Aicha Ladjouze-rezig

The aim of this study was to compare the epidemiology of rheumatoid arthritis (RA) in North Africa to that of Western countries. We have enrolled in a cross-sectional study all consecutive patients presenting with the diagnosis of RA according to the 1987 ACR criteria, and during a 5-month period, patients were included in 11 centers across northern Algeria. Demographics, clinical data, and health assessment questionnaires (HAQ) were collected for each patient. We have estimated means, standard deviations, and 95 % confidence intervals for all parameters. Of the 249 patients (213 females and 36 males) enrolled in the study, 10 (4 %) had juvenile onset of the disease. The mean age was 50.1 ± 14.5 years, and the mean duration of RA was 8.4 ± 7.8 years. In terms of comorbidities, 18.9 % of patients reported hypertension and 5.2 % had diabetes. The mean DAS28 at inclusion was 4.3 (95 % CI 4.1-4.5); 14.0 % were in remission (DAS28 ≤ 2.6). The mean HAQ score was 0.81 ± 0.82. Rheumatoid factor was positive in 78.5 % of cases, and anti-citrullinated protein/peptide antibodies, when measured, was positive in 69.0 % of cases. Seronegative patients were older and had a relatively less severe disease. For treatment, 89.7 % of patients were taking disease-modifying anti-rheumatic drugs and only 4 % were taking biologics (rituximab); 90.8 % of patients were taking glucocorticoids, and none of the patients satisfied the recommended calcium intake guidelines. RA in Algeria is more common in women. Compared to reports from Western countries, RA in Algeria appears to be less aggressive, with more dominant seronegative oligoarthritis forms. The remission rate is comparable to that of Western populations.

ABSTRACT Background There is evidence that rheumatoid arthritis (RA) patients have an over-risk of cardiovascular disease. This is mainly due to an increase in the prevalence of metabolic syndrome (MS). The prevalence of MS among adults in Algeria is 17,8%. Objectives The aim of the study was to evaluate the prevalence of MS among RA patients in Algeria. Another aim was to evaluate the relationship between MS, inflammation biomarkers and disease scores (DAS28 and HAQ). Methods The study was performed on a cohort of 249 patients meeting the ACR/EULAR criteria for RA, followed in 11 Algerian centers. A standard clinical evaluation was performed, along with blood samples taken to measure biochemical and inflammatory parameters. The diagnosis of MS was based on the NCEP/ATP III (MS+ if ≥3/5). Prevalence of MS was calculated, and patients were divided in two groups (MS+ and MS-). Comparison between the 2 groups was performed using a T-test. Results Among 249 RA patients, 213 were female and 36 males of a mean age 50,1±14,5 years, disease duration 8,4±7,8 years, DAS28 3,9±4,8, CRP 11±16mg/L, ESR 41±26mm, HAQ 0,81±0,82, rheumatoid factor positive in 78,5% cases, mean BMI 25,3±5,1kg/m2. The overall prevalence of MS was 13,9% (CI95: 9,5%>20,1%), it was 14,3% in males and 13,8% in females. There was no correlation between the presence of MS and levels of CRP, DAS28, HAQ scores, morning stiffness, RF, ACPA and presence of erosions. However, The ESR level was significantly higher in MS+ patients than in MS- patients (p=0,036) (see table 1). Conclusions In this multicenter study, unlike most studies on RA patients, the prevalence of MS was as high in Algerian RA patients (13,9%) as in the Algerian general population (17,8%). ESR levels correlate with the presence of MS and thus go with the conclusions drawn on occidental cohorts. However, CRP and DAS28 levels do not, this may be due to the moderate cohort size and needs to be confirmed. This reinforces the role of inflammation in RA on cardiovascular disease in those patients or the role of metabolic syndrome on systemic inflammation. A further analysis is scheduled at follow-up to determine whether disease control can reverse the clustering of MS in RA. Disclosure of Interest None Declared

