Search

Resume Objectifs : Les etudes sur l’efficacite des bDMARD (biological Disease-Modifying Anti-Rheumatic Drugs) en fonction du statut des anticorps anti-peptides cycliques citrullines (ACPA) dans la polyarthrite rhumatoide (PR) trouvent de nombreuses discordances. Dans le but de contribuer a lever l’equivoque, notre etude visait a evaluer l’association entre le statut des ACPA et la reponse therapeutique aux biomedicaments chez les patients PR issus d’un registre national de vraie vie. Methodes : Il s’agissait d’une etude de cohorte historico-prospective multicentrique ayant inclus des patients PR traites par bDMARD. Apres leur inclusion, les patients etaient suivis tous les 6 mois et les donnees d’efficacite et de tolerance etaient recueillies. Dans notre etude, nous avons evalue la reponse therapeutique aux bDMARD a 12 mois (M12) de suivi en fonction du statut des ACPA avec comme critere de jugement principal un DAS28-CRP ≤ 3,2 a M12. Resultats : 225 patients dont 28 hommes ont ete inclus. Les ACPA etaient positifs dans 67,1 % des cas. Les bDMARD utilises etaient le rituximab (60 %), le tocilizumab (23,6 %) et les anti TNF α (Tumor Necrosis Factor alpha) (16,4 %). Le DAS28-CRP avait significativement diminue de 4,8 ± 1 a 2,8 ± 1,2 chez les patients de l’inclusion a M12 (p Conclusions : L’association entre l’efficacite des bDMARD et le statut des ACPA chez les patients PR n’a pas ete retrouvee dans notre etude.

Introduction:This study aims at reporting the RA male frequency while undergoing biotherapy and describing the epidemiological characteristics (clinical, biological and radiological) in relation to female RA. It also evaluates its impact on the response to biological treatments. Materials and methods: There are 224 patients followed for rheumatoid arthritis, responding to ACR/EULAR 2010 criteria during their biotherapy. They were included in the national RBSMR registry. The patients were divided into two groups and were compared at the basis of their gender in terms of the socio-demographic, clinical, biological, radiological parameters, and response to the treatement. Results: The average age of the patients under study is 51.94 ans±11.36 years old [20-80]. The presence of male rheumatoid arthritis under biotherapy is 12.4%. The mean age of RA male is 55.96+9 years old. The estimated duration of progression of male RA is 542 weeks with an average diagnostic deadline of 562.61 weeks. As a description of the case study, 28,6% of men are diagnosed with cormobidities (mainly tuberculosis 21.4%) while 10,7% of men are smokers. There is an average sedimentation rate (1st hour) at 52.6mm. Rheumatoid serology is found to be positive in 96.4% of cases. Radiological abnormalities are observed in 90.5% of the cases. Male rheumatoid arthritis is related to a shorter duration of progression (542 versus 768 weeks in females, p=0.01), liberal profession (p=0.00), study level (p=0.003), duration between diagnosis and the starting of biotherapy (p=0.021), EVA pain patient and physician (p=0.003, p=0.01) Tobacco (p=0.006), and pulmonary tuberculosis (p=0.029). On the other hand, it was not associated with the following parameters: age, duration of diagnosis, disease intensity, rheumatoid serology, structural damage nor with the DAS 28vs response during one year. Conclusion: The male RA rate in RBSMR study is 12.4% in that there is no significant difference between the sexes in clinical presentation, disease activity, disease severity, rheumatoid serology and response to the biotherapy. However, male RA was related to smoking, liberal profession, and history or occurrence of pulmonary tuberculosis.

