Prevalence of chronic pain with neuropathic characteristics in the Moroccan general population: a national survey.

OBJECTIVE: We conducted a telephonic survey to determine the prevalence of chronic pain with neuropathic characteristics (NC) in the Moroccan general population. DESIGN: We performed a large nationwide telephonic survey based upon a random sampling of households in the 16 administrative regions of Morocco to determine the prevalence of chronic pain with NC in the general population. We used a stratified sampling taking into account the number of residents in each region. A sample of households was drawn for each of the 16 regions using systematic sampling. OUTCOME MEASURES: A questionnaire aimed at identifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration, and body locations was used. The Moroccan validated version of DN4 questionnaire was used to identify neuropathic characteristics. RESULTS: A total of 5,328 respondents participated in the survey. 21% of the respondents (1,074) (95%CI: 19,9-22,2), reported chronic daily pain for more than 3 months. The point prevalence of chronic pain with NC, was 10.6% (95% CI: 9,75-11,45). The prevalence was higher in women and individuals older than 60. Chronic pain with NC was significantly more prevalent in women, elderly, illiterate respondents, and respondents from lower social class. It was more frequently located in the lower limbs, and its intensity and duration were higher in comparison with chronic pain without neuropathic characteristics. CONCLUSION: Chronic pain with neuropathic characteristics is probably more prevalent in the general population than was previously thought and is generally more severe than other chronic pain.

C1-C2 spondylodiscitis in an adult with SAPHO syndrome: an unusual presentation.

The main advantage of recognition and diagnosis of SAPHO syndrome is the avoidance of unnecessary prolonged antibiotic treatment and repeated invasive procedures. The combination of synovitis, acne, pustulosis, hyperostosis and aseptic osteitis is known as SAPHO syndrome. The most common site of the disease is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions, hyperostosis, and arthritis of the adjacent joints. Osteosclerosis of the vertebral bodies, hyperostosis, and erosions of the vertebral plates are rarely encountered. We present a case of SAPHO syndrome with C1-C2 spondylodiscitis. Diagnosis of SAPHO syndrome was established using Khan et al. criteria (Schilling, SAPHO syndrome, Encyclopedie Orphanet, 2004). CT showed osteosclerotic lesions of dens axis. MRI sequences reveal inflammatory bone marrow oedema. Radiologists should be aware of this unusual syndrome to avoid misdiagnosis (tumour/infection), unnecessary surgery, and antibiotic therapy.

Validity and reliability of the Arabic adapted version of the DN4 questionnaire (Douleur Neuropathique 4 Questions) for differential diagnosis of pain syndromes with a neuropathic or somatic component.

BACKGROUND: Verbal descriptors of pain can provide a basis for distinguishing neuropathic pain (NP) from pain of non-neuropathic origin. Much research has been undertaken to develop screening tools for this purpose. The DN4 questionnaire (NP in four questions), is one of theses tools, which was developed and validated in French in 2005. The purpose of this work is to provide an Arabic, culturally appropriate, reliable, and valid version of the DN4 interview questionnaire for the diagnosis of NP. METHODS: A study was conducted consisting of two phases. In the first phase, translation and cultural adaptation of the questionnaire into dialectal Arabic according to international guidelines was accomplished. The final version was reviewed by an expert panel, then tested on a group of 30 patients. The second phase was the validation of the translated version. The analysis of psychometric properties included reliability (internal consistency, inter-rater agreement) and validity (receiver operating characteristics curve analysis and determination of sensitivity, specificity, and positive and negative predictive values). RESULTS: A sample of 170 subjects (129 women, 75%; age: 49.5 ± 12.4 years), 94 (55.3%) with NP and 76 with non-neuropathic pain was enrolled. The questionnaire was reliable (Cronbach's alpha coefficient: 0.63, inter-rater agreement coefficient: 0.96 [0.94-0.97]) and valid for a cut-off value ≥3 points, which was the best value to discriminate between NP and NNP subjects. DISCUSSION: This study represents the second validation DN4 in a language different from the original after the Spanish adaptation. These results support the high discriminatory value of the DN4 questionnaire for identification of NP.

