Background:Infertility is a disease of the reproductive system defined by the failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Although rheumatoid arthritis (RA) tends to have a late onset, the disease also occurs during child-bearing years and may interfere with procreation.Objectives:The aim of this study was to compare fertility rates in women with RA with birth-year-matched references from the general population.Methods:This is a case-control study. Menopausal married women who were diagnosed in the department of Rheumatology at Hedi Chaker Hospital before the age of forty were recruited into this study as cases and apparently healthy age matched married women were recruited as controls. Demographic, clinical, immunological, radiological and therapeutic data were collected from each case using the medical record of patient. Data obtained included age, age of RA onset, duration of RA, extra-articular manifestations, Rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACPA), the presence of erosions on radiographs of hands and feet and the therapy.Rheumatoid arthritis and controls women were asked to state their menstrual regularity, age at menarche, age at menopause, gestity, parity, number of living children, time to first pregnancy, presence of primary or secondary infertility, the interpregnancy interval, presence of miscarriage or in utero foetal death (IUFD) or preterm delivery and their number.Results:The mean ages of the cases and controls was 54 ± 8,11 years [39, 69]. The median duration since onset of RA in the patients was 22,5 ± 10,53 years [1, 47]. The mean age of onset of the disease was 31,4 ± 6,3 [18, 39] years. Forty-nine percent (49%) of patient had extra-articular manifestations: ocular sicca syndrome in 43,8% of cases, pulmonary fibrosis in 5,3% of cases and rheumatoid nodules in 1,8 % of cases. Rheumatoid factor (RF) was present in 61,4% of cases while anti-CCP anti-body was present in 59,6% of cases.Erosive polyarthritis was found in 80,7% of patients. The mean rate of RF was 319,7 ± 462,4 UI/ml and the mean rate of anti-CCP was 185,8 ± 264.Women with RA had a statistically significant mean time to pregnancy longer than the control group. Primary infertility was seen in 15 (26,3%) patients and 2 (3,5%) controls, whereas secondary infertility was seen in 31 (54,5%) patients and 2 (3,5 %) controls. The patients were significantly more likely to have primary and secondary infertility. There were no significant differences in the age at menarche, the number of children, the gestity and the parity between the two groups. The age at menopause was statistically significant lower in the group patients than controls.Conclusion:Our study showed that RA women are more likely to have reduced fertility than general population. Although this study cannot definitively address the issue of impaired fertility among women with RA, the results are suggestive enough to warrant further research into the link between RA and fertility that takes women’s childbearing choices into account.References:[1]Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 2012; 64: 668-74.[2]Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015; 74: 1836-41.[3]Pope JE, Bellamy N, Stevens A. The lack of associations between rheumatoid arthritis and both nulliparity and infertility. Semin Arthritis Rheum 1999; 28:34250.[4]Akintayo RO, Aworinde O, Ojo O, Akintayo FC, Akinlade OM, Awodun RO, Isa SO. Is rheumatoid arthritis an innocent bystander in female reproductive problems? A comparative study of fertility in Nigerian women with and without rheumatoid arthritis. Eur J Rheumatol 2018; 5(3): 179-83.Disclosure of Interests:None declared
Background:Spondylodiscitis is an infective process of the disc and the two adjacent vertebrae. It is quite a rare disease accounting for 2–7% of all cases of septic osteomyelitis. These spinal infections touch commonly a single level, the lumbar spine being the most affected. Non-contiguous spine level involvement is seldom reported in the literature. This last group is for the most part imputable to granulomatous organisms [1,2].Objectives:Study the clinical, microbiological, radiological, therapeutic and evolutional characteristics of non-contiguous multi-levels spondylodiscitis.Methods:We conducted a retrospective descriptive study over twenty-one years in the Department of Rheumatology. The diagnosis of spondylodiscitis was based on combination of clinical, biological and radiological arguments.Results:Eight patients had non-contiguous multi-levels infectious spondylodiscitis. There were 6 men and 2 women. The mean age was 53.3±26.2 years. The mean delay from onset of symptoms to diagnosis was 134.6±77.6 days. Back pain was the most common symptom. All patients had spinal syndrome. The Signs of spinal cord compression were observed in 3 patients. C-reactive protein levels were elevated in 6 patients (mean: 56 ± 30.8 mg/L). Plain radiography, performed in all cases, showed pathological pictures in 7 patients. Magnetic resonance imaging was performed in 6 patients. Vertebral levels affected were thoracic / lumbar in 6 cases, cervical/thoracic in 1 case and cervical/lumbar in 1 case. The paravertebral abscess was associated to the disc involvement in 3 cases. Epiduritis was associated in 3 cases. Pathogens were isolated in all cases. Tuberculosis was the most common cause. The leading causative agents in non-tuberculosis spondylodiscitis were staphylococcus aureus, brucella and streptococcus B. Two microorganisms combined were found in two cases (mycobacterium tuberculosis associated to Escherichia coli in one case and mycobacterium tuberculosis associated to Brucella in another). Medical treatment was adapted to the microbial culture and the sensitivity profile of the etiological agent. After therapy, 7 patients had regression of symptoms and 1 patient had a permanent neurological impairment.Conclusion:Multilevel spondylodiscitis involving non-contiguous spine segments is rare. Although atypical organisms are generally held to be responsible, the common bacteria such as Streptococcus B or Staphylococcus aureus should not be overlooked.References:[1]Zimmerli W. Clinical practice.Vertebral osteomyelitis. N Engl J Med 2010 Mar;362(11):1022–9.[2]Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56(June (6)):401–12.Disclosure of Interests:None declared
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