Post-COVID-19 reactive arthritis: Myth or reality?

Since December 2019, a new virus of the coronaviridae, called Coronavirus 2019 (COVID-19), has appeared in the Wuhan province of China. It has been declared a pandemic by the World Health Organization (WHO). The clinical manifestations of COVID-19 reported in the literature are diverse and very heterogeneous. Among these manifestations, reactive arthritis (ReA) remains ambiguous, because of the difficulty of linking these arthritides to COVID-19. ReA is a condition caused by bacteria. The clinical pattern of ReA commonly consists of an inflammation of fewer than five joints, which often includes the lower extremities, joints, eyes, skin, and urethra. It is triggered by an infection in another part of the body;generally the intestines, genitals, or urinary tract. Arthritis may be "additive" or "migratory" (new joints become inflamed after the initially inflamed site has already improved). The time required to develop ReA after infection must not exceed 6 weeks. It occurs most often in men between the ages of 18 and 40. Some patients carry the HLA-B27 gene. Some authors reported cases of ReA caused by COVID-19. They argued that the timing of disease onset was consistent with COVID-19 infection and that no other clear sources of infection were identified. The presence of arthritis, digestive or genital associated manifestations, and the absence of other evident etiologies (after clinical and laboratory exams) were also advanced as arguments for the diagnosis of ReA. The treatment of ReA depends on its stage. Acute inflammation can be treated with nonsteroidal anti-inflammatory drugs. The late stage of reactive arthritis is considered chronic and generally treated with a diseasemodifying antirheumatic drug such as sulfasalazine or methotrexate. In more severe cases, biologic disease-modifying antirheumatic drugs may be used. © 2023 Nova Science Publishers, Inc.

16 Spectrum of infections during juvenile idiopathic arthritis

Background: The incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used. Objectives: To assess the incidence of infections during JIA. Methods: We conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up. Results: There were 17 women and 12 men. The mean age was 35.69 ± 11.72 [18–61] years. The polyarticular form was seen in 55.2% of cases. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years.Diabetes and arterial hypertension were the main comorbidities associated with JIA, observed in 13.8% of cases each. At least one extra-articular manifestation was noted in 16 cases: pulmonary (3 cases), cardiac (4 cases), renal (2 cases), cutaneous (4 cases) and ocular (7 cases).The most prescribed DMARDs was Methotrexate in 79.3% (n = 23), biotherapy was used in 3 (10.3%), NSAIDs and corticosteroids were used in 62.1% (n = 18) and 69% (n = 20) respectively.All the infections observed in our population were of community origin. Urinary tract infection was the most common infection (n = 5). Bronchopulmonary infections were observed in 2 cases including a case of tuberculosis. Sub periosteal abscess of the femur was also seen in one of the patients.Regarding the SARS-CoV-2 infection, 6 patients were infected, 2 of whom required hospitalization, including one in the intensive care. Conclusion: The risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.

COVID-19 VACCINE HESITANCY among RHEUMATOID ARTHRITIS PATIENTS on BIOLOGICS

Background: Vaccine hesitancy is defned by the OMS as 'a delay in acceptance or refusal of vaccines despite availability of vaccination services' [1], and it is considered as one of threats to global health. This hesitancy emerges around Covid-19 vaccination. Patients on biologic Disease-Modifying Anti-Rheumatic Drug (bDMARD) are vulnerable to Covid-19 infection and their perception to vaccination is unknown. Objectives: The aim of our study was to identify Covid-19 vaccine hesitancy among rheumatoid arthritis (RA) patient on bDMARD. Methods: We conducted a monocentric, cross-sectional study, including patients with RA who met the ACR/EULAR 2010 criteria. All patients were on bDMARD with or without conventional synthetic (Cs) DMARD for at least 3 months. Disease activity was assessed using the Disease Activity Score (DAS) 28 (CRP) and the functional impairment using the Health Assessment Questionnaire (HAQ). A structured interview was done using a prepared questionnaire evaluating their vaccine hesitancy behavior. Results: We enrolled 60 patients: 10 male (16.7%) and 50 females (83.3%). Their average age was 58.16±9.04 years [34-80]. For the education level;38.5% of patients were illiterate, 34.6% had primary education, 23.1% had secondary education, and 3.8% have a university degree. Forty-four patients (73.3%) had no occupation, 13 patients (21.7%) were employed, and 5% were retired. The majority of patients lived in urban areas (85%) and 98.2% with their families. The average duration of RA was 15.23±8.92 years [2-39]. The average DAS28 (CRP) and the average HAQ were 4.05±1.22 [1.5-7.2] and 0.7±0.4 [0-2.4], respectively. Fifteen patients (25%) had a high disease activity and seven (11.7%) were in remission. When asking patients about their Covid19 infection and vaccination status;15% had caught the virus and 61.7% have already received the vaccine. One third (35.6%) believed that they had enough information about vaccination. Their main sources were their family, friends, and the media. More than half of the asked patients (68.3%) reported vaccine hesitancy. Reasons of vaccine hesitancy were divided into three categories: lack of confdence (66.7%, p<0.005) (63.3% fear related to side effects, 10% conspiracy theory, 6.7% lack of confdence in the provider), complacency problem (16.7%, p=0.01) and lack of convenience (8.6%). There was no association between vaccine hesitancy and sociodemographic data. The existence of comorbidities had no influence on vaccine hesitancy (p=0.4). This hesitancy was not associated with DAS28 (CRP) (p=0.6) and with HAQ (p=0.7). Patients with moderate to high disease activity were more likely to deny the usefulness of Covid-19 vaccination (p=0.09). Regarding to the therapeutic data, there was no association between corticotherapy and vaccine hesitancy (p=0.1). There was no influence on the type of the current bDMARD (p=0.3) or of the rate of administration (p=0.4). The route of administration was associated with hesitation (53.65% intravenous vs 46.34% subcutaneous, p=0.04). Conclusion: Our study showed that Covid-19 vaccination coverage among RA patients on bDMARDs was not optimal with a high percentage of hesitancy. The reasons are complex and they may be related to a lack of awareness. Rheuma-tologists should play a key role in the vaccine company.

