a case of coxitis diagnosed in a patient suffering from scleroderma-polymyositis overlap syndrome successfully treated by ultrasound-guided infiltration of triamcinolone hexacetonide.

We report two cases of primary Non-Hodgkin's Lymphoma in the spine leading to radicular compression secondary to infiltration of lumbar body vertebras. The two patients were free of either nodular or other extra-nodular disease. Treatment consisted of chemotherapy alone, one patient have had a cauda equina syndrome and surgical decompression was performed in emergency. The patients were in remission for 20 months after diagnosis. A review is given for the incidence of primary vertebral localization of lymphoma, its diagnosis, treatment and prognosis.

Le présent travail consiste à évaluer le degré de contamination de lestuaire de Bouregreg (Maroc) à travers le suivi spatio-temporel des teneurs de certains éléments métalliques (Cd, Cr, Cu, Fe, Pb et Zn) au niveau des sédiments et chez la moule Mytilus galloprovincialis. L'écosystème est soumis à de nombreux rejets complexes d'origine diverse. Une situation qui se complique davantage au niveau de l'estuaire par le jeu des marées rendant difficile l'évacuation aisée de la charge polluante résultant de l'activité anthropique. Les résultats obtenus font état d'une contamination métallique généralisée le long de l'estuaire, importante pendant l'été au niveau des sédiments et pendant lhiver chez la moule. Le degré de contamination le plus élevé correspond au plomb avec des taux quatre fois supérieurs aux normes de la CEE. La consommation de la moule provenant de l'estuaire de Bouregreg reste redoutable et dangereuse quant aux risques toxicologiques que peut induire sa contamination.

Introduction Reflex sympathetic dystrophy (RSD) during pregnancy is a rare condition and may be misdiagnosed. We report a case of RSD involving the hip in a 22-year-old woman with onset during the third trimester of pregnancy. Case presentation A 22-year-old Moroccan woman presented in the third trimester (34 weeks of gestation) of her second pregnancy with permanent pain in the left hip that made standing and walking difficult. Physical examination of the hip showed mild painful range-of-motion restriction. Erythrocyte sedimentation rate was 40 mm (1st hour) and C-reactive protein was 10 mg/l. Ultrasound of the left hip was normal. Magnetic resonance imaging (MRI) revealed a characteristic image of RSD involving the left hip. Treatment was symptomatic, combining non-weight-bearing exercises with rest and analgesics (Paracetamol). Physical therapy was gradually undertaken and was carried out only to the point of pain. Clinical recovery was rapidly obtained (within 2 weeks). Conclusion Pregnancy is a potential cause of hip RSD. This diagnosis must be always kept in mind when attending a pregnant patient or a patient with hip pain and functional impairment.

Myositis ossificans is a benign self limiting condition that usually related to trauma. Despite a clinically and histologically distinct entity, myositis ossificans still causes considerable difficulties in diagnosis. A 33-year-old Moroccan woman presented with a 2-month history of left inguinal inflammatory pain with limping gait, MRI examination suggested a malignant neoplasm such as soft tissue osteosarcoma. A diagnosis of myositis ossificans was made by incisional biopsy. Conservative management with clinical and radiological follow up of 19 months confirm the diagnosis. The symptoms resolved within seven months. Myositis ossificans should be considered by clinicians as a possible diagnosis for a soft tissue lesion.

Resume La myopathie sarcoidosique est rarement symptomatique, notre observation illustre le premier cas de syndrome de compression du nerf radial par des nodules sarcoidosiques. Une femme de 58 ans porteuse d’une sarcoidose mediastino-pulmonaire a ete admise pour un deficit moteur des deux mains avec une deviation radiale lors de l’extension des poignets. Le diagnostic de syndrome de compression de la branche motrice du nerf radial a ete retenu. La patiente a beneficie d’une neurolyse du nerf radial avec des biopsies musculaires multiples. L’etude anatomopathologique a conclu a une myopathie sarcoidosique dans sa forme nodulaire a l’origine de la compression du nerf radial.

Tumoral calcinosis is an uncommon and severe complication of hemodialysis therapy. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product, not necessarily related to hyperparathyroidism. We report here a patient on hemodialysis who presented with increasing multifocal and uncommon sites of massive calcifications. The patient was examined, and a diagnosis of uremic tumor calcinosis was made. The patient was treated with the noncalcemic phosphate binder sevelamer, a strict diet, multiple hemodialysis sessions per week, and a low calcium dialysate, with improvement on biological findings a decrease in the volume of some tumors on his fingers and a global stable disease. Some nodes in hands and feet disappeared; in other sites, their diameter was reduced, and the largest nodule decreased from 5- to 2-cm diameter.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 13 octobre 2010

Patients undergoing hemodialysis therapy develop serious osteoarticular diseases. The treatment is based on prevention. The aim of our study is to determine the frequency and the associated factors to the rheumatic manifestations in hemodialysis patients. A cross-sectional study was conducted, including all hemodialysed patients in our dialysis unit. Information was obtained from patients' symptoms, examination findings, and biological and radiological signs. The frequency of symptoms was 70% in our patients. It was proportional to the duration of hemodialysis and number of hemodialysis sessions per week. Early transplantation is of course a plausible solution, but other therapies such as improved dialysis must be considered.

Celiac disease (CD), a malabsorption syndrome caused by hypersensitivity to gliadin fraction of gluten. CD can manifest with classic symptoms; however, significant myopathy and multiple fractures are rarely the predominant presentation of untreated celiac disease. Osteomalacia complicating celiac disease had become more and more rare. We describe here a case of osteomalacia secondary to a longstanding untreated celiac disease. This patient complained about progressive bone and muscular pain, weakness, fractures and skeletal deformities. Radiological and laboratory findings were all in favor of severe osteomalacia. Improvement of patient's weakness and laboratory abnormalities was obvious after treatment with gluten free diet, vitamin D, calcium and iron. This case affirms that chronic untreated celiac disease, can lead to an important bone loss and irreversible complications like skeletal deformities.Key words: Osteomalacia, celiac disease, vitamin D, bone loss, Morocco

Pregnancy complicated by Non Hodgkin lymphoma (NHL) is rare, about 100 cases have been reported. We will describe the case of a multifocal bone lymphoma revealed by a left hyperalgetic and deficient cruralgia in a female in the second trimester of pregnancy.

Les complications infectieuses sont redoutables au cours de la polyarthrite rhumatoïde (PR). Le but de notre étude est d'estimer leur fréquence et de déterminer les facteurs associés à l'infection chez ces patients. Il s'agit d'une étude rétrospective incluant les cas de PR établis recensés entre 2007 et 2011 au service de rhumatologie au CHU Hassan II de Fès au Maroc. Nous avons inclu 164 patients atteint de PR, l'âge moyen des patients était de 47,9 ans, avec une prédominance féminine (137 F/27H). La fréquence des infections dans notre série était de 26,2 %, dominées par les infections urogénitales (22 cas), pleuro pulmonaires (11 cas) dont 2 cas de tuberculose pulmonaire et un cas d'infection H1N1, 3 cas d'infections cutanées et 4 cas d'arthrite septiques. Dans notre série 127 patients étaient sous corticothérapie orale, 147 patients étaient sous méthotrexate, 25 patients étaient sous rituximab et 8 patients étaient sous tocilizumab. Dans notre étude, les facteurs associés à la survenue d'infection étaient l'âge avancé (p= 0,02), une CRP élevée (p= 0,04) et une dose de corticothérapie - 7.5 mg/j (p= 0 ,03). Notre étude a mis en évidence certains facteurs associés à la survenue d'une infection au cours de la PR. En connaissant ces facteurs, il faut instaurer une surveillance particulière pour améliorer la qualité de prise en charge.

Resume L’atteinte cardiaque survient habituellement tardivement au cours de la polymyosite. Elle touche preferentiellement le cœur gauche. Nous rapportons une observation de syndrome des antisynthetases originale par sa presentation clinique. M. D., 26 ans, consultait pour une polyarthrite, de la fievre et des myalgies evoluant depuis six mois. Le bilan biologique montrait un syndrome inflammatoire et une myolyse. La recherche des auto-anticorps trouvait des FAN positifs avec la presence d’anti-SSA et d’anti-JO1. L’electromyogramme objectivait une atteinte myogene severe. La biopsie musculaire confirmait le diagnostic de polymyosite. La radiographie pulmonaire, le scanner thoracique et l’echographie transthoracique etaient normales. Une semaine plus tard, un tableau aigu d’insuffisance cardiaque droite s’installait, accompagne d’un epaississement inflammatoire de la paroi du ventricule droit a l’IRM. L’evolution clinique etait rapidement favorable sous corticosteroides et methotrexate, avec normalisation du bilan biologique dont les CPK.

Cardiac involvement is a complication of end stage polymyositis with left heart insufficiency reported to be the most frequent manifestation. We here describe an unusual clinical presentation of antisynthetases syndrome, beginning with right-sided cardiomyopathy associated with right heart failure. A 26 year-old Caucasian male experienced a 6-month clinical course of polyarthritis, fever, sweats, and myalgia. Laboratory studies showed elevated C reactive protein, elevated sedimentation rate, and myolysis associated with anti SSA and anti JO1 antibodies. Electromyography showed a myopathic pattern. Muscle biopsy confirmed the diagnosis of polymyositis. Chest X ray, chest scan, and cardiac echography were normal. One week after hospital admission, the patient developed acute right heart insufficiency, and magnetic resonance imaging showed a right ventricular myocarditis with myocardial inflammatory thickening. Treatment with corticosteroids rapidly improved both symptoms and biological abnormalities.