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BACKGROUND: Kinesiotaping (KT) is widely used in several musculoskeletal disorders particularly in shoulder pain. However, literature shows controversial results regarding the effect of KT on shoulder pathology. The aim of this study was to assess the clinical effects of KT in the short term on rotator cuff tendinopathy (RCT). METHODS: A randomized controlled double-blind clinical trial was conducted. The sample consisted of 50 subjects (25 per group). Patients were randomly assigned to the KT group (to receive therapeutic KT application) or to the placebo group (to receive sham KT application). Taping was applied every 4 days, a total of three times during the study period. We assessed the patients at baseline, at the end of taping period (D12), and at one-month post-taping (D30). Primary outcome was assessed through the Arabic version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Secondary outcomes were assessed through Visual Analogue Scale (VAS) for pain intensity at rest (VASr), during active movement (VASm), and at night (VASn). RESULTS: There were no significant differences between the two groups in the demographic and clinical characteristics and the pre-test scores. Results of repeated measures ANOVA showed significant improvement in DASH scores and in VAS for pain (at rest, during active movement and at night) from D12 in both groups. The use of ANCOVA, controlling for pre-test scores, showed no significant differences between groups, except for VASm at D30. CONCLUSION: This study showed that the standardized therapeutic KT used for shoulder pain was not superior to a sham KT application in improving pain and disabilities in patients with RCT. TRIAL REGISTRATION: The study was retrospectively registered on Pan African Clinical Trial Registry (identification number: PACTR202007672254335) on 21/07/2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12200.
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Fita Atlética , Lesões do Manguito Rotador , Tendinopatia , Humanos , Manguito Rotador , Dor de Ombro/diagnóstico , Dor de Ombro/terapia , Tendinopatia/diagnóstico , Tendinopatia/terapia , Resultado do TratamentoRESUMO
Before the initiation of biotherapy in the treatment of rheumatic diseases, it is highly recommended for the patients to be screened for latent tuberculosis infection (LTBI). The objective of this study is to identify the prevalence of LTBI among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) before the initiation of biologic therapy in the Moroccan biotherapy registry (RBSMR). A cross sectional study was conducted using the baseline data of the Moroccan biotherapy registry. Tuberculin skin test or IGRA test or both tests were done before starting anti-TNF treatment for screening LTBI. The comparisons between positive and negative LTBI patients according to rheumatic disease were examined using categorical comparisons. 259 patients were included in this study.94 patients had RA and 165 had SpA. The mean age of the RA patients was 50.49 ± 11.82 years with a majority of females (84%). The mean age for the SpA patients was 36 ± 13.7 years with a majority of males (67.3%). The prevalence of LTBI in the RBSMR was 21.6%. This prevalence was at 24.8% in SpA patients, while it was at 15.9% for RA patients. After the comparison between positive and negative LTBI patients according to rheumatic disease, no demographic, clinical, or therapeutic characteristics were statistically associated with LTBI. This study found that in an endemic TB country like Morocco, a high prevalence of patients with SpA and RA had LTBI, and that RA patients had a lower prevalence than SpA patients.
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Artrite Reumatoide/tratamento farmacológico , Espondiloartrite Axial/epidemiologia , Tuberculose Latente/tratamento farmacológico , Adulto , Artrite Reumatoide/epidemiologia , Produtos Biológicos/uso terapêutico , Comorbidade , Feminino , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Prevalência , Sistema de Registros , Estudos Retrospectivos , Teste Tuberculínico/estatística & dados numéricosRESUMO
The aim of the study was to estimate the annual direct costs of biological therapies in rheumatoid arthritis (RA), and to establish possible factors associated with those costs. The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry). We included patients with available 1-year data. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Differences in costs across groups were tested by Mann-Whitney and Kruskal-Wallis tests. Correlations analysis was performed in search of factors associated with high costs. We included 197 rheumatoid arthritis patients. The mean age was 52.3 ± 11 years, with female predominance 86.8%. Receiving one of the following therapies: rituximab (n = 132), tocilizumab (n = 37), or TNF-blockers (n = 28). Median one-year direct costs per patient were 1665 [1472-9879]. The total annual direct costs were 978,494. Rituximab, constituted 25.7% of the total annual budget. TNF-blockers and tocilizumab represented 27.3% and 47% of this overall budget, respectively. Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation. A positive correlation was found between the annual direct cost and body mass index (r = 0.15, p = 0.04). In Morocco, a developing country, the annual direct costs of biological therapy are high. Our results may contribute to the development of strategies for better governance of these costs.
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Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/economia , Terapia Biológica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/economia , Fatores Biológicos/uso terapêutico , Produtos Biológicos/uso terapêutico , Análise Custo-Benefício , Etanercepte/economia , Etanercepte/uso terapêutico , Feminino , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Rituximab/economia , Rituximab/uso terapêuticoRESUMO
PURPOSE: There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The objective of this consensus was to develop guidelines for PRP injections in knee osteoarthritis according to the French National Authority for Health recommendations. METHODS: Fifteen physicians from different French-speaking countries (10 rheumatologists, 4 specialists in rehabilitation and sports medicine and 1 radiologist) were selected for their expertise in the areas of PRP and osteoarthritis. A comprehensive literature review was conducted on Medline including all published therapeutic trials, open studies, meta-analysis and systematic reviews focusing on the effects of PRP in knee OA, as well as fundamental studies concerning the characteristics of the various types of PRP and their mechanisms, indexed before April 2019. Using the method recommended by the French National Authority for Health inspired by the Delphi consensus process, 25 recommendations were finally retained and evaluated. The recommendations were classified as appropriate or not appropriate, with strong or relative agreement, or uncertain if a consensus was not achieved. RESULTS: Among the 25 recommendations selected, the main ones are the following: (1) Intra-articular injections of PRP are an effective symptomatic treatment for early to moderate knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 6-9). Level of evidence 1A. (2) A PRP treatment sequence in knee osteoarthritis may include 1-3 injections. This recommendation was considered appropriate with a strong agreement (Median = 9; rank = 7-9). Level of evidence 1A. (3) Leucocytes-poor PRP should be preferred in knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 5-9). Level of evidence 5. (4) Intra-articular PRP knee injections should be performed under ultrasound or fluoroscopic guidance. This recommendation was considered uncertain with no consensus (Median = 8; rank = 3-9). Level of evidence 5. (5) PRP should not be mixed with an anesthetic or intra-articular corticosteroid. This recommendation was considered appropriate with a relative agreement (Median = 9; rank = 6-9). Level of evidence 5 CONCLUSION: Those 25 recommendations should standardize and facilitate the use of IA PRP injections, which are considered by experts as an effective treatment especially in early or moderate knee OA. Although a strong or relative agreement from the experts was obtained for most of the recommendations, many of them had a very low level of evidence (Level 5) and were principally based on the clinical experience of the experts.
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Osteoartrite do Joelho , Plasma Rico em Plaquetas , Consenso , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Articulação do Joelho , Osteoartrite do Joelho/tratamento farmacológico , Resultado do TratamentoRESUMO
To assess the modalities and current practices in gout management reported by Moroccan rheumatologists. We performed a cross-sectional online survey using a questionnaire e-mailed to 360 rheumatologists included 30 multiple-choice questions. 105 rheumatologists responded to the survey with 29% of response rate. The number of gout patients seen per month was five (3-9); they were referred in 58.7% by a general practitioner. The clinical presentation of gout patients was dominated by gout crisis in 71%, and the association gout crisis and gouty arthropathy accounted for 19% of severe forms. 40% of rheumatologists apply the 2015ACR/EULAR classification criteria. Obesity accounted for 85.7% of the associated comorbidities. The most commonly prescribed Urate-lowering therapy (ULT) was allopurinol in 81.3% (± 12). 48% of rheumatologists reported starting allopurinol at 200 mg daily and associated it with colchicine during the first 6 months by 33.3%. The determination of uric acid levels was monitoring in 76.2% every 3 months. Administration of ULT to asymptomatic hyperuricemia was found in 69.5% when patients had renal complications, while only 14.3% recommended dietary and lifestyle measures. The median duration for therapeutic education was 15 min (10, 20). In 96.2%, the education of the patient was done orally. 93.3% of rheumatologists inform their patients on how to manage a gout attack, and 96.2% on the measures of hygiene and diet has adopted. Our survey gives an insight into the elements that should be improved in the management of gout by the Moroccan rheumatologists. It highlights the need to standardize the management of gout, hence the importance of developing Moroccan recommendations on gout.
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Alopurinol/administração & dosagem , Colchicina/administração & dosagem , Supressores da Gota/administração & dosagem , Gota/tratamento farmacológico , Estudos Transversais , Quimioterapia Combinada , Feminino , Gota/classificação , Humanos , Masculino , Marrocos , Padrões de Prática Médica , Reumatologia/métodos , Inquéritos e Questionários , Ácido Úrico/sangueRESUMO
BACKGROUND: The Functional Index of Hand Osteoarthritis (FIHOA) is a clinically and methodologically validated score used to assess functional impact in patients with hand osteoarthritis (OA). The aim of the study was to translate the FIHOA into classical Arabic, and to validate the psychometric properties of the translated version. METHODS: The FIHOA was translated into Arabic (FIHOA-AR) according to cross-cultural adaptation guidelines. The FIHOA-AR was administrated to patients diagnosed with hand OA according to the criteria of the American College of Rheumatology (ACR). A 5-day test-retest reliability and internal consistency study was performed using the intra-class correlation coefficient (ICC) and the Cronbach's alpha coefficient. External validity was measured by correlations between FIHOA-AR, hand pain visual analog scale (VAS) and the Health Assessment Questionnaire (HAQ). RESULTS: The sample consisted of 101 patients with hand OA. The obtained ICC > 0.9 and Cronbach's alpha of 0.93 indicated excellent reliability and internal consistency respectively. The evaluation of external validity showed strong correlation with hand pain VAS (r = 0.88, p < 0.001), and strong correlation with HAQ score (r = 0.86, p < 0.001). CONCLUSION: The FIHOA-AR is a reliable and valid score to assess functional disability in Arabic- speaking patients with hand OA.
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Força da Mão/fisiologia , Mãos/fisiopatologia , Osteoartrite/fisiopatologia , Idoso , Comparação Transcultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/psicologia , Osteoartrite/reabilitação , Medição da Dor , Psicometria , Qualidade de Vida/psicologia , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are useful tools for the evaluation of disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Moroccan population. Therefore, this study was designed to assess validity and reliability of CDAI and SDAI in comparison to disease activity score-28 joints (DAS-28) in Moroccan patients with RA. METHODS: Patients with RA were included in a cross-sectional study. Patient characteristics and RA were collected. The disease activity was assessed by DAS-28, CDAI and SDAI. Patients were splitted into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28, CDAI, and SDAI. A Spearman correlation between composite indexes and inter-group comparison of the indexes were performed. Using DAS-28 as a gold standard, the Receiver operator characteristic (ROC) curve was used to assess the performance of a screening test at different levels. RESULTS: The study was conducted with 103 patients of female predominance (87.4%). Mean age was 49.7 ± 11.4 years. Median disease duration was in the order of 8 years [3-14]. There was an excellent correlation between DAS-28 and CDAI (r = 0.95, p <0.001), CDAI and SDAI (r = 0.90, p <0.001), and DAS-28 and SDAI (r = 0.92, p <0.001). There was a good inter-rater alignment between the DAS-28 and CDAI (Weighted kappa =0.743) and there was a moderate inter-rater alignment between the DAS-28 and SDAI (Weighted kappa =0.60), and also between the SDAI and CDAI (Weighted kappa = 0.589). There was no statistically significant difference between AUROC of CDAI and SDAI as both were performed equally well. DISCUSSION: This study is the first Moroccan case study to compare the performance of both CDAI and SDAI in evaluation of disease activity in patients with RA. Our study showed that there was a direct and excellent correlation between DAS-28 and CDAI, and SDAI and DAS-28. CONCLUSION: Our study shows a strong positive correlation between DAS-28, CDAI and SDAI. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Moroccan scenario.
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Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Reprodutibilidade dos TestesRESUMO
Background In general, rheumatologists often have limited knowledge regarding the use of complementary and alternative medicine (CAM) among patients with rheumatic diseases. Understanding the prevalence, reasons for use, and perceived benefits of CAM can help improve patient care and guide clinical practices. This study aimed to assess the prevalence, reasons for use, and perceived benefits of cupping therapy, apitherapy, and traditional cautery treatments among patients with rheumatic diseases. Additionally, it aimed to explore adverse effects, location and pricing disparities in CAM practices, information sources, and the rate of reporting CAM use to treat rheumatologists and to identify factors associated with the use of these CAM approaches. Methodology This single-center, cross-sectional study was conducted in a Moroccan University Hospital and included patients receiving care for rheumatic diseases during hospitalization or outpatient visits from January 2024 to March 2024. The data were collected using a structured, validated, and pilot-tested questionnaire administered by attending rheumatologists. The questionnaire aimed to gather demographic information and to identify patients using CAM, collecting data related to their utilization. Results A total of 100 patients were enrolled (mean age: 52.3 ± 12.8 years, 75% female). Among them, 43% had chronic inflammatory rheumatism. Additionally, 46% reported using at least one of the three CAM methods studied, with 36% using cupping therapy (specifically the wet method), 9% using apitherapy, and 16% using traditional cautery. The main reason for using CAM was to alleviate their pain (55%). Perceptions of effectiveness were reported by 38% of patients using cupping therapy, 20% using apitherapy, and 5.9% using traditional cautery. The use of CAM was significantly lower in patients with a university education (odds ratio = 0.05, 95% confidence interval = 0.003-0.92). Conclusions Our study revealed a significant prevalence of CAM use among patients with rheumatic diseases in Morocco, with cupping therapy emerging as the most commonly utilized method. These findings underscore the importance of enhancing awareness and understanding of CAM practices among both patients and healthcare providers to promote more structured and informed CAM practices.
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Introduction Non-radiographic axial spondyloarthritis (nr-axSpA) is within the spectrum of axial spondyloarthritis (axSpA). The emergence of the nr-axSpA concept, defined by the absence of significant erosive damage to the sacroiliac joints, has prompted numerous initiatives aimed at enhancing the early detection and management of this condition. The aim of the study was to assess the knowledge, attitudes, and practices related to the diagnosis and management of nr-axSpA by rheumatologists in Morocco. Methods We conducted a cross-sectional online survey among the rheumatologist community in Morocco. Rheumatologists received via e-mail a structured Google Forms (Google Inc., Mountainview, CA) questionnaire divided into four sections: sociodemographic data of rheumatologists, knowledge, attitudes, and practices related to the diagnosis and treatment management of nr-axSpA. Results A total of 110 rheumatologists (mean age of 44±13 years, 77.3% females, median professional experience of 12 years (4, 75; 26.25 years)) participated in the survey (response rate of 25%). Most responders reported a diagnosis delay issue in spondyloarthritis (SpA) (93.6%); 70.9% of rheumatologists incorrectly regarded the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA as diagnostic criteria. Rheumatologists' awareness of recommended magnetic resonance imaging (MRI) sequences for detecting sacroiliac joint inflammation and structural changes in SpA varied significantly, from 69.1% to 14.5%. Their knowledge of additional subchondral edema cases in these joints, beyond SpA, ranged from 48.2% to 87.3%. Almost all rheumatologists believed that the use of sacroiliac MRI would contribute to the early diagnosis of axSpA (97.3%) but could also lead to false positive diagnoses, according to 47.3% of rheumatologists; 73.6% believed that incorrectly using the 2009 ASAS classification criteria as diagnostic criteria in nr-axSpA could also result in false-positive diagnoses. In their practice, 2009 ASAS classification criteria were used as diagnostic criteria in axSpA by 39.1% of rheumatologists. Of the total participants, 91.8% indicated that they approach nr-axSpA similarly to radiographic axial spondyloarthritis, with disparities in recommendations of biological therapies. Conclusion Our survey provides insight into the current status of nr-axSpA management among Moroccan rheumatologists. It also addresses concerns regarding the risk of false positive diagnoses when using the 2009 ASAS classification criteria for axSpA as diagnostic criteria by rheumatologists and the potential risk of misdiagnosis associated with excessive reliance on MRI, despite its utility for early diagnosis.
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OBJECTIVE: To evaluate the vaccination coverage of patients with chronic inflammatory rheumatic disease (CIRD) against influenza, pneumococcus, and COVID-19 and to determine, per the patients' point of view, the possible factors related to vaccination hesitation and/or refusal. METHODS: A cross-sectional study carried out by the vaccination working group of the Moroccan Society of Rheumatology, including patients with CIRD in Morocco. Information about vaccination coverage and reasons for non-vaccination against influenza, pneumococcal infection, and COVID-19 was collected. RESULTS: This survey included 230 patients (mean age of 46.9 +/-13.89 years; 68.7% females) affected by CIRD (rheumatoid arthritis 53%, spondyloarthritis 39.6%, psoriatic arthritis 7%). The study shows a significant lack of influenza and pneumococcal vaccination in CIRD patients, with vaccination coverage against influenza, pneumococcal infection, and COVID-19 at 2.2%, 0.4%, and 80.9%, respectively. The main reason for non-vaccination against influenza and pneumococcus was related to the absence of recommendations by their doctors (77%, 87%, p = 0.04). Additionally, the primary reason for non-vaccination against COVID-19 was the fear of the vaccine's side effects (51%, p = 0.0001), mainly a flare-up of CIRD (44%, p = 0.001). CONCLUSION: This survey shows a lack of influenza, pneumococcal, and COVID-19 vaccination in CIRD patients. The principal actions to improve vaccination should aim to educate patients and encourage rheumatologists to vaccinate their patients.
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OBJECTIVES: The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. METHODS: A 4-week prospective study of 387 outpatients suffering from chronic rheumatic diseases was carried out. Pain level was evaluated using a 0-100 mm visual analog scale. An anchoring method based on patient's opinion was used. The PAccSS was defined as the 75th percentile of the score for patients who considered their state satisfactory. Pearson's chi-square and binary logistic regression were used to analyze the data. RESULTS: The underlying disease of the patients (mean age 50 ± 13 years; female sex 70%) was rheumatoid arthritis (N = 102), ankylosing spondylitis (N = 100), peripheral osteoarthritis (N = 100), and degenerative back pain (N = 85). The mean disease duration was 7.4 ± 6.7 years. At the time of the study, the level of pain was 44 ± 23 mm. One hundred ninety (49%) patients considered their state as satisfactory, and the PAccSS threshold was 50 mm. Significant contributors to PAccSS were high educational level, high socioeconomic status, higher functional status scores, and shorter term disease duration. CONCLUSION: Half of patients were satisfied of their disease state, while the PAccSS threshold of pain was unexpectedly high. This could be explained by an overestimation of the pain intensity or a Moroccan patients' high tolerance to pain. The main protective factors that contribute to achieving the PAccSS were high educational level, high socioeconomic status, higher functional status, and shorter term disease duration.
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Artralgia/diagnóstico , Artralgia/epidemiologia , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
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.
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[This corrects the article DOI: 10.7759/cureus.39100.].
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We aimed to validate QUALEFFO-41 in Arabic language and to examine the use of QUALEFFO-41 in clinical practice for assessing quality of life in patients with vertebral fractures (VF). A total of 201 women were included in the study: 106 (53%) cases with at least one vertebral fracture which had been defined morphometrically and 95 (47%) women with OP or osteopenia and no fractures as a control group. The QUALEFFO was translated into Arabic and applied to case-control pairs with prevalent osteoporotic vertebral fractures to evaluate its reliability, validity, and discriminatory ability. It was also used to evaluate the quality of life (QOL) of case-control with prevalent morphometric fractures. The QOL of all subjects was concurrently assessed using SF-36 for comparison. QUALEFFO-41 had good reliability with adequate convergent and discriminatory validity. There were good correlations between QUALEFFO-41 and SF-36. Subjects with clinical osteoporotic vertebral fractures showed significant impairment of HRQoL on the QUALEFFO compared with controls. Similar results were also observed using the SF-36. ROC curve analysis revealed that QUALEFFO-41 had significant ability to discriminate between morphometric fracture subjects versus and controls. The QUALEFFO discriminates for pain (P = 0.002), physical function (P < 0.0001), social function (P = 0.04), general health (P = 0.001), and mental function (P = 0.01), whereas the SF-36 discriminates exclusively for physical function (P = 0.01) and social function (P = 0.02). The Moroccan Arabic version of the QUALEFFO is a reliable and valid instrument that can be administered to Arabic patients suffering from vertebral fracture osteoporosis to evaluate their quality of life. Its measurement properties were comparable with versions in other languages. In addition, the quality of life measured by QUALEFFO is decreased in patients with vertebral fracture due to OP.