Comorbidités et biothérapies au cours de la pandémie Covid-19 : quel impact chez les patients atteints de polyarthrite rhumatoïde ?

Les patients suivis pour un rhumatisme inflammatoire chronique tel que la polyarthrite rhumatoïde (PR) sont vulnérables aux infections. Durant la période de la Covid-19, le problème de l'adhésion au traitement biologique chez cette population a été soulevé. L'objectif de notre étude était d'identifier le degré d'adhésion au biologique chez une population de patients suivis pour une PR durant la période de la pandémie Covid-19 et de déterminer l'influence des comorbidités sur cette adhésion. Il s'agit d'une étude transversale incluant des patients atteints d'une PR recevant un traitement biologique depuis au moins trois mois. L'adhésion au traitement biologique a été évaluée à l'aide d'une question directe posée aux patients portant sur la prise régulière du traitement biologique en cours comme prescrite par le médecin (adhésion auto-déclarée). Les données de l'étude ont été saisies et analysées au moyen du logiciel Statistical Package for Social Sciences (SPSS) version 23.0. Le seuil de signification (p) a été fixé à 0,05. Ils s'agissaient de 75 patients atteints de PR sous traitement biologique répartis en 60 femmes (80 %) et 15 hommes (20 %). Le sex-ratio était de 0,25. L'âge moyen des patients était 56,92 ± 9,06 ans. La tranche d'âge la plus représentée était celle des 50–59 ans. Trente-trois pour cent des patients étaient non instruits. Vingt patients avaient une activité professionnelle. La durée moyenne d'évolution de la PR était 14,85 ± 8,5 ans. Des comorbidités ont été relevées chez 36 patients (48 %). Ils étaient répartis comme suit : diabète (n = 22), HTA (n = 13, dyslipidémie (n = 13), maladie gastro-intestinale (n = 4), hypothyroïdie (n = 2), accident-vasculaire cérébral (n = 2) et fibrillation auriculaire (n = 1). Au moment de l'étude, l'activité moyenne de la maladie mesurée par le DAS28 CRP était 4,08 ± 1,3 chez les patients ayant des comorbidités et 3,81 ± 1,3 chez les patients sans comorbidités. La présence de comorbidités n'avait pas d'influence sur l'activité de la maladie (p = 0,690). Concernant le traitement de fond biologique actuel, les molécules les plus prescrites étaient l'Infliximab (22,7 %), le Certolizumab (22,7 %) et le Tocilizumab (22,7 %). La durée moyenne de prise du traitement biologique actuel était similaire dans les 2 groupes (comorbidités (+) : 38,91 ± 48,59 mois vs comorbidités (−) : 35,56 ± 29,14 mois, p = 0,206). L'infection par le Covid-19 était observée seulement dans le groupe comorbidités (−). La couverture vaccinale anti-Covid-19 était comme suit : 46 % dans le groupe comorbidités (+) vs 54 % dans le groupe comorbidités (−) sans différence significative (p = 0,752). L'adhésion au traitement biologique était auto-déclarée par 94 % des patients comorbidités (+) vs 95 % des patients comorbidités (−). Cette adhésion n'était pas statistiquement différente entre les 2 groupes (p = 0,934). Notre étude a montré que la présence de comorbidités n'a pas empêché les patients PR de continuer de prendre leur biologique durant la période de la pandémie Covid-19. (French) [ FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Perceived stress during the COVID-19 pandemic among the tunisian population

IntroductionDocumenting Tunisian’ stress responses to an unprecedented pandemic is essential for mental health interventions and policy-making.ObjectivesTo describe the perceived stress generated by the Covid-19 epidemic and confinement among the Tunisian people.MethodsParticipants had to fill out a questionnaire including epidemiological data and the Perceived Stress Scale 10 (PSS10), which is the most widely used psychological instrument for measuring the stress perception. Individual scores can range from 0 to 40 with higher scores indicating higher perceived stress.ResultsOur study included 121 subjects, of which 70.6% were women.They had an average age of 36.52 years and a history of psychiatric disorders in 13.1% of cases, such as anxiety disorders (10.4%), depressive disorders (5.9%) and obsessive compulsive disorders (2.3%). More than one in two participants (61.4%) reported the presence of sleep disorders. Regarding medical history, participants declared having asthma (5%), diabetes (1.8%), high blood pressure (3.6%), and a chronic disease with corticosteroid treatment (5%). The mean PSS score was 16.96. This last was correlated to age (p<0.001), female gender (p<0.001), primary or secondary school level (p=0.03), a history of anxiety (p<0.001) and depressive disorders (p<0.001), and to sleep disorders (p<0.001).ConclusionsThe stress level among the Tunisian people during the Covid-19 pandemic was very close to that observed in other countries, deserving special attention especially among vulnerable populations.

