Background:Behcet’s disease (BD) is a systemic vasculitis that affects young adults aged between 20 and 30 years old. It is rare in childhood.Objectives:This work aims to analyze the clinical features of this form by comparing it with adult BD.Methods:Through a retrospective study including 192 cases with BD seen in The Internal Medicine Department at Tahar Sfar Hospital Mahdia TUNISA, we report 8 cases of juvenile BD (4.2%) that occurred under the age of 16 years.Results:There were 8 male. The average age of BD onset was 14 years [11, 16 years]. Genital aphthosis was noted in 5 patients. Ophthalmologic damage was observed in 4 patients, dominated by uveitis (75% of cases). No cases of blindness were observed. Joint damage was seen in 5 patients and vascular and neurological damage in 2 patients respectively. All patients received colchicine in addition to a platelet aggregation inhibitors at the moment of BD diagnosis. When comparing juvenile BD group with that of adults, we have noticied, the frequency of cutaneo-mucous and articular manifestations, the rarity of neurological damage and the absence of cardiac and digestive damage in the juvenile BD group.Conclusion:Juvenile BD is a rare form, with a male predominance. The younger age is not a poor prognostic factor. Early diagnosis and treatment can reduce the disease’s complications.References:[1]doi: 10.1007/s00296-018-4208-9Disclosure of Interests:None declared
Background:Around 10 million people worldwide contract tuberculosis (TB) every year. According to the World Health Organization (WHO), approximately one-quarter of the world’s population is latently infected with Mycobacterium tuberculosis. Its treatment is extremely long and patients may experience a variety of adverse reactions.Objectives:The aim of this study was to assess the different adverse drug reactions (ADR’s) in patients treated with first-line anti-tubercular drugs.Methods:This retrospective study included 45 cases of TB followed in the Rheumatology department of Farhat Hached hospital in Sousse, Tunisia, over a period of 22 years (1998-2020).Results:The mean age was 52.2 ± 17.72 years [14-95 years]. These were 19 men (42.2%) and 26 women (57.8%).The different locations of tuberculosis were as follows: pulmonary for 5 patients (11.1%), spinal for 26 patients (57.8%), articular for one patient (2.2%), urinary for two (4.4%), and multifocal for 8 patients (17.8%). An anti-tuberculosis treatment (based on quadrytherapy: Rifadine(R), Isoniazide(I), Pyrazinamide (Z) and Ethambutol (E)during 2 months, followed by biotherapy based on (R)and (I) was prescribed for an average duration of 10.85 months [6-24 months]. ADR’s were observed in 53.33% of patients. Abdominal pain and nausea were detected in 5 cases (11.1%). Hepatic cytolyse was noticed in 8 cases (17.8%) under (R). Cholestatic hepatitis occurred in 9 cases (20%) under (R). Asymptomatic Hyperuricemia was detected in 15 cases (33.3%) with (E). Two cases of toxiderma were detected: the first under (E) and the second under (E) + (Z). Ethambutol was responsible for a case of DRESS syndrome and a case of drug-induced hepatitis. One case of hemolytic anemia had occurred under (R). A sensorineural hearing loss was noted under streptomycin in one case. No fatal side effects were observed. These ADR’s were reversible in all cases.Conclusion:The treatment of TB can cause a variety of ADRs’. Early recognition by active surveillance and appropriate management of these ADRs’ might improve adherence and treatment success.References:[1]Prasad, R., Singh, A., & Gupta, N. Adverse drug reactions in tuberculosis and management. Indian Journal of Tuberculosis, 66(4), 520–532 (2019).Disclosure of Interests:None declared
Background:Early recognition and treatment of inflammatory arthritis is imperative for the further course of the disease.Objectives:This study aims to determine the evolution of undifferentiated arthritis observed in rheumatology.Methods:Retrospective descriptive study which collects patients files identified as undifferentiated Arthritis and followed in the Rheumatology Department at Fattouma Bourguiba Hospital Monastir TUNISIA over a period of 15 years (2005, 2019). Epidemiological, clinical, paraclinical, and evolutionary data were collected and analyzed.Results:99 files were analyzed. The average age was 42.06±15.56; they were 42 males and 57 females with an average body mass index of 27±6.1 Kg/m2. The reason leading to consultation