[Usefulness of magnetic resonance imaging in the diagnosis of early rheumatoid arthritis: a prospective study about 20 cases]

Diagnosing early rheumatoid arthritis is difficult and radiographic signs are often late. MRI detects erosions at an early stage and visualizes synovitis, bone edema and tenosynovitis. To assess the value of MRI for diagnosis of early forms of rheumatoid arthritis. Prospective study involving 20 patients who had non erosive rheumatoid arthritis lasting for less than 2 years. MRI of the hand was performed by sequences coronal and axial T1-weighted, T2 with saturated fat signal [FatSat] FatSat and T1 with gadolinium injection. The median age of patients was 52 years and sex ratio M/F of 0.05. The median disease duration was 9 months. Ten patients had antibodies Anti-Cyclic citrullinated protein positive. The MRI was abnormal in 75% of patients. This review found 36 erosions which 50% were in carpal bones, 55 joints with synovitis mainly localized midcarpal and metacarpophalangeal. Bone edema was found mainly in carpal bones. Tenosynovitis affected most frequently the flexor tendons. Seventy percent of patients without anti-Cyclic citrullinated protein had a pathological MRI. MRI has an important role in detecting infraradiological lesions in early RA. This contributes to early diagnosis and initiation effective treatment

[Rheumatic manifestations of genetic hemochromatosis]

Rheumatic manifestations of genetic hemochromatosis are frequent with axial or peripheral arthropathies [mono-, oligo- or polyarticular]. These manifestations are characterized by articular damage and osteoporosis. To review the rheumatic manifestations of genetic hemochromatosis. A narrative review of literature. The diagnosis should be brought to mind when we discover arthropathy resembling degenerative joint disease with involvement of unusual articular sites, almost identical to the arthropathy in calcium pyrophosphate dihydrate crystals deposition disease [chondrocalcinosis]. There is a significant bone loss in HC that cannot solely be explained by hypogonadism or cirrhosis and must lead to measure bone mass density to each patient with HC

synovirthesis: a reappraisal

The evolution of the rheumatologic practice involved a handing-over in question of the place and methods of application of the synoviorthesis. The last innovations, in particular the appearance of the biotherapies, allowed a better control of inflammatory rheumatisms thus making it possible to better select arthritis likely to profit precociously from a synoviorthesis before the installation of major articular destruction. Through a general review of the literature, we recall in this work the various means of synoviorthesis, their current indications and their results. An extensive electronic search of the relevant literature was carried out using medline. Key words used for the final search were: synoviorthesis, osmical acid, radiosynoviorthesis, arthritis, traitment. this systematique review allowed us to conclude that fields of application of the synoviorthesis is in addition widens because of the interesting results to see spectacular this technique in some other affections such as the haemophilia. In addition we have compared the efficiency and the tolerance of the different methods of synoviorthesis. The synoviorthesis constitutes a tempting therapeutic alternative of share its effectiveness and its good tolerance so much so that it constitutes an undeniable factor of articular protection. Its fields of application widened. Thus on the good knowledge of the indications and the precautions necessary to its realization its success willdepend

[Osteopenia for patients with crohn diseas]

Osteoporosis and osteopenia are frequently reported during chronic inflammatory bowel diseases, particularly in Crohn disease [CD]. To determine the frequency of osteoporosis and osteopenia of patients with CD and to study associated risk factors. A forward-looking study was performed about 56 cases of CD, 34 men and 22 women, aged 32+10.4 years [18-54 years], with no other disorders affecting osseous metabolism. A biphotonic X-rays absorptiometry densitometry [DEXA] was performed at femoral neck and lumbar spine. A multivariate statistical analysis was performed to check for factors contribiuting in lowing osseous mineral density. Osteoporosis and osteopenia are noticed with respective frequency of 35.7%and 23.2%. A statistically significant association is found between low osseous density on one hand and physical mass index [IMC], localisation on large bowel of the disease and corticotherapy on the other hand. The IMC was a risk factor independant from the two other factors. Under nutrition, with IMC<18 kg/m c, was observed at 21 patients. It was associated to a pathological densitometry in 76.2%of cases, versus 48.6%in patients having an IMC>18 kg/m c [p=0.03, Odds ratio 3.4]. Among risk factors involved in the osteoporosis during CD, the nutritional status plays an important role which must be taken into account in the treatment of these patients

Rheumatoid arthritis: current status of therapy

Rheumatoid Arthritis [RA] is a frequent chronic inflammatory disease characterized by distal, bilateral and symmetrical lesions, leading to joint distortions and articular destructions. RA can also cause severe extra-articular manifestations associated with a poor prognosis. Recent advances in the field of immunopathology of RA have oriented treatment targeting the pro-inflammatory cytokines like tumor necrosis factor-a [TNF alpha], interleukin [IL]1 and IL6. These biotherapies are considered as an important therapeutic progress in the treatment of RA acting at the level of cellular processes responsible for rheumatoid disease. These new therapies are active not only in controlling the disease inflammatory processes but also to stop the radiological course of RA. These new therapies are however efficient as long as prescribed, their interruption being rapidly followed by a flare-up of RA. Multiple adverse events attributed to anti-TNF-alpha have been described especially severe opportunistic infections and tuberculosis. B cells playing a critical role in sustaining the chronic inflammatory process in RA, targeted depleting B cells therapies have been developed in refractory forms of RA giving promising results. However, before any biotherapy prescription especially of anti-TNF-alpha, an initial screening should be achieved to exclude patients with history of untreated tuberculosis, solid cancers, malignant hemopathies or demyelinating disorders. It is also essential to assure a strict follow-up in patients under biotherapy to detect adverse events that can be sometimes severe. Thus, the ratio benefit/risk must be evaluated before any biotherapy prescription

[Thyrotoxicosis revelated by bilaterel Hip fracture]

Hyperthyroidism is an important cause of secondary osteoporosis and therefore of fractures. Nevertheless, facing an osteoporotic fracture, we do not systematically seek after such thyroid disorder in our daily practice. In this purpose, we report the case of 73 year old women, presented with a bilateral pathological femoral neck fracture. Investigations find a hyperthyroid related osteoporosis. Beyond orthopaedic treatment, radioiodine and bisphosphonate drugs were prescribed

[Juvenile idiopathic arthritis and lyme disease: a case report]

Lyme disease is a systemic infection due to Borrelia burgdor-feri. Joint involvement in children, when primary phase is unknown, can be confounded with juvenile idiopathic arthri-tis. We report a case of a 16 years old girt. who developed at the age of 14 a bilateral and symetrical polyarthritis of big and small joints with fever and cutaneous eruption of trunk. No clinical improvement was seen under disease modified treatment. More biological investigations were performed. leading to the diagnosis of Lyme disease. Clinical recovery was obtained under adapted antibiotherapy, Hence Lyme serology must be performed when atypical polyarthritis appears in a child especially in an endemic region of borrelia. burdogferi

[Septic oligoarthritis as a complication of rhumatoid arthritis - a case report]

We present the case a 53-year-old patient followed-up since 1999, for erosive AR treated with methotrexate and glucocorticoids. In April 2000, he had an arthritis of the right knee. The identification of an enterobacter in blood culture, and synovial biopsy results permitted the diagnosis of septic arthritis. After 23 days of antibioterapy treatment, the patient had an arthritis of the left knee. The infectious origin was confirmed by synovial biopsy. The course was better after adaptation of the antibiotics. Septic arthritis is then a serious complication of AR. It requires a fast and multidisciplinary management. It can be threatenig in fragile and immunocompromised patients. The functional prognosis is especially compromised in polyarticular septic arthritis