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Sir, An 83-year-old patient hospitalized in the intensive care unit (ICU) of the pulmonary department for chronic respiratory failure complicated by severe COVID-19 pneumonia with respiratory involvement of 50% of the lungs. The comorbidities included diabetes, uncontrolled hypertension, ischemic heart disease, Parkinson’s disease, and bronchial asthma. The patient was unable to maintain adequate arterial oxygen saturation with a face mask and nasal prongs. The attending physician ordered non-invasive ventilation (NIV) and a continuous positive airway pressure (CPAP) mask was applied. On day ten of the patient’s ICU stay, his attending physician noticed a grade II cheekbone ulcer. The patient was put on a paraffin dressing. The evolution was marked five days later by a worsening in the stage of the pressure ulcer, which had become a stage III ulcer and, therefore, our opinion was requested. An examination of the patient revealed a well-adjusted, full-face mask with pressure against the zygomatic bone aggravated by the application of compresses, which further increased the aggression against the bone. A dermatological examination found two necrotic patches on both cheekbones without a peripheral detachment or inflammatory border (Fig. 1). There were no signs of bacterial infection. Upon investigation, the caregivers revealed that the CPAP mask had been left in place for nearly eighteen hours daily without formal monitoring or the inspection of the pressure areas. Fortunately, the patient’s condition began to improve as did her arterial oxygen saturation. The pulmonologist was gradually attempting to remove the patient from NIV. Strict monitoring of the pressure points was recommended and the patient was put on a hydrogel dressing for five days until the necrosis was eliminated, then on a hydrocolloid dressing after the mechanical removal of the remnants of the necrosis and fibrin with good improvement of the ulcer. The COVID-19 epidemic represents a new challenge for critical care physicians (ICU). In the context of this epidemic, the management of arterial oxygenation during critical care procedures is one of the main challenges for ICU physicians. As an effective means of ensuring satisfactory arterial oxygenation during COVID-19 pneumonia, more than 50% of patients treated in China required non-invasive ventilation (NIV) [1]. During NIV with headgear, ICU nurses should focus on interventions that help to improve the patient’s comfort to maximize the acceptability of the device and minimize mask-induced skin irritability [1]. Skin pressure sores secondary to helmet application may be prevented by applying hydrocolloid dressings associated with close monitoring of the patient’s tolerance to the pressure exerted by the mask [2]. The development of NIV-related pressure sores is due to a combination of pressure effects and shear forces exerted by the presence of a mask, pressure changes during the different phases of ventilation, and the tension of the mask’s strap [3]. The use of oronasal masks and increased time on NIV increases the risk of pressure ulcer formation, as do patient factors such as age, sensory impairment, chronic skin conditions, and hypotension [4]. Oronasal masks remain the most popular interface, with a European survey revealing that they are the first choice in 70% of cases. The reasons given by respondents for their choice were the reduction of air leakage, patient comfort, and cost [5].

Objective: Diabetes mellitus (DM), a worldwide high-prevalence disease, is associated with a large variety of rheumatic manifestations. It affects the connective tissues in many ways and causes alterations in the periarticular and the musculoskeletal systems. In most cases, these manifestations are associated with functional disability and pain, affecting the quality of life of the diabetic patient. The aim of our study is to review the different articular and abarticular manifestations in diabetic patients and the associated factors of these rheumatic manifestations. Material and Methods: A cross-sectional study that includes all patients suffering from type 2 DM who present with articular or abarticular manifestations. Results: We included 116 diabetic patients presenting with articular or abarticular manifestations. Our study showed four important findings. First, a large variety of articular and abarticular manifestations were present in patients with type 2 DM. Second, osteoarthritis (OA) of the knee was the most frequent articular manifestations. It was seen in 49% of our patients. Third, the most common manifestations in diabetic Moroccan patients were carpal tunnel syndrome (CTS), adhesive capsulitis of the shoulder, and diabetic cheiroarthropathy (29%, 23%, and 16%, respectively). Fourth, there was a significant association between vascular complications and the development of articular and abarticular manifestations. Conclusion: This study shows that the articular and abarticular manifestations in diabetic Moroccan patients are dominated by CTS, adhesive capsulitis of the shoulder, and diabetic cheiroarthropathy, with a significant association between vascular complications and the development of some of these manifestations.

