The objective of this study is to evaluate the prevalence of vitamin D insufficiency in patients with rheumatoid arthritis (RA) and its association with disease activity, severity and physical disability. We included patients with rheumatoid arthritis followed in Rheumatology Department of Hassan II University Hospital, Fez, Morocco. Patients suffering from liver and kidney insufficiency and those who had received vitamin D in the previous 12 months have been excluded. Statistical analysis was done using SPSS v 18. A bivariate analysis and logistic regression were used to identify factors associated with vitamin D deficiency. One hundred seventy patients were included with a mean age of 50 ± 12.1 [17-83] years, and a female predominance (88.1%). All of our patients had hypovitaminosis D. The prevalence of 25(OH)-D insufficiency and deficiency was 64.5 and 35.5% successively. In unadjusted analysis, vitamin D concentration was inversely associated with pain visual analog scale VAS score (p < 0.001), asthenia VAS (p < 0.001), morning stiffness (p = 0.03), number of tender joints (p = 0.004), number of swollen joints (p < 0.001), inflammatory markers (p = 0,012), Disease Activity Score (p = 0.009), physical disability using Health Assessment Questionnaire (HAQ) (p = 0.001), and severity of the disease (p < 0.001). After logistic regression persisted association with female sex (OR = 4.3, CI = [0.94 to 20.976], p = 0.05), asthenia VAS (OR = 1.029, CI = [1.011 to 1.046], p = 0.001), and with the severity of the disease (OR = 2.910, CI = [1.314-6.441], p = 0.008). The vitamin D deficiency is common in our patients with RA. This deficiency is associated with female sex, severe asthenia, and the severity of the disease.

In addition to weight reduction, appropriate treatment of metabolic syndrome needs to become an important management strategy for knee pain and functional impairment.

Gout is a metabolic disease, which is characterized by acute or chronic arthritis, and deposition of monosodium urate crystals in joint, bones, soft tissues, and kidneys. But large tophi are unusual in chronic gout. We report the case of a 67-year-oldArabman presenting chronic tophaceous gout with unusual large tophi involving multiple joints: hands, feet, elbows, and knees. Laboratory workup revealed elevated serum uric acid (96 mg/l, normal: 20-74 mg/l), with normal renal function test. In untreated patients, chronic tophaceous gout may develop, which is characterized by chronic destructive polyarticular involvement and tophi. The treatment consists to decrease serum uric acid level which eventually allows the regression of tophi.

BackgroundMetabolic syndrome (MetS) is a metabolic disorder whose causes are: central obesity, hyperglycemia, dyslipidemia, and hypertension. In ankylosing spondylitis (AS), the prevalence of MetS appears to be high, suggesting that systemic inflammation and therapeutic used play a role in the development of MetS.ObjectivesThe aim of our study was to determine the prevalence of MS in AS, to identify factors associated with its presence, and to evaluate the influence of treatment used on its occurrence.MethodsThe prevalence of MetS was assessed cross-sectionally in 103 patients with AS fulfilling the modified New York criteria and collected in the Rheumatology Department of the University Hospital Hassan II of Fez. This study was conducted over a period of 18-months (September 2012- March 2014). The assessment of the prevalence of MS in these patients was established using the definition of NCEP/ATP III 2005 since it is the most commonly used in the literature.ResultsThe average age of patients was 38.62±13.330, with a male predominance (67%). 75% of patients are aged under 60 year-old. The median duration of the course of the disease was 7.11 years. The MetS is present in 34% of patients according to the definition used. It is associated with a Young-Onset disease (p=0.016), female gender (p=0.041), professional inactivity (p=0.015), disease activity assessed by ASDAS (p=0.039) and duration of disease progression (0.04)After multivariate logistic regression only female sex was identified as an independent predictor factor of MetS in patients with AS (OR=0,42; IC 95% [0,18-1,006]; p=0,041).ConclusionsOur findings showed a greater prevalence of MetS in AS female patients than in male patients. Age, disease activity, functional impact of the disease and the therapeutic use include NSAIDs did not appear to be related to the development of MetS in the population of patients studied. Further studies on a larger scale and covering a larger population with AS are needed to assess the association between chronic inflammation in AS and MetS, and to determine the effect of biological therapy in the development of the MetS.ReferencesDomenico Malesci, Alferio Niglio, Gianna Angela Mennillo & al. High prevalence of metabolic syndrome in patients with ankylosing spondylitis. Clin Rheumatol (2007) 26:710–714.Pehlevan S, Yetkin DO, Bahadır C, Goktay F, Pehlevan Y, Kayatas K, Ince N. Increased prevalence of metabolic syndrome in patients with psoriatic arthritis. Metab Syndr Relat Disord. 2014 Feb;12(1):43-8.Divecha H, Sattar N, Rumley A, Cherry L, Loe GD, Sturrock R(2005). Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation. Clin Sci (Lond)109:171–176.Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006; 33: 2167-72.AcknowledgementsTo all membrs of the departement group of r...

Myositis ossificans progressiva (MOP) is an autosomal dominant disorder. There is a progressive ectopic ossification and skeletal malformation, mainly in the connective tissue of muscle. The diagnosis is based on the clinical findings and radiological demonstration of the skeletal malformations. A 38-year-old female patient was admitted to our department with progressive increase of the thigh. Results of laboratory studies were normal. The radiography of the right thigh showed multiple intramuscular calcifications. Myositis ossificans progressiva should be diagnosed as early as possible and non-invasively, based upon history, clinical and radiological findings. Early and correct diagnosis is fundamental for indication of proper management of the disease.