[Takaysu's arteritis in Tunisia: a monocentric study of 11 patients]

Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. To assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. This retrospective study analyzed 11 patients with Takayasu arteritis between 1999 and 2010 who met the criteria for inclusion proposed by the American College of Rheumatology [ACR]. The file review identified 11 women, with a mean age at diagnosis of 29.1 years [range: 17-50 years]. Our series included involvement of the aortic arch and its branches in 8 cases, while only 3 cases of the abdominal aorta. Arterial hypertension due to stenosis of the renal arteries was noted in 4 cases. Aortic insufficiency and pulmonary hypertension were noted in one case. In all, 3 patients had type I disease, 3 type V and one type IV. In all, 4 patients had glucocorticoid treatment, and one needed immunosuppressive therapy. Three patients required surgical intervention. Our patients were followed for a mean period of 67.5 months. Disease remained stable in all patients. Despite the small number of our patients, the clinical manifestations, angiographic data and course in our study were similar to those in other reported series

Health-related quality of life assessment on 100 tunisian patients with ankylosing spondylitis using the sf-36 survey

The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis [AS] compared with the general population and the secondary objective [in the AS group] was to study the association between health status, demographic parameters, and specific disease instruments in AS. A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and diseasespecific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF- 36 health questionnaire. This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level [p=0.01]. Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI. Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life

[Rheumatoid arthritis in the elderly: ten cases report]

The occurrence of rheumatoid arthritis [RA] in elderly is frequent. If the reality of a real difference in clinical presentation between younger and older subjects is discussed, the central point remains that the prognosis is not better for the elderly. Finally, conventional treatment is as effective and safe as in younger patients, and the same stringent targets for management of the PR used for young subjects must be applied in the elderly. To identify the characteristics of RA in the elderly in its epidemiological, clinical, radiological, evolutive and therapeutic. We conducted a retrospective study of RA in the elderly aged 65 and over, we've compiled ten cases hospitalized over a period of 4 1/2 years in the service of Internal Medicine, Habib Thameur Hospital [Tunis]. There were 8 women and 2 men. The average age was 70.6 years. The onset of arthritis and the disease was progressive in seven cases. An inflammatory syndrome was present in seven cases. Rheumatoid factor was positive in eight cases. Five patients were classified as stage III and IV according to the radiological classification of Steinbrocker. The treatment was based on painkillers and anti-inflammatory drugs in all cases. Long-term treatment was initiated in seven patients. The outcome was favorable in all cases. Late-onset RA is a heterogeneous framework in which multiple clinical forms deserve to be individualized and should reflect this diversity, rather than approach to the problem of global RA after 60 years

[Special features of systemic sclerosis in men]

Systemic sclerosis [SS] is a generalized disorder of connective tissue and microvasculature characterized by tissue fibrosis and obliteration of the vessels. Several features of systemic scleroderma in men are discussed in the literature. To investigate the initial clinical features, evolution and prognosis of systemic sclerosis in men. patients with systemic sclerosis based on ACR's criteria were included. In this retrospective study we compared a cohort of men to a cohort of women, diagnosed between 2000 and 2010 in department of internal medicine. Fifty four patients were included amongst which nine men. The mean follow-up duration was 39.5 months. A higher proportion of cardiac, renal and lung involvement were noted at diagnosis. Localized cutaneous sclerosis was predominant in men. This work has highlighted several features of systemic sclerosis encountered in men. These results warrant confirmation by analyzing a larger population

[Validation of the Tunisian versions of bath ankylosing spondylitis functional index [BASFI] and disease activity index [BASDAI]]

The Bath Ankylosing Spondylitis Functional Index [BASFI] and the Bath Ankylosing Spondylitis Disease Activity [BASDAI] are the most commonly used instruments to evaluate respectively functioning and disease activity in ankylosing spondylitis [AS]. The aim of this study was to translate, adapt and validate these instruments into the Tunisian language. The studied population consisted of 68 AS patients [59 males and 9 females]. Their mean age was 37.9 years [range: 18-76]. The mean disease duration was 13.6 years [range: 1-40].After translation and retranslation the BASFI and BASDAI questionnaires were administrated to the patients and tested for reliability, internal consistency and construct validity. The reproducibility of the indices BASFI and BASFAI was good, the intraclass correlation coefficient for reliability was 0.96 [CCI: 0.93-0.97] for the BASFI and 0.93 [CCI: 0.90 -0.97] for the BASDAI, and the coefficient of internal consistency [Cronbach's alpha] was 0.91 for BASFI and 0.90 for BASDAI. Concerning construct validity, both questionnaires were significantly correlated to each other, to the disease-specific instruments [BASG-s, BASMI, BASRI, ASQoL] and to all domains of the SF-36. The Tunisian versions of the BASFI and the BASDAI preserve the metrological properties of the original versions and were easy to use for the assessment of disease status in ankylosing spondylitis

[Benign osteoporotic vertebral fracture due to compression of the spinal cord?]

