[Show abstract][Hide abstract]ABSTRACT: This study aims to translate and cross-culturally adapt the Moroccan version of the Quebec Back Pain Disability Scale (QDS) and to investigate its reliability and validity in Moroccan patients with low back pain (LBP). The translation and cross-cultural adaptation of the QDS were developed in agreement with published guidelines. The QDS was translated by use of the forward and backward translation procedure. After pretest, it was validated in 64 Moroccan patients with LBP. The QDS was recorded twice, at baseline visit and 72 h later. Reproducibility was evaluated using intraclass correlation coefficient (ICC) and Bland and Altman method. Internal consistency was measured by Cronbach α coefficient. Ceiling and floor effects were assessed. Validity was measured by correlating the scores of the Moroccan QDS with visual analogue scale (VAS) for Pain, Disability VAS, Schober test, fingertip-floor measurement and the Moroccan version of the Roland Morris Disability Questionnaire (RMDQ) by means of the Spearman rank correlation coefficient. Association with gender and education level was also studied. Reliability was excellent with an ICC (type 2.1) of 0.959 (CI 95%: 0.934-0.975). The internal consistency was high with a Cronbach α of 0.979. The Bland and Altman method showed homogenous distribution of the differences, with no systematic trend. There were no floor or ceiling effects. The correlation between QDS and RMDQ was very good (r = 0.664; p ≤ 0.001). There was no correlation between QDS and the other variables. Accordingly, the Moroccan version of QDS has good reproducibility, internal consistency and validity for the assessment of disability in Moroccan-speaking patients with LBP.
Full-text available · Article · Feb 2012 · Clinical Rheumatology
[Show abstract][Hide abstract]ABSTRACT: Cas cliniques en MPR locomotrice / Annals of Physical and Rehabilitation Medicine 54S (2011) e255–e269 e263 for less than 10% of the variance in disability while 35% is related to psycho-social factors . Isolated information has a limited impact while educational approaches appear to modify behavior .
Full-text available · Article · Oct 2011 · Annals of Physical and Rehabilitation Medicine
[Show abstract][Hide abstract]ABSTRACT: Objective of the study is to test the reliability and validity of a translated version of health assessment questionnaire (HAQ) on Moroccan patients with rheumatoid arthritis (RA). We led a prospective study from July 2004 to September 2005. A total of 100 Moroccan patients were recruited. After translation to dialect Arabic, back translation, expert committee review and pretesting of the questionnaire, it was administered to the selected patients and tested for construct validity, reliability and internal consistency. The construct validity was evaluated by correlating the yield of the questionnaire with other disease activity and severity parameters. The questionnaire was administered again after a time interval of between 2 and 10 days for evaluation of the reliability of this test. All the items were tested for their loyalty to the principal component. The adapted questionnaire showed a good internal consistency. Cronbach's alpha test was 0.994. The test-retest showed a strong reliability with a kappa test ranging from 0.70 to 0.92 for all domains. Intraclass correlation coefficient for the total score was 0.987. The Moroccan HAQ showed a strong validity. It correlates significantly with disease activity and severity parameters. The unidimentionality has been demonstrated. About 71.5% of all variabilities was accounted for by the first principal component. The Moroccan Arabic dialect version of HAQ is a reliable and valid instrument that can be self-administered by Moroccan RA patients to assess their functional disability.
