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

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

[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