Relationship between diagnosis delay and disease features in Moroccan patients with ankylosing spondylitis.

We aimed to evaluate diagnosis delay and its impact on disease in terms of activity, functional disability, and radiographic damage in Moroccan patients with ankylosing spondylitis (AS). We recruited 100 Moroccan patients who fulfilled New York Classification criteria for AS. Diagnosis delay was defined as the interval between the first symptom of AS and the moment of a correct diagnosis. Disease activity was evaluated by the bath ankylosing spondylitis disease activity index (BASDAI), functional status by the bath ankylosing spondylitis functional index (BASFI), and radiographic damage by the bath ankylosing spondylitis radiologic index (BASRI). Measurements of spinal mobility were assessed. The average age at disease onset was 28.56 ± 10.9 years. Of the patients, 16% had juvenile-onset AS. Disease duration was 9.5 ± 6.8 years, and the average of diagnosis delay was 4.12 ± 3.99 years. There were no differences in diagnosis delay according to the age at onset, educational level, or the presence of extra-articular involvement. Our patients had altered functional ability. Patients with late diagnosis (>5 years) had statistically significant higher structural damage (BASRI) and severe limited spinal mobility. There was no correlation between diagnosis delay and the activity of disease. Few studies focused on diagnostic delay and its impact in patients with AS. It is necessary in our context to establish an early diagnosis taking into account the high frequency of severe functional disability in Moroccan AS.

Assessment of fatigue and its relationships with disease-related parameters in patients with systemic sclerosis.

We aimed to assess the prevalence and severity of fatigue in Moroccan patients with systemic sclerosis (SSc) and its relationship with disease-related parameters of activity and severity and quality of life (QoL). Patients with SSc according to the American College of Rheumatology criteria (diffuse disease) and/or the LeRoy and Medsger criteria (limited disease) for SSc were recruited. The multidimensional assessment of fatigue (MAF), a self-administered questionnaire developed to measure five dimensions of fatigue with a total score ranged from 0 (no fatigue) to 50 (severe fatigue), was used to assess fatigue. The activity of disease was assessed by evaluating the severity of skin involvement, vascular manifestations, pulmonary involvement, joint and/or muscle involvement, and the erythrocyte sedimentation rate. Functional disability was assessed by using the scleroderma health assessment questionnaire. QoL was assessed using the SF-36 generic instrument. Sixty-four patients (91% women) were included. The mean age of patients was 49.5 ± 12.4 years. Fifty-nine patients (92.1%) had diffuse SSc and 5 (7.8%) had limited disease. Among our patients, 89% experienced severe fatigue with a VAS fatigue ≥50 mm. The mean total score of the MAF was 28 ± 8.6 (10-44.8) and all domains of fatigue were affected. In univariate and multivariate analysis, fatigue was correlated with severe joint involvement, pain intensity, low vital capacity, high level of ESR, and with functional disability (for all p ≤ 0.01). There were statistically significant correlations between fatigue and the deterioration of all domains of SF-36. Fatigue is a disabling symptom in our SSc patients and is associated with poor QoL. Pain, joint involvement, functional impairment, and pulmonary involvement seem to be the most important factors that predict severe fatigue. Large studies are necessary in order to confirm those findings.

Psychometric properties evaluation of the childhood health assessment questionnaire (CHAQ) in Moroccan juvenile idiopathic arthritis.

The objective of this study is to develop and validate a Moroccan version of the childhood health assessment questionnaire (CHAQ), a disability measure for children suffering from juvenile idiopathic arthritis. The CHAQ has been validated in a cross-sectional study in 60 JIA, classified into systemic (33%), polyarticular (38%), extended oligoarticular (6.4%), and persistent oligoarticular (21.6%) subtypes. The CHAQ was tested for reliability and construct validity by correlating the yield of the questionnaire with other disease activity parameters. Disability index was significantly different among the four JIA subtypes. CHAQ proved to be valid in clinically discriminating between healthy subjects and patients with different patterns of JIA. The convergent validity was demonstrated by strong correlations of the disability score with the JIA score set of variables. In conclusion, the Moroccan version of the CHAQ has good psychometric properties. This validated version of the Moroccan CHAQ should help to individual follow-up of children suffering from JIA.

Hip dislocation revealing hip tuberculosis. A case report.

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.