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Kronbi F, Rkain H, Benzine N, Ez-Zaoui S, Abouqal R, Belayachi J, Hajjaj-Hassouni N, Tahiri L, Allali F. Knowledge, Attitudes, and Practices of Moroccan Community Rheumatologists' Regarding the Management of Non-radiographic Axial Spondyloarthritis: A National Cross-Sectional Study. Cureus 2024; 16:e61162. [PMID: 38803407 PMCID: PMC11129670 DOI: 10.7759/cureus.61162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Non-radiographic axial spondyloarthritis (nr-axSpA) is within the spectrum of axial spondyloarthritis (axSpA). The emergence of the nr-axSpA concept, defined by the absence of significant erosive damage to the sacroiliac joints, has prompted numerous initiatives aimed at enhancing the early detection and management of this condition. The aim of the study was to assess the knowledge, attitudes, and practices related to the diagnosis and management of nr-axSpA by rheumatologists in Morocco. Methods We conducted a cross-sectional online survey among the rheumatologist community in Morocco. Rheumatologists received via e-mail a structured Google Forms (Google Inc., Mountainview, CA) questionnaire divided into four sections: sociodemographic data of rheumatologists, knowledge, attitudes, and practices related to the diagnosis and treatment management of nr-axSpA. Results A total of 110 rheumatologists (mean age of 44±13 years, 77.3% females, median professional experience of 12 years (4, 75; 26.25 years)) participated in the survey (response rate of 25%). Most responders reported a diagnosis delay issue in spondyloarthritis (SpA) (93.6%); 70.9% of rheumatologists incorrectly regarded the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA as diagnostic criteria. Rheumatologists' awareness of recommended magnetic resonance imaging (MRI) sequences for detecting sacroiliac joint inflammation and structural changes in SpA varied significantly, from 69.1% to 14.5%. Their knowledge of additional subchondral edema cases in these joints, beyond SpA, ranged from 48.2% to 87.3%. Almost all rheumatologists believed that the use of sacroiliac MRI would contribute to the early diagnosis of axSpA (97.3%) but could also lead to false positive diagnoses, according to 47.3% of rheumatologists; 73.6% believed that incorrectly using the 2009 ASAS classification criteria as diagnostic criteria in nr-axSpA could also result in false-positive diagnoses. In their practice, 2009 ASAS classification criteria were used as diagnostic criteria in axSpA by 39.1% of rheumatologists. Of the total participants, 91.8% indicated that they approach nr-axSpA similarly to radiographic axial spondyloarthritis, with disparities in recommendations of biological therapies. Conclusion Our survey provides insight into the current status of nr-axSpA management among Moroccan rheumatologists. It also addresses concerns regarding the risk of false positive diagnoses when using the 2009 ASAS classification criteria for axSpA as diagnostic criteria by rheumatologists and the potential risk of misdiagnosis associated with excessive reliance on MRI, despite its utility for early diagnosis.
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Affiliation(s)
- Fatine Kronbi
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Hanan Rkain
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
- Exercise Physiology and Autonomous Nervous System Team, Physiology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Nada Benzine
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Samya Ez-Zaoui
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Radouane Abouqal
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, MAR
- Biostatistics, Clinical, and Epidemiological Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Jihane Belayachi
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, MAR
- Biostatistics, Clinical, and Epidemiological Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | | | - Latifa Tahiri
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fadoua Allali
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Maatallah K, Cherif I, Ferjani H, Ben Nessib D, Boumaiza R, Kaffel D, Hamdi W. Navigating the Factors Affecting Functional Impairment in Spondyloarthritis. Sultan Qaboos Univ Med J 2024; 24:235-242. [PMID: 38828242 PMCID: PMC11139368 DOI: 10.18295/squmj.3.2024.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 06/05/2024] Open
Abstract
Objectives This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). Methods This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. Results A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Conclusion Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.
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Affiliation(s)
- Kaouther Maatallah
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Ines Cherif
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Hanen Ferjani
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Dorra Ben Nessib
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Rania Boumaiza
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Dhia Kaffel
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
| | - Wafa Hamdi
- University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia; Kassab Institute of Orthopedics, Manubah, Tunisia
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Lassoued Ferjani H, Kharrat L, Ben Nessib D, Kaffel D, Maatallah K, Hamdi W. Does sacroiliitis is a mandatory criterion for enthesitis-related arthritis diagnosis? REUMATOLOGIA CLINICA 2024; 20:187-192. [PMID: 38644029 DOI: 10.1016/j.reumae.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 04/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) sensitivity and specificity seem to be less studied in enthesitis-related arthritis (ERA). We aimed to determine the ability of sacroiliac MRI to diagnose ERA patients. MATERIALS AND METHODS We conducted a retrospective study including 44 patients with juvenile idiopathic arthritis (JIA). Each patient had a sacroiliac joint MRI. We divided patients into two groups: G1 patients with ERA and G2 patients with non-ERA subtype. RESULTS ERA was noted in 61% of the cases. Sacroiliac joints were painful in 15 patients (34%). MRI was normal in 25 patients (57%) (G1:11 versus G2:14) and showed bone marrow edema in the sacroiliac joints in 19 patients (34%) (G1=16 versus G2=3, p=0.005). Sacroiliac joints MRI's sensitivity and specificity in the ERA diagnosis were 61.54% and 82.35%, respectively. Positive and negative predictive values were 84.21% and 58.33%, respectively. Furthermore, sacroiliac joint pain in the clinical examination was able to predict sacroiliac bone edema in MRI with an odds ratio of 6.8 (95% CI 1.68-28.09; p=0.006). CONCLUSION Our study showed that sacroiliac joint MRI has good specificity and positive predictive value in the diagnosis of ERA patients among JIA patients. This underlines the usefulness of sacroiliac joint MRI in the early diagnosis of ERA patients.