Joint manifestations in scleroderma (Scl) and polymyositis (PM) are dominated by inflammatory arthralgia. Arthritis is less common and preferentially affects the hands, wrists, knees, and ankles. Involvement of the hip has been rarely reported in the literature. We report a case of coxitis diagnosed in a patient suffering from scleroderma-polymyositis overlap syndrome successfully treated by ultrasound-guided infiltration of triamcinolone hexacetonide.

Pregnancy complicated by Non Hodgkin lymphoma (NHL) is rare, about 100 cases have been reported. We will describe the case of a multifocal bone lymphoma revealed by a left hyperalgetic and deficient cruralgia in a female in the second trimester of pregnancy.

Les complications infectieuses sont redoutables au cours de la polyarthrite rhumatoïde (PR). Le but de notre étude est d'estimer leur fréquence et de déterminer les facteurs associés à l'infection chez ces patients. Il s'agit d'une étude rétrospective incluant les cas de PR établis recensés entre 2007 et 2011 au service de rhumatologie au CHU Hassan II de Fès au Maroc. Nous avons inclu 164 patients atteint de PR, l'âge moyen des patients était de 47,9 ans, avec une prédominance féminine (137 F/27H). La fréquence des infections dans notre série était de 26,2 %, dominées par les infections urogénitales (22 cas), pleuro pulmonaires (11 cas) dont 2 cas de tuberculose pulmonaire et un cas d'infection H1N1, 3 cas d'infections cutanées et 4 cas d'arthrite septiques. Dans notre série 127 patients étaient sous corticothérapie orale, 147 patients étaient sous méthotrexate, 25 patients étaient sous rituximab et 8 patients étaient sous tocilizumab. Dans notre étude, les facteurs associés à la survenue d'infection étaient l'âge avancé (p= 0,02), une CRP élevée (p= 0,04) et une dose de corticothérapie - 7.5 mg/j (p= 0 ,03). Notre étude a mis en évidence certains facteurs associés à la survenue d'une infection au cours de la PR. En connaissant ces facteurs, il faut instaurer une surveillance particulière pour améliorer la qualité de prise en charge.

Les complications infectieuses sont redoutables au cours de la polyarthrite rhumatoïde (PR). Le but de notre étude est d'estimer leur fréquence et de déterminer les facteurs associés à l'infection chez ces patients. Il s'agit d'une étude rétrospective incluant les cas de PR établis recensés entre 2007 et 2011 au service de rhumatologie au CHU Hassan II de Fès au Maroc. Nous avons inclu 164 patients atteint de PR, l’âge moyen des patients était de 47,9 ans, avec une prédominance féminine (137 F/27H). La fréquence des infections dans notre série était de 26,2%, dominées par les infections urogénitales (22 cas), pleuro pulmonaires (11 cas) dont 2 cas de tuberculose pulmonaire et un cas d'infection H1N1, 3 cas d'infections cutanées et 4 cas d'arthrite septiques. Dans notre série 127 patients étaient sous corticothérapie orale, 147 patients étaient sous méthotrexate, 25 patients étaient sous rituximab et 8 patients étaient sous tocilizumab. Dans notre étude, les facteurs associés à la survenue d'infection étaient l’âge avancé (p= 0,02), une CRP élevée (p= 0,04) et une dose de corticothérapie - 7.5 mg/j (p= 0,03). Notre étude a mis en évidence certains facteurs associés à la survenue d'une infection au cours de la PR. En connaissant ces facteurs, il faut instaurer une surveillance particulière pour améliorer la qualité de prise en charge.

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

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 14 mai 2011

Revue du rhumatisme - In Press.Proof corrected by the author Available online since samedi 1 juin 2013