Les facteurs associés à l’infection au cours de la polyarthrite rhumatoïde

Les complications infectieuses sont redoutables au cours de la polyarthrite rhumatoïde (PR). Le but de notre étude est d'estimer leur fréquence etde déterminer les facteurs associés à l'infection chez ces patients. Il s'agit d'une étude rétrospective incluant les cas de PR établis recensés entre 2007 et 2011 au service de rhumatologie au CHU Hassan II de Fès au Maroc. Nous avons inclu 164 patients atteint de PR, l'âge moyen des patients était de 47,9 ans, avec une prédominance féminine (137 F/27H). La fréquence des infections dans notre série était de 26,2 %, dominéespar les infections urogénitales (22 cas), pleuro pulmonaires (11 cas) dont 2 cas de tuberculose pulmonaire et un cas d'infection H1N1, 3 cas d'infections cutanées et 4 cas d'arthrite septiques. Dans notre série 127 patients étaient sous corticothérapie orale, 147 patients étaient sous méthotrexate, 25 patients étaient sous rituximab et 8 patients étaient sous tocilizumab. Dans notre étude, les facteurs associés à la survenued'infection étaient l'âge avancé (p= 0,02), une CRP élevée (p= 0,04) et une dose de corticothérapie - 7.5 mg/j (p= 0 ,03). Notre étude a mis enévidence certains facteurs associés à la survenue d'une infection au cours de la PR. En connaissant ces facteurs, il faut instaurer une surveillanceparticulière pour améliorer la qualité de prise en charge

Clinicopathological, therapeutic and prognostic features of the triple-negative tumors in moroccan breast cancer patients (experience of Hassan II university hospital in Fez)

<p>Abstract</p> <p>Introduction</p> <p>Triple-negative breast cancer (TNBC) is defined as a group of breast carcinomas that are negative for expression of hormone receptors (ER, PR) and Her2, we can distinguish between two groups: basal-like (ER-, PR-, Her2-, cytokeratin (CK) 5/6+ and/or Her1+) and unclassified subtype (ER-, PR-, Her2-, Her1- and CK5/6-).</p> <p>The aim of this study is to determine the clinicopathological, histological, therapeutic and prognostic features associated with this type of breast cancer.</p> <p>Methods</p> <p>This is a retrospective study of 366 female breast cancer patients, diagnosed between January 2007 and June 2010 at the Department of Pathology. Epidemiological, clinical, histological, therapeutic and evolutive data were analyzed. OS and DFS rates were estimated by Kaplan-Meier analysis and a log-rank test to estimate outcome.</p> <p>Results</p> <p>A total of 64 women were identified as having TNBC (17.5% of all female breast cancer patients), 12.6% were basal-like, 4.9% were unclassified subtype, with a median age of 45 years. The median histological tumor diameter was 4.3 cm. TNBC were most often associated with a high grade, 49.2% grade III (53% for unclassified subtype, 47.6% for basal-like). Vascular invasion was found in 26.6% of cases (22% for unclassified subtype and 28.3% for basal-like). For the lymph node involvement: 51% had positive lymph nodes, and 22.4% had distant metastases. Neoadjuvant chemotherapy was administered to 18% patients with 26% of complete pathologic response; therefore adjuvant chemotherapy was given to 82%. 98% received anthracycline based regimen and only 30% received taxanes.</p> <p>The Kaplan-Meier curves based showed the lowest survival probability at 3-years (49% of OS, and 39% of DFS).</p> <p>Conclusion</p> <p>TNBC is associated with young age, high grade tumors, advanced stage at diagnosis, difference chemo response compared to other subtypes, and shortest survival. Critical to optimal future management is accurate identification of truly triple negative disease, and adequately powered prospective TNBC trials to establish treatment efficacy and define predictive biomarkers.</p

Influence of exposure to climate-related hazards in the phenotypic expression of primary Sjögren’s syndrome

Objective: To analyse how the key components at the time of diagnosis of the Sjögren’s phenotype (epidemiological profile, sicca symptoms, and systemic disease) can be influenced by the potential exposure to climate-related natural hazards.Methods: For the present study, the following variables were selected for harmonisation and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Climate-related hazards per country were defined according to the OECD and included seven climate-related hazard types: extreme temperature, extreme precipitation, drought, wildfire, wind threats, river flooding, and coastal flooding. Climatic variables were defined as dichotomous variables according to whether each country is ranked among the ten countries with the most significant exposure.Results: After applying data-cleaning techniques and excluding people from countries not included in the OECD climate rankings, the database study analysed 16,042 patients from 23 countries. The disease was diagnosed between 1 and 3 years earlier in people living in countries included among the top 10 worst exposed to extreme precipitation, wildfire, wind threats, river flooding, and coastal flooding. A lower frequency of dry eyes was observed in people living in countries exposed to wind threats, river flooding, and coastal flooding, with a level of statistical association being classified as strong (p&lt;0.0001 for the three variables). The frequency of dry mouth was significantly lower in people living in countries exposed to river flooding (p&lt;0.0001) and coastal flooding (p&lt;0.0001). People living in countries included in the worse climate scenarios for extreme temperature (p&lt;0.0001) and river flooding (p&lt;0.0001) showed a higher mean ESSDAI score in comparison with people living in no-risk countries. In contrast, those living in countries exposed to worse climate scenarios for wind threats (p&lt;0.0001) and coastal flooding (p&lt;0.0001) showed a lower mean ESSDAI score in comparison with people living in no-risk countries.Conclusion: Local exposure to extreme climate-related hazards plays a role in modulating the presentation of Sjögren across countries concerning the age at which the disease is diagnosed, the frequency of dryness, and the degree of systemic activity.</p

AB0855 Comparison of cardiac involvement between ankylosing spondylitis and non-radiographic axial spondylitis

BackgroundWhile cardiac involvement is increasingly recognized and investigated in patients with axial spondyloarthritis (axSpA), few studies have investigated the occurrence of cardiac involvement in patients with non-radiographic axial spondyloarthritis (nr- axSpA) in relation to ankylosing spondylitis (AS).ObjectivesThe objectives of the present study are to describe and compare the characteristics of cardiac involvement between AS and axSpA nr patients.MethodsA cross-sectional study was conducted in the rheumatology department of the University Hospital of Fes in Morocco, including patients diagnosed as having axial spondyloarthritis according to the ASAS 2010 criteria, for a period of 9 years. Patients were classified as r-axSpA by the presence of radiographic sacroiliitis according to the modified New York criteria and nr-axSpA defined by the presence of sacroiliitis on MRI.Results375 patients were included in the study. We compared 257 AS to 118 with nr-axSpA.The cohort was predominantly female (54.9%) with a mean age of 46.83 years (S.D. 14.00).AS patients were significantly young (45 vs 50 years), more frequently male (55% vs 22%) and had higher serum inflammatory markers than those with nr-axSpA.Between AS and nr-axSpA groups, arterial hypertension was higher in nr-SpA patients (24.6% versus 14.4%, p = 0.016). While valvulopathy, myocardial infarction, pericarditis and heart failure were higher in AS patients with respectively (8.6% vs 3.4%, p=0.067) (1.6% vs 0.8%, p=0.578) (1.2% versus 0.8%, p = 0.779) (0.4% versus 0%, p = 0.497). However, arrhythmias were similar in AS patients and nr-SpA patients (0.8% versus 0.8%, p = 0.571).ConclusionCardiac involvement was common in both axSpA populations and similar between AS and nraxSpA except in hypertension where there is a significant difference between the two groups. These results highlight the importance of identifying and managing cardiac involvement in these patientsDisclosure of InterestsNone declared</jats:sec

AB0817 COMORBIDITIES IN ANKYLOSING SPONDYLITIS AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: ARE THERE ANY DIFFERENCES?

