Explore the vast range of titles available.

Chronic pain in rheumatology often has a psychic impact, which may aggravate the daily life of patients. Chronic neck pain, as an example, is a frequent reason for consultation. The aim of this study is to assess the prevalence of anxiety and depression in patients with neck pain, and identify risk factors associated with their occurrence. It was a cross-sectional study that concerned 80 patients with neck pain lasting for more than 3 months, seen in rheumatology consultations. All patients with symptomatic neck pain or psychological history or receiving psychotropic medication were excluded from the study. For each patient, we determined the sociodemographic characteristics and clinical ones. The anxious and depressed mood was assessed by the Hospital Anxiety and Depression Scale (HAD). Of the 80 patients, 67 (83.8%) were women. Average age of our population was 51.8± 11.8 years. Median duration of symptoms was 24 months [12, 48]. Mean VAS pain was 63.9% ± 12.5, mean VAS functional discomfort was 60.9% ± 14.2 and mean VAS disability was 59.8% ± 14.7. 32 patients (40%) were illiterate and 18 (22.5%) had university level. Anxiety was found in 54 (68.4%) and 44 (55.7%) patients were depressed. In univariate analysis, VAS disability was statistically linked to anxiety (OR:1.05; 95%CI: 1.01-1.08; p = 0.02). The cervicobrachial neuralgia (CBN) was significantly associated with depression (OR: 3.33; 95%CI: 1.20-9.23; p = 0.02). Primary education level had a statistically significant relationship with anxiety (OR: 6.00; 95%CI: 1.03-34.84; p = 0.04) and depression (OR: 5.00; 95%CI: 1.09-22.82; p = 0.03). In multivariate analysis, VAS disability and CBN were independently associated with anxiety and depression respectively. This study underlines the fact that anxiety and depression are prevalent in chronic neck pain (CNP) patients. Furthermore, disability and CBN which are linked to CNP can predict which patient is at higher risk of psychological distress.

This study outlines the diagnostic and therapeutic approaches - both pharmacological and non-pharmacological - used by Moroccan rheumatologists in managing fibromyalgia (FM). It also addresses other key aspects, such as assessing the psychosocial context of patients and referring them to other medical specialties. A descriptive cross-sectional study was conducted using a survey designed to assess the management approach of Moroccan rheumatologists towards FM. The survey was carried out anonymously. Out of 275 rheumatologists, 140 responded to the questionnaire (with a total of approximately 450 rheumatologists in Morocco). Ninety-nine percent ( = 139) reported encountering FM patients in their practice. Diagnosis of FM was predominantly based on clinical assessment without a scoring system ( = 66; 47%), while 20.7% ( = 29) used the FIRST score. A substantial proportion (70%) of participants requested biological and imaging workups despite apparent FM, with 92% ( = 129) opting for an inflammatory workup. Regarding the treatment aspect, paracetamol was the first-line analgesic prescribed by 58% ( = 81), followed by tramadol ( = 43; 30.9%). Pregabalin was the most commonly prescribed first-line treatment ( = 37; 27.4%), with antidepressants being the second-line choice in 35.8% ( = 42). Non-pharmacological treatments such as physical therapy, therapeutic education, and psychotherapy were the most highly recommended. Nearly all rheumatologists ( = 131; 93.6%) emphasized the need for multidisciplinary management for FM patients, often referring them to psychiatrists either alone or in conjunction with other specialists. Diagnosing and treating FM presents significant challenges. This survey sheds light on the diverse approaches adopted by Moroccan rheumatologists towards managing patients with FM, emphasizing the importance of multidisciplinary care in addressing the complex needs of these patients.