ABSTRACT Objectives To asses the prevalence of infections in rheumatic diseases and study their risk factors. Methods Retrospective study conducted on algerien patients’ medical files with inflammatory rheumatic diseases admitted from January, 2009 to June, 2011 in BenAknoun hospital in Algeria. Demographic and clinical data were recorded. A current or past infection was looked for by precising the type of infection, its location, and its gravity. A severe infection was defined as a tuberculous infection or an infection other than tubercular but motivating admission to the hospital. Results One hundred and sixty five algerien patients with chronic inflammatory rheumatic diseases were admitted (96 rheumatoid arthritis, 17 systemic erythematosus lupus, 15 systemic sclerodermas, 13 Sjögren’s syndrome, 9 JIA, 1 primary Hughes syndrome, 2 Reynolds syndromes, 6 dermatomyositis, 3 mixed connective diseases, 2 Behçet diseases and 1 Still disease. There were 132 women and 33 men, average age 43.1±16.1 years, evolution duration 7.1±6.8 years. All patients were treated with glucocorticoids for more than 3 months and among them, 26,7% received an equivalent of prednisone >10mg/d. Global prevalence of the infectious events was 30,3%, 30,2% for RA and 30,4% for the other diseases. The most frequent locations were lung (24%) and urinary (10%) infections as well as tuberculosis (10%). Conclusions Infections in connective tissue diseases are frequent and involve approximately 1/3 the patients, severe infection involves about 10% of the patients. Age is associated with more infectious events; males are associated with severe infections. Lupus is the most associated disease with infections. Disclosure of Interest None Declared

Paraneoplastic syndromes commonly occur in malignancies and often precede the first symptoms of the tumor. By definition, paraneoplastic syndromes are only associated with malignancies although some exceptions have been reported, occurring with benign tumors. We report a patient presenting with a clinical and serological Sharp syndrome, followed a few months later by a cervical schwannoma. Curative surgical resection of the mass resulted in a clinical and serological healing from the Sharp syndrome. To our knowledge, this is the first report of a benign schwannoma complicated by a possible paraneoplastic Sharp syndrome.

ABSTRACT Background Previous studies on ultrasonography in the diagnosis of knee osteoarthritis have described different features seen in painful osteoarthritic knees. We statistically evaluated the diagnostic values of these features as compared to healthy controls. Methods We prospectively performed ultrasonography on 43 painful osteoarthritic knees of 25 subjects, comparing them with 40 knees of 20 sex and gender-matched healthy subjects, using a linear probe (Shimadzu SDU 1200; 10-5 MHz). Comparisons between the two groups were carried-out using Mann-Whitney U test for continuous variables and Chi-square test or Fisher exact test for relevant categorical variables. Relative risks were also calculated. Results The mean age of patients was 52.1±5.3 years, 60% women. Abnormal features were found in 100% cases and 27% controls (p<0.0001; RR=3.6, 95% CI: 2.2-6.0). The most relevant features were the presence of joint effusion >2mm (79% Vs 12%; p<0.0001; RR=6.3, 95% CI: 2.7-14.5), joint effusion’s height (10.4 mm Vs 0.8 mm; p<0.0001), the presence of synovial thickening (46.5% Vs 10%; p<0.0001; RR=4.6, 95% CI: 1.7-12.5) and the presence of at least one femoro-tibial osteophyte (100% Vs 12%; p<0.0001; RR=8; 95% CI: 3.5-18.2). Cartilage thickness (inter-condylar: 2.3mm Vs 2.2mm; p=0.233), as well as the presence of a Power Doppler signal (4.6% Vs 0%; p=0.265) did not statistically differ between groups. Conclusions Joint effusion, synovial thickness and femoro-tibial osteophytes are the most useful features for an ultrasonographic diagnosis for knee osteoarthritis. There is a need to develop an ultrasonographic scoring system for diagnosing knee osteoarthritis and assessing its severity and prognosis. Disclosure of Interest None Declared

