L. Abdelmoula

Hôpital Charles-Nicolle, Tunis-Ville, Tūnis, Tunisia

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Publications (79)15.01 Total impact

  • La Tunisie médicale 02/2014; 92(2):194-5.
  • La Tunisie médicale 02/2014; 92(2):189-90.
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    ABSTRACT: Objectif Évaluer la prévalence de la dépression dans une série tunisienne de patients souffrant de polyarthrite rhumatoïde (PR), et déterminer les facteurs associés à sa survenue. Méthodes Étude transversale sur 60 patients atteints de PR. L’évaluation de la dépression a été réalisée à l’aide de l’échelle Montgomery and Asberg depression rating scale. Résultats Notre étude a mis en évidence une prévalence importante de la dépression au cours de la PR (45 %). Les principaux facteurs prédictifs de sa survenue étaient le sexe féminin, l’absence d’activité professionnelle, l’absence de couverture sociale, la forte activité de la PR, l’altération de la qualité de vie et l’existence d’une atteinte structurale. Perspectives Une bonne prise en charge de la PR pourrait prévenir la survenue d’une dépression. Il faut dépister la dépression chez les patients atteints de PR, cela pour sa propre prise en charge d’autant plus que le traitement est le plus souvent efficace, mais aussi pour éviter ses conséquences néfastes sur l’évolution de la PR.
    La Presse Médicale. 05/2012; 41(5):e220–e225.
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    ABSTRACT: Spinal injections of corticosteroid are commonly performed by rheumatologists in their daily practice but little is known about the frequency, the intensity and the management of procedural pain observed in these osteoarticular injections in daily practice. To evaluate the prevalence and intensity of pain caused by spinal injections. In this observational prospective study, data were collected over 6 months, for up to 44 procedures (corticosteroid spinal injection). Evaluation of the pain was evaluated immediately before and after the injection using Huskisson's visual analogue scale (VAS). Statistical analysis was carried out in order to compare patients who had suffered from pain whilst undergoing the procedure to those who had not. Data were analyzed for 17 patients (12 female, mean age 53.6 ± 10.5 years). Over 50% of patients experienced procedural pain. Significant predictive factors of genesis of the procedural pain were the young age (p=0.022) and the intensity of the initial pain (p < 0.001), while the existence of a co morbidity is rather a protective factor (p = 0.006). Others factors such us sex, origin, level of studies, socioeconomic conditions, didn't seem to have of effect on the procedural pain. Most patients undergoing spinal injections suffer from procedural pain. Specific research and guidelines for the management of procedural pain related to rheumatologic care should be established to improve the quality of care provided by physicians.
    La Tunisie médicale 03/2012; 90(3):219-22.
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    ABSTRACT: To assess the prevalence of depression in a series of Tunisian patients with rheumatoid arthritis (RA) and to identify factors associated with its occurrence. We performed a cross sectional study on 60 patients with RA. The evaluation of depression was performed using the Montgomery and Asberg depression rating scale. Our study revealed a high prevalence of depression in RA patients (45%). The main predictor factors of its occurrence were female gender, absence of professional activity, absence of social support, high activity of RA, impaired quality of life and existence of structural damage. Our results highlight the importance of a good management of RA in order to prevent the occurrence of depression. They also underline the interest of screening for depression in RA patients to avoid its adverse effects on the course of RA.
    La Presse Médicale 01/2012; 41(5):e220-5. · 0.87 Impact Factor
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    ABSTRACT: The thoracic outlet syndrome (TOS) is recognized as a cause of upper limb pain. It is often under-diagnosed and its frequency under-estimated by rheumatologists. To report the diagnostic problems related to TOC though a literature review. A narrative review of literature The diagnosis of TOS is difficult because of intricacy of vascular and neurological symptoms. It requires provocative tests, electrophysiological investigations and Doppler ultrasonography. A good anatomical knowledge is mandatory in order to clarify the mechanisms and the location of the lesions which depend on sophisticated imaging exams. It is also recommended to exclude all other causes of upper limb pain, as well as peripheral nerve compression syndromes, which can coexist with TOS. Diagnosis and treatment of the TOS involves rheumatologists, neurologists, physiatrists, orthopedic surgeons,vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists who have to cooperate in order to prevent severe functional after-effects.