Full-text available · Article · Jul 2008 · Rheumatology International
[Show abstract][Hide abstract]ABSTRACT: The aim of this study is to assess the reliability and validity of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) in Moroccan patients with knee osteoarthritis. The WOMAC was translated and back translated to and from dialectal Arabic, pre-tested and reviewed by a committee following the Guillemin criteria. The Moroccan version of the WOMAC was administered twice during a 24-48 h interval to 71 Moroccan patients with symptomatic knee osteoarthritis, fulfilling the revised criteria of the American College of Rheumatology. The test-retest reliability was assessed using intra-class correlation coefficient, and the Bland and Altman method. Internal consistency was assessed by Cronbach's alpha coefficient. Construct validity was tested by correlating the WOMAC subscales with visual analogic scale (VAS) of pain, VAS of handicap, maximum distance walked and clinical characteristics. The Moroccan version of the WOMAC showed good reliability, with ICC values of the three dimensions: pain, stiffness and physical function being 0.80, 0.77 and 0.89, respectively. Bland and Altman analysis showed that means of differences did not differ significantly from 0 and that no systematic trend was observed. Internal consistency with Cronbach's alpha for pain was found to be 0.76, and its equivalents for stiffness and physical function subscales were evaluated at 0.76, 0.90, respectively. Construct validity showed statistically significant correlation with all WOMAC subscales and VAS of pain (rho=0.38, 0.42, 0.63 respectively, P<0.01). Correlation between VAS handicap (rho=0.38 P<0.001) and maximum distance walked (rho=-0.40, P<0.01) was observed with physical function subscale. There was no correlation between age, duration of disease, BMI and severity of pain and physical function in knee OA. The Moroccan version of the WOMAC is a comprehensible, reliable, and valid instrument to measure outcome in patients with knee OA.
Full-text available · Article · May 2008 · Rheumatology International
[Show abstract][Hide abstract]ABSTRACT: The goal of this study was to determine the impact of ankylosing spondylitis (AS) on the socioeconomic well-being of Moroccan patients. One hundred (100) consecutive AS patients (71 men, 29 women) were included. The socioeconomic consequences were studied by measuring direct costs, indirect costs (consequences on work capacity), and intangible costs (social impact) of AS. The mean age at AS onset was 26.85 years +/- 11.71 (7-64). The mean disease duration of AS was 12.05 years +/- 8.32 (0.5-39). Financial difficulties due to AS were observed in 82% of the patients. In 28% of them, these conditions explained a bad observance to treatments. In 14% of the cases, they led children to leave school to support their handicapped parents. Work disability occurred in 22.9% of initially employed patients. Withdrawal from work was correlated to bad social conditions at work, higher scores of Bath ankylosing spondylitis functional index (BASFI), and absence of adherence to a social security system. Sexual problems were present in 64.2% of the patients and were correlated to higher scores of BASFI. There were also disturbances in housekeeping (65.8%) and in leisure time activities (72.2%). Patients received a financial and a psychological familial support in, respectively, 66 and 87% of the cases. Despite the great familial support, Moroccan AS patients suffer from important socioeconomic consequences because of the illness, the bad socioeconomic conditions, the insufficiency of state help, and the social security problems.
Full-text available · Article · Jan 2008 · Clinical Rheumatology
[Show abstract][Hide abstract]ABSTRACT: Unlabelled:
Progressive pseudorheumatoid dysplasia is an inherited skeletal dysplasia with autosomal recessive transmission. Radiographs of the spine show abnormalities similar to those seen in spondyloepiphyseal dysplasia tarda. The clinical presentation, but not the imaging study findings, suggest juvenile idiopathic arthritis. We report 3 cases of progressive pseudorheumatoid dysplasia in the same family.
A 4-year-old girl had been receiving follow-up for 3 years for seronegative, polyarticular juvenile idiopathic arthritis progressing by flares and remissions. The disease was unresponsive to anti-inflammatory medications. Findings at admission included inflammatory joint pain, joint swelling, range-of-motion limitation, and joint deformities in the hands, wrists, ankles, and knees. The hips were normal. Normal values were found for the erythrocyte sedimentation rate and C-reactive protein level. Synovial fluid removed from one of the knees exhibited mechanical properties. Plain radiographs of the hands and forefeet showed no evidence of joint destruction. Bilateral hip dysplasia was noted on a radiograph of the pelvis. The diagnosis of juvenile idiopathic arthritis was reconsidered. A study of the family identified two similar cases, in a brother and paternal uncle. The brother, who was 14 years old, had similar manifestations without laboratory evidence of inflammation; radiographs disclosed dysplasia of the hips and metacarpophalangeal epiphyses. Manifestations in a paternal uncle consisted of spinal stiffness, thoracic kyphosis, and motion-range limitation at the hips; radiographs showed normal sacroiliac joints and bilateral hip dysplasia. A diagnosis of progressive pseudorheumatoid dysplasia with polyarticular involvement was given.
