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Background: Axial spondyloarthritis (axSpA) is a common group of chronic rheumatic inflammatory diseases, which usually affects the axial skeleton, and are more frequently observed in males than in females. Several differences have been brought up in the clinical presentation of axSpA, according to the patient’s gender. In fact; axSpA severity in women tends to be moderate, leading then, to an underdiagnosis in this category of patients. While male axSpA patients seem to set forth more spinal destructions on radiographs. Objective: As the main goal, our study aims to bring up the particularities of female axial spondyloarthritis, all the while comparing them with the male form. Materials and Methods: This is a cross-sectional study carried out in the period lying between January 2012 and December 2017, at a single rheumatology department in Morocco. All patients with an axial spondyloarthritis meeting the Assessment of SpondyloArthritis international Society (ASAS) classification criteria 2010, and who have been admitted in our department, during that period, were included. The data was recorded and analyzed using SPSS v20 univariate and bivariate analysis. A value of p Results: A total of 277 patients were enrolled, of which 147 are female and 130 are male with a sex ratio of 1.1. Cervical stiffness was more common in men. On the other hand, women had more arthritis and enthesitis. However, no considerable divergences have been underscored between the two genders, neither in the prevalence of extra-articular manifestations, nor in disease activity BASDAI and BASFI. Men had more radiographic sacroiliitis compared to women (57.5% vs. 42.5%, p=0.01), more coxitis (66.7% vs. 33.3%, p = 0.0001). The Multivariate logistic regression analysis showed that female gender was associated with a greater age at the diagnosis onset (IC: 1.053-1.103, OR=1.07, p=0.001) and arthritis (IC: 2.37-4.26, OR=2.3, p=0.004). While the male sex was associated with a young age of onset (CI: 4.50-19.52, OR = 9.3), coxitis (CI: 2.53-4.23, OR = 3.3) and smoking (CI: 15.667-900.18, OR = 118.7). Conclusion : The comparison between male and female patients suffering from axial spondyloarthritis found many differences and similarities as well, in the disease expression. This study showed actually that women had the less severe form of spondyloarthritis.

Background: According to the new classification criteria developed by The Assessment of SpondyloArthritis International Society, patients with axial spondyloarthritis (axSpA) can be classified in 2 subgroups: Patients with radiographic axial spondyloarthritis: ankylosing spondylitis patients (AS) and those with non-radiographic axial spondyloarthritis (nr-axSpA). Objective: The aim of the present study is to describe and discuss the differences and similarities between the two subgroups. Patients and Methods: A cross-sectional study was conducted in a single rheumatology hospital in Morocco. These included patients diagnosed as having axial spondyloarthritis according to ASAS criteria 2010, during a period of 6 years. The AS and the nr-axSpA subgroups were compared for the various axSpA-related variables. Results: Of the 277 patients with a diagnosis of axial SpA who were included in this study, 160 had AS and 117 had nr-axSpA. AS and nr-ax-SpA shared a similar age at diagnosis, similar prevalence of low back pain, lumbar stiffness, extra-articular manifestations, BASDAI and BASFI. In the multivariate analysis, AS patients were mainly male with cervical stiffness, enthesitis, coxitis and high level of ESR (erythrocyte sedimentation rate). The females generally had a family history of SpA and arthritis and were associated to the nr-axSpA form in the univariate analysis. Conclusion: This was the first study to characterise patients with AS and nr-axSpA in Morocco. Consistent with other studies published, this study showed that patients with nr-axSpA and patients with AS shared a comparable degree of disease burden.