    La Tunisie médicale 11/2011; 89(11):809-13.
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    ABSTRACT: Cervicobrachial neuralgia (CBN) is frequent in out patient clinic as well in general medicine as in rheumatology. Even though cervical disc degeneration and osteophytosis constitute the most frequent etiology of such a trouble, the practitioner must be aware of much more serious underlying cause. To investigate the epidemiology, clinical features, aetiologies and paraclinical characteristics of uncommon CBN. Retrospective chart review about 17 cases of uncommon CBN among the 84 cases of CBN hospitalized at the rheumatology department of the Charles Nicolle Hospital during a 16-years-period [1990-2005]. There were 11 men and 6 women with a mean age of 63 years [33y-81y]. All patients presented a CBN since in average five months [2 months- 24 months]. Neck stiffness was noted in 60% of cases and a neurological impairment in 47% of cases. X-ray radiographs of cervical spine were normal in five cases. In the remaining cases, they showed lytic images (six cases), disk space narrowing with vertebral erosions (two cases) and vertebral fracture (three cases). Further investigations concluded that the CBN was due to a Pancoast'syndrome in five cases, an infectious spondylitis in three cases, cervical bone metastasis in two cases, a syringomyelia in two cases, a neuroma in one case, a thoracic outlet syndrome in one case and an erosive spondylarthropathy in a patient presenting chronic renal failure managed by hemodialysis. In comparison with common CBN, our patients presenting symptomatic CBN were characterised by an inflammatory and refractory pain. The more frequent recourse to modern imaging is justified.
    La Tunisie médicale 07/2011; 89(7):598-603.
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    ABSTRACT: AIM: Report of bisphosphonates indications for osseous diseases other than osteoporosis. METHODS : Narrative review of the literature. RESULTS : Bisphosphonates represent a new medication which is increasingly used. Besides osteoporosis, it is indicated as first choice in different bone diseases such as Paget's disease and the prevention of bone complications in tumoral osteolysis. Bisphosphonates' efficiency has been proven in other pathologies: the fibrous dysplasia and the osteogenesis imperfecta. More over, many studies are driven having for goal to show the efficiency of bisphosphonates in the algoneurodystrophy, non corticosteroid-treated osteoporosis in chronic inflammatory rheumatism and aseptic osteonecrosis. CONCLUSION: Bisphosphonates are a powerful inhibition of osseous resoption frestable indicated for osteoporosis. Their indications were retended to paget's disease, malignant hypercalcemia, and osseous complications of malignant osterlysis.
    La Tunisie médicale 06/2011; 89(6):511-6.
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    ABSTRACT: Obesity is a state of chronic low-grade inflammation that predisposes people to several diseases and that is increasingly prevalent. Rheumatoid arthritis (RA) is marked by the presence of proinflammatory cytokines and, in general, the presence of high levels of inflammatory markers is associated with a severe disease course and joint damage. To assess the impact of obesity on disease activity, quality of life and articular damage in patients with established RA. Between July 2009 to December 2009, 119 RA patients were included and divided in two groups according to the body mass index (obeses and controls). RA activity was assessed by the Disease Activity Score (DAS) 28, quality of life by the Health Assessment Questionnaire (HAQ) and radiographic joint damage by the modified Sharp score. Obesity was not correlated with worsen RA activity (p=0.71) nor quality of life impairment (p=0.51). The obese group had a lower modified Sharp score than the control group (64.97versus113.64; p < 0.032) and this association remained significant after adjustment for age, sex, disease activity, extraarticular manifestations, comorbidities, presence of rheumatoid factor, and disease duration. Obesity does not have an impact on disease activity nor changes in quality of life, but it has a protective effect on the amount of joint destruction in established rheumatoid arthritis.
