[Validation of the ankylosing spondylitis quality of life questionnaire in Tunisian language]

The Ankylosing Spondylitis Quality of Life [ASQoL] questionnaire is a Wide-world used, unidimensional, disease-specific measure of quality of life. Arabic or Tunisian versions of ASQoL or any other quality of life index are not provided. To adapt the Ankylosing Spondylitis Qhality of life Questionnaire [ASQoL] for use in Tunisian and to test its reliability and validity. 99 patients who fulfilled the modified New York criteria for ankylosing spondylitis [AS] were included in this study [84 male and 15 female]. The translation process included the recent guidelines for cross-cultural adaptation. Reliability of the Tunisian version of the ASQoL was assessed by test-retest method [day 1 and day 10] and internal consistency using Cronbach's alpha coefficient. For construct validity, ASQoL scores were correlated with specific instruments of AS. The mean age of patients was 38.35 years +/- 12.26 [18- 73] and the mean disease duration was 11.3 years +/- 9.4 [0.6 - 40]. The mean time to complete the questionnaire was 5 minutes. Reproducibility was good with no significant difference between ASQoL0 [mean score = 9.8 +/- 5.04] and ASQoL10 [mean score = 9.46 +/- 5.89] as well as the statically significant positive correlation intra-class coefficient: 0.87 [IC 95%: 0.79-0.92]. Internal consistency was good [Cronbach: 0.933; IC95%=0.86-0.95]. ASQoL was significantly correlated with BASDAI [p<0.001], BASFI [p<0.001], BASG-s [p<0.001], BASMI [p=0.026], MASES [p=0.024] and all items of SF-36.Validation of the ASQoL for use in Tunisia was successful. The results of the present study indicate that the Tunisian version for ASQoL is reliable and valid

Health-related quality of life assessment on 100 tunisian patients with ankylosing spondylitis using the sf-36 survey

The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis [AS] compared with the general population and the secondary objective [in the AS group] was to study the association between health status, demographic parameters, and specific disease instruments in AS. A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and diseasespecific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF- 36 health questionnaire. This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level [p=0.01]. Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI. Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life

Non contiguous multilevel spondylitis: an exceptional presentation of spinal brucellosis

The aim of this study was to describe the imaging features of multilevel brucellar spondylitis and discuss the diagnostic challenges The authors report describes one case of noncontiguous synchronous multifocal involvement of thoracic and lumbar spine. Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, but multilevel involvement is uncommon and only ten cases were reported in literature. Although it is an exceptional form, multifocal brucellar spondylitis is worth to be known to avoid diagnostic mistakes

[Rhumatologic disorders of Sarcoidosis]

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has various clinical features. The most commonly affected organs are the lung, the lymph nodes, the eyes and the skin. Involvement of the musculoskeletal system is far less common and may be inaugural. Articular involvement is dominated by Lofgren syndrome and acute polyarthritis. Abarticular manifestations are often confounded with arthritis. Bone locations are dominated by unknown and can appear as 3 clinical features: spread form, myositique form or pseudotumoral form. Calcium balance disturbances are dominated by hypercalcemia which is often asymptomatique, but sometimes it reveal the sarcoidosis. Treatment of rheumatologic disorders often involves non steroidal anti-inflammatory drugs, corticosteroids and methotrexate. Biological therapies such as the anti-TNFalpha and the anti-CD20 were showed to be effective in some case reports of severe and refractory disease

[Validation of the Tunisian versions of bath ankylosing spondylitis functional index [BASFI] and disease activity index [BASDAI]]

The Bath Ankylosing Spondylitis Functional Index [BASFI] and the Bath Ankylosing Spondylitis Disease Activity [BASDAI] are the most commonly used instruments to evaluate respectively functioning and disease activity in ankylosing spondylitis [AS]. The aim of this study was to translate, adapt and validate these instruments into the Tunisian language. The studied population consisted of 68 AS patients [59 males and 9 females]. Their mean age was 37.9 years [range: 18-76]. The mean disease duration was 13.6 years [range: 1-40].After translation and retranslation the BASFI and BASDAI questionnaires were administrated to the patients and tested for reliability, internal consistency and construct validity. The reproducibility of the indices BASFI and BASFAI was good, the intraclass correlation coefficient for reliability was 0.96 [CCI: 0.93-0.97] for the BASFI and 0.93 [CCI: 0.90 -0.97] for the BASDAI, and the coefficient of internal consistency [Cronbach's alpha] was 0.91 for BASFI and 0.90 for BASDAI. Concerning construct validity, both questionnaires were significantly correlated to each other, to the disease-specific instruments [BASG-s, BASMI, BASRI, ASQoL] and to all domains of the SF-36. The Tunisian versions of the BASFI and the BASDAI preserve the metrological properties of the original versions and were easy to use for the assessment of disease status in ankylosing spondylitis

arthrites reactionnelles

Reactive arthritis are definied as steriles arthropathies using classic bacteriological techniques. They are due to extra articular infection and are often associated with HLA B27. the outcome of these arthritis is caracterised by the recurrence of flares with sometimes appearition of ankylosing spondylitis. The pathogenesis of reactive arthritis is modified when bacterial antigens or alive micro-organisms are discovered in involved joints. Several current works have underlined the interest of antibiotic therapy in the chlamydial reactive arthritis. Chronic forms can justify the use of anti-rheumatic drugs such as salazopyrine

Association lupus erythemateux systemique - hypothyroidie. A propos d'un cas

The association of systemic lupus erythematosus [SLE] and hypothyroidism is uncommon, and concerns essentially the autoimmun thyroiditis. However, the coexistence SLE-primary hypothyroidism is exceptional. We report an observation of 25-old woman, who presents a clinical form of hypothyroidism, confirmed by hormonal tests, and which is associated lo polyarthritis and proximal myopathy non ameliorated by opo-therapy. The explorations conclude in SLE. A favourable evolution of muscular and articular signs is obtained with cortico-therapy

Spondylodiscitis in spondylarthropathies [about 10 cases]

The involvement of enthesis like disc space is the typical lesion of spondylarthropathies. Out of 240 patients with spondylarthropathies, 10 [7 M, 3 W; mean age: 37 years] have spondylodiscitis, affecting a total of 13 disc spaces: 1 cervical, 2 thoracic, 10 number. The mean duration of spondylarthropathy at the time of diagnosis of spondylodiscitis is 10 years. Spondylodiscitis has a variable clinical pressntation: painful [6 cases], asymptomatic [4 cases]. Its coexistence with typical radiographic sings of spondylarthropathy added to the exclusion of bacterial origin, permit to link it to spondy, larthropathy. Its evolution is generally favorable