Resume Introduction La biotherapie permet un controle sur l’activite des spondyloarthrites et une reduction ou un arret des traitements symptomatiques est espere. Il y a peu d’etudes qui se sont interessees a l’utilisation concomitante des AINS et des antalgiques avec les biologiques. A partir des donnees du registre de biotherapie de la Societe Marocaine de Rhumatologie, on a evalue la consommation concomitante des traitements symptomatiques avec les biologiques dans les spondyloarthrites et on a determine les habitudes de prescription des cliniciens. Methodes Il s’agit de 194 patients ayant une SpA sous biotherapie inclus dans le registre de biotherapie de la Societe Marocaine de Rhumatologie. Les malades ont ete scindes en 2 groupes : ceux qui ont arrete les AINS et les antalgiques et ceux qui continuent a les consommer. La frequence des prises a ete determinee (chaque jour, ≥ 5 jours par semaine, 3 a 5 jours par semaine, 1 a 3 jours par semaine ou 12 mois. Les comparaisons ont ete realisees par le test Khi-2 ou le test de Fisher exact pour les variables qualitatives et par le test de Student ou Mann-Whitney pour les variables quantitatives. Une regression logistique a ete effectuee a la recherche des facteurs associes a la consommation des traitements symptomatiques sous biotherapie. Resultats Durant les 3 mois qui ont precede l’inclusion, la moitie des patients (52,4 %) garde un traitement symptomatique, dont 58,5 % ont une prise journaliere. Les AINS representent 82,9 % des prescriptions, le paracetamol 9,7 % et les antalgiques pallier II representent 7,3 %. Les AINS les plus prescrits sont l’Indometacine (24,3 %) et le Diclofenac sodique (23 %). Trente-huit pour cent des patients sous biotherapie depuis plus d’un an gardent un traitement symptomatique contre 65,8 % de ceux sous biologique depuis moins de 3 mois. Quarante-huit pour cent des malades en remission selon le BASDAI et 36,5 % selon l’ASDAS gardent, malgre tout, un traitement symptomatique. La comparaison statistique entre les groupes a objective que la consommation des traitements symptomatiques est liee a la duree d’exposition au biologique et a l’activite de la maladie evaluee par le BASDAI et l’ASDAS. La regression a revele qu’en ajustant sur les autres facteurs, seule la remission selon l’ASDAS-CRP est significativement associee a la consommation des traitements symptomatiques. Conclusion Les AINS et les antalgiques continuent a etre utilises chez la moitie de nos patients sous biotherapie, surtout si la SpA est active et recemment mise sous biologique. La consommation des AINS pourrait etre un moyen efficace pour evaluer la reponse therapeutique et la remission chez les patients sous biotherapie. Toutefois cette consommation persiste meme chez certains patients en remission et malgre une duree suffisante de traitement biologique.

Introduction: The purpose of our study is to compare between physical activity (PA) in postmenopausal women with osteoporotic vertebral fractures and healthy women and to evaluate the relationship between PA and clinical and paraclinical parameters related to osteoporotic fracture. Methods: A case-control cross- sectional study, which included 128 postmenopausal women with densitometric osteoporosis as defined by Worlds Health Organization, with at least one radiological vertebral fracture. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) short version with three items: vigorous, moderate activity and walking. Bone mineral density (BMD) and X-rays were performed in all patients. The controls were healthy women included in a randomized order in the general population, they were matched for age. Results: 128 patients with a mean age of 61.01± 8.40 years were included. 100 controls were included with a mean age of 60.61 ± 8.25 years. The patients had a median age of menopausal of 48.90 years [48-50], were osteoporotic in 49.2% and had osteopenia in 34.9%. 84 patients had a current back pain, and an average of three vertebral fracture with a median Genant score of 3.02[1-23]. There was no significant difference between the subjects of our study for total PA. However, vigorous-intensity activity and walking were significantly different between the two groups (p

Type 2 diabetes mellitus (T2DM) and osteoporosis are chronic diseases with increasing prevalence. The aim of this study was to determine the prevalence of osteoporosis and osteoporotic fracture in women with T2DM and to identify predictive factors of fracture occurrence. The prevalence of osteoporosis and fractures in postmenopausal women with T2DM was 23.1% and 16.9%, respectively. 46.2% of T2DM patients had normal bone mineral density (BMD) (P

The objective of our study was to evaluate the aseptic technique used in interventional rheumatology by Moroccan and Tunisian rheumatologists. We performed an online survey among rheumatologists from Morocco and Tunisia. The questionnaire included 15 questions with single and multiple-choice answers and three open sections for freetext comments. An online survey was prepared and sent to 380 rheumatologists. One hundred and four rheumatologists (27.36%) replied to the survey. More than half of the participants (56.7%) were from Tunisia and 43.3% were from Morocco. Interventional procedures on superficial joints were performed by all participants. Ultrasonography was used by 41.3% of respondents to guide interventional procedures. Regarding the aseptic precautions taken to avoid infection, the majority of participants used povidone iodine to clean the skin and only 8.7% wore a mask. Hand washing alone without gloves wearing was done by 19.2% of participants. 2.9% of participants reported a history of iatrogenic septic arthritis and the duration of practice was the only factor associated with its occurrence (P=0.007). Our study showed that aseptic technique used during interventional rheumatologic procedures is heterogeneous. However, the majority of participants were aware of its necessity to avoid iatrogenic septic arthritis.