A neurologic compromise associated with vertebral fractures is generally due to a malignancy causes. Therefore, an osteoporotic vertebral fracture can sometimes cause neurologic complications. Report a case of neurologic compromise associated with osteoporotic vertebral fractures. A-62-year-old man suffered from rheumatoid arthritis since 1985, presented a cervical pain associated with quadriparesia secondary to a C5 osteoporotic vertebral fractures. Osteonecrosis may be the cause of neurologic compromise associated with osteoporotic vertebral fractures

[Arterial involvement in Behcet's disease: a series of 7 cases]

Arterial involvement is rarely described in Behcet disease BD and it is associated with poor prognosis. We report our experience with a rare and interesting subset of Behcet disease patients with arterial involvement: thrombosis and aneurysm formation types of angio-BD. From 1994 to 2008, seven cases of arterial BD with 3 aneurysm formation and 4 thrombosis were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. Combination of venous and arterial manifestations occurred in 4 patients. All patients were male and the mean age when arterial involvement manifested was diagnosed was about 39.3. The artery most often affected is the aorta followed by the pulmonary arteries. Brain infraction occurred in about 4 cases. Pericarditis and neurological symptoms were more frequently noted in patients with arterial BD than others without vasculo-Behcet disease. All patients underwent corticosteroids and immunosuppressive therapy. Two patients were successfully operated for aneurysms. All patients were alive after a mean of 7.8 years fo11owup, Arterial involvement is more frequently noted in vasculo-Behcet than venous thrombosis and it's associated with a high morbidity and mortality rate

Magnetic resonance imaging evaluation of the cervical spine in patients with rheumatoid arthriris. report of 30 cases

To investigate by magnetic resonance [ME] imaging the occurence of cervical spine [CS] involvement in rheumatoid arthritis [RA] patients. Thirty consecutive unselected patients, who fulfilled the revised American College of rheumatology criteria for RA, Were investigated. All patients had a complete physical and laboratory evaluation. Radiological evaluation included hand and wrist x-rays, as well as CS radiographs in anteroposterior, lateral and lateral in full flexion views. In addition, MR [Spin Echo T2-weighted saggital scans, palm and contrast enhanced Ti-weighted sagittal and axial scans] was performed in all patients. Hand x-rays were evaluated according to the Sharp score. Disease activity was assessed by disease activity score for 28 joint indices [DAS-28]. There were 25 females and 5 males with a mean age of 46.6 years [23-67] and mean disease duration 9years [1-22]. Twenty three patients [76.6%] had positive 1gM rheumatoid factor [RF]. five patients presented clinical findings, mainly cervical pain and stiffness of CS [four with positive and one with negative MR],while radiological findings of CS involvement were found in seven patients [23%]. Five patients [16.6%] presented MR findings of CS involvement [anterior atlantoaxial subluxation 100%; vertical subluxation 20%; peridental pannus 80%; dens erosion 40%; brainstem compression 20%]. Atlantoaxial subluxation correlated with high DAS-28, high level of swellen joint, high level of Cr‚acitve protein and advanced erosive changes of the wrist and hand [high level of Sharp score] in the univariate analysis. We conclude that the frequency of CS involvement in RA patients is high. In pateints with active erosive peripheral disease it is very probable to also have some changes in CS. These may be clinically important and in such cases, MR offer valuable information

[Venous involvement in behcet's disease: a series of 28 cases]

Venous involvement is a rare and severe clinical feature in Behcet disease [ED]. We reported our experience with a rare and interesting subset of ED patients with venous involvement. From 1994 to 2008, twenty eight eases of venous ED were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. 45 episodes of venous thrombosis occurred in 28 patients. There were 25 men and 3 women the mean age when venous involvement manifested was diagnosed was about 32.25. Venous thrombosis occur in the first five years following the diagnosis of BD. Pericarditis was more frequently noted in patients with venous ED than others without vasculo-Behcet disease. In contrast digestive and rheumatologic symptoms were more likely observed in patients without vasculo-l3ehcet disease. Thirteen patients underwent corticosteroids. Relapses occurred more frequently in patients without corticosteroid therapy. Venous involvement is more frequently noted in vasculo-Behcet than arterial involvement. Its treatment should include anticoagulation in association with corticosteroids

leflunomide [Arava] dans le traitement de la polyarthrite rhumatoide

The aim of this study was to assess the effect and safety of leflunomide [LEF] in refractory RA and to review the literature on this subject. A one year prospective study was conducted on a group of patients [n: 15]. Mean duration of the disease was 6,46 years. Rheumatoid factor was present in 12 cases. Leflunomide was administered at a dos of 20mg/day following a loading dose of 100mg/day for three days. The efficacy of LEF was evaluated on clinical and biological parameters of RA evolutivity at one, 3,6,9 and 12 months. Our mean follow up period was about 8 months [2 to 12 months]. Good prognostic indicators of disease progression were observed with LEF at one month and later in eleven cases with a good safety. Non serious adverse events were observed with LEF. Our results confirm that LEF may present another therapeutic choice that is efficacious for the long term treatment of refractory RA. Nonetheless, these results must be evaluated on a larger series

modulateurs du TNF alpha dans le traitement de la polyarthrite rhymatoide

Current slow-acting anti-rheumatic drugs available at now for rheumatoid arthritis fail in majority of cases and have an inconstant chondro-protective effect. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made possible to develop selective immunotherapy approaches. Tumor necrosis factor alfa [TNF alfa] is an important inflammatory mediator that play a crucial role in rheumatoid arthritis. This studies summarizes clinical essays that evaluate beneficial effects and tolerance of anti TNF alfa antibodies. This study showed the clinical, biological and radiological efficacy of these therapeutic agents. But some doubts persist concerning their long term side effects particularly infections, neoplasm or auto immune ones. High price of this treatment should evaluate report cost benefice to appreciate the better utilisation of these drugs

atteinte cardiaque au cours des spondylarthropathies

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic reguragitation an conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy [responded to Amor criteria] in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolue for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spodylartropathy: psoriasic rheumatism [12 cases], inflammatory bowel disease: crohn's disease [4 cases], RCH [three cases] and fiessenger le Roy-reiter syndrom in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest trans-thoracic echographi, Holter rhythmic done in five cases only. Cardiac involvement is found in five cases [10%]: aortic regurgitation in 3 cases [6%] and mitral regurgitation in 2 cases [4%]. These valvular disease are well tolerated