Predictors factors of atlanto-axial subluxation in Tunisian patients with rheumatoid arthritis.

BACKGROUND: The aim of this study was to describe clinical and imaging features of atlantoaxial subluxation (AAS) and the associated risk factors in patients with rheumatoid arthritis (RA). METHODS: We conducted a retrospective and comparative study including 51 RA patients with AAS and 51 RA patients without AAS. Atlantoaxial subluxation was defined by the presence of an anterior C1C2 diastasis on the cervical spine radiograph in hyperflexion and/or an anterior, posterior, lateral or rotatory C1C2 dislocation on MRI with/without inflammatory signal. RESULTS: In G1, clinical presentations revealing AAS were mainly neck pain (68.7%) and neck stiffness (29.8%). MRI revealed: diastasis C1C2 (92.5%), periodontoid pannus (92.5%), odontoid erosion (23.5%), vertical subluxation (9.8%) and spinal cord involvement (7.8%). A collar immobilisation and corticosteroid boluses were indicated in 86.3% and 47.1% of cases. C1-C2arthrodesis was performed in 15.4% of cases. Atlantoaxial subluxation was significantly associated with: age at disease onset (p = 0.009), history of joint surgery (p = 0.012), disease duration (p = 0.001), rheumatoid factor (p = 0.01), anti-cyclic citrullinated peptide (p = 0.02), erosive radiographic status (p < 0.005), coxitis (p < 0.001), osteoporosis (p = 0.012), extra-articular manifestations (p < 0.001), and high disease activity (p = 0.001). Multivariate analysis identified RA duration (p < 0.001, OR = 1.022 CI[1.01-1.034]) and erosive radiographic status (p = 0.01, OR = 21.236 CI[2.05-219.44]) as predictive factors of AAS. CONCLUSION: Our study showed that longer disease duration and joint destruction are the major predictive factors of AAS. Early treatment initiation, tight-control and regular monitoring of cervical spine involvement are required in these patients.

A tale about an unusual cause of pygalgia in non-radiographic axial spondyloarthritis.

Schwannoma are tumors of Schwann cells of the peripheral nerve sheath. Sacral location is rarely reported especially in spondyloarthritis patients. Herein, we report a case of uncommon pygalgia in a 25-year-old man with history of a non-radiographic axial spondyloarthritis and in whom the diagnosis of sacral Schwannoma was established.

Journey of rheumatoid arthritis patients in Tunisia: From symptoms to treatment.

Objectives: This study aims to assess the different delays of rheumatoid arthritis (RA) patients' journey from disease onset to treatment initiation and to identify possible influencing factors. Patients and methods: This cross-sectional study included a total of 100 patients (14 males, 86 females; mean age: 56.5±12.4 years; range, 26 to 82 years) who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for RA between January 2019 and January 2020. Demographic and clinical data and disease characteristics were collected from the patient interviews and medical files. Five different intervals were defined from symptom onset until the initiation of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Results: The mean age at RA onset was 46.6±12.4 years. Median delays from onset of symptoms until general practitioner (GP) and rheumatologist consultations were six (range, 0.25 to 240) months and 12 (range, 0 to 242) months, respectively. Median delays from onset of symptoms to RA diagnosis and treatment with csDMARDs were 15.7 (range, 2 to 252) months and 18 (range, 2 to 270) months, respectively. The mean number of consultations was 7.3±4.2 and the median number of physicians visited before the diagnosis was three (range, 1 to 8). The RA diagnosis delay was associated with rural geographic environment (p=0.02), lack of social insurance (p=0.027), progressive symptoms onset (p=0.006), morning stiffness (p=0.023), being initially examined by a GP (p=0.02), number of consultations (p<0.001; r=0.49), and number of physicians consulted before diagnosis (p=0.001; r=0.33) respectively. Based on the patients' self-perception, the main causes of this long delay were lack of financial means (33%), wait times until exploration results (31%), wait times until the first GP or rheumatologist visit (26%), and geographical difficulty in accessing healthcare services (18%). Conclusion: Our study results suggest that patients with RA experience a significant delay until diagnosis and initiation of treatment. Healthcare providers should urgently consider factors related to diagnosis delay to shorten RA patients' journey.

Pharmacological Management of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome Syndrome: A Proposal of a Treatment Algorithm.

ABSTRACT: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic disease with marked clinical and radiological heterogeneity. It is characterized by a combination of dermatological and osteoarticular manifestations. The treatment of SAPHO syndrome is not yet codified. It includes several therapeutic options such as anti-inflammatory drugs, bisphosphonates, antibiotics, conventional disease-modifying antirheumatic drugs, and biological treatment.This article aims to provide an updated review of the different pharmacological options for SAPHO syndrome. We also propose a therapeutic algorithm for the management of this disease.