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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.

Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management. A sarcoidose é um distúrbio inflamatório multissistêmico de causa desconhecida, frequentemente afetando o sistema pulmonar e também o sistema músculo-esquelético, mas de forma menos frequente. Em pacientes com sarcoidose, o acometimento reumático é polimórfico, podendo ser o sintoma de apresentação da doença ou aparecer durante sua progressão. O acometimento articular é dominado por artralgia inespecífica, poliartrite e síndrome de Löfgren, que é definida como a presença de adenopatia pulmonar, artralgia (ou artrite) e eritema nodoso. Manifestações esqueléticas, especialmente dactilite, aparecem principalmente como complicações de sarcoidose crônica e em vários órgãos. O acometimento muscular na sarcoidose é raro e geralmente assintomático. O diagnóstico de sarcoidose reumática baseia-se em achados radiográficos e de ressonância magnética, embora o diagnóstico definitivo seja feito pelo estudo anatomopatológico de amostras de biópsia. O acometimento músculo-esquelético na sarcoidose é geralmente aliviado com o uso de anti-inflamatórios não esteroidais ou corticosteroides. Em formas da doença resistentes ao corticosteroide ou corticosteroide dependentes, a terapia de imunossupressão, como o tratamento com metotrexato ou anti-TNF-α, é utilizada. O objetivo desta revisão foi apresentar uma visão geral dos vários tipos de acometimento osteoarticular e muscular na sarcoidose, com foco no diagnóstico e manejo.

L’acromégalie est une maladie endocrinienne rare, en rapport avec une hypersécrétion d’hormone de croissance. Elle a des conséquences rhumatologiques: l’arthropathie périphérique, l’atteinte rachidienne et les syndromes canalaires. L’atteinte articulaire accompagne une acromégalie active, sa survenue après un traitement radical et une rémission complète est rare. Nous présentons le cas d’une patiente de 70 ans ayant un antécédent d’acromégalie sur adénome hypophysaire il y a 25 ans, traitée chirurgicalement et déclarée en rémission complète, a développé une arthropathie destructrice des deux épaules. Le but de notre observation est de mettre le point sur la possibilité d’une atteinte articulaire au cours de l’acromégalie et de son retentissement fonctionnelle.Key words: Arthropathie, acromégalie, épaules, Maroc

We report the first case of an unusual sarcoidosic muscular involvement, complicated with radial nerve palsy. A 58-year-old woman suffering from a mediastinopulmonary sarcoidosis, was admitted for a driving deficit of the hands with a radially deviation during the wrist extension. She had been given a diagnosis of motor branch radial nerve entrapment syndrome. The patient had neurolysis with many muscle biopsies compatible with multiples sarcoidosic nodules, especially at the level of supinator muscle at the origin of the radial nerve compression.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 26 avril 2013