[Fatigue in multiple sclerosis: management]

Fatigue is not only the most frequently reported symptom in MS, but also a frequent source of activity and participation limitations, psychological distress, and impairment of quality of life. A review of the literature shows the importance of its detection and management, and allows one to propose therapeutic strategies. Its management, which must be initiated early, is based on a comprehensive evaluation of its characteristics and consequences [sometimes with the use of scales such as the Fatigue Severity Scale and the Modified Fatigue Impact Scale], and on the identification of many potential contributing factors [psychological disorders, sleep disturbances, pain, infections and other comorbidities, medications, and deconditioning]. Rehabilitative interventions are essential to the treatment of fatigue. Beyond the traditional energy conservation strategies and cooling techniques, several randomized controlled studies have demonstrated the positive impact of aerobic exercise. Medications are partially beneficial, and with the exception of amantadine, their efficacy has not been confirmed by randomized double-blind trials

[Involvement of the hip in rheumatoid arthritis]

Involvement of the hip occurs in 15 to 20% of the rheumatoid arthritis. It engages the functional prognosis. Our objective was to specify the frequency of coxitis among our patients, the ground of its which has occurred and its clinical and radiological characteristics. We conducted a cross study including seventy patients with rheumatoid arthritis according to American college of rheumatology criteria. All patients had a clinical exam with measurement of index of evolutivity and of severity from RA, and radiographs of pelvis. We included 57 women and 13 men with rheumatoid arthritis, the mean age was 35,38 +/- 11,21 year, and mean duration of rheumatoid arthritis was of 11,82 +/- 6,9 years. The diagnosis delay was 2 years. Eleven cases of coxites were noted including 7 women and 4 men. The mean duration of the coxitis was 3,66 +/- 4,24 years with a diagnosis delay of 7,25 +/- 7,75 years. Involvement was bilateral in seven cases [63,63%]. The radiological analysis had objectivised a pinching in 11 cases, erosions in seven cases, an acetabuli protrusion in 4 cases and a secondary osteoarthritis in six cases. Only 2 patients had hip joint replacements. In our rheumatoid arthritis the coxitis is common, correlated with disease duration, delay diagnosis and severity of rheumatoid arthritis. It is often bilateral. It can be very invalidating, justifying an early and correct treatment

[Reactive arthritis]

Study the frequency of the reactive arthritis, and specify its clinico-biological and therapeutic characteristics with a review of the literature. We conducted a retrospective study including 22 cases of reactive arthritis. All patients had a clinical exam and serology of the germs accused according to clinical data. Urethral prelevement and coprocultures were carried out in the event of sign of orientation. Eighteen men and four women were included, whose mean age was 34 +/- 11, 79 years. The mean duration of reactive arthritis was of 7,95 +/- 5,89 years with a diagnostic delay of 0,79 +/- 1,55 years. Origin of infection was identified in 12 cases [genital in 10 cases and digestive in two cases]. The clinical presentation was as follows: monoarthritis in six cases, oligoarthritis in 11 cases, polyarthritis in four cases. The heel pain was present in six cases, and the ocular manifestation in form of iritis was noted in four cases. Serology of Chlamydia was positive in 16 cases. Genital taking had isolated a Chlamydia and a mycoplasma in two cases. The corproculture had isolated a shigella in two cases. The treatment comprised anti-inflammatory drugs in 22 cases, antibiotics in 18 cases and intra-articular steroids in 10 cases. Evolution to ankylosing spondylitis was notes in 12 cases [10 men and 2 women]. Reactive arthritis with Chlamydia seems more frequent at the men. The evolution is often towards to ankylosing spondylitis. A prospective study on a large scale could be able to confirm these data

[Physical medicine and rehabilitation in Morocco]

This survey was conducted in order to assess the degree of knowledge of physical medicine and rehabilitation [PMR], as an emerging medical discipline, by Moroccan Doctors and to evaluate its place in their daily practice. 500 questionnaires were distributed to interns and residents in Rabat and Casablanca teaching hospitals. 307 questionnaires were analyzed. The mean score of the knowledge of PMR on a scale ranging 0 to 25 was 15.63 +/- 4.51 [3-25]. The comparison of means between different groups puts Rheumatology residents in the top rank with a mean score of 20.18 +/- 3.00 with a significant difference when compared to the other group [p= 0.001]. On the other hand, 57.7% of doctors declared never having sought the advice of a Physiatrist. Finally, 85% of participants felt that the introduction of PMR in the curriculum of general medicine would be very useful. PMR is poorly known to doctors training in Moroccan teaching hospitals. More efforts must be combined to promote this discipline that has become essential in patient care

[Early diagnosis of rheumatoid arthritis: importance of ultrasonography]

Early diagnosis of rheumatoid arthritis needs collaboration between primary care doctors and rheumatologist. Three signs evoke this diagnostic more than three swollen joints; squeeze test positive for metacarpophalangeal and metatarsophalangeal and morning stiffness of >/= 30 minutes. The patient must be referred o rheumatologist for better assessment if there is one of this signs. The specific test as auto-antibodies to citrullinated proteins and joint ultrasonography are used for etiologies and retraining early rheumatoid arthritis diagnosis. Anti ccp are early positive and have a high specificity [99%]. The new generation tests with ELISA can give better sensibility [70%]. Osteoarticular ultrasonography can visualize synovitis, joint effusin, erosions in joints which are difficult to be assessed clinically. Also ultrasonography can visualize erosions and narrow joint space before radiological stade and synovitis activity with Doppler. It can also guide local intervention and assess evolution of rheumatoid arthritis under treatment. Early prescription of treatment can decrease and even stop articular destruction which is the principal factor of functional handicap in rheumatoid arthritis

acropathies ulceromultilantes: considerations nosologiques physiopathologiques et therapeutiques

About a case of ulcero-mutilating acropathy, the authors make a review of the literature and stress the most interesting points of this affection, itself very particular inside the group of nervous arthropathies. This review of the literature worries about three problems: - nosologic problem about the relations between ulcero-mutilating acropathy and others diseases,- physiopathologic problem,- and the treatment, consequence of the actual physiopathologic concepts

syndrome paraneoplastiques en rhumatologie [Revue generale de la litterature]

The rheumatological paraneoplasic syndromes are actually well known: among them the best known is the hypertrophic osteoarthropathy. Other clinical and biological manifestations may appear and have a parallel evolution with a cancer: such as some disturbances of the phospho-calcic metabolism, the algoneurodystrophic syndrome, the dysmetabolic arthropathies.The paraneoplasic significance of these entites and the nosologic individualisation of real "paraneoplasic rheumatism" are discussed