Recommendations of the Moroccan Society of Rheumatology (SMR) for Diagnostic Management of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA).

In 2017, the Moroccan Society of Rheumatology (SMR) issued guidelines for the treatment of severe ankylosing spondylitis. The emergence of new therapeutic classes, the update of international guidelines for axial SpA and psoriatic arthritis, and the diagnostic and therapeutic challenges encountered by rheumatologists has led to the development of recent SMR guidelines for the management of SpA patients. A group-work included rheumatologists, specialists in physical medicine and rehabilitation, and epidemiologists from various sectors was tasked with writing these recommendations based on a literature review, then adapting them to the national context. Thus, 33 recommendations were selected and organized into two sections: diagnostic and therapeutic. The diagnostic section included three general principles and fourteen recommendations. The first, second, and third recommendations concerned the definition and diagnostic criteria for psoriatic arthritis and psoriatic arthritis. In the management of SpA, Recommendation 4 prioritized the importance of opportunity windows. The recommendation5 concerned the diagnostic and prognostic significance of HLAB27. The sixth and seventh recommendations related to imaging of the sacroiliac joints and the spine. The eighth recommendation focuses on the diagnosis and evaluation of perivascular thrombosis activity. The ninth and tenth recommendations concerned the evaluation of SpA activity and psoriatic arthritis. The eleventh and twelfth recommendations concern the evaluation of function and structural progression. The recommendation number thirteen concerned the diagnosis and treatment of coxitis. Recommendation 14 focuses on the most common co-morbidities and extra-rhinitological manifestations observed in SpA.

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA).

The advent of new therapeutic classes and the updating of international recommendations have justified the development of recent recommendations by the Moroccan Society of Rheumatology. Methods Guidelines were drafted by a core steering committee after performing a literature search. A multidisciplinary task force, including three fellows, eleven rheumatologists, a specialist in physical medicine and rehabilitation, an epidemiologist from hospital-university, hospital and liberal sectors and one patient assessed the Best Practice Guidelines using 2 rounds of anonymous online voting by modified Delphi process. Thus, 19 recommendations were developed. Recommendation 1 concerns the therapeutic principles, recommendation 2 insists on the information and education of the patient, recommendation 3 concerns the general measures to be adopted, namely physical activity, smoking cessation and psychological support, recommendation 4 concerns Non-Steroidal Anti-Inflammatory Drugs which constitute the first-line treatment, recommendations 5 to 7 concern the use of analgesics, of general and local corticosteroid therapy and conventional synthetic disease-modifying antirheumatic drugs, recommendations 8 to 13 deal with the use of biologic agents, including new classes and their indications in radiographic and nonradiographic axial and peripheral spondyloarthritis, follow-up and management in case of failure or remission, recommendation 14 deals with the indication for Janus kinase inhibitors drugs, recommendation 15 deals with physical treatment and recommendation 16 deals with the indication of surgery. Recommendations 17 to 19 deal with special situations, namely fibromyalgia, vaccination and pregnancy. A well-defined therapeutic strategy with first- and second-line treatments has been established.

Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases.

Introduction The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial and peripheral spondyloarthritis (SpA) allow for the classification of patients with an age of onset of disease of less than 45 years. However, SpA can start after this age. This study aimed to assess the characteristics of late-onset SpA (SpA>45 years) in the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). Methods A cross-sectional study was conducted using the baseline data of the RBSMR. The protocol for the original RBSMR study was reviewed and approved by the Ethics Committee for Biomedical Research Mohammed V University - Rabat, Faculty of Medicine and Pharmacy of Rabat (approval number for the study was 958/09/19, and the date of approval was September 11, 2019), and all patients had given their written consent. Patients who met the 2009 ASAS criteria for SpA were included. They were divided into two groups: early-onset SpA (≤ 45 years) and late-onset SpA (>45 years). Clinical, biological, radiological, and therapy data of the two groups were compared. Statistical analysis was performed using SPSS v25 software (IBM Corp. Armonk, NY). Parameters with a p-value ≤0.05 were considered significant. Results Our population consisted of 194 patients. Thirty-one patients (16%) had late-onset SpA. Comparison between patients with early-onset (≤45 years) and late-onset SpA (>45 years) revealed that late-onset SpA had a higher tender joint count (p=0.01), a higher swollen joint count (p=0.02), depression (p=0.00), fibromyalgia (p=0.001), hypercholesterolemia (p=0.01), and a lower frequency of coxitis (p=0.008). Logistic regression analysis confirmed that late-onset SpA was associated with a higher tender joint count (OR=0.93, CI 95%: 0.88-0.98), a higher swollen joint count (OR=0.92, CI 95%: 0.85-0.99), depression ( OR=0.19, CI 95%:0.04-0.38), fibromyalgia (OR=1.75, CI 95%: 1.74-17.85), and a lower frequency of coxitis ( OR=0.29, CI 95%: 0.11-0.75). Conclusion As life expectancy increases, late-onset SpA will become increasingly common. It is therefore imperative to determine its characteristics. In the RBSMR study, late-onset SpA was associated with a high number of tender and swollen joints, depression, fibromyalgia, and a lower frequency of coxitis.

Correction: Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases.

[This corrects the article DOI: 10.7759/cureus.39100.].

Diffuse adverse cutaneous reactions induced by zoledronic acid administration: a case report : Eruptions cutanées diffuses induites par l'administration de l'acide zolédronique.

Zoledronic acid, an amino-bisphosphonate, is an antiresorptive drug given intravenously. It is commonly used for the treatment of severe postmenopausal osteoporosis, and it is also used for other types of osteoporosis, management of bone metastasis, multiple myeloma, hypercalcemia, and Paget's disease. The use varies according to these diseases. The drug is usually well-tolerated with the most common side effects being acute-phase reactions with weakness and musculoskeletal pain as well as gastrointestinal effects. However, the increase in usage of zoledronic acid has produced rare reports of side effects, such as atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, or buccal or genital mucosa. Less common cutaneous side effects associated with zoledronic acid include fever rash, maculopapular lesions, keratitis, dermatitis, B-cell pseudolymphoma, skin erythema multiform, and vasculitis. Although these cutaneous reactions are generally mild and self-limiting, others can be severe such as toxic epidermal necrolysis and pancytopenia. We hereby describe a case of diffuse skin adverse reactions, a type of confluent erythematous macules in the trunk and arms with extended petechial macules along the left thigh and leg, induced 2 days after the administration of zoledronic acid for primary osteoporosis in a 53-year-old woman, without any allergic context or other associated drugs taken.

Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report.

BACKGROUND: Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound. CASE PRESENTATION: A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months. CONCLUSIONS: Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.

Rhumatismes chroniques et covid-19 : recommandations thérapeutiques des sociétés savantes

Le SARS-CoV-2 est la pandémie la plus redoutable depuis un siècle. Son évolution est caractérisée par une phase initiale virale infectieuse et une autre immunologique réactionnelle qui peut être létale. L'inhibition de la réplication virale n'est donc qu'une partie du traitement et la gestion de l'emballement dysimmunitaire constitue une étape cruciale dans la prise en charge des patients. Cette phase immunologique fait appel à des molécules largement utilisées en rhumatologie et Prise en charge de la maladie dont l'efficacité dans le COVID-19 (en dehors du conformisme scientifique requis) doit interpeler l'importance de notre arsenal thérapeutique dans la prise en charge des maladies auto inflammatoires dont l'évolution sans traitement adéquat pourrait être une image au ralenti de celle du COVID-19

Aseptic necrosis of the femoral head after pregnancy: a case report.

A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus, dyslipidemia especially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's disease. Among the less established factors, we mention procoagulations abnormalities, HIV infection, chemotherapy. We report a case of osteonecrosis of femoral head after pregnancy.

Gastroprotection et anti-inflammatoires non stéroïdiens : Enquête auprès des médecins généralistes de Casablanca

Introduction : Si les anti-inflammatoires non stéroïdiens (AINS) sont largement utilisés pour leurs effets anti-inflammatoires, analgésiques et antipyrétiques, ils sont pourvus d'effets secondaires graves essentiellement gastriques. La coprescription de gastroprotecteur connait certaines règles. Aussi avons-nous mené cette enquête, avec pour objectif d'étudier l'approche des médecins généralistes vis-à-vis de la prescription de gastroprotecteurs au cours d'un traitement par AINS.Matériels et méthodes : Enquête téléphonique auprès de 230 médecins généralistes. Données recueillies grâce à une fiche d'exploitation précisant les modalités, la fréquence ainsi que les moyens de surveillance d'une prescription d'AINS et identifiant les déterminants de la coprescription d'une gastroprotection. Résultats : Parmi les 300 médecins sollicités, 230 (77 %) ont répondu au questionnaire. 40% prescrivaient les AINS moins de 5 fois par jour, alors que la majorité plus de 5 fois. La durée de prescription ne dépassait pas 7 jours dans la majorité des cas (73%). Un gastroprotecteur type inhibiteur de la pompe à protons (94% des cas) était prescrit de façon systémique par 108 (47%) médecins. 90% des médecins ne connaissaient pas les effets secondaires d'un excès d'IPP. Les raisons de la prescription des IPP chez les autres médecins étaient: l'antécédent de problème gastrique (74%), le reflux gastro-œsophagien (0,5%), l'âge avancé (21%), la prescription prolongée d'AINS (9%), le tabagisme chronique (6%) ou la poly médication (6%). Conclusion : La prévention de la toxicité digestive des AINS impose leur bonne prescription et une évaluation appropriée des facteurs de risque chez certains patients, avant la coprescription de protecteurs gastriques, en premier lieu un inhibiteur de la pompe à proton, sans oublier les effets secondaires liés à un excès de ces derniers

Long-term systemic glucocorticoid therapy: patients' representations, prescribers' perceptions, and treatment adherence.

INTRODUCTION: Glucocorticoids have been used since 1948 for their anti-inflammatory and structural effects in various inflammatory diseases. The optimal use of glucocorticoids remains controversial. Patients may have a number of concerns about the effects of glucocorticoids. Many factors can adversely affect treatment adherence. OBJECTIVES: To evaluate the main adverse effects reported by patients and physicians, and to assess representations associated with glucocorticoid therapy and the underlying disease, via measurements of treatment adherence, with the goal of optimizing treatment strategies and improving patient information. METHODS: From December 2011 to May 2012, we conducted two surveys in 125 patients receiving long-term glucocorticoid therapy and followed-up at the rheumatology department of the teaching hospital in Casablanca, Morocco, and in 85 hospital physicians in various specialties, respectively. RESULTS: Mean glucocorticoid therapy duration was 6 years, mean maximal prescribed dosage was 44.87 mg/d, and 50.4% of the patients had inflammatory joint disease. Adverse neuropsychiatric effects were reported by 70 out of 125 (56%) patients. Weight gain was the adverse effect deemed most bothersome by the physicians, who significantly underestimated the occurrence of neuropsychiatric adverse effects (27% vs 56%, P=0.034). Adherence was poor in 80 out of 125 (64%) patients, and 22 out of 125 (18%) patients reported episodes of treatment discontinuation. CONCLUSION: Prescribers underestimate the frequency of neuropsychiatric adverse effects of long-term systemic glucocorticoid therapy. Regular follow-up visits during treatment, with collection of systemic adverse effects might improve treatment adherence.