AB1504 WILL YOU CHOOSE RHEUMATOLOGY? SURVEY ON THE ATTRACTIVENESS OF RHEUMATOLOGY AMONG MOROCCAN STUDENTS, INTERNS AND FRESHLY GRADUATED DOCTORS

Background

In several countries, studies have shown that fewer medical students choose rheumatology as specialty. In Morocco no study has yet focused on this subject.

Objectives

The aim of our study is to assess the attractiveness of rheumatology as a specialty among Moroccan medical students, recently graduates and interns, and to analyze the factors that may be associated with it.

Methods

An online survey was sent to 297 medical students who had started their hospital practice, to 100 medical interns (students in 6th and 7th year who successfully passed the internship competition) and to 280 freshly graduated doctors (residency program candidates before choosing a medical or surgical specialty). The survey covered three areas: anonymous social and demographic informations, data on clinical trainee in a rheumatology department, and the attitude toward rheumatology as a specialty. Descriptive data were collected and Chi 2 Tests were used to assess differences between groups, Logistic regression was performed to investigate associations between demographic and exposure variables and the choice of rheumatology as a career.

Results

We collected responses from 161 students (response rate: 54%), 68 interns (68%) and 89 freshly graduated doctors (32%). The demographic characteristics are presented in Table 1.

Table 1.Medical students (N=161)Interns (N=68)Freshly graduated doctors (N=89)Age*21.5 ±124.2 ±1.128.62.3Gender (females) (%)+93 (57.8)30 (44.1)64 (71.9)level (%)+Third year: 44 (27.3)First year: 44 (64.7)-Fourth year: 53 (32.9)Second year: 24Fifth year:64 (39.8)(35.3)Training in a rheumatology departement (%)+118 (73.3)28 (41.2)37 (41.6)Dduration of training (weeks)*3.4 ± 0.75.3 ±1.46.3 ±2.6

(*) expressed as a number and percentage /(+) expressed as a mean and standard deviation

73% of students, 41.2% of interns and 41.6% of graduates said they had already completed a clinical trainee in a rheumatology department. While 41.6% of students and 43.8% of graduates consider the possibility of choosing rheumatology as their specialty, only 11.2% of students, 5.9% of interns and 7.9% of graduates said that rheumatology is their dream career specialty. In uni and multivariate analysis, clinical exposure to rheumatology is retained as the main statistically significant factor predicting the choice of rheumatology in all categories (Odds ratio (95% CI) = 0.191 (0.07- 0.497; p= 0.02)), to this is added the female sex among freshly graduated doctors (Odds ratio (95% CI) = 4.02 (1.251- 12.918; p= 0.001).

Conclusion

Our study showed that rheumatology is considered a fascinating specialty by Moroccan medical students and freshly graduated doctors. Clinical exposure to rheumatology is the strongest predictor factor for choosing rheumatology as a future career.

Disclosure of Interests

None declared

AB1575-PARE DIETS AND JOINT SYMPTOMS: SURVEY OF MOROCCAN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISM

Background

The role of diet in triggering or aggravating chronic diseases, in particular chronic inflammatory rheumatism (CIR), is a question frequently asked by patients.

Objectives

The objective of our study is to investigate whether Moroccan patients report a relationship between certain diets or foods and the symptoms of the disease and also to study whether patients adopt specific eating behaviors in order to relieve their symptoms.

Methods

This is a survey based on a questionnaire that included any patient followed for CIR who presents to the rheumatology department. The questionnaire has 3 parts: 1) Sociodemographic data, comorbidities, and information on the CIR (type, duration of evolution, activity, functional impact and treatments), 2) beliefs and attitudes of patients in this regarding diet in relation to their CIRs 3) a list of 24 foods for which patients are asked whether they worsen, improve or leave their joint symptoms unchanged.

Results

To date we have included 120 patients. The average age was 45.3 ± 13.4, 73.3% of the patients were women, 39.3% had comorbidities, 50% were illiterate, 57.5% were followed for RA and 42.5% for SPA. The median duration of evolution of the RIC was 7 years [3; 15], for the treatments 45% of the patients in our study were on corticosteroid therapy, 3.3% used a biological treatement while 7.5% received no treatment.

25% of patients think that the diet influences the activity and/or the evolution of the rheumatism. 26% of subjects said food had an effect on their CIR, with 11.7% reporting improvement and 25% worsening. Honey (6.7%), garlic (5%) and olive oil (4.2%) were the foods most often cited as improving CIR symptoms, while red meat (18.3%), fish (6.7%) and legumes (3.3%) were most often cited as aggravating symptoms. 20.8% of patients declare that they have avoidance behaviors vis-à-vis certain foods while 7.5% adopt certain diets and 3.3% have already tried fasting in order to relieve joint symptoms.

