[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

[Evaluation of knowledge of fibromyalgia in Tunisia]

Fibromyalgia is a chronic, non inflammatory, pain syndrome, characterized by widespread musculoskeletal pain and excessive fatigue. Although it is considered like being the second pathology met in ambulatory rheumatology practice, it is again, poorly understood by medical and scientific community. Value the level of knowledge, attitudes and practices of Tunisian physicians, general practitioners concerning fibromyalgia. It was about a cross-sectional survey using questionnaire, achieved by a representative sample of Tunisian physicians, general practitioners. These last, answered a questionnaire previously used in France, in Portugal and in Russia, valuing their knowledge on fibromyalgia, their attitudes and practice in the face of patients suffering from fibromyalgia. Fibromyalgia was recognized as a clinical entity by 26.7% of our physicians. Each general practitioner followed an average of 5.7 patients. The diagnosis of fibromyalgia was made based on widespread pain that persists more than 3 months, sensitive to NSAIDs, for 48% of general practitioners, or on tenderness that occurs in precise, localized areas of the body [trigger points] according to 54% among them. Main symptoms of Fibromyalgia were known with various degrees: pains [87.9%], excessive fatigue [85.7%], muscular weakness [78%], sleeping troubles [65.9%] and psychological disturbance [68.1%]. Knowledge of physicians about attitudes and practices in front of cases of fibromyalgia were limited. Knowledge of this disease is still mysterious and not well know. General practitioners are aware of fibromyolgia which not included in the program during that training in the medical school. In consequence, our institution, our medical schools in Tunisia should teach this disease to our student and during post graduate courses

[Occupational Carpal tunnel syndrome [Concerning 27 cases]]

Carpal tunnel syndrome is the most frequent of tunnel syndromes in the field of the professional sphere. It is related to repetitive movements of flexion-extension of the wrist and fingers or to a support on the heel of the hands. To determine the posts in a risk and to specify the modalities of guaranteed reimbursement of professional carpal tunnel syndrome. A retrospective and descriptive study of 27 medical files of employees indemnified for professional carpal tunnel syndrome registered in the medical control services of the social security office in charge of medical insurance of Tunis and Sousse during a period of 10 years [1995 - 2004]. There were 24 women and 3 men with the average age of 40 years all occupying posts in a risk. Their average time of service is 15 years. Two-thirds of them work in the clothing and textile industry. The attack is bilateral in 13 cases. Nightly acroparaesthesia rules the clinical rate [44.44% of cases]. Motor disorders are noted in the quarter of cases. The electromyogram had confirmed diagnosis in all of cases. The previous state study put in evidence the antecedent of carpal tunnel syndrome in 5 cases and diabetes in one case. Twenty-one patients had profit of permanent partial incapacity with a rate varying from 3 to 25%. Five had got a transfer of working place and one stayed in the same post with a half-time work. The professional origin of carpal tunnel syndrome must be called up in front of an activity in a risk. The reparation is done according to picture 82 of occupational diseases

[Stress facture: epidemiology, physiopathology and risk factors]

The aim of this paper is to give an overview on the scientific information related to stress fracture risk factors. We searched the Medline and Embase databases using the keywords stress fracture, risk factors and bone microarchitecture. Only French and English articles were included and 52 were chosen because they corresponded to literary reviews, prospective and retrospective studies concerning individuals who participate in athletics, in military recruits or civil. Stress factures are common injuries in individuals who participate in athletics, in military recruits. Stress fractures of the lower extremity most commonly involve the tibia. A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading. To prevent stress fractures, an appreciation of their risk factors is required. Risk factors include intrinsic risk factors such as female gender, amenorrhea, lower bone density, inadequate muscle function and biomechanical features as well as extrinsic risk factors such as overtraining program, inadequate equipment and the energetic nutrition deficit. The coexistence of different risk factors makes so difficult the isolation of etiologic variables Several risk factors have been comprehensively assessed in numerous studies. Hence, to date, there is still no general screening tool available to identify individuals at risk. Bone texture analysis seems to offer new prospects in the identification of stress fracture susceptibility

[Place of the functional treatment and the multidisciplinary approach in the coverage of occupational accidents lumbar vertebra]

