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.

[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

Anti-CCP antibodies, rheumatoid factors and anti-keratin antibodies: clinical value in established rheumatoid arthritis

It is well documented that in early rheumatoid arthritis, anti-CCP antibodies have better diagnostic value than rheumatoid factors and anti-keratin antibodies. However, their role is less well defined in patients with established or long duration disease. To evaluate and to compare diagnostic performances of anti- CCP, anti-keratin, IgM and IgA rheumatoid factors in established rheumatoid arthritis. In a cross-sectional study, 90 patients with established rheumatoid arthritis and 100 controls were tested for these autoantibodies. The association of these markers with disease activity and severity was investigated. The sensitivity and specificity were calculated for each of four tests, using the clinical diagnosis as the gold standard. The anti-CCP and IgM rheumatoid factor exhibited the best diagnostic value. None of the tested antibodies had any significant association with the disease activity score [DAS28]. After adjustment by multiple linear regression, only anti-CCP positivity was found to be significantly associated with erosive disease. In long duration rheumatoid arthritis, anti-CCP and IgM rheumatoid factor have similar diagnostic value. However anti- CCP are useful in seronegative patients. They are also a reliable marker of severe erosive disease

[Thoracic outlet syndrome]

The thoracic outlet syndrome [TOS] is recognized as a cause of upper limb pain. It is often under-diagnosed and its frequency under-estimated by rheumatologists. To report the diagnostic problems related to TOC though a literature review A narrative review of literature. The diagnosis of TOS is difficult because of intricacy of vascular and neurological symptoms. It requires provocative tests, electrophysiological investigations and Doppler ultrasonography. A good anatomical knowledge is mandatory in order to clarify the mechanisms and the location of the lesions which depend on sophisticated imaging exams. It is also recommended to exclude all other causes of upper limb pain, as well as peripheral nerve compression syndromes, which can coexist with TOS. Diagnosis and treatment of the TOS involves rheumatologists, neurologists, physiatrists, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists who have to cooperate in order to prevent severe functional after-effects

[Morbidity of the elderly in impatient rheumatology clinic]

The improvement of life expectation in our country explains at least in part the increase of the proportion of the elderly in hospitalized patients. The aim of this study was to identify the main diseases leading to hospitalization of the aged in a rheumatology department, to establish their clinical profiles and to evaluate the quality of their management. Retrospective chart review about the elderly [age >/= 65 years] admitted in the rheumatology department of the Charles Nicolle Hospital during a 2-year-period [January 2003-December 2004]. Among the 831 patients admitted to our inpatient clinic during that period, 86 were 65-year-old or more representing 10% of the total. Mean age was 71.2 years [65-88]. The sex ratio was 1/3. A history of a mean of two associated diseases [0-5] was noted. They were dominated by hypertension [50%] and diabetes [26,7%]. Almost 1/3 of the elders had a surgical history. Gastro-intestinal troubles have been noted in only 19% of cases. The main cause of hospitalization was a diagnosis exploration [77,6%]. The remainings were admitted for therapeutic adjustment. The disease was evolving since in mean 16 months [15 days- 15 years]. The mean duration of hospitalization was 21,2 days [4-60]. The pathologies involved were varied dominated by degenerative rheumatisms [26,7%] with a predilection to lumbar spine, systemic diseases: 18 cases [20,9%] with 13 cases of rheumatoid arthritis, and malignant bone diseases [18,7%]. At least two rheumatic diseases were found together in 49 patients [57%]. The clinical findings were atypical in almost half cases [42,4%] in such aged patients. Besides drugs prescribed for non rheumatic diseases, our patients took a mean of 3.4 drugs [1-8] as symptomatic, adjuvant or etiologic treatment. The treatment observance was good in 74,4% of cases. Latrogenic incidents occurred in 14 cases [16,2%]. The outcome was favorable in 68,9% of cases. Twelve of our patients necessitated a third help. Half of our patients [54%] were controlled in our outpatient clinic 1-2 months after their issue. 12 have been hospitalized for the same disease, 8 deceased, and 19 have been lost. The management of the elderly patients in hospitalization must be multidisciplinary. It should take into account the clinical and therapeutic particularities of such a population. Prevention remains the best guarantee for a good quality of life and to decrease social and economic costs

Usefulness of videocapillaroscopy in clinical practice: systomatic review of indications and results in rheumatology and in non rheumatic disorders

Nailfold videocapillaroscopy [VCP] is nowadays worldwide considered as one of the best diagnostic noninvasive imaging technique able to study microcirculation in vivo. To review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases. Review of literature. The possibility of managing the imaging, by means of dedicated software able to characterize quantitative and qualitative data, represents another relevant property of VCP. This technique is very useful at the identification of microvascular involvement in many rheumatic diseases, particularly in systemic sclerosis and related disorders. At the same time, VCP has been showed valuable in many other extra-rheumatic diseases. The authors review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases