Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study.

Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.

Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance.

This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥ 5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS.

An extensive vertebral hydatidosis revealed by a lumbosciatica.

The vertebral hydatidosis is uncommon. It causes problems in diagnosis and in management. A case of an extensive vertebral hydatidosis with few symptoms is reported. A 21-year-old man has consulted for recurrent lumbosciatica that has been evolving for 1 year. Clinical exam was normal. Plain radiographic films disclosed a lytic lesion throughout the bodies of L4 and L5 and calcifications thrown on the liver area. The computed tomography (CT) and the magnetic resonance (MR) images revealed multicystic bony lesions involving the lumbar spine with extension into the spinal canal. Abdominal ultrasound showed also cyst lesions in the right kidney and in the liver. The diagnosis of vertebral and abdominal (liver and kidney) hydatidosis was retained. Four sets of 4-week albendazole cures were given with a 2-week interval in between. Our case of extended vertebral hydatidosis with few symptoms confirms the clinical latency and diagnosis difficulties usually encountered in this disease. This often leads to a late diagnosis of the stage of spinal cord compression. Radiological diagnosis and determination of extension of the hydatid cyst are usually provided by CT and MRI. Vertebral hydatidosis should be evoked in lumbosciatica especially in endemic regions.

[Leukemia revealed by polyarthritis]. / Polyarthrites révélatrices d'une leucémie.

INTRODUCTION: Ostéoarticular manifestation whose reveal leukaemia in 4% of the cases, regress completely with haematological remission. EXEGESIS: We report two observations of leukaemia revealed by polyarthritis. A 22-year-old woman has presented a polyarthritis 8 months before de diagnosis of acute leukaemia. A 34 years old men, has presented one month before admission an acute polyarthritis revealing chronic myeloid leukaemia. CONCLUSION: Polyarthritis may reveal an acute or chronic leukaemia. Systematic blood analysis can make a difference in diagnosis of recent polyarthritis.

Cervical spine involvement in ankylosing spondylitis.

Our objective was to study cervical spine involvement in a Moroccan population of ankylosing spondylitis (AS) patients and evaluate correlations with disease symptomatic and structural severity. Patients were prospectively enrolled for a 1-year period. Clinical, biological, and radiological data were collected. The risk of cervical spine involvement was estimated using the Kaplan-Maier method. Sixty-one patients were enrolled: 38 males (62.2%) and 23 females of mean (SD) age 35.1 years [11] (range 17-66). The mean disease duration was 10.6 years [7] (0.5-30). Forty-three patients (70.4%) had a history of neck pain. Radiological involvement was present in 33 cases (54%). The concordance between clinical and radiological involvement was statistically significant (kappa=0.49; P<10(-6)). The risk of cervical spine involvement with regard to disease duration showed that 19.6% of patients had radiological involvement after 5 years, 29.9% after 10 years, 45.1% after 15 years and 70.0% after 20 years. Comparison between patients with and without cervical spine radiological involvement showed no difference in age of onset or sex. There was statistical difference in symptomatic severity parameters (Schöber, chest expansion, BASMI, BASFI, BASDI, BASG) and structural severity parameters (lumbar syndesmophytes score, BASRI). Our study confirms the greater severity of AS in North African countries. Cervical spine involvement increases with age and disease duration in AS and is more frequent in symptomatic and structural severe forms of the disease.

Responsiveness of the EuroQol EQ-5D and Hospital Anxiety and Depression Scale (HADS) in rheumatoid arthritis patients receiving tocilizumab.

The aim of this study was to assess the responsiveness to change of the quality of life evaluated by the EuroQol Five Dimensions Questionnaire (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) after biological treatment in a population of rheumatoid arthritis patients. A cohort of patients with RA (n = 29) treated with tocilizumab (TCZ) were analyzed in the study. The inclusion criteria were patients aged between 18 and 65 years, fulfilling American College of Rheumatology 1987 criteria for RA. All patients had inadequate response to methotrexate and with no prior biologic exposure. They were evaluated clinically including Disease Activity Score 28 (DAS28), and the European Quality of Life 5 Dimensions (EQ-5D) to measure the quality of life, and HAD assessed the anxiety and depression status at the initiation of treatment with anti-IL 6 receptor antibody agent and after 6 months. Sensitivity to change was quantified by the effect size (ES) before and after the treatment with TCZ. Among 29 patients with RA included in the study, 25 were females and 4 males. The mean age was 42 years ± 13.4 (SD). Three patients were excluded from the study before 24 weeks because of serious side effects, and five have missing data. The study population exhibited significant decreases in all measures of disease activity at 24 weeks. Physical activity expressed by the Health Assessment Questionnaire (HAQ) score increased through the observation period (for all p < 0.001). Sensitivity to change was high for the VAS and EQ-5D (ES 1.58 and 1.36, respectively) but only moderate for the HAD anxiety component (ES = 0.70) and small for the HAD depression component (ES = 0.4). The EQ-5D and VAS were more responsive than HADS to evaluate the quality of life on patient with RA treated with TCZ.

Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study.

We report the clinical case of a 54-year-old woman presenting radicular low back pain on the right side of L4 associated to spondylolisthesis on L4-L5, without any notion of trauma or spine surgery. Furthermore this patient is regularly seen for benign rheumatoid polyarthritis complicated by steroid-induced osteoporosis. A preventive treatment was implanted with good results on pain improvement and functional capacities. For pedicle fractures the literature review reports several different etiologies: spontaneous fractures, hereditary fractures or stress-related fractures. There was a discussion on the various treatments available and in this case of spondylolisthesis on pedicle fracture a conservative treatment was implemented similar to the one for isthmic spondylolisthesis. It yielded satisfying results.

Translation and validation of Moroccan Western Ontario and McMaster Universities (WOMAC) osteoarthritis index in knee osteoarthritis.

The aim of this study is to assess the reliability and validity of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) in Moroccan patients with knee osteoarthritis. The WOMAC was translated and back translated to and from dialectal Arabic, pre-tested and reviewed by a committee following the Guillemin criteria. The Moroccan version of the WOMAC was administered twice during a 24-48 h interval to 71 Moroccan patients with symptomatic knee osteoarthritis, fulfilling the revised criteria of the American College of Rheumatology. The test-retest reliability was assessed using intra-class correlation coefficient, and the Bland and Altman method. Internal consistency was assessed by Cronbach's alpha coefficient. Construct validity was tested by correlating the WOMAC subscales with visual analogic scale (VAS) of pain, VAS of handicap, maximum distance walked and clinical characteristics. The Moroccan version of the WOMAC showed good reliability, with ICC values of the three dimensions: pain, stiffness and physical function being 0.80, 0.77 and 0.89, respectively. Bland and Altman analysis showed that means of differences did not differ significantly from 0 and that no systematic trend was observed. Internal consistency with Cronbach's alpha for pain was found to be 0.76, and its equivalents for stiffness and physical function subscales were evaluated at 0.76, 0.90, respectively. Construct validity showed statistically significant correlation with all WOMAC subscales and VAS of pain (rho=0.38, 0.42, 0.63 respectively, P<0.01). Correlation between VAS handicap (rho=0.38 P<0.001) and maximum distance walked (rho=-0.40, P<0.01) was observed with physical function subscale. There was no correlation between age, duration of disease, BMI and severity of pain and physical function in knee OA. The Moroccan version of the WOMAC is a comprehensible, reliable, and valid instrument to measure outcome in patients with knee OA.

Erosive polyarthritis in Crohn's disease. Report of a case.

Erosive polyarthritis in Crohn's disease is rare and raises diagnostic and pathophysiological problems. A case with destructive lesions of the shoulders and hips is reported in a 43-year-old woman with a 26-year history of Crohn's disease. Ankylosis of the spine and hips, motion range limitation of the shoulders and wrists, and boutonnière deformity of the third finger of the right hand were present. Tests were negative for rheumatoid factor and the HLA-B27 antigen. Plain radiographs showed a triple rail pattern at the spine; synostosis of the hips; and destructive lesions of the shoulders, wrists, tarsal bones, and third proximal interphalangeal joint of the right hand. Glucocorticoid therapy was effective in suppressing the bowel symptom flares but only partially improved the joint symptoms, whose treatment relied mainly on nonsteroidal antiinflammatory agents and rehabilitation therapy. Erosive arthritis in Crohn's disease is frequently monoarticular, with the hip being the most common target. It can complicate a spondylarthropathy or reveal granulomatous synovitis. Polyarticular forms pose difficult diagnostic and therapeutic challenges and add to the disability caused by the bowel disease. The potential role of genetic factors remains to be studied.