Profile and course of early rheumatoid arthritis in Morocco: a two-year follow-up study

<p>Abstract</p> <p>Background</p> <p>This study aimed to establish the profile and the evolution of an early Rheumatoid arthritis <b>(RA) </b>cohort in the Moroccan population and also to search possible predictor factors of structural progression.</p> <p>Methods</p> <p>Patients with early RA (< 12 months) were enrolled in a 2-year follow-up study. Clinical, biological, immunogenetic, and radiographical data were analyzed at study entry and at 24 months. Presence of radiographic progression was retained when the total score was superior to the smallest detectable difference (SDD) calculated to be 5.4 according the Sharp/van der Heijde (SVDH) method.</p> <p>Results</p> <p>Fifty one patients (88.8% women, mean age of 46.9 [ 24-72 ] ± 10.8 years, mean disease duration of 24 [ 6-48 ] ± 13.9 weeks) were enrolled in this study. 68.6% were illiterate and 19.6% reported at least one comorbid condition. The mean delay in referral for specialist care was 140 [ 7-420 ] ± 43 days.</p> <p>Thirteen patients (62.5%) were IgM or IgA RF positive. HLA-DRB1*01 and DRB1*04 alleles were present respectively in 11.8% and 45.1% of patients.</p> <p>At baseline, 35.3% patients were taking corticosteroids and 7.8% were under conventional DMARDs.</p> <p>At 24 months, 77.2% received a median dose of 5 mg/day of prednisone. Methotrexate (MTX) was the most frequently prescribed DMARD, being taken by 65.2% of patients. 13.6% of patients had stopped their DMARD because of socioeconomic difficulties.</p> <p>Comparison of clinical and biologic parameters between baseline and 24 months thereafter revealed a significant global improvement of the disease status including morning stiffness, pain score, swollen joint count, DAS 28 and HAQ scores, ESR and CRP.</p> <p>Sixteen patients (34.8%) were in remission at 2 years versus no patients at baseline; <it>P </it>< 0.001.</p> <p>Forteen patients (27.5%) had at least one erosion at baseline. Radiographic progression occurred in 33.3% of patients and was associated in univariate analysis to swollen joint count (p = 0.03), total SVDH score (<it>P </it>= 0.04) and joint space narrowing score (<it>P </it>= 0.03). No independent factors of radiographic progression were shown by logistic regression.</p> <p>Conclusions</p> <p>These study reports, provided for the first time in Morocco, a developing African country, a large amount of information concerning the profile and the course of early RA.</p> <p>Patients who were receiving, for most of them, Methotrexate in monotherapy and low doses of corticosteroids, showed an improvement of all clinic and biologic disease parameters. Moreover, DAS remission was obtained in one third of patients and two thirds of the cohort had no radiographic progression at 2 years. No predictor factors of radiographic progression were found out.</p> <p>These results should be confirmed or not by a large unbiased RA cohort which will give more relevant information about early RA characteristics and its course and will constitute a major keystone of its management.</p

Study of postural imbalances : modeling in healthy subjects, consequences of muscle deconditioning and joint pathology

IntroductionLes chutes constituent un véritable problème de santé publique. Les objectifs de ce travail sont d’analyser les variations de l’équilibre postural chez des sujets sains exposés à conditions déstabilisantes. Nous avons également étudié l’impact de l’intégration d’orthèses plantaires au protocole de réhabilitation respiratoire (RR) sur la stabilité posturale chez les patients suivis pour une bronchopneumopathie chronique obstructive (BPCO). Nous avons enfin analysé les effets de la pose d’une prothèse totale du genou (PTG) sur la stabilité posturale et également les résultats fonctionnels et posturographiques d’orthèses plantaires chez les patients avec un pied rhumatoïde.Matériel et méthodesNous avons combiné des mesures baropodométriques pour l’analyse posturographique, des mesures de force musculaire et des questionnaires cliniques adaptées aux situations étudiées.RésultatsLe port de charge supplémentaire, la suppression du contrôle visuel ou la réduction du polygone de sustentation augmentent l'instabilité posturale.L’ajout d’orthèses plantaires dans la BPCO a réduit la fatigue corporelle, augmenté la distance de marche et la force maximale de flexion plantaire et a amélioré le contrôle postural.La PTG améliore la stabilité posturale. il est de même pour les orthèss plantaires dans la PR.Conclusion Le port d’une charge supplémentaire en antérieur, en postérieur ou en antéropostérieur augmentent le déséquilibre postural. Le déconditionnement musculaire dans la BPCO, la gonarthrose avancée et l’atteinte rhumatoïde des pieds sont également associées à une instabilité posturale.Falls are a real public health problem. The objectives of this work are to analyze the variations in postural balance in healthy subjects exposed to destabilizing conditions. We also studied the impact of integrating plantar orthotics into the respiratory rehabilitation (RR) protocol on postural stability in patients followed for chronic obstructive pulmonary disease (COPD). Finally, we analyzed the effects of fitting a total knee replacement (TKA) on postural stability and also the functional and posturographic results of plantar orthoses in patients with rheumatoid foot.Material and methodsWe combined baropodometric measurements for posturographic analysis, muscle strength measurements and clinical questionnaires adapted to the situations studied.ResultsCarrying additional load in the posterior predispose to a higher risk of falling. This risk is also increased with the removal of visual control and with the reduction of the support polygon.In COPD patients with static foot disorders, the addition of plantar orthotics reduced body fatigue, significantly increased the distance of the walking test by 6 min 6MWT and maximum plantar flexion force and also improved parameters providing information on postural control.In patients operated on for knee osteoarthritis, the study of the change in baropodometric parameters 1 month after the placement of a TKA found an improvement in the parameters of postural stability.In RA patients, plantar orthotics improved plantar support parameters and decreased postural sway. The stabilogram position also improved without statistical significance

