Paraneoplastic digital necrosis: a case report

Digital necrosis is a frequent vascular disease. Its very often reflects arterial disorders of macro or mirocirculation. Paraneoplastic digital necrosis is rare, however.Report a new case of paraneoplastic digital necrosis. Our patient was a 62-year old diabetic female patient with a history of total thyroid ablation at 50 year old. She presented with bilateral digital necrosis of the second, third and fourth fingers. During her recovery, we have found a biological inflammatory syndrome and abdominal echography revealed a metastatic liver. Radiological investigations in search for the primitive tumour were negative. The patient was referred to a specialized center for a palliative chemotherapy. Etiologies of digital necrosis are various, mainly iatrogen, professional, toxic, atheroma or systemic disease. In case of no evident cause, explorations should be gone to detect underlying malignancies

[Validation of the Tunisian version of the health assessment questionnaire [HAQ] in rheumatoid arthritis patients]

One hundred twenty two rheumatoid arthritis patients were consecutively included in the study. Test-retest reliability was assessed in 61 patients based on the intra-class correlation coefficient. For the 122 patients [104 female and 18 male] the median age was 47 years [18-70]. The mean age of the patients who filled in the questionnaire at test and retest times was 45 years [18-70]. Test- retest reliability of the HAQ was 0.84. Internal consistency was 0.94. There was a good correlation between the HAQ and the Lee index [r = 0.75, p <10 -4], the HAQ and the RAQoL [rs = 0.96, p <10 -4]. In a logistic regression model Lee index, RAQoL and age account for the variance of the HAQ. The Tunisian version of the HAQ preserves the metrological properties of the original version and can be used for measuring and following functional abilities of Tunisian rheumatoid arthritis patients

Arthropathie de Jaccoud et chondrocalcinose articulaire: Une association rare

Jaccoud's arthropathy [JA] is a chronic deformity affecting hands and feet, which are voluntarily correctable by the patients. JA was usually reported in assocation with rheumatic fiver and systemic lupus erythematosus. We describe an exceptional association between a pyrophosphate arthropathy and JA of the hands. It is a 48 year old woman, having a 13 years history of polyarthritis involving shoulders, elbows, hips and knees, and 4 years after, a progressive under deviation of the fingers of the hands. Calcium pyrophosphate dihydrate crystals were identified in the synovial knee biopsy. Hands xrays as RMI don't identify erosions and confirmed the JA

Le syndrome sapho. une observation tunisienne

A morbid association: synovitis, acne, pustulosis, hyperostosis and osteitis is a rare entity. The authors report the first case in Tunisia: A fourty four years old woman with pustulosis of palms and soles and sternal arthritis. There is no association neither with an inflammatory bowel disease nor with spondyloarthropathy. Treatment with cortico-steroids was initially successful, but recurrence occurs after a remission of six months