[Percutaneous vertebroplasty for pain relief in patients with osteoporotic spine fractures]

Percutaneous vertebroplasty [PVP] is an interventional radiology technique where pathological vertebral bodies are filled with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in certain diseases involving the vertebrae such as osteoporosis. To evaluate PVP in symptomatic osteoporotic vertebral fractures after failure of conservative management. Between November 2008 to December 2009, PVP was performed for osteoporotic vertebral fractures in 12 consecutive patients in a single institution. Medium term [3 days and 15 days post PVP] and long term follow up [1 month and 3 months post PVP] consisted in the evaluation of residual or secondary pain using Huskisson's visual analogue scale. A total of 20 vertebrae were treated. Mean follow up was 80 days [30-90 days]. Significant symptomatic improvement [p=0.002] was noted with pre PVP pain score of 7.4 [ +/- 1.6], 3 days post PVP score of 4.1 [ +/- 2.1], 15 days post PVP score of 1.8 [ +/- 1.1], 1 month post PVP score of 1.22 [ +/- 1.06] and 3 months post PVP score of 1.4 [ +/- 1.14]. PVP appears to be an effective technique in the treatment of symptomatic osteoporotic vertebral fractures with approximately 94% of satisfactory results in the short and medium term period

[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

[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

[Bisphosphonates': indications in bone diseases other than osteoporosis]

Report of bisphosphonates indications for osseous diseases other than osteoporosis. Narrative review of the literature. Bisphosphonates represent a new medication which is increasingly used. Besides osteoporosis, it is indicated as first choice in different bone diseases such as Paget's disease and the prevention of bone complications in tumoral osteolysis. Bisphosphonates' efficiency has been proven in other pathologies: the fibrous dysplasia and the osteogenesis imperfecta. More over, many studies are driven having for goal to show the efficiency of bisphosphonates in the algoneurodystrophy, non corticosteroid-treated osteoporosis in chronic inflammatory rheumatism and aseptic osteonecrosis. Bisphosphonates are a powerful inhibition of osseous resoption frestable indicatied for osteoporosis. Their indications were retended to paget's disease, malignant hypercalcemia, and osseous complications of malignant osterlysis

[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

[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

[Monoarthritis of the elbow revealing an intraarticular osteoid osteoma]

Osteoid osteoma is one of the unusual causes of musculoskeletal pain. Its diagnosis is usually not difficult in classic diaphyseal localization. However, the diagnosis of juxta or intraarticular osteoid osteoma is challenging because of atypical clinical presentation responsible for long diagnosis delay. Report a new case. We report herein the case of a 22-year-old woman presenting an intraarticular osteoid osteoma of the elbow. Diagnosis has been established on imaging findings [MRI and CT-scan] after 10 months because of atypical clinical presentation as a chronic monoarthritis of the elbow. The picture of an osteoid osteoma of the lower extremity of the humerus associated to a synovitis and a joint effusion was suspected on MRI. It had been confirmed on CT-scan which showed the nidus. Surgical removal of the tumor allowed pain relief and functional restoration in postoperatively. Regarding an unexplained chronic monoarthritis, the diagnosis of intraarticular osteoid osteoma should be evoked. CT-scan remains the investigation of choice for identifying the nidus. Surgical exicision permits the relief of symptoms

[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

[Update in treatment of psoriatic arthritis]

Psoriatic arthritis is a chronic rheumatic disease making part of spondylarthropathies. It is the most frequent chronic inflammatory rheumatism after rheumatoid arthritis. Eventhough, it is usually a benign affection, it may be destructive leading to handicap. Several new medications have been introduced, including anti-tumor necrosis factor [TNF alpha blockers] and leflunomide for treatment of psoriatic arthritis. Many studies show the efficacy of these medications in this disease

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

Adult onset still's disease: about 11 cases

Adult onset Still's disease [AOS] is an inflammatory disorder which associates variable articular and systemic manifestations. Despite a better knowledge of its biological and clinical particularities, the pathogeny of this disease remains unknown. The aim of this study is to analyze the epidemiological, clinical, biological and, outcome characteristics of AOS. It is a retrospective study about 11 cases of AOS hospitalized over a 24-year-period [1982-2005] at The Rheumatology Department of Charles Nicolle's Hospital of Tunis. All patients responded to the Yamaguchi criteria. Mean age was 35.4 years [20y-70y] with a sex-ratio of 0.57.Fever and articular involvement were the most frequent signs. Cutaneous symptoms were present in 6 patients. Three of our patients developed destructive arthritis. Renal amyloidosis, a rare complication of AOS, has been noted in one case. AOS is an unfrequent disorder characterized by its diagnosis and treatment difficulties. Recent advances in immunotherapy may better the management of AOS