    La Tunisie médicale 05/2011; 89(5):462-5.
  • Journal of Crohn s and Colitis 04/2011; 5(2):171-2. · 3.39 Impact Factor
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    ABSTRACT: It is well documented that in early rheumatoid arthritis, anti-CCP antibodies have better diagnostic value than rheumatoid factors and anti-keratin antibodies. However, their role is less well defined in patients with established or long duration disease. To evaluate and to compare diagnostic performances of anti- CCP, anti-keratin, IgM and IgA rheumatoid factors in established rheumatoid arthritis. In a cross-sectional study, 90 patients with established rheumatoid arthritis and 100 controls were tested for these autoantibodies. The association of these markers with disease activity and severity was investigated. The sensitivity and specificity were calculated for each of four tests, using the clinical diagnosis as the gold standard. The anti-CCP and IgM rheumatoid factor exhibited the best diagnostic value. None of the tested antibodies had any significant association with the disease activity score (DAS28). After adjustment by multiple linear regression, only anti-CCP positivity was found to be significantly associated with erosive disease. In long duration rheumatoid arthritis, anti-CCP and IgM rheumatoid factor have similar diagnostic value. However anti- CCP are useful in seronegative patients. They are also a reliable marker of severe erosive disease.
    La Tunisie médicale 03/2011; 89(3):231-5.
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    ABSTRACT: Cytotoxic T lymphocyte antigen 4 (CTLA-4) is a negative regulator of T-cell function, which has been suggested to be involved in a wide-range susceptibility to autoimmune diseases. We sought a probable implication of the CTLA-4 polymorphism (A/G +49) in two autoimmune diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and its possible interaction with HLA-DRB1 polymorphism. CTLA-4 gene polymorphism A/G in exon 1 (+49) was analyzed by PCR-RFLP method in 78 patients with SLE, 132 with RA and 110 normal controls. HLA-DRB1 typing was performed by PCR-SSP (one lambda®) in only 46 SLE patients, the 132 RA patients and 100 normal controls. The results showed that there were no significant differences in exon 1 gene of CTLA-4 polymorphism between SLE, RA and controls. HLA-DRB1*03 and DRB1*15 were significantly more frequent in SLE patients than in controls (p = 0.0001, OR (95% CI) = 4.35 (1.94 -9.86) and p = 0.01, OR (95% CI) = 3.24 (1.28 -8.24) respectively). In addition, the frequencies of DRB1*04 and its subtype DRB1*0405 were statistically higher in RA patients than in controls (p = 0.00043, OR (95% CI) = 2.79 (1.54 -5.07) and p = 0.0001, OR (95% CI) = 5.65 (2.14 -15.74) respectively). No association between CTLA-4 and HLA-DRB1 polymorphisms was observed in either SLE or RA patients. In conclusion, the CTLA-4 exon 1 polymorphism does not appear to interfere with susceptibility to SLE and RA in Tunisian patients. Corresponding with data in other populations, HLA-DRB1 seems to play major role in conferring susceptibility to SLE and RA.
    Journal of Medical Genetics and Genomics. 02/2010; 2:8-17.
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    ABSTRACT: This study aimed to investigate HLA-DRB1 alleles in rheumatoid arthritis (RA) patients from Tunisia and to examine the effect of these alleles on disease severity. HLA-DRBI alleles and sub-typing of DRBI*04 and *01 were determined in 90 patients and 100 healthy controls, by PCR-SSP. HLA-DRB1*04 was significantly higher in patients (51.1%) than in controls (27%) [OR=2.83, p=0.00066]. DRBJ*0405 was found to be the unique DR4 allele associated with RA (28.88% vs 6%) [OR=6.36, p=0.000059]. A significant decrease in the frequency of HLA-DRB1*0701 was observed in RA patients (16.66%) compared to controls (36%) [p=0.0026]. However, the frequency of patients carrying the shared epitope (SE) QRRAA, was slightly increased compared with controls (37.8% vs 23%) [OR=2.03, p=0.039]. We found that the presence of rheumatoid factor, HLA-DR4 and HLA-DRBI*0405 were not significantly associated with bone erosions or the presence of extra-joint involvement. In our population, the SE (QRRAA) expressed in DRBI*04 alleles is related to the susceptibility to RA but it is not involved in RA severity in Tunisia, while DRBI*0701 might protect against this disease.