In uni and multivariate analysis no factor, only the duration of evolution was associated with the fact of declaring that food has an influence on the symptoms of the CIR (OR: 0.947, IC95%: [0.901-0.996], p=0.03).

Conclusion

The results of our investigation suggest a possible link between certain foods and joint pain in patients followed for CIR.

References

[1]Sara K. Tedeschi et al, Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry, 2017 Arthritis Care & Research

Disclosure of Interests

None declared

AB1505 MOROCCAN MEDICAL STUDENTS SURVEY: WHAT ARE THE MOTIVATIONS AND BARRIERS TO CHOOSE RHEUMATOLOGY AS A CAREER?

Background

Rheumatology has experienced a genuine progress in recent decades, especially with the development of new treatments and the use of ultrasound as a mean of exploring the musculoskeletal system, which has contributed to its attractiveness for medical students.

Objectives

The objective of this survey is to study the factors that motivate or discourage medical students to choose rheumatology as a career.

Methods

Web-based questionnaire was sent to 297 medical students who had begun their Hospital training, 100 medical interns, and 280 general practice graduates after passing the residency program’s examinations and before choosing their specialty. This questionnaire covered three areas: anonymous demographic information, attitudes toward rheumatology as a specialty, and reasons behind choosing or not choosing rheumatology (multiple choice and open-ended questions).

Results

We collected responses from 161 students (answer rate: 54%), 68 interns (68%), and 89 (32%) medical school graduates.

41.6% of students and 43.8% of graduates consider that they can choose rheumatology as a specialty, whereas 11.2% of students, 5.9% of interns and 7.9% of graduates considered rheumatology as their dream career.

The main motivation for students to choose rheumatology is “the diversity of the musculoskeletal pathology”. According to interns and graduates, the benefit of choosing rheumatology is the quality of life it can offer, given that it is a “relatively less time consuming specialty». The main barrier to choose rheumatology is “the interest in surgical specialties” for students and interns and ‘‘the limited therapeutic aspects’’ for graduates. Other commonly reported reasons are shown in Table 1.

Table 1.

Main motivations and barriers to choose rheumatology according to Moroccan medical students, interns and medical graduates.

MotivationsStudentsInternsGraduatesN=67N=4N=39-Wide-ranging specialty with diversity of musculoskeletal pathologies48 (71,6 %)2 (50 %)11 (28,2 %)24 (35,8 %)2 (50 %)10 (25,6 %)19 (28,4 %)3 (75 %)28 (71,8 %)2---Interventional aspect of rheumatology: ultrasound guided injections, biopsy, Hydrodilatation.---Relatively less time-consuming specialtyBarriersN=88N=62N=50-I am interested in surgical specialties44 (50 %)32 (49,2 %)23 (46 %)21 (23,9 %)12 (18,5 %)21 (42 %)22 (25 %)18 (27,7 %)26 (52 %)--Monotonous specialty--Limited therapeutic aspects

Conclusion

Our study has shown that rheumatology fascinates Moroccan medical students by its clinical abundance and the diversity of musculoskeletal pathology and also by the quality of life it can offer. According to the students, the main barriers to choose rheumatology are the interest in a surgical specialty, and the limited therapeutic aspects of the specialty.

Disclosure of Interests

None declared

AB0998 Diet and joint symptoms: a survey of Moroccan patients with osteoarthritis

Background

The question of diet is frequently asked by patients with osteoarthritis. Beyond the effect of weight on the aggravation of their symptoms, patients often ask whether certain foods, described as inflammatory or anti-inflammatory, can improve or worsen their disease.

Objectives

The objective of our study is to investigate whether Moroccan patients report a relationship between certain foods and their symptoms and also to study whether they adopt specific dietary behaviors in an effort to alleviate their symptoms.

Methods

This is a survey based on a questionnaire, that included any patient followed for osteoarthritis who presented to the rheumatology department.

The questionnaire consisted of 3 parts:

1) Socio-demographic data, co-morbidities, and information on osteoarthritis (location, duration of evolution, functional impact and treatments).

2) Beliefs and attitudes of patients regarding diet in relation to osteoarthritis.

3) A list of 24 foods for which patients were asked to indicate whether they aggravated, improved or left their joint symptoms unchanged.

Results

At this time we included 120 patients. The mean age was 57.1 ± 11.8, 88.3% of the patients were women, 41.2% had comorbidities, 62.5% were illiterate. The median duration of osteoarthritis was 4 years [2; 7]. 64.2% of the patients were followed for gonarthrosis, 25% for discarthrosis and 10.8% for digital osteoarthritis. The average BMI was 27.8 ± 5.2.

