Mental Health Problems Experienced by Patients with Rheumatic Diseases During COVID-19 Pandemic.

BACKGROUND: Patients with rheumatic diseases are more likely to suffer from anxiety, depression and insomnia. Yet, little is known about mental health status during COVID-19 pandemic. OBJECTIVE: This study aims to measure the prevalence of mental health disorders among patients with rheumatic diseases in the era of COVID-19 pandemic and to determine potential risk factors for major symptoms of depression, anxiety, and insomnia in participants. METHODS: Participants with rheumatic diseases were asked to complete a questionnaire using a telephonic interview. Sociodemographic and rheumatic disease characteristics were recorded. Mental health status was assessed by the patient health questionnaire-9 (PHQ-9), generalized anxiety disorder (GAD)-7, and insomnia severity index (ISI) questionnaires to detect depression, anxiety and insomnia symptoms, respectively. RESULTS: We included 307 patients in the survey. Rheumatoid arthritis was the most frequent diagnosis (55%). Of all participants, 7.5% had known depression and 5.5% known anxiety. Mental health disorders were insomnia (34.9%), anxiety (33.2%), and depression (24.4%). Major symptoms of insomnia, anxiety, and depression were noted in respectively, 19.9%, 12.4%, and 7.8% of participants. Risk factors for major insomnia were male gender (OR= 4.36, 95% CI 2.06 to 9.25; p<0.0001), low socioeconomic status (OR= 2.64, 95% CI 1.44 - 4.83; p<0.002) and having rheumatoid arthritis (OR= 2.00, 95% CI 1.04 to 3.84; p<0.036). Major anxiety was associated with low monthly income (OR=1.79, 95% CI 1.07 to 3.01; p<0.026), and higher Numerical Rating Scale (NRS) of pain (OR=1.795, 95% CI 1.074 to 2.994 ; p<0.026). Major depression was associated with the worsening of rheumatic disease (OR=1.86, 95% CI 1.06 to 3.26; p<0.03). CONCLUSION: A high frequency of undiagnosed depression, anxiety and insomnia symptoms was found in rheumatic patients. Rheumatologists should be aware of these comorbidities, especially in the era of COVID-19 pandemic.

Patients with Rheumatic Diseases Overlooked during COVID-19 Pandemic: How are They Doing and Behaving?

BACKGROUND: People with rheumatic disease may be at higher risk for more severe course with COVID- 19, and the adverse effects of drugs used to treat rheumatic diseases is a major concern. OBJECTIVE: We conducted this survey to learn about the real impact of COVID-19 pandemic on patients with rheumatic diseases. METHODS: Participants were asked to complete a questionnaire using a telephonic interview conducted by two rheumatologists. Rheumatic disease characteristics, knowledge and attitude toward COVID-19, and impacts of pandemic on rheumatology care and patient's compliance were assessed. RESULTS: We included 307 patients in the survey, and rheumatoid arthris was the main rheumatic disease. Patients had mostly moderate level of knowledge about COVID-19, and patients with higher level of education were more likely to have better knowledge. Participants respected mainly recommended preventive measures. The pandemic and sanitary containment impacted strongly the rheumatology care. Over quarter of patients noted worsening of their rheumatic disease, two-thirds reported postponed or canceled medical apointments and more than three quarters postponed their laboratory tests. Patients with higher disease activity were more likely to have lack of follow-up. Medication change was noted in more than third of cases. It was mostly stopped, and DMARDs were mainly affected. Patients living in rural areas and who had canceled, or postponed their appointments were more likely to change their treatment. CONCLUSION: Our data are useful to better manage rheumatic patients. Physicians are encouraged to renew contact with their patients to insure medication compliance.

[Comparing data from ultrasound with electroneuromyography in the diagnosis of carpal tunnel syndrome]. / Comparaison des données de l'échographie par rapport à l'électroneuromyogramme dans le diagnostic de syndrome de canal carpien.