was, polyarthritis (37), oligoarthritis (27), mono-arthritis (21), and polyarthralgia (15). The median time to visit was 60 days [15 days, 3 months]. The median number of painful joints and swollen joints was 4 [2, 8], and 2 [1, 4] respectively. The mean duration of morning derusting was 34.8 ±24.4 minutes. Extra-articular manifestations were: a dry syndrome (22), a rheumatoid nodule (2), and serosal damage (1). Anemia (52 patients), leukopenia (6 patients), and lymphopenia (13 patients) were found in the blood cell count with a biological inflammatory syndrome in most patients (72/99). The immunology results showed: positive anti-nuclear antibodies (15/99), positive Anti-Citrullinated Protein Antibodies (9/99) and positive rheumatoid factor (8/99). 31 patients had standard radiological signs represented mainly by joint pinching and erosions. A joint puncture was done in 36/99 revealing inflammatory fluid in most cases. After an average follow-up of 1047 days [365, 1460]. undifferentiated arthritis was classified as rheumatoid arthritis (RA) (23), spondyloarthritis (SpA) (10), connective tissue disease (11), Crystalline Arthritis (5), and paraneoplastic arthritis (2). One patient had self resolution of symptoms and 38 remain undifferentiated.we found that the more the patients were seropositive, the more likely to develop Rheumatoid Arthritis (p=0.001), the more there was disorder in the blood cell count, the more the evolution was towards connective tissue disease (0.01), The more male patients were, the more likely to develop SpA (p=0.04). The patients management was mainly based on: analgesics (94), systemic corticosteroids (57) with a mean dose of 10.89± 5.8 mg/day. The use of Methotrexate and antimalarial drugs was noted in 18 and 15 patients respectively.Conclusion:Follow-up of patients with undifferentiated arthritis leads to a definite inflammatory rheumatism diagnosis in 61.6% of cases. Our data indicate that seropositive patients with chronic symptoms carry an increased risk of developing Rheumatoid Arthritis (P=0,001). Clinical, biological and genetic data can help the health care provider to predict future outcomes.References:[1]DOI: 10.1007/s00132-018-3539-2.Disclosure of Interests:None declared
Background:Biologic therapies are emerging as a significant therapeutic option for many with debilitating inflammatory and autoimmune conditions including rheumatoid arthritis (RA).These biological agents are highly effective in RA. Potential complications are dominated by infections.Objectives:To evaluate the different infections occurred under biotherapy.Methods:This is a descriptive retrospective study including patients under biotherapy, hospitalized between 2000-2016 in the Rheumatology Department of Farhat Hached hospital in Sousse,Tunisia. We evaluated for each patient the different infections that have occurred, specifying the different types of biotherapy received.Results:Sixty one patients are included (54 women and 7 men).The average age is 55.33 years ±11.51 [34-81 years].We found 47 infections in 40 patients (65.57%) with at least one infection under biotherapy: 41 women and 6 men with a mean age at 57.72 years [34-81 years]. Infections occurred under anti IL6 in 46.32%, Infliximab in 31.58%, anti CD20 in 11.58%, Etanercept in 7.37% and under Certolizumab in 3.16%. The infection was bacterial in 68.42%: 28 pulmonary infections, 8 oto rhino laryngology infections, 14 urinary infections, 2 soft tissue abscess, 13 cutaneous infections, 02 ocular infections. A viral origin of the infection was noted in 12.63% of cases. As for mycosis infections they represent 18.75% of the etiologies identified. The treatment was medical in 100% of cases and the evolution was favorable in all patients without resorting to the definitive discontinuation of biotherapy.Conclusion:The infections reported in our series are much more frequent under anti IL6 treatment and bacteria are the most incriminating pathogenic agents in our patients.References:[1]Simon, T. A.,and al. Comparative risk of malignancies and infections in patients with rheumatoid arthritis initiating abatacept versus other biologics: a multi-database real-world study. Arthritis Research & Therapy, 21(1).(2019).[2]Pawar, A.,and al Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study. Annals of the Rheumatic Diseases, annrheumdis–2018–214367(2019).Disclosure of Interests:None declared
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