Background The objectives of this study were to evaluate NSAID use over time in patients with axial spondyloarthritis (axSpA) receiving biologic therapy, to determine the prevalence of axSpA remission without NSAIDs, and to identify factors associated with continued NSAID use after one year of follow-up. Methods This is a prospective longitudinal study included 85 patients with axSpA who were diagnosed according to the ASAS criteria and treated with biologics. Assessments were performed at baseline and at 3,6, and 12 months, and disease activity was evaluated with the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use and type were collected, and the ASAS-NSAID index was calculated. This prospective longitudinal study included 85 patients with axSpA, diagnosed according to the ASAS criteria and treated with targeted therapies, regardless of the duration of prior exposure. All patients received targeted therapies. Assessments were conducted at baseline and at 3, 6, and 12 months. Disease activity was evaluated using the ASDAS-CRP, BASDAI, and CRP. Data on NSAID use, type, and dosage were collected, and the ASAS-NSAID index was calculated. At baseline, patients were categorized into two groups according to their NSAID use status, and baseline characteristics were compared accordingly. Results The mean age was 37.46 ± 11 years, with a male predominance (69.4%). Axial radiographic involvement was present in 87.1% of patients. The mean disease duration was 12 years [9–19.25], with a median time from diagnosis to biologic initiation of 3 years [1–8.5]. Thirty-four patients (40%) were in remission. At baseline, 42.3% of the participants used NSAIDs, which significantly declined to 11.5% at M12 ( p  < 0.001). At M12, 36.1% of patients achieved remission, all without NSAIDs. The ASAS-NSAID score significantly decreased over time. Persistent NSAID use at M12 was due primarily to mechanical pain (57.1%) rather than to inflammatory activity (42.9%). Multivariate analysis revealed that mechanical pain was the main factor associated with continued NSAID use. Conclusion Biologic therapy significantly reduces NSAID use and ASAS-NSAID scores in axSpA patients, highlighting the NSAID-sparing effect of bDMARDs. Additionally, NSAID use is not always linked to SpA activity but may be driven by mechanical pain. Clinical trial number Not applicable. Highlights There was a significant reduction in NSAID use among SpA patients recieving biologic therapy: 42.35% at baseline and 11.5% at M12 ( p  < 0.001). A significant decrease in the ASAS-NSAID score ( p  < 0.001) was observed. Mechanical pain was linked to continued NSAID use, regardless of disease activity. At M12, 36.1% of patients were in remission, all of whom were NSAID-free.

Introduction The primary objective of our study was to describe the variation of anti-citrullinated protein antibodies (ACPA) antibody levels in patients with rheumatoid arthritis (RA) under disease-modifying therapy. The secondary objectives were to evaluate the variation of ACPA levels according to disease activity and to determine the characteristics of patients who have negative ACPA. Methods It was a prospective study including patients with ACPA-positive RA treated with disease-modifying antirheumatic drugs (DMARDs) and having a Disease Activity Score (DAS) greater than 2.6, indicating at least low disease activity or higher. A medical checkup including a clinical evaluation, an inflammatory test, and a measurement of ACPA levels using the enzyme-linked immunosorbent assay (ELISA) was performed for each patient at M0, M6, and M12. Two groups were defined: the rituximab (RTX) group, consisting of patients treated with RTX, and the no-RTX group, which included patients receiving other therapies, such as tumor necrosis factor inhibitors (TNFi) and interleukin 6 inhibitors (anti-IL6) or conventional disease-modifying antirheumatic drugs (csDMARDs). Results Ninety ACPA-positive RA patients were included. Seventy-seven (85.6%) were female and the mean age was 54.96 ± 13.13 years. The median disease duration was 11 years, and the baseline Disease Activity Score 28-C-reactive protein (DAS28-CRP) was 4.35 ± 0.99. Forty-eight (53.3%) of patients were already on RTX. The median ACPA level at baseline was 186 IU/ml (74-200), showing a significant decline over time (M0: 186 (74-200); M6: 111 (59-195); M12: 95 (45-195); p<0.001). This reduction was significant in the RTX group (ACPA M0: 191 (70-200); ACPA M6: 96 (33-195); ACPA M12: 75 (17-147); p<0.001) but not in the no-RTX group (ACPA M0: 156 (68-200); ACPA M6: 121 (70-195); ACPA M12: 175 (67-200); p=0.26). At M12, 27 (30%) patients achieved remission based on the DAS28 score. Their median ACPA level was 157 IU/ml (75-200) at baseline, which significantly decreased over time (p<0.001). When analyzing the delta ACPA, it was significantly larger in the RTX group (p<0.001). Conclusion In this real-life study, ACPA antibody levels decreased significantly in RA patients who had received RTX. This could suggest the possibility of achieving immunological remission with biotherapy, more specifically with RTX.

