BackgroundThis study aimed to establish the profile and the evolution of an early Rheumatoid arthritis (RA) cohort in the Moroccan population and also to search possible predictor factors of structural progression.MethodsPatients with early RA (< 12 months) were enrolled in a 2-year follow-up study. Clinical, biological, immunogenetic, and radiographical data were analyzed at study entry and at 24 months. Presence of radiographic progression was retained when the total score was superior to the smallest detectable difference (SDD) calculated to be 5.4 according the Sharp/van der Heijde (SVDH) method.ResultsFifty one patients (88.8% women, mean age of 46.9 [ 24-72 ] ± 10.8 years, mean disease duration of 24 [ 6-48 ] ± 13.9 weeks) were enrolled in this study. 68.6% were illiterate and 19.6% reported at least one comorbid condition. The mean delay in referral for specialist care was 140 [ 7-420 ] ± 43 days.Thirteen patients (62.5%) were IgM or IgA RF positive. HLA-DRB1*01 and DRB1*04 alleles were present respectively in 11.8% and 45.1% of patients.At baseline, 35.3% patients were taking corticosteroids and 7.8% were under conventional DMARDs.At 24 months, 77.2% received a median dose of 5 mg/day of prednisone. Methotrexate (MTX) was the most frequently prescribed DMARD, being taken by 65.2% of patients. 13.6% of patients had stopped their DMARD because of socioeconomic difficulties.Comparison of clinical and biologic parameters between baseline and 24 months thereafter revealed a significant global improvement of the disease status including morning stiffness, pain score, swollen joint count, DAS 28 and HAQ scores, ESR and CRP.Sixteen patients (34.8%) were in remission at 2 years versus no patients at baseline; P < 0.001.Forteen patients (27.5%) had at least one erosion at baseline. Radiographic progression occurred in 33.3% of patients and was associated in univariate analysis to swollen joint count (p = 0.03), total SVDH score (P = 0.04) and joint space narrowing score (P = 0.03). No independent factors of radiographic progression were shown by logistic regression.ConclusionsThese study reports, provided for the first time in Morocco, a developing African country, a large amount of information concerning the profile and the course of early RA.Patients who were receiving, for most of them, Methotrexate in monotherapy and low doses of corticosteroids, showed an improvement of all clinic and biologic disease parameters. Moreover, DAS remission was obtained in one third of patients and two thirds of the cohort had no radiographic progression at 2 years. No predictor factors of radiographic progression were found out.These results should be confirmed or not by a large unbiased RA cohort which will give more relevant information about early RA characteristics and its course and will constitute a major keystone of its management.
Objectives
Assessment of fatigue in Moroccan patients with rheumatoid arthritis (RA) and its relationship with disease parameters.
Methods
1089 Moroccan patients with rheumatoid Arthritis (RA) were included in the multicenter cross-sectional study QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis). The presence of fatigue was researched and its degree was assessed by a visual analogue scale (VAS) ranging from 0 to 100 mm. The presence and intensity of fatigue were correlated to the RA patient and disease parameters (sex, DAS 28, score of Health assessment Questionnaire (HAQ), corticosteroids intake, presence or absence of sleep disorders or psychological problems).
Results
The mean age of our patients was 49 ± 12.6 years with a female predominance of 80.3%. The average of disease duration was 6 (3, 12) years. The mean DAS28 was 4.9 ± 1.68. The average of HAQ was 1 (0.4, 1.6).
Fatigue was present in 97.1% patients and the average of VAS fatigue was 43.2 ± 26.6 mm. A high level of fatigue was associated with female gender (44% versus 39%, p = 0.05), an important level of disease activity (r = 0.544, p <0.001), more functional disability (r = 0.660, p <0.001), corticosteroids intake (r = 0.510, p = 0.003), presence of sleep disorders (65.4% versus 36%, p <0.001), and the psychological problems caused by the disease (43.8% versus 21 9%, p <0.001).
Conclusions
Fatigue is a major problem in our patients with RA and must be included in their routine assessment. In our sample, fatigue appears to be related to female sex, high level of disease activity and greater functional disability.
Disclosure of Interest
None Declared
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