8.3% of the patients thought that diet influenced their osteoarthritis. 9.5% of the subjects stated that food had an effect on their symptoms, 9.2% of them reporting an improvement and 8.3% an aggravation. Fish (1.7%), garlic (1.7%), and olive oil (1.7%) were the foods most often cited as improving joint symptoms, while red meat (3.3%), and sweetened soft drinks (2.5%) were the most often cited as worsening symptoms. 6.7% of the patients had food avoidance behaviors, 10.8% adopted certain diets and 5.8% had tried fasting in order to relieve joint symptoms.

In univariate and multivariate analysis, education level (OR: 0.165; 95% CI [0.046-0.592]; p=0.006) and experience with a food that improves symptoms (OR: 46.8; 95% CI [1.798-1222.5]; p=0.021) were associated with reporting that food influences OA symptoms.

Conclusion

Our study showed that associations between certain foods and worsening or improving joint symptoms were reported by a minority of patients and appeared to be mostly associated with patients’ education level and experience of a food improving symptoms.

References

[1]Cedraschi C, Delézay S, Marty M, et al. “Let’s talk about OA pain”: a qualitative analysis of the perceptions of people suffering from OA. Towards the develop-ment of a specific pain OA-Related questionnaire, the Osteoarthritis SymptomInventory Scale (OASIS). PLoS ONE 2013;8:e79988.

[2]Grover AK, Samson SE. Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality. Nutr J 2016;15:1.

[3]Sally T, Heather B, Mobasheri A, Rayman PM. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology 2018;57:iv61_iv74doi:10.1093/rheumatology/key011.

[4]Veronese N, Stubbs B, Noale M, Solmi M, Luchini C, Smith TO, et al. Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative. Clinical nutrition (Edinburgh, Scotland). 2017 Dec; 36(6):1609–1614.

Disclosure of Interests

None declared

AB1577-PARE DO MOROCCAN PATIENTS DISCUSS WITH THEIR RHEUMATOLOGISTS ABOUT DIET AS PART OF THE MANAGEMENT OF THEIR OSTEOARTHRITIS?

Background

The question of diet is frequently asked by patients with osteoarthritis. Beyond the effect of weight on the worsening of their symptoms, patients often ask whether certain foods, labelled as inflammatory or anti-inflammatory, can improve or worsen their disease.

Objectives

The aim of our study is to find out whether patients with osteoarthritis discuss diet during their medical visits and to investigate the association between patients’s reported dietary beliefs and practices and their willingness to discuss them.

Methods

This is a survey based on a questionnaire that included all patients followed for osteoarthritis who presented to the rheumatology department. The questionnaire consists of 3 parts:

1) Socio-demographic data, co-morbidities, and information on osteoarthritis (location, duration of evolution, functional impact and treatments),

2) Patients’s beliefs and attitudes about diet in relation to osteoarthritis

3) Discussions about diet during medical visits and whether there is any patient interest in such discussions.

Results

At that time we included 120 patients. The average age was 57.1 ± 11.8, 88.3% of the patients were women, 41.2% had comorbidities, 62.5% were illiterate. The median duration of evolution of osteoarthritis was 4 years [2; 7]. 64.2% of the patients were followed for Gonarthrosis, 25% for Discarthrosis and 10.8% for Digital osteoarthritis. The average BMI was 27.8 ± 5.2. 8.3% of the patients thought that diet influenced their osteoarthritis. 9.5% of the subjects stated that food had an effect on their symptoms, with 9.2% reporting an improvement and 8.3% an aggravation. 6.7% of patients reported food avoidance behaviours, while 10.8% adopted certain diets in order to relieve joint symptoms.

Only 2.5% of the patients reported having ever had discussions about diet with their rheumatologists while 99.2% showed interest in such discussions. For those who had never done so, the main reason was that the rheumatologist had never broached the subject.

In uni and multi-variate analysis, the experience of a food that improves symptoms (OR: 13; 95% CI [1,258-134,333]; p=0.019) and the adoption of dietary practices (OR: 13; 95% CI [1,258-134,333]; p=0.019) were associated with discussing diet.

Conclusion

Discussions about diet are reported by a minority of osteoarthritis patients and seem to be mainly related to patients’s experiences with certain foods that improve their symptomatology and also to patients’ adoption of certain diets. This situation needs to be improved as nutritional advice should be an integral part of the management of our patients.

Disclosure of Interests

None declared

AB0847 Profile of Spondyloarthritis in the Moroccan population: Results of a multicenter study

Background

Spondyloarthritis (SpA) is a frequent group of chronic inflammatory rheumatic diseases, their epidemiology varies considerably in different regions of the world.