This study aims to evaluate the advantages of ultrasound in the diagnosis of carpal tunnel syndrome by comparing it with electroneuromyography (ENMG). We conducted a cross-sectional study over a period of 6 months. All patients underwent ultrasound with measurement of the surface of the median nerve at the entrance of the carpal tunnel and electroneuromyographic examination of both wrists. The sensitivity and specificity of ultrasound was compared to those of ENMG. The average age of patients was 49.6 years with a clear female predominance (98%). The majority of patients were housewives. Paresthesias were the most common reason for consultation in 86%. Bilateral clinical manifestation occurred in 78% of cases. ENMG showed pathological result in 89 wrists (89%). Ultrasound was abnormal in 63 wrists (63%) with a median surface area of the median nerve of 11 mm2. This study highlights an ultrasound sensitivity of 70%, a specificity of 100% with a positive predictive value (PPV) of 100% and a negative predictive value (VPN) of 29.7%. It was concluded that ultrasound has sensitivity only to carpel tunnel with severe involvement on ENMG.

Chronic tophaceous gout with unusual large tophi: case report.

Gout is a metabolic disease, which is characterized by acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues, and kidneys. But large tophi are unusual in chronic gout. We report the case of a 67-year-oldArabman presenting chronic tophaceous gout with unusual large tophi involving multiple joints: hands, feet, elbows, and knees. Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test. In untreated patients, chronic tophaceous gout may develop, which is characterized by chronic destructive polyarticular involvement and tophi. The treatment consists to decrease serum uric acid level which eventually allows the regression of tophi.

Gonococcal polyarthritis with sternoclavicular joint involvement in pregnant woman: a case report.

Pregnancy is one of conditions that increase the risk of gonococcal arthritis which result from blood dissemination of neisseria gonorrhoeae. A 20-year-old africain female patient (in the second trimester of pregnancy), was admitted to hospital because of fever, asymmetric joint swollen affecting the hands, wrists, left ankle, and right sternoclavicular joint. Laboratory findings (erythrocyte sedimentation rate was 117 mm in first hour, The serum C-reactive protein level was 152 mg/L) the gram stain of genital sample was positif of neisseria gonorrhoeae and trichomonas vaginalis. With antibiotics, outcome of pregnancy was timely and uneventful. Patients should be educated about the mode of transmission of gonorrhea. Sexual partners should also be treated to prevent dissemination and gonococcal re-infection.

Bilateral coxitis in scleroderma-polymyositis overlap syndrome.

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.

Etanercept in the treatment of SAPHO syndrome: Which place?

Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (SAPHO) is a rare disease combining skin, bone, and joint manifestations. Its treatment remains a debated issue in the absence of a valid therapeutic strategy. The experience with tumor necrosis factor alpha (TNF alpha)-blocking agents is still small but encouraging. This therapy is reserved for refractory cases. The most commonly used agent is infliximab. Only few cases treated by etanercept have been reported in the literature. We report a new case treated by this biologic therapy and discuss its place in the treatment of SAPHO syndrome. A 30-year-old male, with a history of left clavicular osteitis that required surgical bone biopsy to rule out infection and malignancy, was admitted to the rheumatology department because of recurrent anterior chest pain, lower limb arthralgia, and sacroiliac pain. Laboratory findings revealed an inflammatory syndrome. Conventional radiography and computed tomography (CT) scan of the sternocostoclavicular region showed sclerosis and hyperostosis of the left clavicle. Right sacroiliitis was diagnosed based on the radiographic findings. Moreover, the patient reported palmoplantar pustulosis, thereby strengthening the diagnosis of SAPHO syndrome. As conventional treatment based on methotrexate, corticosteroids, and zoledronic acid was not effective, etanercept was initiated with good and rapid clinical and biological improvement. The diagnosis and treatment of SAPHO syndrome are challenging due to the heterogeneity of symptoms and unknown pathogenesis. Etanercept can be an effective therapy, especially in refractory cases. Further studies are needed in order to establish a therapeutic strategy.

A successful treatment of juvenile idiopathic arthritis with rituximab: A report of two cases.

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.

A rare association of rheumatoid arthritis and primary biliary cirrhosis treated with rituximab: a case report.

INTRODUCTION: Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure. Primary biliary cirrhosis is often associated with other non- hepatic autoimmune diseases. An association with rheumatoid arthritis has been suggested to coexist in 1.8% to 5.6% of patients with primary biliary cirrhosis, but data supporting this association are scarce. The etiologic and pathogenetic mechanisms are not yet fully understood and several factors have been implicated. The therapeutic management must consider the two pathologies. CASE PRESENTATION: We describe the case of a 60-year-old Moroccan woman with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab. During treatment, we observed a good clinical and biological response of her rheumatoid arthritis but persistent abnormal liver function tests. CONCLUSION: B cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. Additional studies are necessary to better determine the therapeutic role of rituximab in both diseases.