Progressive pseudorheumatoid dysplasia is an autosomal recessive disease characterized by abnormal cartilage homeostasis. It should be included among the differential diagnoses of juvenile idiopathic arthritis.
Full-text available · Article · Aug 2007 · Joint, bone, spine: revue du rhumatisme
[Show abstract][Hide abstract]ABSTRACT: Cross-cultural adaptation and cross-sectional psychometric testing.
To translate and culturally adapt the Moroccan version of the Roland Morris Disability Questionnaire and to validate its use for assessing disability in Moroccan patients with low back pain (LBP).
The RMDQ is a reliable evaluation instrument for LBP disability, but no validated Moroccan version is available.
The RMDQ was translated and back-translated to dialectal Arabic, pretested, and reviewed by a committee following the Guillemin criteria. It was then validated on 76 Moroccan patients with chronic LBP. Reliability for the 1-week test-retest was assessed using internal consistency by Cronbach's alpha coefficient, the intraclass correlation coefficient, and the constructed Bland Altman plot. Structure validity was evaluated by multiple correspondence analysis. External construct validity was assessed by association with pain, spinal mobility, and other key variables (weight, height, duration of LBP).
The reproducibility of the 24 items was satisfactory with a kappa statistic of agreement superior to 0.6 except item 10 and ranging from 0.47 to 0.9. The intraclass correlation coefficient for global score reproducibility was good and reached 0.93 (95% confidence interval, 0.89-0.95). The constructed Bland and Altman plot for test-retest agreement showed a good reliability. The internal consistency was very good with a Cronbach's alpha coefficient of 0.96. The multiple correspondence analysis for internal structure validity showed a preponderant factor explaining 22% of the variance in the score. The construct validity showed a positive correlation between RMDQ and the visual analog scale (r = 0.32; P = 0.005). There was no statistic correlation between RMDQ and the other variables.
The Moroccan version of the RMDQ has good comprehensibility internal consistency, reliability, and validity for the evaluation of Moroccan-speaking patients with LBP.
[Show abstract][Hide abstract]ABSTRACT: La dysplasie progressive pseudorhumatoïde est une dysplasie squelettique héréditaire autosomique récessive. Elle est caractérisée par des modifications radiologiques du rachis similaires à la dysplasie spondyloépiphysaire tardive avec un tableau clinique mais, non radiologique, évocateur d'une arthrite juvénile idiopathique. Nous présentons trois cas d'une même famille ayant une dysplasie progressive pseudorhumatoïde.
Une enfant, âgée de quatre ans, est suivie depuis trois ans pour une arthrite juvénile idiopathique dans sa forme polyarticulaire séronégative, évoluant par poussée rémission, sans réponse aux traitements antiinflammatoires. À son admission, elle présentait des arthralgies inflammatoires avec tuméfactions, limitations et déformations articulaires touchant les mains, les poignets, les chevilles et les genoux. Les hanches étaient libres. La vitesse de sédimentation et la protéine C réactive étaient normales. La ponction articulaire du genou montrait un liquide mécanique. Les radiographies standards des mains et des avants pieds ne montraient pas de destruction articulaire. La radiographie du bassin montrait une dysplasie des hanches. Le diagnostic d'arthrite juvénile idiopathique a été reconsidéré. L'enquête familiale a trouvé deux cas similaires : le frère aîné, âgé de 14 ans, présentait un tableau similaire avec absence de syndrome inflammatoire et une dysplasie des hanches et des épiphyses métacarpophalangiennes ; l'oncle paternel présentait une raideur rachidienne avec cyphose dorsale et limitation des hanches. Les radiographies montraient des sacro-iliaques normales et une dysplasie des hanches. Le diagnostic retenu était celui d'une dysplasie progressive pseudorhumatoïde avec polyarthropathie.