The chronic affections of the rachis lumbar vertebra are a challenge for XXI-th century. Epidemiological observations have to incite us to think about new modalities of coverage. The objective of our work is to discuss the place of the functional treatment in the coverage of occupational accidents lumbar vertebra [ATL] and to analyze new multidisciplinary therapeutic practices. Our study is retrospective concerning 242 files of occupational accidents lumbar vertebra examined by the medical commission of Tunis of the national social security [private sector] authorized to fix the partial permanent incapacity resulting from occupational accidents and from professional diseases during 5 years. We convened subjects having a global rest superior to one year [44 patients], 27 of them are present [61.3%]. These last ones were examined after an average duration of 7, 2 years from the initial ATL. The characteristics of this group of 27 insurants will be compared with those of the 242 victims of ATL. the functional treatment in the two groups is lower than those of the literature. Subjects which did not benefit from rehabilitation leave more in the pension and keep less the same job after occupational accident. Functional rehabilitation is important in the evolution of the ATL and in the improvement of the professional preview

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

[Fibromyalgia prevalence in Tunisia]

To estimate fibromyalgia [FM] prevalence in Tunisia Data on a cross-section of 1000 individuals aged 15 years or older living in Sfax were collected by interviewers using the London Fibromyalgia Epidemiology Study - Screening Questionnaire [LFES- SQ]. The sampling was realized by empirical poll and respecting quota according to delegation, rural or urban environment, sex and age according to the demographic national data. The positive screened subjects were invited to be examined to confirm or exclude the FM by applying the 1999 ACR criteria. The questionnaire was administered to a second group of 252 volunteers, all were afterward examined. This allowed 10 study specificity and sensibility of the questionnaire and allowed to calculate the FM prevalence. 159 subjects were screened positive, only 141 were examined. The specialized exam allowed confirming the diagnosis of FM in 67 subjects. FM prevalence is different according to sex, age, study level and socio-economic level. Two hundred and fifty two volunteers answered the questionnaire then all examined. The questionnaire specificity was 90.8% and the sensibility 79;4%. FM prevalence in Tunisia, calculated by Bayes theorem, is estimated between 8.27% and 12.3%. FM prevalence in Tunisia is estimated at least at 8.27%

Common lumbosciatic of the elderly. about 67 cases

The common lombosciatic is a disease observed at all ages. To the elderly, clinical data, treatment, clinical outcome and prognosis present sometimes some peculiarities. Aim: Report of lombosciatic in the elderly. It is a retrospective study including 67 cases of sciatica concerning old patients over 65 years presenting with common lombosciatica, hospitalized between January the 1-st, 2000 and December 31st, 2004. The mean age of our patients is of 71.2 years, sex ratio female / male of 1.88. A chronic lumbago is found at 16.34% of our patients and a starting factor pains in 14.3% of cases. Pain is of progressive installation in 93.4% of cases. Mechanical in 77.5% of cases and impulsive in 55% of cases. Sciatica was unilateral in 67.3% of cases and interesting the root L 5 in 40.8% of cases. Physical exam find a painless attitude in 26.5% of cases and a spasm of spinal muscles in 65.3%. The average of schober index is of 2.4 cms + 1.18. Lasegue is present in 36.7% of cases. Neurological exam find overdrawn signs in 8% of cases, sensory signs in 61.2% of cases. No cauda equine syndrome was individualized in our series. Lumbar spine X-rays, made in 98% of cases, show a L5-S1 disc impairment in 83.6% of cases, a scoliotic attitude in 22.4% of cases, a spondylolithesis of L4L5 in 26,5% of cases and lumbar cannal stenosis in 12.2% of cases. Lumbar densitometry, realized in 22.4% of cases, shows a herniated disc in 27.2% of cases, and a lumbar canal stenosis in 27.2% of cases. The MRI, made once, was normal. During their hospitalization, 87.7% of patients received NSAID's, 18.4% of them analgesics drugs [landing I, II, III] and 79.6% epidurals infiltrations. All our patients observed bed rest. A physiotherapy was prescribed for 44.9% of them. A good outcome was quickly noticed in 85.7% of the patients. A therapeutic failure was observed at 14.3%. 6% underwent surgery. Only 10,2% of the non operated patient had pain recurrence. Nowadays sciatica is a frequent pathology either in young or in geriatric population. Nevertheless it is necessary to eliminate a tumoral or infectious sciatica that can be misleading by the condition of the old age and by the frequent associated pathologies at such age