Tunis Jewish Hospital

Spondyloarthritis (SA) can directly affect sleep quality via stiffness, night-time pain, and deformation. The objective of this study was to determine the prevalence of sleep disturbances in patient with (SA) and their associated factors. We conducted a cross-sectional study including patients with SA. Disease activity was assessed by using the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The functional state was evaluated by using the Bath Ankylosing Spondylitis Functional Index (BASFI). Sleep quality was examined by using the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) covering the month preceding the evaluation. Participants were considered poor sleepers if their PSQI total score was>5. There were 43 patients. The mean age was 44.09 ±11.87 years. The mean scores of ASDAScrp, BASDAI, and BASFI were 2.7±1.53, 3.7±1.94, and 3.71±3, respectively. The mean sleep duration was 6.19 hours/night. The mean percentage of sleep efficiency per night was 79%. The median sleep latency was 30 minutes. Participants judged sleep quality to be: very bad (21%, n = 9), bad (12%, n = 5), good: (35%, n = 15), and very good (33%, n = 14). Daytime dysfunction was altered in five patients and only two patients used hypnotics. The prevalence of poor sleep was 58.1%, and the mean total PSQI score was 7.19. Age and age of diagnosis were more advanced within poor sleepers (age: 39.61 vs 47.32 years, p = 0.034), (age of diagnosis: 31.33 vs 38.83 years, p = 0.015). A positive correlation was observed between the total PSQI score and the following variables: age (r = 0.483, p = 0.001), age of diagnosis (r = 0.444, p = 0.003), BASDAI (r = 0.441, p = 0.004), and BASFI (r = 0.438, p = 0.004). Sleep duration was negatively correlated with age (r=-0.614, p < 10-3), age of diagnosis (r=-0.402,p=0.008), and BASFI (r=-0.381, p = 0.014). Our study showed that more than half of our patients presented impaired sleep quality. Our results highlight the connection between sleep disturbances and spondyloarthritis variables, emphasizing the importance of screening for sleep decay in this population. M. Slouma: None. M. Dhifallah: None. I. Gharsallah: None.

Osteoarticular involvement is the most common manifestation of focal brucellosis. Spinal involvement represents the most severe form. Our objective was to describe the radiological presentation of brucellar spondylodiscitis. We retrospectively collected data from 12 patients diagnosed with brucellar spondylodiscitis in a rheumatology department over 7 years [2016-2023]. The diagnosis of brucellosis was established based on clinical findings, magnetic resonance imaging (MRI) findings, identification of Brucella species in blood cultures or disco-vertebral biopsy, and/or positive Wright serology. Among 80 Patients with spondylodiscitis, brucella was diagnosed in 12 cases (15%). There were 6 women and 6 men with a median age of 59,75±13,97 years. Six patients reported the consumption of unpasteurized dairy products. The mean duration of symptom evolution was 2.85 ± 1.65 months. Patients predominantly complained of inflammatory back pain (83%), fever (83%), and profuse night sweats (42%). The spondylodiscitis affected the lumbar, dorsal, and cervical regions in 2, 4, and 4 patients, respectively. Two patients had multifocal involvement: 1 in the cervico-lumbar region and 1 in the dorso-lumbar region. Shoulder involvement was seen in another patient. Wright’s test was positive in 10 patients. Plain radiographs revealed disc space narrowing (n = 9, 75%), vertebral endplate irregularities (n = 7, 58%), erosions (n = 5, 41%), and vertebral collapse (n = 3, 25%). Bone spurs were seen in 2 patients (17%). Computed tomography (CT) scans performed in 10 patients showed disc space narrowing in 80%, erosions of adjacent endplates in 40%, and paravertebral soft tissue abscesses in 40%. MRI performed in 10 cases revealed abnormal signal intensity of the disc and adjacent endplates in all patients, erosions in 3, intracanalicular abscess in 5, paravertebral abscess in 5, epidural collection in 5 and spinal cord compression in 4. Brucellar spondylodiscitis represented 18% of infectious spondylodiscitis. The most affected regions in our series were cervical and dorsal regions contrasting with literature findings. The discretion of vertebral destruction and late constructive signs can provide clues for diagnosis. A comprehensive assessment of the complete clinical context, combined with laboratory findings, contributes significantly to establishing the diagnosis. M. Dhifallah: None. M. Slouma: None. R. Battikh: None. I. Gharsallah: None.

INTRODUCTION:Posttraumatic spondylodiscitis is an uncommon but serious complication of spinal trauma. It may lead to severe neurological impairment and systemic infection. Retropharyngeal abscess (RPA), typically associated with upper respiratory infections, is rarely reported as a complication of nontuberculous spondylodiscitis, especially in the context of cervical trauma. This rare association poses a dual threat: airway obstruction and spinal cord compression. Our work aimed to report a rare case of posttraumatic, nontuberculous cervical spondylodiscitis complicated by an RPA, leading to both respiratory and neurological compromise, and to highlight the importance of early multidisciplinary management. OBSERVATION:We present the case of a 45- year-old male with posttraumatic dorsal and cervical spondylitis following a road traffic accident. He developed progressive paraplegia and respiratory distress. Imaging revealed multilevel vertebral involvement with spinal cord compression and an RPA. The first transoral drainage was ineffective, and the recurrence within 48 hours necessitated a second external surgical approach. Cultures identified methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae. Broad-spectrum antibiotics and intensive care management led to gradual improvement. CONCLUSION:This case underlines the complexity and severity of posttraumatic spondylodiscitis with RPA. Prompt diagnosis and a multidisciplinary therapeutic strategy are vital to prevent life-threatening complications and improve patient outcomes.

Several studies have shown that spondyloarthritis (SpA) by itself may be a risk factor for decreased bone mineral density (BMD). Our study aimed to assess the decline in BMD in patients with SpA and to identify factors associated with this decrease in BMD. We conducted a cross-sectional study including 112 patients with SpA according to the ASAS criteria. Patients with conditions or treatments that could induce osteoporosis were excluded. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Mobility was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI). BMD was evaluated using dual-energy X-ray absorptiometry (DXA) at both the femoral and lumbar sites. Osteoporosis as T-score≤2.5DS and osteopenia between -1 and -2.5DS. Our study included 112 patients. The average age was 46.12±12.16 years, with a male-to-female ratio of 2.29. The median age at diagnosis was 38 years. The average disease duration was 12.16 years. The average body mass index (BMI) was 24.8 ± 4.39 kg/m², with 36.5% of patients being overweight or obese. The mean values for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 46.12 ± 12.16 mm and 28.42 ± 39.27 mg/L, respectively. The respective mean scores for BASDAI, ASDAScrp, and BASMI were 3.99 ± 1.93, 2.93 ± 1.27, and 2.63 ± 2.42. The mean BMD was 1.023 ± 0.530g/cm² at the lumbar site and 0.945 ± 0.149g/cm² at the femoral site. Osteoporosis and osteopenia were found in 30.4% and 27.7% of cases, respectively. A decrease in BMD was observed in 48% of cases at the lumbar site and in 35% of cases at the femoral site. Patients with low BMD (osteoporosis and osteopenia) had a lower BMI (23.71vs26.35 kg/m² p = 0.002). BASMI was negatively correlated with femoral BMD (r = -0.363, p = 0.001) and femoral T-score (r=-0.418, p = 0.001). No associations were noted between the decline in BMD and gender (p = 0.8), smoking (p = 0.246). Our study has shown that a decrease in BMD is common in patients with SpA. Limited axial mobility appears to be associated with the decline in BMD. Additionally, as demonstrated in postmenopausal osteoporosis, a lower BMI was associated with a higher risk of decreased BMD. M. Slouma: None. M. Dhifallah: None. I. Gharsallah: None.

INTRODUCTION:Papillary thyroid microcarcinomas (PTMC) can exhibit invasive behavior with lymph node metastasis despite their small size. In some cases, they may present as cystic lymph node metastases, clinically and radiologically mimicking benign lesions such as branchial cleft cysts. These misleading presentations may delay the diagnosis of an underlying thyroid malignancy. We report a rare and atypical presentation of PTMC as a large contralateral cystic lymph node metastasis initially diagnosed as a branchial cleft cyst, highlighting the need to consider metastatic thyroid carcinoma in the differential diagnosis of lateral neck cysts. OBSERVATION:A 51-year-old woman presented with a left lateral cervical mass diagnosed as a second branchial cleft cyst. Surgical excision and histology revealed a metastatic lymph node from papillary thyroid carcinoma. Subsequent workup identified a 4 mm PTMC in the right thyroid lobe. The patient underwent total thyroidectomy, lymph node dissection, and radioactive iodine therapy. CONCLUSION:PTMC may behave aggressively and present with misleading cystic nodal metastases. Clinicians should include metastatic papillary thyroid carcinoma in the differential diagnosis of isolated cystic neck masses, even in the absence of an identifiable thyroid lesion on initial imaging.