Introduction Dans les pays Nord-Africains, ayant un contexte infectieux different des pays occidentaux, peu de donnees sont disponibles sur le risque infectieux sous anti-TNFα. A travers les donnees du registre de biotherapie de la Societe marocaine de rhumatologie (RBSMR), on va evaluer le risque infectieux (hors tuberculose) sous anti-TNFα dans la polyarthrite rhumatoide et la spondyloarthrite. Patients et methodes Ce travail, issu du RBSMR, a ete realise a partir des donnees de l’inclusion et apres 1 an de suivi. Il concerne 194 patients ayant une SpA et 224 patients ayant une PR. L’etude a ete initialement descriptive, de la frequence, du type et de la gravite des incidents infectieux. Ensuite nous avons determine par une regression logistique univariee puis multivariee, les facteurs associes aux infections et aux infections graves chez les patients sous anti-TNFα. Resultats Au total, 226 patients sont sous anti-TNFα, dont 189 ont une SpA et 37 une PR. Durant la premiere annee de suivi, l’incidence des infections sous anti-TNFα est de 20,79 par 100 patients-annee, l’incidence des infections graves est de 3,09 par 100 patients-annee. L’âge moyen de ces patients est de 46,17 ± 14,28 ans, 50,5 % sont des femmes, 31 malades ont une SpA et 11 une PR. La duree mediane de la maladie est de 600 [404–845] jours. Concernant les infections, 18 ont touches la sphere ORL, 9 etaient respiratoires communes, 6 urinaires, 12 cutaneomuqueuses, une arthrite septique et un cas de meningite. 7 patients ont fait une infection grave. Aucun cas de deces n’a ete enregistre. Dans l’analyse multivariee, la duree de l’anti-TNFα, une duree de la biotherapie inferieur a 6 mois et l’adalimumab ont ete associees a la survenue des infections. Concernant les infections graves, dans le modele univarie, l’âge et la prise actuelle de corticoides ont ete associes au risque infectieux, dans l’analyse multivariee seule la lymphopenie a ete associee aux infections graves. En ajustant sur les autres facteurs et en prenant l’etanercept comme molecule de reference, le golimumab a un odds ratio de 0,24 (IC95 % [0,029–2,142]), 0,240 (IC95 % [0,029–2,011]) pour le remsima, 1,040 (IC95 % [0,308–3,504]) pour le remicade et 2,359 (IC95 % [1,013–5,492]) pour l’adalimumab. Conclusion Les infections rapportees sous anti-TNFα, dans le registre marocain des biotherapies, restent dans la plupart des cas benignes.

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.

To describe and analyse the prevalence of extra-articular manifestations (EAMs) including acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD) in patients with ankylosing spondylitis (AS) in the Moroccan registry of biological therapies in rheumatic diseases RBSMR (Registre des Biothérapies de la Société Marocaine de Rhumatologie).A cross-sectional, multicentre and analytical study based on the RBSMR database, which included 170 AS. Incidence rates for the development of AAU, psoriasis and IBD were calculated, and risk factors were analysed.Prevalence of EAMs in AS was 13.5%, 4.7% and 11.2% for AAU, psoriasis and IBD respectively. No significant differences were found while establishing a comparison of the prevalence of these EAMs between AS patients with and without peripheral arthritis. Interestingly, AAU was the most common EAM, and was positively associated in multivariable regression with family history of spondyloarthritis (OR= 7.21, CI 95%: 2.23-23.24).AAU was the leading EAM in patients with AS included in the Moroccan biotherapy registry (RBSMR) and it was associated with family history of spondyloarthritis.

Background: 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.Methods: 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.Results: 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 3rd 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.Conclusion: 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.

The aim of the study was to estimate the annual direct costs of biological therapies in rheumatoid arthritis (RA), and to establish possible factors associated with those costs. The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry). We included patients with available 1-year data. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Differences in costs across groups were tested by Mann–Whitney and Kruskal–Wallis tests. Correlations analysis was performed in search of factors associated with high costs. We included 197 rheumatoid arthritis patients. The mean age was 52.3 ± 11 years, with female predominance 86.8%. Receiving one of the following therapies: rituximab (n = 132), tocilizumab (n = 37), or TNF-blockers (n = 28). Median one-year direct costs per patient were €1665 [€1472–€9879]. The total annual direct costs were € 978,494. Rituximab, constituted 25.7% of the total annual budget. TNF-blockers and tocilizumab represented 27.3% and 47% of this overall budget, respectively. Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation. A positive correlation was found between the annual direct cost and body mass index (r = 0.15, p = 0.04). In Morocco, a developing country, the annual direct costs of biological therapy are high. Our results may contribute to the development of strategies for better governance of these costs.