Impact of the COVID-19 virus and confinement on the mental health of the tunisian population: Anxiety and depression

IntroductionThe 2019 Coronavirus disease epidemic is a public health emergency of international concern and poses a challenge to psychological resilience.ObjectivesTo study the psychological repercussions in terms of anxiety and depression of the Coronavirus pandemic on the Tunisian population.MethodsThis was a cross-sectional, descriptive and analytical study. We used an online questionnaire on Facebook, on June 2020. The heteroquestionnaire included epidemiological data and two scales: the State-Trait Anxiety Inventory (STAI Form Y-1) to evaluate the anxiety level at the time of the study, and the Patient Health Questionnaire (PHQ 9) to detect a characterized depressive episode.ResultsWe included 121 participants. They had an average age of 36.52 years with a sex ratio (M/F) of 0.41. The mean STAI score was 43.12 while the PHQ score was 7.46, indicating that 30.8% of the participants suffered from depression. Both scores were correlated to female sex (p=0.01 for STAI and p=0.02 for PHQ), a history of anxiety (p<0.001) and depressive disorders (p<0.001) and to poor sleep quality (p<0.001). The STAI score was also associated with a family history of high blood pressure (p=0.004), while the PHQ score was correlated to a family history of diabetes (p=0.02), a widowed or divorced marital status (p<0.001) and to a single lifestyle (p=0.03). Furthermore, the two scores (STAI-Y and PHQ 9) were also associated (p<0.001;r=0.67).ConclusionsThe psychological impact of Coronavirus epidemic seems not negligible requiring psychological interventions to improve the mental health of vulnerable groups.

Limites de la gestion thérapeutique des maladies inflammatoires auto-immunes au cours de la COVID-19

Le début de l'année 2020 était marqué par l'émergence d'un nouveau virus SARS-CoV-2. L'importance de sa virulence et sa contagion rapide ont poussé les autorités sanitaires dans plusieurs pays du monde à prendre des mesures de précautions allant jusqu'au confinement total. Ces mesures ont limité l'accès aux soins en milieu hospitalier pour les pathologies chroniques, les maladies inflammatoires auto-immunes (MIA) en font partie. Étude prospective multicentrique intéressant les patients suivis pour MIA sous traitement immunosuppresseurs per os et/ou intraveineux au long cours consultant après la première vague les services de rhumatologie et de médecine interne. Il s'agit de 142 patients suivis pour : rhumatismes inflammatoires chroniques 47,9 % (polyarthrite rhumatoïde 33,1 %, spondyloarthrite ankylosante 14,1 % et rhumatisme psoriasique 0,7 %) connectivites 23,9 % (lupus érythémateux systémique 9,2 %, myopathies inflammatoires 6,3 %, sclérodermie 3,5 %, syndrome de Gougerot Sjörgen 3,5 % et connectivite mixte 1,4 %) et vascularites 28,2 % (Maladie de Behçet 14,8 %, vascularites à ANCA 7,8 % et autres vascularites 5,6 %). L'âge moyen était à 54,5 ans (25–84) et le sex ratio était 0,4 (41 Hommes, 101 Femmes). Une stabilisation et/ou régression des manifestations de la maladie était observée chez 66,9 % et une aggravation chez 33,1 %. La majorité des patients (n = 124) n'avait pas consulté au cours de confinement soit un retard d'une seule consultation de contrôle pour : peur de contagion à l'hôpital (n = 78) ou de contagion en utilisant les moyens de transport (n = 46). Le traitement de fond (méthotrexate, salazopyrine, léflunomide, azathioprine, mycophenolate mofetil et corticothérapie) était poursuivi chez la majorité des patients (n = 116). Le traitement de fond injectable en intra-veineux ou en sous-cutané (cure de biothérapie ou de cyclophosphamide) était interrompu chez 40 patients : volontairement pour risque d'immunodepression (n = 23) involontairement pour problèmes de renouvellement des prescriptions par les pharmacies ou les caisses d'assurance maladie (n = 17). Les antipaludéens de synthèse (hydroxychloroquine et chloroquine) étaient indisponibles (n = 22) ou délivrés avec des mesures supplémentaires de vérification d'indication (n = 10). La pandémie a influencé le circuit de distribution de traitement des MIA et a limité l'accès des patients à leur traitement de fond. Cependant un accompagnement et une éducation thérapeutique adéquate sont nécessaires pour les patients réticents vis-à-vis leur traitement de fond. (French) [ABSTRACT FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)