ABSTRACT Background The Madrid sonography enthesitis index (MASEI) is a validated ultrasound score for the diagnosis of spondyloarthritis. It explores six entheses and thus requires about 20 minutes to be performed for each patient by a trained sonographist. Objectives The aim of this study was to determine the validity of a simplified ultrasound score, limited to the exploration of two calcaneal sites (plantar aponeurosis and Achilles tendon), on Algerian spondyloarthritis (SpA), which is known to be more severe than European and north American one. Methods A bi-center case-control study on SpA (Amor’s criteria) patients was performed. Plantar aponeurosis and Achilles tendons were evaluated ultrasonographically (tendon thickness, structure, calcifications, erosions, Doppler Signal and bursitis) according to the description given for the MASEI score. Demographic and clinical parameters as well as pelvic X-rays were noted. A ROC curve was constructed in order to determine the cut-off value associated with the best sensitivity/specificity. Results Twenty-one SpA patients (15 males) and 17 controls (12 men) were recruited. Mean BMI and age were similar in both groups. Mean disease duration was 8.7 ± 6.8 years. The mean simplified ultrasound score was 1.35 ± 1.46 in controls and 7.19 ± 3.44 in SpA patients (p < 0.001). The area under the curve was highly significant (0.933; p < 0.001) and by choosing a cut-off value of ≥ 4 for positivity, we’ve obtained a sensitivity of 85.7% and a specificity of 94.2%. Radiographic sacro-iliitis had a sensitivity of 85%. among the 3 SpA patients without sacro-iliitis, 2 had a positive ultrasound score. Conclusions This study shows that a simplified ultrasound score based only on the evaluation of calcaneal enthesitis is feasible for the diagnostis of SpA on Algerian patients, with a clear benefit on time gain (5 minutes vs 20 minutes for the MASEI). Disclosure of Interest None Declared

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive hereditary disorder (less than 80 cases reported), characterized by multiple nodular lesions on the skin and musculoskeletal involvement, very debilitating because most adolescents and adults become bedridden. Only 10 cases have been reported on JHF in adulthood. We report the case of a 34-year-old male patient in whom clinical and histological findings were consistent with a mild JHF and focus on the radiographic features. The main purpose of this report is to increase the information available related to the radiographic manifestations and prognosis of JHF.

ABSTRACT Une jeune fille de 14 ans qui présentait une dermatomyosite (DM) juvénile a développé une calcinose extensive et invalidante, réfractaire à la colchicine, mais avec une diminution de son atteinte musculaire. Le pamidronate (2 mg/kg par an) a entraîné une amélioration spectaculaire de la douleur et de la fonction dans les deux mois qui ont suivi et la calcinose a été complètement résolutive en deux ans. Aucune nouvelle calcification n’a été observée à cinq ans de suivi.

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory and multifactorial disease. Genetic predisposition seems to play an important role. The aim of this study is to explore the relationship between human leukocyte antigen (HLA)-DRB1 alleles and susceptibility, clinical and biological features of RA in an Algerian patient population. Using polymerase chain reaction - sequence specific primers (SSP), 134 RA patients and 132 healthy controls were genotyped for HLA-DRB1 and HLA-DRB1*04 subtypes. HLA-DRB1*04 was found to have increased frequency in the RA group compared to controls (P < 0.001, OR = 3.14), and was associated with anti-citrullinated protein antibodies positivity (ACPA) (P = 0.01, OR = 2.35). In contrast, HLA-DRB1*07 was found to have a decreased frequency in patients compared to controls (P = 0.003, OR = 0.44) and significant decrease was observed in patients with the rheumatoid factor (RF) positivity subgroup (P = 0.009, OR = 0.29). HLA-DRB1*04:05 was associated with RA (P = 0.005, OR = 3.41), whereas, HLA-DRB1*04:02 showed a protective effect against RA (P = 0.003, OR = 0.20). HLA-DRB1*04 was associated with increased risk for RA and ACPA positivity, while HLA-DRB1*07 was associated with reduced risk for RA and RF synthesis in Algerian patients.

Biologics, including tumor necrosis factor (TNF) inhibitors, are increasingly used for the treatment of inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis. The efficacy of these drugs has been demonstrated in randomized controlled trials (RCTs). However, these studies are conducted in controlled environments, and the results may not necessarily reflect clinical outcomes in daily clinical practice. In Europe and other western countries, numerous biologics registries that enroll and monitor patients receiving biologics have been established. These registries follow patients irrespective of whether they continue with the initial biologic drug. Thus, real-life efficacy data from these registries can be used to assess the long-term safety of biologics through longitudinal studies. In Africa and Middle East (AFME), such registries currently exist only in Morocco and South Africa. In light of the increasing availability of biologics and scarcity of long-term safety data of these agents in the AFME population, there is a need to establish biologics registries in other countries across the region. This review discusses the value of biologics registries versus RCTs as well as safety and efficacy data from observational studies presented as lessons from well-established biologics registries. In addition, the rationale for establishing such registries in the AFME region is also presented.