Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: A case study

AbstractWe report the clinical case of a 54-year-old woman presenting radicular low back pain on the right side of L4 associated to spondylolisthesis on L4-L5, without any notion of trauma or spine surgery. Furthermore this patient is regularly seen for benign rheumatoid polyarthritis complicated by steroid-induced osteoporosis. A preventive treatment was implanted with good results on pain improvement and functional capacities. For pedicle fractures the literature review reports several different etiologies: spontaneous fractures, hereditary fractures or stress-related fractures. There was a discussion on the various treatments available and in this case of spondylolisthesis on pedicle fracture a conservative treatment was implemented similar to the one for isthmic spondylolisthesis. It yielded satisfying results

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges

Assessment of disease activity and carpal erosions by MRI of the wrist in children with juvenile idiopathic arthritis

Objective: MRI is an important tool for assessing activity and structural progression in patients with juvenile idiopathic arthritis (JIA). Assessment of erosions on the wrist is difficult given the presence of normal variations in healthy children. We aimed to compare bone depressions in JIA patients and differentiate them in healthy children and to validate the RAMRIS erosions, synovitis and bone edema score in JIA. Patients and Methods: MRI of the wrist was performed in healthy children and those with JIA aged between 5 and 18 years. We evaluated the number of bone depressions in the carpal bones using coronal T1 and fat-saturated T2 sequences. Results: A total of 13 patients with JIA were included and 22 healthy children. The number of bone depressions was significantly higher in the JIA group compared with healthy children in both age groups; for the age group 5-9 years 6.55 ± 2.25 (n = 7) of bone depressions were found in the JIA group vs. 2.15 ± 1.12 (n = 10) in the control group (p = 0,03). In the group aged 10-18 years the number of bone depressions in the JIA group and the healthy children group were respectively 9.08 ± 4.36 (n=6) and 5.35 ± 2.06 (n = 12) (p = 0.02). Conclusions: Our study suggests that bone erosions on MRI of the wrist are more common in JIA unlike healthy children, and synovitis on MRI is highly correlated with disease activity and functional impact

Risk of infection and disease activity of patients with juvenile idiopathic arthritis treated with and without biologics

Objective: Juvenile idiopathic arthritis is the most common rheumatic disease children suffer from. Many questions arise regarding the risk of infection related to the disease and to the treatments with conventional and biological DMARDs. We aimed to assess the rate of infection in JIA patients treated with and without biologics and confirm the link between the infection and the disease activity. Patients and Methods: The risk of infection was evaluated in 2 groups (biological vs. conventional DMARDs). JIA activity was assessed using JADAS-10, physician and parent VAS. Results: Two minimal infections were noted under conventional DMARDs and 5 infections under biologics giving an infection rate ratio of 1.9. No correlation was found between the disease activity assessed by JADAS-10 and the risk of infection. The infection rate was higher in the biological group compared to the conventional DMARDs group (62.5% vs.33%), but the difference was not statistically significant (p=0.6). Conclusions: Our results suggest no significant difference in infection rates between JIA subjects treated with and without biologics. Larger scale studies of the relationship between infection rates, type of treatment and disease activity are needed

Comparison of elderly and young onset rheumatoid arthritis

Objective: To describe demographic, clinical, paraclinical and therapeutic characteristics of elderly onset (EORA) compared to young-onset (YORA) rheumatoid arthritis. Patients and Methods: We studied 50 EORA and 100 YORA. Socio-demographic characteristics, clinical and paraclinical data of the disease were collected as well as the treatments assigned to patients. EORA patients were defined as disease onset ≥ 60 years. Results: At the study visit, EORA patients had a mean age of 68.3 ± 6.4 years old and YORA patients were aged 42.5 ± 9.1 years old. A male predominance was noted in EORA group than the YORA group (38% vs. 12%, p <0.001). The onset of disease in EORA was more acute (p <0.001) with more systemic symptoms (p <0.001). EORA patients had higher Disease Activity Score of 28 joints (DAS28) (p=0.03) and higher erythrocyte sedimentation rate (ESR) (40 [10-110] vs. 28 [2-88], p=0.015). There was no significant difference in seropositive character, prevalence of radiographic erosions or joint deformity. The EORA patients had a higher Health Assessment Questionnaire (HAQ) (1 [0.4-2.2] vs. 0.6 [0.2-2], p<0.001) and more comorbidities (84% vs. 37%, p<0.001). Methotrexate was the most conventional synthetic disease-modifying antirheumatic drugs used in the two groups (95% in the YORA and 96% in the EORA; p=0.740). The EORA group received fewer biologic drugs than the YORA group (30% vs. 47 %; p=0.041). Conclusions: There were more male in EORA group. Activity and HAQ was higher in the EORA group. The EORA had more comorbidities which may explain the lesser use of biological treatments