Introduction Fibromyalgia (FM) is characterized by widespread pain and fatigue, accompanied by symptoms such as decreased concentration, autonomic dysfunction, and abdominal pain. It can be either primary or secondary, notably to rheumatoid arthritis (RA). The Fibromyalgia Assessment Screening Tools (FAST 4), derived from the Multidimensional Health Assessment Questionnaire (MDHAQ), is a composite tool allowing for the rapid screening of FM. Our primary objective is to determine the prevalence of FM among RA patients using the FAST 4 index. Secondary objectives include comparing the FAST 4 index with the FiRST score and describing the correlation between FM and RA activity and different factors associated with FM in RA patients. Methods This was an observational cross-sectional study including patients diagnosed with RA according to the ACR/EULAR criteria. The FAST questionnaire comprises four sections assessing pain and fatigue on a visual analog scale, painful joints reported by the patient, and a list of 60 symptoms. A FAST 4 score of ≥ 3/4 indicates a positive screening for FM. Demographics and disease features were compared using descriptive statistics. Univariate and multivariate analyses using logistic regression models were performed to calculate odds ratios (ORs) with 95% CI. The sensitivity and specificity of the FAST 4 index were evaluated, and Fagan's nomograms were used to illustrate post-test probability. Statistically significant results were considered for p-values less than 0.05. Results The study enrolled 97 patients diagnosed with RA. The mean age of the patients was 56 ± 12.7 years, with a predominance of females (90.7%, N=88). The mean duration of RA was 13.5 ± 8.69 years. RA activity measured by DAS 28-ESR showed that 40.2% (N=39) had high disease activity, 38.1% (N=37) had moderate disease activity, 11.3% (N=11) had low disease activity, and 10.3% (N=10) were in remission. The prevalence of comorbid FM, according to the FAST 4 index, was 30.9% (N=30). Based on the Multidimensional Health Assessment Questionnaire (MDHAQ), depression was observed in 66.7% (N=20) patients with FM, while anxiety was reported in 60% (N=18). Moreover, 30.4% of patients screened positive for FM using the FiRST score. The FAST 4 index detected FM patients defined by FiRST with a sensitivity of 78.6% and a specificity of 87.1%. The positive predictive value (PPV) was 73.3%, and the negative predictive value (NPV) was 90%. Univariate analysis revealed that a positive FAST 4 index was associated with the number of painful and swollen joints (p<0.001 and 0.03, respectively). Additionally, patients with a positive FAST 4 index showed higher DAS 28 scores (p=0.002). No significant association was found with CRP levels (p=0.328), ESR (p=0.499), or the use of biological treatments (p=0.146) or corticosteroids (p=0.940). In multivariate analysis, only depression remained a risk factor, increasing the risk sixfold with an OR of 5.917, 95% CI (1.91-18.3), p=0.002. Conclusion Our study suggests a high prevalence of concomitant FM in our population, highlighting the importance of screening for FM, particularly using the FAST 4 index based solely on the MDHAQ questionnaire.

Rheumatoid arthritis rarely involves the cricoarytenoid joint, symptoms of varying severity ranging from foreign body sensation, fullness or tension in the throat, hoarseness, odynophagia, speech or cough pain to stridor and respiratory distress during bilateral paralysis of the vocal cords. We are reporting a case of rheumatoid arthritis with bilateral involvement of the vocal cords. The diagnosis was clinically made and confirmed by endolaryngoscopy, responding to antirheumatic treatment but coming to the stage of permanent tracheotomy.

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.

Background Brucellosis is an anthropozoonosis. It is an endemic disease in the Mediterranean basin. The clinical presentation is polymorphic. The osteoarticular form is the most frequent of the focal forms affecting mainly the spine. In our endemic context, the diagnosis can lead to confusion with tuberculosis. Case presentation We report a case of brucellar spondylodiscitis treated initially as tubercular spondylodiscitis with a good initial evolution. Then, the diagnosis was rectified towards a Brucella origin, after a clinical and biological relapse. Diagnostic confirmation was based on the isolation of Brucella spp in the disco-vertebral CT-guided biopsy and the positive Brucella serology. Then, the patient was put on three antibacterial treatments with doxycycline, rifampicin, plus streptomycin over a period of 6 months with a good evolution. Conclusion Brucellar spondylodiscitis is still common in the Maghreb. It is generally insidious and leads to a delay in diagnosis. The clinician must always mention it when faced with spondylodiscitis in an endemic country and ask for brucella serology.

the aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment. cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized. a total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3 position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type. our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.

Background Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.