Background:Smoking is one of the main environmental risk factors involved in several rheumatic diseases according to ACR 2014, it is included among the risk factors for severe axial spondyloarthritis.Objectives:The objective is to study the association between smoking and the activity of the disease, the functional impact and the severity of the axial spondyloarthritis.Methods:It is a transversal study with a descriptive and analytical aim, during the period between January 2014 and December 2015 conducted in the department of rheumatology at the CHU Hassan II of Fes.The data was recorded and analyzed using SPSS v20 univariate and bivariate analysisA value of p Results:The study included 214 patients, 130 men and 84 women. The mean age was 39.77 ± 13.06 (16-68) years with an average disease duration of 7.97 ± 6.4 (2-35) years.The prevalence of smoking in patients with spondyloarthritis was 36%.According to the univariate and bivariate analysis: Smoking was associated with the male sex (p≤0.0001), with a functional impairment BASFI (p = 0.038) and activity BASDAI (p=0.004) and ASDAS CRP, (p=0.036).Multivariate logistic regression analysis suggested that smoking was associated with male sex and the severity of the disease.Conclusion:Our study suggests that there is a significant association between smoking and male sex and the severity of the disease.

Introduction The jumped shoulder blade or “snapping scapula” is a rare cause of shoulder pain that entails cracking of the scapula in connection with multiple causes. In 30% of cases no etiology is found. Case presentation We report a case of a 54 year old Moroccan male patient with left shoulder pain lasting for 14 years associated with pain at the anterior-upper corner of the scapula. Clinical examination did not reveal any deformation of neither cervical nor thoracic spine on inspection; testing of the tendons of the shoulder rotators and active and passive shoulder mobility were normal and an audible crack was noted during the arm movement or apprehension test with left arm pain on mobilization of the scapula “vital sign” without limitation of the range of motion. The anterior drawer sign of laxity and refocusing sign were negative. Imaging performed including plain radiographs, musculoskeletal ultrasound and CT scan of the scapula with 3D image reconstruction found no bone or soft tissue abnormalities that could explain this syndrome. The diagnosis of jumped scapula of unknown origin was made and symptomatic treatment with non-steroidal anti-inflammatory drugs and a rehabilitation protocol based on isometric and isotonic strengthening periscapular muscles, posture and endurance exercises were instituted. Conclusion Our case illustrates a new case of a jumped shoulder blade of unknown origin after completion of all etiological imaging. Further analysis of clinical events is needed to better understand this type of jumped shoulder blade.

Introduction: Rheumatoid arthritis (RA) is biologically marked by a positive serum rate of rheumatoid factor (RA) and/or anti-citrullinated protein antibodies (ACPA). Nevertheless, 20% of RA cases remain seronegative. Objective: The main purpose of this study, is to bring out the clinical, biological, imaging, therapeutic, and evolutionary distinctions between seropositive RA and seronegative one. Methods: This is an observational cross-sectional study that involves patients with RA admitted in the rheumatology department, from the period between January 2012 and January 2018. RA seronegativity is described as the absence of both RF and ACPA, while seropositivity is recognized by the presence of at least one of the two antibodies. Results: 294 patients were included, of which 90% were seropositive and 10% seronegative. Therefore, RA in this study is seropositive most often. The bivariate analysis underscored plenty of differences, statistically notable, according to the RA immune status. In fact, patients with seropositive RA had more synovitis (p=0.049), more deformities (p=0.01), and more bone destruction on radiographs (p=0.04). Furthermore, RA in this Moroccan study was quite severe (p=0.006) and got more complicated by systemic manifestations (p=0.02). Whereas, no distinction was brought up between the two groups, concerning the use of biotherapy. As for the multivariate study, seropositive RA in these patients, had greater severity (p=0.009, OR=4.53) and was more deforming (p=0.03 OR=2.45). Conclusion: RA in our Moroccan context is dominated by the seropositive form. This seropositivity is often coupled with clinical severity and joint destruction, resulting in more deformities.

