[Uncommon cervicobrachial neuralgia: about 17 cases]

Cervicobrachial neuralgia [CBN] is frequent in out patient clinic as well in general medicine as in rheumatology. Even though cervical disc degeneration and osteophytosis constitute the most frequent etiology of such a trouble, the practitioner must be aware of much more serious underlying cause. To investigate the epidemiology, clinical features, aetiologies and paraclinical characteristics of uncommon CBN. Retrospective chart review about 17 cases of uncommon CBN among the 84 cases of CBN hospitalized at the rheumatology department of the Charles Nicolle Hospital during a 16-years-period [1990-2005]. There were 11 men and 6 women with a mean age of 63 years [33y-81y]. All patients presented a CBN since in average five months [2 months- 24 months]. Neck stiffness was noted in 60% of cases and a neurological impairment in 47% of cases. X-ray radiographs of cervical spine were normal in five cases. In the remaining cases, they showed lytic images [six cases], disk space narrowing with vertebral erosions [two cases] and vertebral fracture [three cases]. Further investigations concluded that the CBN was due to a Pancoast'syndrome in five cases, an infectious spondylitis in three cases, cervical bone metastasis in two cases, a syringomyelia in two cases, a neuroma in one case, a thoracic outlet syndrome in one case and an erosive spondylarthropathy in a paatent presentig chronic renal failure managed by hemodialysis. In comparison with common CBN, our patients presenting symptomatic CBN were characterised by an inflammatory and refractory pain. The more frequent recourse to modern imaging is justified

[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

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

[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

[Osteomalacia and giant cell tumor: a rare case]

Oncogenic octeomalacia is an unusual and rare clinicopathologic syndrome characterized by mesenchymal tumors that apparently produce osteomalacia and biochemical abnormalities consisting of hypophosphatemia and normocalcemia. We have investigated the mechanism by which a giant cell tumor of bone caused biopsy-proved osteomalacia in a 50-year-old woman. A 50-year-old woman presented with generalized bone and pelvicrural pain, associated with fatiguability and muscle weakness. The diagnosis of osteomalacia was retained, associated with a giant cell tumor. The coexistence of giant cell tumor of bone and osteomalacia suggested the diagnosis of oncogenic osteomalacia. Resolution of the biochemical abnormalities of the syndrome after tumor resection, established this diagnosis. oncogenic osteomalacia can be a form of vitamin-D-refractory osteomalacia due to altered vitamin D3 metabolism

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