BackgroundWhile comorbidity is increasingly being recognized and examined within patients with Axial spondyloarthritis (axSpA), few studies have investigated the occurrence of comorbidities in patients with non-radiographic axial spondyloarthritis (nr-axSpA) in relation to ankylosing spondylitis (AS).ObjectivesThe aims of our study were to compare characteristics, comorbidities and medications between AS and nr-axSpA patients and to compare comorbidities between the two groups.MethodsA cross-sectional study was conducted in a single rheumatology hospital in Morocco, including patients diagnosed as having axSpA according to ASAS criteria 2010, during a period of 9 years. The comorbidities studied were hypertension, diabetes, dyslipidemia, cardiac, digestive and pulmonary disorders, osteoporosis, renal insufficiency and neoplastic pathologies. Demographic, clinical, laboratory, comorbidities and treatment data were compared between AS and the nr-axSpA subgroups.Results375 patients were included in the study. The cohort was predominantly female (54,9%) with a mean age of 46,83 years (± 14,00). 129 (50,2%) had at least one comorbidity. The mean number of comorbidities was 0,8 (± 1,05). We compared 257 AS to 118 with nr-axSpA.AS patients were significantly young (45 vs 50 years; p=0,0001), more frequently male (55% vs 22%; p=0001) and had higher serum inflammatory markers than those with nr-axSpA. The mean number of comorbidities was similar between AS and nr-axSpA groups. 31,1% of patients SA have a history of biologics DMARD-use (p=0,046) and less use NSAID (89,5 % vs 96,6 %; p=0,02). There were no statistically significant differences in prevalence of comorbidities between AS and nr-axSpA groups except hypertension which was higher in nr-SpA patients (24,6% vs. 14,4%, p=0,016) and digestive disorders which was most frequently detected in patients with AS (12,5 % vs 5,9%, p=0,05). The prevalence of cardiac disorders (p =0,068) and diabetes (p = 0,09) was nearly statistically significant. The multivariate analysis showed that hypertension is associated to AS form (OR: 1,976; IC [1,088-3,589])ConclusionComorbidities were common in both axSpA populations with small differences between AS and nr-axSpA. These results highlight the importance of identifying and managing comorbidities.Disclosure of InterestsNone declared</jats:sec

AB0816 COMORBIDITY AND THE USE OF BIOLOGICAL THERAPY IN AXIAL SPONDYLOARTHRITIS, IS THERE ANY IMPACT?

BackgroundSpondyloarthritis (SpA) is a chronic inflammatory rheumatism that can be associated with a lot of comorbidities. Comorbidity seems to be a factor that is can influence the treatment tactics.ObjectivesThe aims of our study were to describe the prevalence of commonly reported comorbidities in spondyloarthritis and to study the influence of comorbidity on the prescription of biological therapies in patients with SpA.MethodsA retrospective study was conducted in a single rheumatology hospital in Morocco, including patients diagnosed as having SpA according to ASAS criteria 2010, during a period of 9 years. Comorbidity data were obtained through careful examination of the history and medical records. The Charlson comorbidity index [1] calculated for every patient.Results375 patients were included in the study. 206 (54,9%) women, mean age 46.8±14,0 years. 105 patients were treated with biologic therapy (28%), in majority with TNF alpha inhibitors (99 patients). 188 (50,1%) patients had Charlson comorbidity index =1. The most common comorbidities were type 2 diabetes (12% patients), cancer (4,5%), chronic liver disease (2,9%), chronic kidney disease (2,1%), peptic ulcer (1,6%), ischemic heart disease (1,3%). Mean Charlson index was 1,14 ± 1,56 in total group; it was significantly lower in patients who were treated with biological therapy (0,6 ± 1,03) than in biologic naïve SpA (1,35 ± 1,68), p=0,0001. Biologics were prescribed in 66,7% of patients without comorbidities, in comparison with 17,1% of patients with Charlson comorbidity index = 1, 8,6% with Charlson comorbidity index = 2 and 6,8% of patients with Charlson index = 3 or more.ConclusionComorbidities are common in SpA and have a direct impact on the use of biological therapy. The development of therapeutic strategy for treating comorbid conditions is a must to achieve therapeutic goals in SpA.References[1]Charlson E M et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40(5):373-83.Disclosure of InterestsNone declared</jats:sec