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Background: During its course, spondyloarthritis (SpA) may be associated with extra-articular manifestations affecting several organs. Renal involvement is one of the most common extra-articular manifestations and is dominated by secondary amyloidosis (AA), immunoglobulin A (IgA) nephropathy, and urolithiasis. Other nephropathies such as Focal segmental glomerulosclerosis and hyalinosis (FSGS) are less common and are limited to few case reports. Case: We report the case of a patient followed for axial SpA, who consulted, after being lost to follow-up for 3 years, for elevated blood pressure and edema of both lower limbs associated with an hydrocele and bilateral pleural effusion. Biological examinations showed hypoproteinemia, hypoalbuminemia, and proteinuria. In this context of nephrotic syndrome, the diagnosis of FSGS was confirmed by renal biopsy. Furthermore, the etiological investigation ruled out the causes of secondary FSGS. Conclusion: Renal involvement is a sign of severity in SpA. Its detection and management should be part of the overall management of SpA.

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BACKGROUND: The objective of the study was to assess clinical and imaging features of rheumatoid arthritis associated with atlantoaxial dislocation (RA-AAD) in comparison to RA without AAD (RA-C) and to identify the associated factors to AAD. METHODS: This was a retrospective comparative study including RA patients over 18 years old. The control group of RA-C was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, AAD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of AAD. RESULTS: A total of 120 patients were included (78 RA-AAD and 42 RA-C); sex-ratio was 0.15. Mean age was 58.55 ± 9.14 years (RA-AAD) versus 60.43 ± 10.78 years (RA-C), (p = 0.31). Regarding RA features, RA-AAD patients have significantly a higher rheumatoid factor (RF) rate (p = 0.002), extra-articular manifestations (p = 0.009) especially osteoporosis (p < 10-3 ), eye involvement (p = 0.02), coxitis (p < 0.0001), Disease Activity Score (DAS28) (p < 10-3 ), and global health status scale (HAQ) (p = 0.003). X-ray analysis showed pathologic PADI (<14 mm) in 51.6% of cases. The AADI was pathological (>3 mm) in 100% of patients with the following distribution: 67.9% between (3-6 mm) and 23.3% between (6-9 mm). Atlantoaxial dislocation (AAD) was presumed anterior (85.4%), lateral (7.3%) and rotatory (7.3%). The abnormalities observed on magnetic resonance imaging (MRI) were: C1-C2 synovitis (61%), confirmed AAD (34.1%) and basilar impression (4.9%). AAD diagnosed by cervical MRI was anterior in 89.8% of cases, lateral (5.3%) and with a double ascending and anterior component in 4.9% of cases. An immobilisation with a type C4 cervical collar was indicated for all the patients and five of them had boluses of corticosteroid (methylprednisolone 1 g/day) for three consecutive days. C1-C2 arthrodesis by trans-articular screwing was performed in four patients with neurological signs or pathological measurements on cervical MRI. The outcome was favourable in 100% of cases after surgical treatment with improvement in neck pain and neurological condition within a mean decline of 4 ± 3 years [1-7]. Multivariate analysis identified coxitis, osteoporosis, high baseline DAS28, and a high rate of RF positivity as predictive factors of AAD. CONCLUSION: Our results confirmed that predictive factors of AAD were related to higher disease activity and structural damage. These modifiable factors may be prevented by tight control, early treatment, and educating RA patients to improve treatment adherence.

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This is the case of a 50-year-old patient suffering from inflammatory low back pain. Radiological exploration showed posterior vertebral damage compatible with discovertebral pseudo-tumor tuberculosis. Pathological examination found no malignant cells, but caseous necrosis was present. The patient was put on antitubercular drugs. The evolution was favorable under treatement.

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BACKGROUND: Hip involvement is a life-changing event during spondyloarthritis (SpA) since it's responsible for significant disability and functional impairment. This study aimed to determine the factors associated with hip involvement in patients with SpA. METHODS: This was a retrospective study, including patients with axial and/or peripheral SpA divided into two groups: patients without and with hip involvement. Hip involvement was defined as pain or abnormality on clinical examination of the hip and/or on imaging. We collected clinical and laboratory data, activity and functional scores, and radiographic parameters. We conducted a multivariate analysis to identify the associated factors of hip involvement. RESULTS: We included 165 patients with a mean age of 46.13 ± 13.07 years, 121 patients were male. The mean duration of disease was 10.91 ± 6.94 years. Hip involvement, defined as SpA-related hip pain, joint limitation, and dysfunction and/or imaging involvement (X-ray/MRI), was noted in 60 cases (36.4%). Multivariate analysis indicated that disease duration over 10 years (OR=3.847, 95% confidence interval (CI95%)[1.324-11.178], p=0.013), radiographic sacroiliitis (OR=8.949, CI95%[1.261-63.513], p=0.028), very high disease activity (Ankylosing Spondylitis Disease Activity Score: ASDASCRP≥3,5) (OR=9.364, CI95%[2.552-34.352], p=0.001), higher Bath Ankylosing Spondylitis Functional Index (BASFI) (OR=1.439, CI95%[1.120-1.850], p=0.004) and higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (OR=1.311, CI95%[1.065-1.615], p=0.011) were independently associated with hip involvement in these patients. Regarding extra-articular features, we found that pulmonary involvement and osteoporosis were significantly more frequent in patients with hip involvement, but neither retained significance in multivariate analysis. CONCLUSION: Disease duration over 10 years, radiographic sacroiliitis, very high disease activity, functional impairment, and limited spine mobility were potential associated factors with hip involvement. Patients with these factors should be closely monitored to detect hip involvement at an early stage.

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