Role of immune system, apoptosis and angiogenesis in pathogenesis of rheumatoid arthritis and joint destruction A systematic literature review

Background:Rheumatoid arthritis [RA] is a chronic inflammatory disorder of unknown cause that is notorious for the chronic polyarticular synovial inflammation and progressive destruction of affected joints. Understanding the pathogenesis of RA provides the basis for optimal management of that disease in patients. The pathogenesis of RA largely explored in many studies in human as much as in mice models with collagen II induced arthritis, nevertheless the pathogenesis puzzle is still incomplete

Aim: The aim of this systematic review was to collect the results of many observations and to put them down into an original story of RA set up

Methods: An exhaustive electronic and library search of the relevant literature was carried out through "science direct" and "interscience wiley" web sites. The key words used for the search were "rheumatoid arthritis", "pathogenesis", "apoptosis", "angiogenesis", "immune response" and "joint destruction"

Results: The suspected responsible antigen isn't yet determined although the great specificity of anti-CCP antibodies suggests that this antigen carries probably many citrullinated residues. The immune-pathogenesis of RA involves both the innate and the adaptive immune system. In the other hand, apoptosis defect contribute to hyperplasia of rheumatoid synovium and in extended half life of fibroblast like synoviocytes [FLS], neutrophils and many other cells implied in rheumatoid synovitis. Hyperplasia of synovium leads to ischemia and that results in neo-angiogenesis with increase of proangiogenic factors such as VEGF. The last part of the pathogenesis of Ra is the joint destruction resulting from increased MMP production and activation of osteoclasts which leads to the breakup of cartilage and to bone damage

arthrites reactionnelles

Reactive arthritis are definied as steriles arthropathies using classic bacteriological techniques. They are due to extra articular infection and are often associated with HLA B27. the outcome of these arthritis is caracterised by the recurrence of flares with sometimes appearition of ankylosing spondylitis. The pathogenesis of reactive arthritis is modified when bacterial antigens or alive micro-organisms are discovered in involved joints. Several current works have underlined the interest of antibiotic therapy in the chlamydial reactive arthritis. Chronic forms can justify the use of anti-rheumatic drugs such as salazopyrine

Manifestations musculo-squelletiques de l'hypothyroidie

Rheumatologic manifestations are varied during the hypothy-roidism. They can be articular, abarticular, muscular or osseous, consequences oF an inappropriale hormonal secretion. Their diagnosis is easy when hypolhyroidism is known, but they can be inaugural. Their evolution is favorable under substitute treatment

Manifestations rhumatologiques de l'infection a parvovirus B19

Rheumatologic manifestations of parvovirus B19 infection is a recent individualization. They are rather frequent and varied and meet at the young adult's. generally, it is responsible for acute, bilateral and symmetrical arthritis, usually involving distal joints and somrtimes associated to signs caused by viral infections. Prolonged articular forms were described but are rare being able to sometimes feign a nocive rheumatoid arthritis because of their clinical aspect and of a seropositivity. Axial manifestations were also repoted. The diagnosis of the recent infection by the parvovirus B19 can be confirmed by ELISA identification of specific IgM antibodies. The mechanism of the articular manifestations is still unknown and the link between parvovirus B19 and systemic vasculitis is questioned

Association lupus erythemateux systemique - hypothyroidie. A propos d'un cas

The association of systemic lupus erythematosus [SLE] and hypothyroidism is uncommon, and concerns essentially the autoimmun thyroiditis. However, the coexistence SLE-primary hypothyroidism is exceptional. We report an observation of 25-old woman, who presents a clinical form of hypothyroidism, confirmed by hormonal tests, and which is associated lo polyarthritis and proximal myopathy non ameliorated by opo-therapy. The explorations conclude in SLE. A favourable evolution of muscular and articular signs is obtained with cortico-therapy