ObjectivesTo identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic.MethodsThe COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to.ResultsA total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists’ practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country.ConclusionCOVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.

The shoulder may be affected in a large portion of patients with rheumatoid arthritis (RA) worldwide. However, this joint does not receive the attention required during follow-up. Indeed, although numerous clinical tests for diagnosis of a painful shoulder are available, differentiating articular from peri-articular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA has benefited from a reliable imaging modality used to detect its exact origin—ultrasonography (US). This study was aimed at assessing the intra- and inter-observer reliability of ultrasonographic findings for patients with established RA with shoulder pain in a patient-based exercise as a clinical challenge among Maghrebian rheumatologist experts in US. A total of 7 operators examined 10 patients in two rounds independently and blindly of each other. Before beginning the session, all of the rheumatologists reached a consensus on sites and US settings by performing a brief exercise on a normal shoulder. Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions of US-detected pathologies were used. Each patient underwent US scanning of the painful shoulder in predefined sites based on US technical guidelines of the European Society of Musculoskeletal Radiology: long head of biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of subdeltoid or subcoracoid bursitis or full rupture of the suprasupinatus was identified if present. Intra- and inter-observer reliability measures were calculated using the κ coefficient. Intra-observer reliability was good for gray-scale (GS) synovitis in subscapularis and posterior recesses (κ = 0.77 and 0.73, respectively). It was moderate in the presence of GS synovitis and effusion in LHB (κ =0.53 and 0.40, respectively), posterior and subscapularis recess effusion (κ = 0.56 and 0.60, respectively) and GS and power Doppler (PD) synovitis in axillary recesses (κ = 0.58 and 0.49, respectively). Inter-observer reliability was good for PD for LHB signals (κ = 0.78). It was moderate for GS for LHB synovitis (κ = 0.54). Inter-observer agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses, and very poor for PD signals in these recesses. US was a reliable imaging tool for detecting tenosynovitis in the LHB. However, reliability was moderate to poor in detecting synovitis in subscapularis, posterior and axillary recesses. These findings could be optimized by standardization of sites to assess.

Purpose of Review The aim of this paper is to provide an overview about reactive arthritis, with an update regarding pathophysiology and therapeutic approach of the disease, outlining the clinical features and diagnostic approach, based on recent literature review. Recent Findings Reactive arthritis is considered to be part of the spectrum of the spondyloarthritis. Its epidemiology is changing worldwide due to several reasons, among them are as follows: different diagnosis approach and clinical presentations, different grades of infection, microbiome changes, etc. The understanding of pathophysiological models is challenging, but recent studies contribute to elucidate the major factors involved in the development of the disease. The management of ReA depends on the triggering agent and the phase of disease, whether it is acute or chronic. Summary The association between the microbiome changes and spondyloarthropathies (ReA) is becoming increasingly evident. The results regarding the biologic treatment on refectory ReA are promising.

ObjectivesTo develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.MethodA task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement.ResultsA total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.ConclusionsThe preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges.Key Points• AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic.• COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists.• Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs.• Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.

The onset of the COVID-19 pandemic has led to far-reaching changes in the delivery of healthcare services across Africa. A number of drugs used in the management of rheumatic diseases have been touted to have roles to play in the treatment and/or exacerbation of COVID-19 symptoms and this has resulted in significant changes in the practice of rheumatology. The global rheumatology community has risen to this challenge by demonstrating collaborative partnership, resulting in the establishment of the global rheumatology registry to collect data on rheumatic patients infected with COVID-19.1 In view of the study by Gianfrancesco et al ,2 an online survey consisting of 40 practice and experience questions ((online supplementary file 1) and (online supplementary file 2)) was created by the COVID-19 African Rheumatology Study Group which was formed through the network of the African League of Associations for Rheumatology (AFLAR). The aim of the study was to identify the changes in rheumatology practice and patient behaviour, as well as to highlight key concerns of rheumatologists across Africa resulting from the ongoing COVID-19 pandemic.### Supplementary data [annrheumdis-2020-218273supp001.pdf] ### Supplementary data [annrheumdis-2020-218273supp002.pdf] A total of 554 completed responses were received from 20 African countries. There were 431 (77.8%) responses from Northern Africa, 43 (7.8%) from West Africa, 6 (1%) from Central Africa, 20 (3.6%) from East Africa and 54 (9.8%) from Southern Africa. The scope of practice was adult only in 296 (53.4%), paediatric only in 15 (2.7%) and both in 243 (43.9%). A total of 288 (52.9%) of the respondents practised in academic institutions, while 162 (29.2%) practised primarily in a private setting. Forty-four (7.9%) were using hydroxychloroquine (HCQ) more than before, 19 (3.4%) admitted to have prescribed HCQ to prevent severe COVID-19 disease, 92 (16.6%) …

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.