La dysplasie progressive pseudorhumatoïde est une maladie génétique autosomique récessive avec une anomalie de l'homéostasie du cartilage. Elle constitue un diagnostic différentiel de l'arthrite juvénile idiopathique.
Full-text available · Article · Jul 2007 · Revue du Rhumatisme
[Show abstract][Hide abstract]ABSTRACT: Osteochondroma, or exostosis, is the most common of all benign bone tumors. Spinal osteochondromas are uncommon but may cause neurological compromise. We report two cases of spinal cord compression by osteochondromas. One patient was a 17-year-old man with hereditary multiple exostoses who was presented with spastic paraparesis, a sensory level at T3-T4, and a pyramidal syndrome. Vertebral exostosis was suspected by magnetic resonance imaging and confirmed by histological examination. Surgical decompression was followed by complete resolution of the neurological impairments. The other patient was a 19-year-old man with spastic paralysis of the right lower limb and a pyramidal syndrome. Whereas magnetic resonance imaging suggested a neurofibroma, histological features were those of osteochondroma. Nine months elapsed from symptom onset to surgery. This delay led to residual neurological impairments, which resolved almost completely after rehabilitation therapy. Vertebral osteochondromas contribute only 1.3-4.1% of all osteochondromas. The lesion may be solitary or a manifestation of hereditary multiple exostosis. Magnetic resonance imaging shows the exact location of the lesion, most notably with relation to neighboring neurological structures. Spinal cord compression is uncommon and usually has a favorable outcome provided surgical decompression is performed before major neurological damage develops.
Full-text available · Article · Apr 2005 · Joint Bone Spine
[Show abstract][Hide abstract]ABSTRACT: Osteochondroma, or exostosis, is the most common of all benign bone tumors. Spinal osteochondromas are uncommon but may cause neurological compromise. We report two cases of spinal cord compression by osteochondromas.Observation no 1. – One patient was a 17-year-old man with hereditary multiple exostoses who presented with spastic paraparesis, a sensory level at T3–T4, and a pyramidal syndrome. Vertebral exostosis was suspected by magnetic resonance imaging and confirmed by histological examination. Surgical decompression was followed by complete resolution of the neurological impairments.Observation no 2. – The other patient was a 19-year-old man with spastic paralysis of the right lower limb and a pyramidal syndrome. Whereas magnetic resonance imaging suggested a neurofibroma, histological features were those of osteochondroma. Nine months elapsed from symptom onset to surgery. This delay led to residual neurological impairments, which resolved almost completely after rehabilitation therapy. Vertebral osteochondromas contribute only 1.3 to 4.1% of all osteochondromas. The lesion may be solitary or a manifestation of hereditary multiple exostosis. Magnetic resonance imaging shows the exact location of the lesion, most notably with relation to neighboring neurological structures. Spinal cord compression is uncommon and usually has a favorable outcome provided surgical decompression is performed before major neurological damage develops.
Full-text available · Article · Mar 2005 · Revue du Rhumatisme
[Show abstract][Hide abstract]ABSTRACT: We report 12 cases of Behçet's disease (BD) in children. The mean age of symptom onset was 12.4 years. Four patients (33.3%) had a past familial history of BD. Clinical manifestations were: oral aphtosis (n = 12), genital aphtosis (n = 9), ocular involvement (n = 9), neuro-Behçet (n = 6), venous thrombosis (n = 4), articular involvement (n = 3), and entero-Behçet (n = 1). All patients but one were initially treated with steroids; three cases with ocular involvement were treated with chlorambucil; and three other cases of neuro-Behçet were treated with cyclophosphamide. After a mean follow-up of 4 years, four patients with neurological involvement developed steroid-dependence with recurrence of symptoms. Four patients had optic atrophy with blindness.
