leflunomide [Arava] dans le traitement de la polyarthrite rhumatoide

The aim of this study was to assess the effect and safety of leflunomide [LEF] in refractory RA and to review the literature on this subject. A one year prospective study was conducted on a group of patients [n: 15]. Mean duration of the disease was 6,46 years. Rheumatoid factor was present in 12 cases. Leflunomide was administered at a dos of 20mg/day following a loading dose of 100mg/day for three days. The efficacy of LEF was evaluated on clinical and biological parameters of RA evolutivity at one, 3,6,9 and 12 months. Our mean follow up period was about 8 months [2 to 12 months]. Good prognostic indicators of disease progression were observed with LEF at one month and later in eleven cases with a good safety. Non serious adverse events were observed with LEF. Our results confirm that LEF may present another therapeutic choice that is efficacious for the long term treatment of refractory RA. Nonetheless, these results must be evaluated on a larger series

modulateurs du TNF alpha dans le traitement de la polyarthrite rhymatoide

Current slow-acting anti-rheumatic drugs available at now for rheumatoid arthritis fail in majority of cases and have an inconstant chondro-protective effect. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made possible to develop selective immunotherapy approaches. Tumor necrosis factor alfa [TNF alfa] is an important inflammatory mediator that play a crucial role in rheumatoid arthritis. This studies summarizes clinical essays that evaluate beneficial effects and tolerance of anti TNF alfa antibodies. This study showed the clinical, biological and radiological efficacy of these therapeutic agents. But some doubts persist concerning their long term side effects particularly infections, neoplasm or auto immune ones. High price of this treatment should evaluate report cost benefice to appreciate the better utilisation of these drugs

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

atteinte cardiaque au cours des spondylarthropathies

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic reguragitation an conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy [responded to Amor criteria] in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolue for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spodylartropathy: psoriasic rheumatism [12 cases], inflammatory bowel disease: crohn's disease [4 cases], RCH [three cases] and fiessenger le Roy-reiter syndrom in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest trans-thoracic echographi, Holter rhythmic done in five cases only. Cardiac involvement is found in five cases [10%]: aortic regurgitation in 3 cases [6%] and mitral regurgitation in 2 cases [4%]. These valvular disease are well tolerated