The aim of this study was to determine the therapeutic maintenance level of methotrexate for rheumatoid arthritis patients enrolled in the Moroccan biotherapy registry and to identify predictive factors for discontinuing MTX treatment.A cross-sectional study was conducted using the baseline data of the Moroccan biotherapy registry for RBSMR (a multicentric study that aims to evaluate tolerance of biological therapy on patients affected with rheumatic diseases). Demographics and disease features were compared using descriptive statistics. Therapeutic maintenance levels were determined according to a Kaplan-Meier survival curve and a univariate Cox proportional hazards regression model was used to compare the strength of potential factors, followed by a multivariate Cox model to identify significant predictors of MTX discontinuation. Statistically significant results were considered for224 patients with rheumatoid arthritis were included in this study. The mean age of patients was 51.83±11.26 years with a majority of females (87.50%). The median duration of disease was 12 [1.66-41.02] years. The therapeutic maintenance level of MTX was 91.1% at 1 year, 87.1% at 2 years, and 68.3% at 5 years. The median of treatment duration was 2, 02 [0, 46-27,76] years. Causes of treatment interruption were side effects (66/88=75%), inefficiency (12/88=13.63%), and other reasons (10/88=11.36%). Predictive factors for stopping MTX were presence of rheumatoid factor (HR 2.24; 95% CI 1.14-5.15;The therapeutic maintenance level of MTX in our study was satisfactory and comparable to other series, and influenced by many factors such as the occurrence of a side effect. It is necessary to sensitise medical practitioners on symptomatic prevention and management of side effects.

Introduction Le switch d’un anti-TNF au rituximab a prouve son efficacite et sa bonne tolerance chez les malades ayant une polyarthrite rhumatoide. Or, dans un pays comme le notre ou le rituximab est frequemment prescrit autant que premier biologique, on est amene a switcher vers une autre biotherapie (souvent un anti-TNF) sans avoir assez de recul documente ou de donnees de litterature prouvant l’efficacite et la tolerance de ce switch. L’objectif de notre etude est d’evaluer l’efficacite et la tolerance des traitements biologiques recus apres un premier traitement par rituximab. Materiels et methodes Des 224 patients PR recrutes dans le registre RBSMR, 165 malades ont recu du rituximab comme premier biologique et ont ete inclus dans notre etude transversale multicentrique. Les donnees sociodemographiques, cliniques et paracliniques ont ete recueillies. Un switcher etait tout malade ayant change de biologique au moins une fois. L’efficacite du switch a ete evaluee par le DAS28 et le ΔDAS28 a l’inclusion, a 6 et 12 mois de suivi. La tolerance a ete evaluee par la survenue d’effets indesirables. La raison du switch a ete precisee ainsi que le type du nouveau biologique. Des comparaisons ont ete effectuees entre les 2 groupes switchers/non-switchers. Le seuil de significativite a ete fixe a p Resultats Cent soixante-cinq malades PR ont recu le rituximab comme premier biologique avec une predominance feminine (87,9 %). L’âge moyen etait de 51,79 ± 11,27 ans et la duree d’evolution de 13,84 ± 9,07 ans. Cent quarante-trois (93 %) patients avaient une forme seropositive, 156 (94,5 %) recevaient de la corticotherapie et 156 (97,5) etaient sous MTX. Trente-six (22 %) patients ont beneficie d’au moins un switch dont la cause etait l’inefficacite chez 72,2 % des cas. Le ΔDAS28 VS est plus important chez les switchers versus les non-switchers apres 1 an de suivi (−0,31 ± 2,22 et −0,17 ± 1,72 respectivement). Parmi les switchers, 53,6 % etaient en remission/LDA a 1 an de suivi versus 43,8 % des non-switchers. Parmi les switchers, 44,4 % ont presente des effets indesirables a la biotherapie versus 31 % des non-switchers avec predominance des infections dans les deux groupes (22,2 % et 13,2 % respectivement), des reactions a la perfusion dans le groupe des non-switchers (13,2 %), et absence des neoplasies dans les deux groupes. Conclusion Les switchs apres rituximab chez les patients PR pourraient etre aussi bien efficaces et tolerables que le switch apres anti-TNF.