Synovialosarcome de la mandibule : à propos d’une observation

Le synovialosarcome est une tumeur mésenchymateuse qui atteint habituellement les parties molles des membres inférieurs, surtout dans la région du genou ou de la cheville, chez les adolescents ou les adultes jeunes. Beaucoup plus rarement, il est observé dans la région de la tête et du cou. Contrairement à ce que le nom laisse entendre, le synovialosarcome ne se développe pas à partir du tissu synovial. Nous rapportons le cas d’une patiente de 54 ans présentant depuis 2 ans un synovialosarcome de la mandibule, dont le diagnostic a été confirmé par une étude immunohistochimique. Le traitement a consisté en une exérèse chirurgicale en monobloc passant en tissu sain, complétée par une radiothérapie. Ce cas vient confirmer l’efficacité d’un traitement combiné dans la région cervico-faciale

Pre-extensively drug-resistant tuberculosis spondylodiscitis in an immunocompetent patient: a case report

Pre-extensively drug resistant tuberculosis (pre-XDR-TB) has been an area of growing concern, and posing a threat to global efforts of TB control. We report a case of PreXDR-TB spondylodiscitis with resistance to a Fluoroquinolone, in an immunocompetent patient under antibacillary treatment for pleural tuberculosis, managed with drug sensitivity-based second-line antituberculous drug regimen. Our case shows the challenges of the diagnostic and management of Drug-resistant TB spondylodiscitis

Rheumatoid shoulder assessed by ultrasonography: prevalence of abnormalities and associated factors

Introduction: The shoulder involvement in rheumatoid arthritis (RA) is common. It can be subclinical and compromise the function of the upper limb. Musculoskeletal ultrasonography can detect subclinical abnormalities in rheumatoid shoulder. Our aim was to assess the prevalence of ultrasound abnormalities in rheumatoid shoulder, and investigate their association with different parameters. Methods: Cross-sectional study including 37 patients with RA, meeting the ACR/EULAR 2010 classification criteria, who were enrolled during a month. A questionnaire with sociodemographic, clinical and laboratory data was filled in for all patients. Ultrasound evaluation was performed by a single experienced operator. For each patient, both of shoulders were evaluated. Results: Mean age was 50 years with female predominance. Median disease duration of RA was 7.5 years. All patients had a seropositive form of RA. Mean clinical DAS28 was 5.1. Mean HAQ was 1.2. Thirty-one (83.8%) patients had involvement of the shoulder: unilateral in 9(24.3%) cases and bilateral in 22(59.5%) cases. Synovitis was found in 16(43.2%) patients with Doppler in 4 (10.8%) cases. Sub-acromial bursitis was noted in 14 (37.8%) cases and the effusion in 20 (54.1%). Synovitis was noted especially in elderly individuals (p: 0.01). The Doppler was visualized in elderly patients (p: 0.01), with a shorter disease duration (p: 0.02) and with a high SDAI (p: 0.006). US inflammatory findings in anterior recess of glenohumeral joint were linked to a higher synovial index (p: 0.03) and a higher level of rheumatoid factor (p: 0.01). Conclusion: 59.5% of our RA patients had bilateral involvement of the shoulder which was related to the disease activity. Ultrasound should be a systematic tool to look for the involvement of this joint in RA patients.Pan African Medical Journal 2016; 2

Evaluation of Vitamin D Status in Rheumatoid Arthritis and Its Association with Disease Activity across 15 Countries: “The COMORA Study”

The aims of this study are to evaluate vitamin D status in 1413 RA patients of COMORA study from 15 countries and to analyze relationship between patients’ RA characteristics and low levels of vitamin D. All demographic, clinical, and biological data and RA comorbidities were completed. The results showed that the average of vitamin D serum dosage was 27.3 ng/mL ± 15.1 [0.1–151]. Status of vitamin D was insufficient in 54.6% and deficient in 8.5% of patients. 43% of RA patients were supplemented with vitamin D and absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency (p<0.001). Finally, our study shows that the status of low levels of vitamin D is common in RA in different countries and under different latitudes. Absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency. Low levels of vitamin D were associated with patients characteristics (age, BMI, and educational level), RA (disease activity and corticosteroid dosage), and comorbidities (lung disease and osteoporosis therapy). This suggests the need for a particular therapeutic strategy to improve vitamin D status in RA patients