Maffucci's syndrome: a case report.

Maffucci's syndrome is a congenital nonhereditary syndrome characterized by a combination of enchondromatosis and hemangiomatosis. It is associated with an increased risk of malignancy. We report a case of a 24-year-old woman who developed severe bone distortion due to generalized enchondromas since the age of 2 years. Physical examination showed a marked shortening of both upper and lower limbs and cutaneous hemangioma in the legs. Radiological study showed symmetric well-circumscribed radiolucent cystic lesions in the hands and severe metaphysical irregularity and a shortening of all long bones. The biopsy of the third right metacarpal showed enchondroma tissue. Histological examination of the skin specimen showed a hemangioendothelioma. The diagnosis of Maffucci's syndrome was established. Abdominal ultrasound, mammography, cerebral computed tomography (CT) scan, and cervical CT were normal.

Spinal cord compression due to vertebral osteochondroma: report of two cases.

Osteochondroma, or exostosis, is the most common of all benign bone tumors. Spinal osteochondromas are uncommon but may cause neurological compromise. We report two cases of spinal cord compression by osteochondromas. One patient was a 17-year-old man with hereditary multiple exostoses who was presented with spastic paraparesis, a sensory level at T3-T4, and a pyramidal syndrome. Vertebral exostosis was suspected by magnetic resonance imaging and confirmed by histological examination. Surgical decompression was followed by complete resolution of the neurological impairments. The other patient was a 19-year-old man with spastic paralysis of the right lower limb and a pyramidal syndrome. Whereas magnetic resonance imaging suggested a neurofibroma, histological features were those of osteochondroma. Nine months elapsed from symptom onset to surgery. This delay led to residual neurological impairments, which resolved almost completely after rehabilitation therapy. Vertebral osteochondromas contribute only 1.3-4.1% of all osteochondromas. The lesion may be solitary or a manifestation of hereditary multiple exostosis. Magnetic resonance imaging shows the exact location of the lesion, most notably with relation to neighboring neurological structures. Spinal cord compression is uncommon and usually has a favorable outcome provided surgical decompression is performed before major neurological damage develops.

Hip dislocation revealing hip tuberculosis. A case report.

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.

Lead-related gout. A case report.

Gout secondary to lead-induced nephropathy is a long-term complication of occupational lead exposure. We report a case of this now-rare condition. The patient was a 63-year-old man who had been a miner from 1950 to 1970. Thirty years after cessation of his exposure to lead, he experienced onset of inflammatory symmetric polyarthritis with joint deformities. Hyperuricemia, moderately severe renal failure, and tubular acidosis were found, indicating gouty polyarthritis. Blood lead levels were high, establishing that the cause was lead poisoning. EDTA chelation therapy was effective. Lead poisoning is frequently under-recognized because the clinical manifestations are often minimal and the diagnosis difficult to establish. We suggest that lead bound to bone may result in continued exposure to lead after cessation of industrial or environmental exposure. Chelating agents are valuable for the diagnosis and can ensure a full recovery.

The practical value of biologics registries in Africa and Middle East: challenges and opportunities.

Biologics, including tumor necrosis factor (TNF) inhibitors, are increasingly used for the treatment of inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis. The efficacy of these drugs has been demonstrated in randomized controlled trials (RCTs). However, these studies are conducted in controlled environments, and the results may not necessarily reflect clinical outcomes in daily clinical practice. In Europe and other western countries, numerous biologics registries that enroll and monitor patients receiving biologics have been established. These registries follow patients irrespective of whether they continue with the initial biologic drug. Thus, real-life efficacy data from these registries can be used to assess the long-term safety of biologics through longitudinal studies. In Africa and Middle East (AFME), such registries currently exist only in Morocco and South Africa. In light of the increasing availability of biologics and scarcity of long-term safety data of these agents in the AFME population, there is a need to establish biologics registries in other countries across the region. This review discusses the value of biologics registries versus RCTs as well as safety and efficacy data from observational studies presented as lessons from well-established biologics registries. In addition, the rationale for establishing such registries in the AFME region is also presented.