Introduction La polyarthrite rhumatoide (PR) est le plus frequent des rhumatismes inflammatoires chroniques. Il s’agit d’une maladie auto-immune systemique avec un etat inflammatoire chronique et un traitement a base de corticotherapie,qui peuvent induire une perte osseuse, ce qui rend le depistage de l’osteoporose indispensable [1] , [2] . Plusieurs etudes ont montre des actions favorables des therapies biologiques sur la protection osseuse [3] . Le traitement avec des anti-TNF est associe a l’amelioration du rapport marqueur de formation/resorption, suggere une diminution de la perte osseuse chez les patients atteints de PR [4] . Objectif Etudier la prevalence de l’osteoporose chez les patients atteints de la polyarthrite rhumatoide (PR) a l’inclusion et apres 12 mois de biotherapie, et de comparer l’effet des differentes biotherapies et la relation avec les parametres d’activite et le retentissement fonctionnel de la maladie. Patients et methodes Etude prospective analytique multicentrique basee sur les donnees du registre marocain de biotherapie portant sur 225 patients suivis pour PR repondant aux criteres ACR-EULAR;L’etat osseux (osteoporose) a ete accueillie a l’inclusion (M0) et apres 12 mois de biotherapie (M12). Resultats Parmi 225 patients ayant une PR inclus dans le RBSMR, l’osteoporose etait presente chez 51 patients (29,31 %) a l’inclusion (M0) et chez 8 patients (3,68 %) apres 12 mois de biotherapie (M12) avec une difference statistiquement significative p Conclusion Notre etude met en evidence un effet protecteur du DMARD biologique sur la perte osseuse au cours de la premiere annee de traitement. Vu la suppression des effets liee a l’activite inflammatoire et pathologique de la PR sur le tissu osseux, soulignant l’importance de controler l’inflammation, mais des etudes complementaires sont necessaires pour confirmer ou infirmer cette tendance.

Introduction Le CT-P13 (Remsima®) est un biosimilaire du produit de reference de l’infliximab INX (Remicade®) et est prescrit, la plupart du temps pour les memes indications que l’infliximab. Notre objectif etait de comparer l’efficacite et la tolerance du CT-P13 versus INX chez les patients atteints de spondyloarthrite (SpA) inclus dans le registre marocain des biotherapies (RBSMR). Patients et methodes Il s’agit d’une etude prospective multicentrique incluant 194 patients atteints de SpA recrutes dans le RBSMR (un registre historicoprospectif multicentrique de 419 patients ayant une polyarthrite rhumatoide (PR) ou une SpA, traites par des medicaments biologiques dans les 10 services universitaires de rhumatologie du Maroc). Les patients sont evalues tous les six mois et chaque fois qu’ils subissent un evenement indesirable ou un changement de traitement. La duree de suivi prevue est de 3 ans. Les donnees disponibles a ce stade portent sur les observations a l’inclusion, a la visite a 6 mois et a la visite a 12 mois. Parmi les 194 patients SpA, 48 etaient sous INX ou son biosimilaire (23 sous INX et 25 sous CT-P13). Les donnees sociodemographiques relatives aux patients ainsi que les donnees cliniques et paracliniques relatives a la maladie ont ete analysees avec une comparaison entre les deux groupes par le test t Student pour les variables quantitatives et le Chi2 pour les variables qualitatifs. L’efficacite a ete evaluee a travers l’evolution du BASDAI, ASDAS (CRP) et BASFI. La tolerance a ete evaluee, en termes de survenue d’effet secondaire entre l’inclusion et la visite de 12 mois. Le seuil de significativite est fixe a p Resultats Nos resultats ont montre que l’amelioration des scores d’evaluation de l’activite entre l’inclusion et la visite a 12 mois etaient similaires entre les deux groupes de traitement [BASDAI (INX : −2,52 contre CT-P13 : −2,98, p : 0,69), BASFI (INX : −2,11 contre CT-P13 : −1,95, p : 0,89), et ASDAS CRP (INX : −1,85 contre CT-P13 : −1,67, p : 0,36)]. Sur le plan de la tolerance, il n’y a pas eu de difference entre les deux groupes concernant l’incidence globale des evenements indesirables (INX : 30,4 % ; CT-P13 : 40 %, p : 0,55). Par type d’effets secondaires, les groupes INX et CT-P13 n’ont pas presente un ecart significatif en termes d’incidence de reactions a la perfusion (INX : 8,7 % ; CT-P13 8 % ; p : 0,93) et de tuberculose maladie (INX : 4,3 % ; CT-P13 : 8 % ; p : 0,6). En revanche une difference significative a ete relevee sur le plan d’apparition des infections (INX : 26,1 % ; CT-P13 : 4 % ; p : 0,04). D’autres effets secondaires ont ete egalement releves a savoir un cas de psoriasis paradoxal et un autre de diverticulite sous INX et un cancer des cordes vocales dans le groupe CT-P13. Conclusion Notre etude suggere l’absence de difference entre l’INX et son biosimilaire, en termes d’efficacite ce qui rejoint les resultats des etudes ulterieurs. Sur le plan de la tolerance l’INX a montre une frequence significativement plus elevee des infections.

Objective To compare perceptions of patients with rheumatoid arthritis (RA) to those of their families regarding pain and subjective experience of the disease. Methods It was a monocentric study, including 120 RA patients (according to the American College of Rheumatology criteria). The questionnaires were developed during meetings of RA patients, rheumatologists, and methodologists while referring to the literature. The patient questionnaire comprised 22 items organized in 4 sections: pain, perceived experience of the disease, activity restrictions, and help received. Concordance among patients, family, and friends replies was evaluated using the kappa coefficient. Results The mean age was 42 ± 12 years with female predominance 110 (91.7%). The family member was usually the spouse (46.3%). Joint pain was described by patients as spontaneous (98.3%), unpredictable (95.9%), and variable (95.1%). RA had negatively affected work-related activities (100%), recreational activities (98.4%), family life (87.6%), relationships with friends (77.7%), sexual activities (50.4%), plans for having children (47.1%), and intimate relationships (46.3%). Concordance between patients and family perceptions was mediocre for pain severity (kappa: 0.3) and main joint-pain characteristics, excellent for majority items of experience of the disease (kappa > 0.80). Family tended to underestimate pain severity and to overestimate negative effects of RA on patient's life. Conclusion We found a good agreement between patients' and family members' perceptions. It is essential that any family support be in accordance with patients' needs. Our qualitative analysis objectified, in addition to a major physical impact of the disease, a negative psychosocial effect.

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.

Objectives:The aim of this study was to calculate direct costs amount in rheumatoid arthritis (R.A) patients in the Moroccan register of biologicals RBSMR registry.Methods:Patients in the Moroccan register of biologicals RBSMR registry with available 1-year data were included. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Biologic use and costs were compared.Results:197 patients data (female sex (86,8%), mean age (52,3± 11 years), illiteraty (45,7%)) were analyzed. The median annual direct costs per patient were €1,665 [€1,472 - €9,879]. For all patients, the mean annual direct costs per treated patient for each biological agent is presented in Figure 1.The total annual direct costs of biological agents in the RBSMR registry were 978 494 €. Rituximab was given to 67% of patients and constituted 25.7% of the total annual budget. TNF-blockers and Tocilizumab were prescribed in 14.2% and 18.8% of cases and represented respectively 27.3% and 47% of this overall budget.Conclusion:This study presents a global overview of the direct costs of biological therapy associated with RA patients, taking as a source the Moroccan registry of biological therapies in rheumatic diseases. Those results show that overall cost of biological agents according to the Moroccan register is very high. There is a real need for development of strategies for better governance of those costs.Disclosure of Interests:None declared

Background:Objectives:The aim of this study was to estimate the annual direct cost of biologics in rheumatoid arthritis and to evaluate the impact of social factors on biological use and costs.Methods:Patients in the Moroccan register of biologicals (RBSMR) with available 1-year data were included. Variables related to socio-economic status, disease and biological were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Biological use and costs were compared based on social factors.Results:Our study included 197 patients (female sex of 86.8%, mean age of 52.3 ± 11 years). Patients were on one of the following therapies: Rituximab (n=132), Tocilizumab (n=37) or TNF-blockers (n=28). 44.2% of included patients have the RAMED medical assistance (health insurance scheme for the economically underprivileged). Illiteracy was noted in 45.7% of cases. Median one-year direct costs per patient were €1,665 [€1,472 - €9,879].There was no statistically significant difference in costs between men and women (p>0.05), between illiterate and literate (p>0.05). There was a statistically significant difference in costs between patients with the RAMED medical assistance scheme and other health insurances (pConclusion:This study showed that Moroccan RA patients had equal access to biologics regardless of their gender or level of education. Indeed, the insurance system influence the costs of biologics. Accessibility of those expensive treatments in a developing country seems be explained by efforts of the Moroccan ministry of health who has allocated a substantial budget for biologic DMARDs for patients with RAMED in the tertiary structures in our country.Disclosure of Interests:None declared