Introduction: The definition of remission in Rheumatoid Arthritis (RA) is still difficult to determine. An ultrasound of the hands may be important in helping confirm clinical remission. Objective: This study’s aim was to evaluate the interest in using an ultrasound of the hands to confirm clinical remission, as well as comparing the various remission scores (DAS 28 VS, DAS 28 CRP, and SDAI) and the ultrasound data, in order to deduce the most accurate score to confirm this remission. Methods: In this prospective monocentric study, we studied patients with rheumatoid arthritis in clinical remission, according to DAS 28 VS, for at least 3 months without corticosteroid therapy. An ultrasound mode B / Doppler of the hands was taken by an experienced rheumatologist, involving 22 joints: wrists, Metacarpophalangeal (MCP) joints and proximal interphalangeal joints (PPI) bilaterally. Results: Fifty-one patients were included. They were classified in remission according to DAS 28 VS as well as DAS 28 CRP, whereas the remission according to SDAI was achieved in 66.7% of our patients. Synovial hypertrophy and power Doppler were present in respectively 65% and 25% of the patients. SDAI was the most accurate score to confirm RA remission (p < 0.003). Conclusion: SDAI appears to be the most appropriate score for the definition of remission in rheumatoid arthritis, but despite the use of the latter, ultrasound synovitis may still be present. Further work deserves to be done to clarify the value of ultrasound evaluation in the definition of RA remission.

Osteochondromatosis of the shoulder is a rare condition characterized by synovial membrane proliferation and metaplasia, with development of multiple osteocartilaginous nodules, the osteochondromas. Any joint may be affected, the knee is the most frequent site but the shoulder is rarely reported in the literature. The physiopathology of this condition remains unknown. It can be divided into primary and secondary forms which are not clinically or pathologically different. Definitivediagnosisofosteochondromatosiscan be established through anatomopathological examination. Conventional radiography may be negative in the first stages of the disease but magnetic resonance imaging is often crucial for early diagnosis. The treatment remains surgical. Surgery has been gradually replaced by arthroscopy with several cases reported in the literature. The aim of the presentworkis to provide an overview of thispathology., L’ostéochondromatosede l’épaule est une maladie rare qui est due à la métaplasie de la membrane synoviale qui finit par s’ossifier et produire des ostéochondromes. Elle se localise partout où se trouve la synoviale. Le genou est la localisation la plus fréquente mais l’épaule reste rarement rapportée dans la littérature. Sa physiopathologie reste inconnue. Elle est classée en ostéochondromatose primaire et secondaire qui ne sont pas différentes sur le plan clinique ou anatomopathologique. Le diagnostic de certitude est anatomopathologique. Les radiographies peuvent être négatives dans les premiers stades de la maladie et l’imagerie par résonance magnétique est souvent déterminante pour poser le diagnostic précoce. Le traitement de choix reste chirurgical. La chirurgie a été progressivement remplacée par l’arthroscopie dont plusieurs cas ont été rapportés dans la littérature. Le but de notre travail est de faire une mise au point de cette pathologie.

Spontaneous tendon rupture is a complication which occurs in patients receiving long-term hemodialysis. There are two principle theories concerning the pathogenesis of spontaneous tendon ruptures: degeneration attributable to chronic acidosis, and weakness of the bone–tendon junction attributable to secondary hyperparathyroidism. Some cases of spontaneous tendon rupture were reviewed, especially, quadriceps tendon, patellar tendon, Achille tendon and tricipital tendon. We present a case of spontaneous and bilateral rotator cuff tear in a man with chronic renal failure. The diagnosis confirmation was established by sonography., La rupture tendineuse spontanée est une complication de l’hémodialyse chronique. Deux principales théories étiopathogéniques de la rupture tendineuse spontanée ont été évoquées : le remaniement dégénératif lié à l’acidose chronique et l’enthésopathie érosive liée à l’hyperparathyroïdie secondaire. Dans la littérature, quelques observations de rupture tendineuse spontanée chez l’hémodialysé ont été rapportées, notamment la rupture du tendon quadricepital, du tendon rotulien, du tendon d’Achille et du tendon tricipital. Nous rapportons une observation d’un patient hémodialysé chronique, qui présentait une rupture tendineuse spontanée et bilatérale de la coiffe des rotateurs, et dont la confirmation diagnostique a été apportée par l’échographie.

