Neuropathic Pain in Patients with Sciatica: Prevalence and Related Factors.

Aim: To assess the prevalence of neuropathic pain (NP) in patients with sciatica and to determine the associated factors with increased incidence of neuropathic component in sciatica. Methods: A cross-sectional study enrolled 80 patients with sciatica from a rheumatology outpatient Hospital. Pain severity was measured us­ing the Visual Analogue Scale (VAS). The prevalence of NP was assessed according to the Douleur Neuropathique 4 (DN4). Statistical analysis was performed to find the factors closely related with NP. Results: A total of 70% of the participants were classified as having NP. The DN4 score≥4 was not significantly cor­related with VAS, but was significantly associated with gender (sex ratio=0.9; p=0,013), low educational level (p=0,008), illiteracy (p=0,012), chronic disease (p=0,019) and facet joint osteoarthritis (p=0,06). In multivariate logistic regression analysis, only chronicity of the disease remained an independent factor associated with NP in sciatica (OR=5,8). Conclusion: In the present study, NP was a major contributor to sciatica and the DN4 scale was a practical and rapidly administered screening tool for distinguishing the relative contributions of neuropathic component. The knowledge of the associated factors with NP in sciatica may improve the management of NP when these factors can be modified and targeted for treatment.

Osteoarticular tuberculosis dactylitis: four cases

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country

[Procedural pain assessment after spinal injections of corticosteroid]

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

[Obesity has a protective effect on radiographic joint damage in rheumatoid arthritis]

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 Questionnary [HAQ] and radiographic joint damage by the modified Sharp score. Obesity wasn't 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