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Affiliation(s)
- Hanene Lassoued Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Lobna Kharrat
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia.
| | - Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
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Ferjani Hanene L, Ben Ammar L, Maatallah K, Ben Nessib D, Triki W, Kaffel D, Hamdi W. Enthesitis-related arthritis and spondylarthritis: the same disease or disparate entities? Expert Rev Clin Immunol 2021; 18:93-99. [PMID: 34812103 DOI: 10.1080/1744666x.2022.2010547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of this study is to compare the clinical features, disease activity and physical impairment, between enthesitis-related arthritis, adult and late-onset spondylarthritis in Tunisian patients. METHODS This study included 190 patients divided into three groups according to their age at the onset of symptoms: ERA (onset of symptoms ≤ 16 years of age), AOSpA (16 < onset of symptoms < 50 years of age) and LOSpA (onset of symptoms ≥ 50 years of age). AOSpA and LOSpA patients fulfilled the ASAS criteria for SpA. Whereas, ERA patients were classified according to the ILAR criteria. RESULTS Among 190 patients, 21% had ERA, 70.5% had AOSpA, and 8.5% had LOSpA. There were no differences in gender ratio between ERA and AOSpA groups. Regarding the clinical presentation, ERA and LOSpA groups had more peripheral symptoms than AOSpA in whom the axial manifestation pattern continued throughout the course of the disease. HLA-B27 was more associated with ERA (p = 0,007). Extra-articular manifestations were more observed in the ERA group (p = 0.004). Disease activity, functional status and anthropometric parameters were similar between groups. Nevertheless, health-related quality-of-life assessed by ASQoL and SF-36 scores were better in the AOSpA group but with no significant differences. Regarding the treatment option, methotrexate was widely used in the ERA group (p < 0.001). CONCLUSION ERA is characterized mainly by marked peripheral arthritis, more extra-articular manifestations, and a higher frequency of hip involvement.
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Affiliation(s)
- Lassoued Ferjani Hanene
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
| | - Lobna Ben Ammar
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia
| | - Kaouther Maatallah
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
| | - Wafa Triki
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Mohammed Kassab National Institute of Orthopaedics, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of rheumatology, Mohammed Kassab National Institute of orthopedics, Research Unit UR17SP04, Tunis, Tunisia
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Abba A, Niasse M, Mohamed Diaby L, Ali H. Spondyloarthritis in Senegal: a study of 770 cases. LA TUNISIE MEDICALE 2021; 99:964-971. [PMID: 35288897 PMCID: PMC8972174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very few studies have focused on spondyloarthritis (SpA) in sub-Saharan Africa. The majority of these studies have focused on series of HLA B27-negative SpA. OBJECTIVE To determine the epidemiological, diagnostic, therapeutic and evolutionary aspects of SpA in the rheumatology department of the CHU Aristide LeDantec in Dakar, Senegal. METHODS We conducted a retrospective, descriptive, analytical study from January 1, 2012 to December 31, 2020, of patients with spondyloarthritis diagnosed according to the ESSG (54.5%), Amor (52.5%), modified New York criteria (48.3%) and ASAS (23%). For each patient, the following information was collected: sex, age, occupation, family history of spondyloarthritis in the parents, time to diagnosis, type of SpA. RESULTS 770 observations were collected from 273 men (35.5%) and 497 women (64.5%). Ankylosing spondylitis (AS) was the most frequent type of SpA in our series with 84% of cases. A biological inflammatory syndrome was present in 77.27% of our patients. HLA B27 phenotyping was performed in 437 patients, of which 225 were HLA B27 positive (51.48%). The majority of our patients were under conventional treatment due to the high cost of biotherapies which limits their prescription. CONCLUSION The profile of SpA patients in our series was characterised by : the predominance of females, the later age of onset, the frequency of radiographic axial forms of SpA and the biological inflammatory syndrome. HLA B27 was present in one patient out of two, as in the North African series.
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Affiliation(s)
- Abbasse Abba
- Service de Rhumatologie, CHU Aristide LeDantecDakarSénégal
| | | | | | - Hassan Ali
- Service de Rhumatologie, CHU Aristide LeDantecDakarSénégal
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Slimani S, Hamdi W, Nassar K. HLA-subtypes B*27 and ankylosing spondylitis features comments on Fellahi's article "Are early onset of disease and uveitis affected by HLA- subtypes B*27 in ankylosing spondylitis?". Clin Rheumatol 2021; 40:3377-3378. [PMID: 34185183 DOI: 10.1007/s10067-021-05838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Wafa Hamdi
- Service de Rhumatologie Institut M.T. Kassab, UR17SP04 Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Kawtar Nassar
- Service de Rhumatologie, Centre Hospitalier Universitaire Ibn Rochd, Faculté de Médecine Et de Pharmacie, Université Hassan II de Casablanca, Casablanca, Morocco
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Fallahi S. Are the earlier disease onset and uveitis affected by the HLA-B*27 subtypes in ankylosing spondylitis? Comments on the article by Silmani et al. Clin Rheumatol 2021; 40:2513. [PMID: 33763800 DOI: 10.1007/s10067-021-05685-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sasan Fallahi
- Internal Medicine Division, Baharloo Hospital, Tehran University of Medical Sciences, Behdari street, South Kargar Street, Tehran, Iran. .,Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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