Relapsing polychondritis (RP) is a rare disorder characterized by recurrent inflammatory episodes involving the cartilage of the ear, nose, larynx and the tracheobronchial tree. Other initial manifestations are various and less evocative: polyarthritis, laryngo-tracheal symptoms, episcleritis which can delay the diagnosis. Nowadays, it is considered to be an autoimmune disease. The diagnosis is clinical. It can be based on the criteria of Michet [1]. Treatment of the disease is not codified. It i depends on the activity and the severity of the disease. Corticotherapy is the cornerstone of the treatment of RP. The immunosuppressive therapy is used in the severe forms and in the corticoid-resistant or corticoid-dependent forms., La polychondrite chronique atrophiante (PCA) est une affection rare, qui correspond à une inflammation du cartilage de l’oreille, du nez, du larynx et de l’arbre trachéobronchique. C’est une affection qui évolue par poussées rémissions parfois suivies de dégénérescence et de déformation du cartilage. D’autres manifestations beaucoup moins évocatrices peuvent survenir comme une polyarthrite, une atteinte respiratoire ou laryngée, une épisclérite et qui peuvent retarder le diagnostic. L’étiologie immunitaire est actuellement retenue. Le diagnostic est clinique. Il peut être aidé par les critères de Michet [1]. Le traitement de la maladie n’est pas codifié. Il est adapté, en fonction de l’activité et de la sévérité de la maladie. Il est en générale au cas par cas. La corticothérapie reste la base du traitement. Les immunosuppresseurs sont utilisés dans les formes respiratoires ou vasculaires sévères ou en cas de corticorésistance ou corticodépendance.

Introduction Le SCC est la mononeuropathie du membre superieur la plus frequente chez la jeune femme. L’electroneuromyogramme (ENMG) reste l’examen de reference pour confirmer le diagnostic et la severite du SCC. Objectifs Comparer la sensibilite et la specificite de l’echographie par rapport L’ENMG dans le diagnostic du SCC puisque l’ENMG reste un examen inconfortable, couteux et non disponible par rapport a l’echographie. Patients et methodes Etude transversale incluant 50 patients consultant pour un tableau du SCC sur une periode de 6 mois. Tous les patients avaient beneficie d’une echographie avec mesure de la surface du nerf median a l’entree du canal carpien et une etude electroneuromyographique des 2 poignets. La sensibilite et la specificite de l’echographie ont ete comparees a ceux de l’ENMG comme reference. Resultats L’âge moyen est de 49,6 ans avec une predominance feminine. Les paresthesies etaient le symptome le plus frequent dans 86 %. L’ENMG etait pathologique chez 89 %. L’echographie etait anormale chez 63 % avec une mediane de la surface du nerf median de 11mm2. La sensibilite d’echographie etait de 70 %, et la specificite etait de 100 % avec une valeur predictive positive (VPP) de 100 % et une valeur predictive negative (VPN) de 29,7 %. Donc l’echographie n’est sensible que pour le SCC avec une atteinte severe a l’ENMG. Discussion Le recours a l’ENMG est devenu incontournable pour confirmer et evaluer la severite le SCC surtout lorsqu’un traitement chirurgical est envisage. L’echographie, methode moderne, cherche sa voie dans l’exploration du SCC et pour evaluer sa sensibilite, sa specificite dans le diagnostic de SCC, plusieurs etudes se sont interessees a la comparaison entre des anomalies a l’echographie de ceux a l’ENMG. Conclusion L’echographie du canal carpien ne permet pas de diagnostiquer l’ensemble des cas de SCC et donc elle ne peut pas remplacer l’ENMG au vu de sa sensibilite moderee et sa faible valeur predictif negatif.