Article · Jan 2004 · Scandinavian Journal of Rheumatology
[Show abstract][Hide abstract]ABSTRACT: Acroosteolysis is characterized by bone resorption in the fingers and toes and can occur in several diseases. Phalangeal acroosteolysis is a rare idiopathic form. We report a case in a 13-year-old girl with a 2-year history of swelling and skin ulcers of the second and third left fingers and second right finger. The fingers were abnormally short and the nails were hypertrophic. Roentgenograms disclosed terminal phalangeal resorption in the fingers and toes. Findings were normal from tests for inflammation and dysimmunity. Biopsies of the skin lesions showed fibrosis without inflammation. Neurological evaluation and electromyographic study were normal. Serological tests for syphilis were negative. Calcium and phosphate levels in blood and urine were normal. A diagnosis of idiopathic phalangeal acroosteolysis (Joseph and Shinz disease) was given. This inherited form of acroosteolysis is transmitted on an autosomal dominant or recessive basis. It affects the tips of the distal phalanges of the fingers and toes but occasionally spreads to other bones.
Full-text available · Article · Apr 2003 · Joint Bone Spine
[Show abstract][Hide abstract]ABSTRACT: Acro-osteolysis is characterized by bone resorption in hands and feet. It may be caused by several diseases. Joseph and Shinz or phalangeal acro-osteolysis is a rare idiopathic form, we report one probable case.Case report. – F.J., 13 years old has presented two years ago a swelling and ulceration of the second and the third left fingers and the second right finger. Physical exam showed short fingers and hypertrophic nails without any other associated abnormalities. X-rays showed terminal phalanges resorption in hands and feet. Inflammatory and immunological laboratory investigations were normal. Lesions biopsy showed skin fibrosis without inflammatory signs. Neurological exam and the electromyographic study were normal. Syphilis serology was negative and the phosphorus/calcium balance studies were normal. The probable diagnosis was Joseph and Shinz or phalangeal idiopathic acro-osteolysis.Discussion. – Joseph and Shinz or phalangeal acro-osteolysis is an hereditery form of acro-osteolysis with autosomal dominant or recessive transmission. It affects distal extremities of last phalanges of hands and feet, but may progress to other bones.
Full-text available · Article · Mar 2003 · Revue du Rhumatisme
[Show abstract][Hide abstract]ABSTRACT: The bones and joints are the fourth most common target of tuberculosis in Morocco. Objective: to review the diagnostic aspects of osteoarticular tuberculosis (OATB), particularly in extraspinal locations, in rheumatology patients. Patients and methods. retrospective study in patients managed between 1980 and 1994 for OATB diagnosed based on positive cultures, positive histology, and/or a combination of highly suggestive features. Results: 120 cases of OATB were identified, 76 women and 44 men, with a mean age of 43+/-17 years. Twenty-three per cent of patients reported contact with a tuberculosis patient and 10% a history of tuberculosis. Precipitating factors included trauma (10.6%) and glucocorticoid therapy (12.5%). The number of foci was one in 76% of cases, two in 18.3%, and more than two in 5.7%, yielding a total of 159 foci in the 120 patients. Sixty-five patients had extraspinal involvement consisting in arthritis (73 foci), osteitis (six foci), and tenosynovitis (two foci). The knee was the most commonly affected joint (43 foci), followed by the hips (8 foci), the sacroiliac joints (8 foci), the feet (7 foci), the shoulders (2 foci), the elbows (2 foci), and the wrist, pubis, and sternoclavicular joint (one focus each). The sedimentation rate was elevated to more than 50 mm/h in 61% of patients with extra-spinal OATB and was normal in 10.7%. The intra-dermal tuberculin test was negative in 15.5% of patients with extraspinal OATB. In this group, the diagnosis was based on examination of specimens from the extraarticular focus in 46 cases or from another focus in 11 cases; in the remaining eight patients, the diagnosis was made based on a combination of highly suggestive features. All patients were given at least three antituberculous agents for at least six months. Discussion: our data suggest that the frequency of tuberculosis is decreasing at the hip and increasing at the knee, and that tuberculous osteitis remains uncommon. Diagnostic pitfalls in extraspinal OATB are discussed and the results of the present study are compared to previously published data.
Article · Oct 1999 · La Semaine des hôpitaux de Paris