Objectives

The aim of our study was to describe the epidemiological, clinical, paraclinical and therapeutic profile of SpA in the Moroccan population.

Methods

This is a multicenter descriptive study, including patients followed for SpA. 8 hospital centers participated in this study. All data were measured by standard instruments.

Results

Seven hundred patients were included, 54% were men, the mean age was 40.42±14.19 years at the time of diagnosis [14 years-90 years]. The patients lived in urban and rural areas in 83.5% and 13.8% of cases, respectively. 38.4% were without occupation. A history of tuberculosis was noted in 5.9% of cases. Associated pathologies were autoimmune in 2.3% and neoplasia in 1.5% of cases. 15.6% of patients were smokers. A family history of SpA was noted in 11.7%, psoriasis in 1% and Inflammatory bowel disease (IBD) in 0.6% of cases. The average diagnostic delay was 59.76 months [0-444 months]. The revealing symptomatology was axial in 19%, peripheral in 10.1%, enthesitis in 0.4%, and a combination of the 3 forms in 22.1% of cases. Dactylitis was noted in 2.3% of cases. SpA was non-radiographic in 14% of cases. The forms of SpA were: ankylosing spondylitis (80.1%), IBD associated with SpA (9.4%), psoriatic arthritis (6%), and undifferentiated SpA (4%). Juvenile SpA accounted for 15.5% of cases. The prevalence of HLA-B27 was 65.51%. The mean BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was 4.42 ± 1.67 and the mean ASDAS (Ankylosing Spondylitis Disease Activity Score) was 3.19 ± 1.24. Systemic involvement was dominated by uveitis (11.3%), followed by IBD (9.4%), restrictive syndrome (2.7%), renal involvement (0.6%) including amyloidosis (0.1%), IgA nephropathy (0.4%), interstitial nephropathy (0.1%), and aortic insufficiency in 0.2% of cases. The most commonly used treatments were non-steroidal anti-inflammatory drugs (81.7%), sulfasalazine (24.2%), methotrexate (22.9%) and 31.8% of patients were on biotherapy. Surgery for arthroplasty was necessary in 5.6% of patients.

Conclusion

This is a study of the clinical and demographic characteristics of Spondyloarthritis in a population in Morocco, on which a large scale data base could be initiated, in order to better determine the role of genetic and environmental factors in the pathogenesis of the disease.

References

[1]Sharip A, Kunz J. Understanding the Pathogenesis of Spondyloarthritis. Biomolecules. 2020 Oct 20;10(10):1461.

[2]Slimani S, Hamdi W, Nassar K, Kalla AA. Spondyloarthritis in North Africa: an update. Clin Rheumatol. 2021 Sep;40(9):3401-10.

[3]Wang R, Ward MM. Epidemiology of axial spondyloarthritis: an update. Current Opinion in Rheumatology. 2018 Mar;30(2):137-43.

Disclosure of Interests

None declared

Does metabolic syndrome or its individual components affect pain and function in knee osteoarthritis women?

BACKGROUND

Current studies and research support the role of metabolic syndrome (MetS) in knee osteoarthritis (OA). However, few studies have focused on its impact on knee OA parameters. The aim of this study was to investigate if metabolic syndrome or its individual components affect the intensity of pain, functional disability, and radiographic severity in knee osteoarthritis women.

MATERIALS AND METHODS

We conducted a cross sectional study including confirmed radiographic knee osteoarthritis according to Kellgren and Lawrence scale, with and without metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The two groups were compared for pain Visual Analogue Scale (VAS), Lequesne index, Womac function, and radiological grade after adjusting for significant covariates. Multiple regression analysis was used to identify the independent effects of each specific component for metabolic syndrome on knee osteoarthritis parameters.

RESULTS

One hundred thirty women were included. The mean age was 56.68±8.07 [34-75] years, and the mean BMI was 32.54±2.92 [23-37] kg/m2. The prevalence of metabolic syndrome was 48.5%. Women with and without metabolic syndrome had similar knee osteoarthritis parameters. However, accumulation of MetS components was associated with higher level of pain (OR = 3.7, CI = [1.5-5.9], p=0.001), independently of age and BMI. Multiple regression analyses showed, after adjusting for all covariates, that hyperglycemia had a positive impact on pain (p=0.009), waist circumference was positively associated with Lequesne index (p=0.04), high triglycerides level was significantly associated with increased pain (p=0.04) and higher Lequesne score (p=0.05), and Systolic blood pressure was positively correlated with Lequesne index (p=0.01).

CONCLUSION

In addition to weight reduction, appropriate treatment of metabolic syndrome needs to become an important management strategy for knee pain and functional impairment.

[Sciatica with motor loss revealing meningoradiculitis due to varicella-zoster virus]

Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome.