Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease which causes functional disability, pain, and joint destruction. The disease has a major impact on patient’s independence, social activities and self-image.Objectives:The aims of this study were to assess whether RA is associated with increased feelings of shame and guilt, and to examine possible correlates with socio demographic characteristics and disease activity.Methods:To measure feelings of shame and guilt, in patients with RA (ACR/EULAR 2010), we used the Experience of Shame Scale (ESS) [1] and the Test of Self Conscious Affect- Version 3 (TOSCA-3S) [2].The ESS is a 25-item questionnaire that assesses the frequency of characterological, behavioral and bodily shame experiences over the past year. Respondents rate each item on a scale ranging from 1 (not at all) to 4 (very much), with higher scores indicating greater shame.The TOSCA-3S is presented with 11 brief hypothetical scenarios followed by 3 common reactions, which reflect shame, guilt and externalization of blame. Each possible response is rated on a five-point scale from 1(not likely) to 5 (very likely). For the purpose of this study, only the shame and guilt response items were analyzed. Total scores for Shame Self-Talk and Guilt Self-Talk were calculated and compared to the scoring interpretation. A p<0.05 was considered significant.Results:A total of 40 patients with RA were included, 36 women and 4 men, with a mean age of 54.2 years old [25-75]. Nine patients (22%) were illiterate, 42.5% were professionally active and 82.5% were married. The mean disease duration was 12.8 years [3-33], 80% of patients were on prednisone at a daily posology of 7 mg [2.5-12.5], 82.5% were on csDMARDs and 27.5% on bDMARDs. The mean DAS 28 ESR and CRP were respectively 4.3 [1.6-6.9] and 3.6 [1-6.2].The mean total score of the ESS was 45.3 [27-81] with subscale means of: 19 [12-37] for characterological shame, 19 [10-30] for behavioral shame and 7.4 [4-16] for bodily shame.For the TOSCA-3S, the mean “shame self-talk Total” score was 33.8 [17-44], and the mean “guilt self-talk Total” score was 48 [37-55], which corresponds to “you often use” for men and “you use an average amount” for women, a shame and guilt self-talk.A significant correlation was found between disease activity (DAS 28 ESR) and total score of ESS, shame self-talk total score and guilt shame self-talk score (p=0.000). A significant correlation was also found between these scores and gender, age, level of education, professional activity and marital status.Conclusion:Our RA patients experienced general feelings of shame and guilt, which correlate with demographic items and disease activity. However, a case-control study with a larger population is necessary to determine whether patients with RA express more shame and guilt than their peers without RA.References:[1] Andrews B, Qian M, Valentine JD. Predicting depressive symptoms with a new measure of shame: the Experience of Shame Scale. Br J Clin Psychol 2002;41:29-42.[2] Tangney JP,...
Background:Spine tumors remain a hot topic because of their associated morbidity by affecting motor and sensory function. Contrary to metastatic spine disease (MSD), extremely prevalent, rise within or surrounding the spinal cord and/or vertebral column, primary spinal tumors are rare, 5% of all primary skeletal tumors and frequently benign (20%). The diagnostic delay of these tumors, even when benign, is associated with a poor prognosis. Establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation.Objectives:to provide an overview of the epidemiology, radiological and histopathological of spinal tumors diagnosed in a rheumatology department.Methods:A retrospective study consisting of clinical characteristics analysis, laboratory and x-ray examinations, was performed on 40 patients who were hospitalised for a spinal tumor, in a rheumatology department, over 5-year period from 2015 to 2020.Results:A total of 40 patients with a mean age of 66 ± 13.5 years [18-93] and a sex-ratio of 1.1, were included. The most common initial complaints were inflammatory back pain (67.5%) and fatigue (52.5%), with a median duration of 5 months. Physical examination abnormalities included lumbar stiffness (32.5%), radicular signs (18.7%), hepatomegaly (12.5%), and lymphadenopathy (17.5%). Neurological deficit was found in only 3 patients (7.5%). Hypercalcemia (corrected serum calcium > 105 mg/l), and anemia (hemoglobin (Hb) < 100 g/l in female, Hb <110g/l in male) were present initially in respectively 47.5% and 46.3% patients, while biological inflammatory syndrome was present in 89.7% patients (median C-reactive protein of 44.7). Tumor markers were performed in 12 patients and they were positive in 9 of them.Plain radiographs findings were vertebral compression fractures (43.6%), osteolytic lesions (30.8%) and osteoblastic lesions (12.5%). Lumbar spine was the most affected (57.5%), followed by the dorsal spine (45%). Magnetic resonance imaging (MRI) was performed in 55%, and the most common lesion was low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences (68.1%).In our study, only one patient was diagnosed for a myxopapillary ependymoma, a benign primary spinal tumor characterised by a metastatic dissemination risk. For the rest (39 patients), the diagnosis of bone metastasis, multiple myeloma (57.7%), and of solid tumor cancers (40%), were established. Primary cancers were mainly prostate cancer (37.5%), lung cancer (18.7%) and kidney cancer (18.7%). By a median follow-up time of 25 months, overall survival rate was 30%.Conclusion:Extradural lesions are the most common, and are typically metastatic. Special attention should be pain to the patient’s medical history and laboratory abnormalities. In fact, an early diagnosis requires a high index of clinical suspicion.Disclosure of Interests:None declared
Background:Studies have shown that the association of pain, stiffness, disability, and social restrictions in rheumatoid arthritis (RA) patients induce a significantly increased level of depressed mood and stress. The use of favorable coping strategies could lead to improve physical and psychological well-being.Objectives:To evaluate coping strategies of RA patients and their associations with health-related quality of life (HRQoL) outcomes.Methods:A cross-sectional sample of patients with established RA was evaluated using measures of coping: the Brief-COPE (scores presented for the two overarching coping styles: Approach coping including active coping, emotional support, use of informational support, positive reframing, planning and acceptance, and Avoidant coping including self-distraction, denial, substance use, behavioral disengagement, venting and self-blame), the HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12), and the Rheumatoid Arthritis Impact of Disease score (RAID]. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes.Results:The study sample comprised 45 patients with a female predominance (91.9 %), and a mean age of 55.7± 9.9 years [38-77]. The median disease duration was 10 years [38-77]. The majority of patients (82.8 %) were positive for either rheumatoid factor or anti-CCP. Half of the patients were on biological disease-modifying antirheumatic drugs. Two active coping strategies were identified: Approach coping (E = 4.29) and Avoidant Coping (E=3.86), which explained 40% of the total variance. Mean RAID was 4.8± 1.6, while the mean PCS and MCS were 31.9 ± 9.4 and 39.7 ± 9.4, respectively. Approach coping and avoidant coping were associated with PCS (r= 0.4, p = 0.03), (r=0.3, p=0.008) respectively. However, no association was found between coping strategies and MCS or RAID (p>0.05). In the multivariate model, approach coping and avoidant coping were significant to explain lower disease-specific HRQoL (PCS) (Beta= 0.4, p= 0.008), (Beta=0.3, p=0.02) respectively.Conclusion:Approach and avoidance are associated with lower disease-specific HRQoL (PCS) but not with lower disease-specific HRQoL (MCS). Doctors should not forget to help their patients developing adaptive coping strategies.Disclosure of Interests:None declared
BackgroundSpondylodiscitis (SD) is an infection of the vertebral body or disc and may also extend to the epidural space, posterior elements, and paraspinal soft tissues. It is a cause of morbidity and mortality. However, the diagnosis is often delayed because of the non-specific clinical features.ObjectivesIn this study, we aimed to describe the clinical and diagnostic features of infectious SDMethodsWe conducted a retrospective study including 40 cases of infectious SD, performed over a period of five years (2014-2019). Epidemiological, clinical characteristics, laboratory results and imaging findings were uniformly collected.Results: Of the 40 patients, 37.3% were male. The mean age was 53.3 ± 13.9 years [28-83] and the median Charlson Comorbidity Index was 1. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The median duration from onset to diagnosis was 41 days [8-300]. Low back pain (LBP) was the most common symptom (98%). Lumbar spine was the most frequent location (71%). Seven patients had contiguous multiple levels (>2 vertebral bodies). Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 15 patients. The median erythrocyte sedimentation rate was 54 mm/1st h [13-223], the median CRP was 26.3 mg/L [7-387]. Leukopenia (<4000 WBCs/mm3) was found in three patients (9.8%). Magnetic resonance imaging confirmed the diagnosis in all cases, and revealed spinal epiduritis in 17 patients (34.8%), paravertebral abscesses in 11 (20.3%) and spinal cord compression in 4 (7.8%). Pathogens were isolated in 19 cases. Computed tomography-guided percutaneous disc biopsy (PDB) was performed in 16 (53.5%) and was conclusive in (11/15) cases (66.8%). Mycobacterium tuberculosis (MT) was the most common pathogene (46.4%) followed by Brucella (21.4%), Pyogenes (17.8%) and Gram-negative bacteria (14.2%). One patient had both MT and Staphylococcus haemolyticus.Paravertebral abscess formation (19.6%) occurred most frequently in patients with tuberculous SD (P= 0.02). Leucocytosis (>10,000 WBCs/mm3) was significantly higher in patients with Pyogenes SD (p=0.002) than in patients with other types of SD. All patients were treated with antibiotics and only one patient underwent surgical act. The outcome was favourable in 27 cases (86.8%).ConclusionSpondylodiscitis should be considered for all patients presenting with chronic backpain especially when associated with laboratory examination abnormalities. In our study, tuberculous spondylodiscitis was the most frequent, which highlights the fact that osteoarticular tuberculosis remains endemic in developing countries, where it still constitutes a major public health problemDisclosure of InterestsNone declared
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