    Archives de l'Institut Pasteur de Tunis 01/2010; 87(1-2):53-9.
  • Joint, bone, spine: revue du rhumatisme 07/2009; 76(4):429. · 2.25 Impact Factor
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    ABSTRACT: Osteoid osteoma is one of the unusual causes of musculoskeletal pain. Its diagnosis is usually not difficult in classic diaphyseal localization. However, the diagnosis of juxta or intraarticular osteoid osteoma is challenging because of atypical clinical presentation responsible for long diagnosis delay. Report a new case. We report herein the case of a 22-year-old woman presenting an intraarticular osteoid osteoma of the elbow. Diagnosis has been established on imaging findings (MRI and CT-scan) after 10 months because of atypical clinical presentation as a chronic monoarthritis of the elbow. The picture of an osteoid osteoma of the lower extremity of the humerus associated to a synovitis and a joint effusion was suspected on MRI. It had been confirmed on CT-scan wich showed the nidus. Surgical removal of the tumor allowed pain relief and functional restoration in postoperatively. Regarding an unexplained chronic monoarthritis, the diagnosis of intraarticular osteoid osteoma should be evoked. CT-can remains the investigation of choice for identifying the nidus. Surgical exicision permits the relief of symptoms.
    La Tunisie médicale 04/2009; 87(3):219-21.
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    ABSTRACT: Psoriatic arthritis is a chronic rheumatic disease making part of spondylarthropathies. It is the most frequent chronic inflammatory rheumatism after rheumatoid arthritis. Eventhough, it is usually a benign affection, it may be destructive leading to handicap. Several new medications have been introduced, including anti-tumor necrosis factor (TNF alpha blockers) and leflunomide for treatment of psoriatic arthritis. Many studies show the efficacy of these medications in this disease.
    La Tunisie médicale 01/2009; 86(12):1036-41.
  • Revue Du Rhumatisme - REV RHUM. 01/2009; 76(7):720-721.
  • La Tunisie médicale 01/2009; 86(12):1095-7.
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    ABSTRACT: To investigate a possible association between functional polymorphisms of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22-R620W) and receptors for the Fc fragment of IgG (FcgRIIa-H131R, FcgRIIIa-F158V FcgRIIIb-NA1/NA2), and rheumatoid arthritis (RA), 133 Tunisian patients with RA and 100 controls were genotyped. We found strong evidence of an association of PTPN22 620W allele and RA. However, analysis does not detect an association between auto-antibodies seropositivity, presence of nodules or erosions and this allele. No significant skewing of any of the three FcgR polymorphisms was seen in this RA group. Nevertheless, we identified FcgRIIIa-V/V158 as the most important FcgR genotype for severe disease subset with joint erosions and observed that patients with FcgRIIIb-NA2/NA2 genotype had an earlier incidence of clinical symptoms. In conclusion, we have confirmed that PTPN22 620W allele is associated with Tunisian RA but does not constitute a factor influencing clinical manifestations. Conversely, this study supports that the FcgRIIa/IIIa and IIIb polymorphisms could influence the course and the severity of this disease. A large number of samples are required to provide independent confirmation of these findings.
    Archives de l'Institut Pasteur de Tunis 01/2009; 86(1-4):51-62.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2009; 30.

Publication Stats

53 Citations
15.01 Total Impact Points


  • 2003–2012
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia
  • 2011
    • University of Tunis El Manar
      Tunis-Ville, Tūnis, Tunisia
  • 2007
    • Cardarelli Hospital
      Napoli, Campania, Italy