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Fraturas por Osteoporose/psicologia , Qualidade de Vida , Inquéritos e Questionários , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Marrocos , Osteoporose Pós-Menopausa/psicologia , Aptidão Física/psicologia , Psicometria , Reprodutibilidade dos Testes , Comportamento Social , TraduçãoRESUMO
BACKGROUND: The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with ankylosing spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients. METHODS: A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index. RESULTS: The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%. CONCLUSIONS: This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research.
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Avaliação da Deficiência , Espondilite Anquilosante/diagnóstico , Adulto , Distribuição por Idade , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Análise Discriminante , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Atividade Motora , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/fisiopatologiaRESUMO
Objectives: To describe and analyse the prevalence of extra-articular manifestations (EAMs) including acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD) in patients with ankylosing spondylitis (AS) in the Moroccan registry of biological therapies in rheumatic diseases RBSMR (Registre des Biothérapies de la Société Marocaine de Rhumatologie). Methods: A cross-sectional, multicentre and analytical study based on the RBSMR database, which included 170 AS. Incidence rates for the development of AAU, psoriasis and IBD were calculated, and risk factors were analysed. Results: Prevalence of EAMs in AS was 13.5%, 4.7% and 11.2% for AAU, psoriasis and IBD respectively. No significant differences were found while establishing a comparison of the prevalence of these EAMs between AS patients with and without peripheral arthritis. Interestingly, AAU was the most common EAM, and was positively associated in multivariable regression with family history of spondyloarthritis (OR= 7.21, CI 95%: 2.23-23.24). Conclusions: AAU was the leading EAM in patients with AS included in the Moroccan biotherapy registry (RBSMR) and it was associated with family history of spondyloarthritis.
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Objectives: The aim of this study was to determine the therapeutic maintenance level of methotrexate for rheumatoid arthritis patients enrolled in the Moroccan biotherapy registry and to identify predictive factors for discontinuing MTX treatment. Methods: A cross-sectional study was conducted using the baseline data of the Moroccan biotherapy registry for RBSMR (a multicentric study that aims to evaluate tolerance of biological therapy on patients affected with rheumatic diseases). Demographics and disease features were compared using descriptive statistics. Therapeutic maintenance levels were determined according to a Kaplan-Meier survival curve and a univariate Cox proportional hazards regression model was used to compare the strength of potential factors, followed by a multivariate Cox model to identify significant predictors of MTX discontinuation. Statistically significant results were considered for p values less than 0.05. Results: 224 patients with rheumatoid arthritis were included in this study. The mean age of patients was 51.83±11.26 years with a majority of females (87.50%). The median duration of disease was 12 [1.66-41.02] years. The therapeutic maintenance level of MTX was 91.1% at 1 year, 87.1% at 2 years, and 68.3% at 5 years. The median of treatment duration was 2, 02 [0, 46-27,76] years. Causes of treatment interruption were side effects (66/88=75%), inefficiency (12/88=13.63%), and other reasons (10/88=11.36%). Predictive factors for stopping MTX were presence of rheumatoid factor (HR 2.24; 95% CI 1.14-5.15; p=0.02) and the access to education (HR 0.37; 95% CI 0.16-0.88; p=0.02). Conclusion: The therapeutic maintenance level of MTX in our study was satisfactory and comparable to other series, and influenced by many factors such as the occurrence of a side effect. It is necessary to sensitise medical practitioners on symptomatic prevention and management of side effects.