Background:Although numerous clinical tests for the diagnosis of painful shoulder are available, differentiating articular from periarticular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA benefited from a reliable imaging modality to detect its exact origin as ultrasonography (US).Objectives:This study aimed to assess the intraobserver and interobserver reliabilities of the ultrasonographic findings for patients with established RA having shoulder pain in a patient-based exercise among maghrebian rheumatologists experts on US.Methods:A total of 7 operators examined 10 patients in 2 rounds independently and blindly of each other.Each patient underwent a US scanning of the painful shoulder in four sites based on US technical guidelines of the European society of musculoskeletal radiology: long head of Biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of a subdeltoid or subcoracoid bursitis or the presence of transfixiant tear of the suprasupinatus were notified if present. Intra and inter-observer reliabilities were calculated.Results:Intraobserver reliability was excellent for GS synovitis in subscapularis and posterior recesses (k=0.91 for both) and for subcoracoid bursitis (k=0.81). It was good in case of presence of a subdeltoid bursitis (k=0.79), transfixiant tear of the suprasupinatus (k=0.65), GS synovitis and effusion in LHB (k=0.67 and 0.6 respectively) and subdeltoid bursitis (k= 0.79). Interobserver reliability was good for PD for LHB signals searched longitudinally (k=0.78) and transversally (k=0.78). It was moderate for GS for LHB synovitis (k=0.55). Interobserver agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses. It was very poor and/or absent for PD signals in these recesses.Conclusion:US is a reliable imaging tool for shoulder in RA especially with regard to LHB effusion, GS and PD synovitis. Interobserver reliability of subscapularis, posterior and axillary recesses could be optimized by standardization of sites to assess.References:[1]Bruyn G a. W, Naredo E, Möller I, Moragues C, Garrido J, de Bock GH, et al. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis 2009;68:357–61.Disclosure of Interests:None declared

Objectives:The aims of our study are to determine the new comorbidities appearing under biologic therapy, their prevalence, and the factors implicated in their appearance.Methods:It’s a multicentric historical-prospective cohort including 10 rheumatology departments of Moroccan University Hospitals. The data were collected from the national register of patients under biologic therapy supervised by the Moroccan Society of Rheumatology. An electronic follow-up questionnaire is completed every 6 months by the investigator.Results:The study included 418 patients: 224 with Rheumatoid Arthritis (RA) who represented 53.6% and 194 with spondyloarthropathy (SP) who represented 46.4%.The prevalence rate of comorbidities appearing after one year of treatment with biologic therapy was 15.7% in RA and 8.4% in SP. The rate of cardiovascular diseases was 12.9% (arterial hypertension, myocardial infarction and/or ischemic stroke), 6.4% was the same value of hypercholesterolemia and depression, diabetes 3.3%, ulcer 3.2%, and osteoporosis 9.7%. The sedentary rate was 54.8% and smoking was about 3.3%.No patient had developed hypertriglyceridemia or chronic obstructive pulmonary disease.In the group of patients with RA, the average age of the patients who had developed a new comorbidity was 51,8 ± 11,3 years, women represented 87.5%, the average of Body Mass Index (BMI) was 27,6 ± 5,9 and the average duration of the disease was 14,1 ± 9,2 years. The disease activity score (DAS28) had an average of 3,15 ± 1,47.59.6% of patients used Rituximab, 23.8% Tociluzimab, 8.1% Etanercept, 5.8% Adalimumab, 0.18% Infliximab, and 0.9% Golimumab.In the group of patients with SP, the average age of the patients who had developed a new comobidity was 40,2 ± 13,7 years, men represented 63.4%, and the average of BMI was 24,3 ± 4,94.The activity of the desease, had an average Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2,62 ± 1,79 and ankylosing Spondylitis Disease Activity Score (ASDAS) of 1,93 ± 1,09.Regarding the type of biologic therapy, 33.2% of patients used Etanercept, 30.1% Adalimumab, 24.9% Infliximab, 9.8% Golimumab, 1.6% Secukinumab, and 0.5% Tociluzimab.Conclusion:Our study showed a high prevalence of cardiovascular disease in patients under biologic therapy. This can be explained by the sedentary lifestyle secondary to rheumatic disease.Disclosure of Interests:None declared