[Rheumatoid arthritis: physiopathological currents and therapeutic implications]

Rheumatoid arthritis is a chronic inflammatory rheumatism responsible for osteoarticular destruction and in some cases it can also affect a wide variety of body systems including skin, eye, lung, heart and kidney. Physiopathology of this disease is better clarified. Indeed, hormonal, genetic and environmental factors are involved in the onset of the disease. All these together activate an innate and adaptive uncontrolled immune response which is characterized by an amplified inflammatory reaction particularly of the synovial membrane, site of immune cell infiltrate and significant neo-vascular proliferation. This auto immune process is responsible for the production and release of cytokines, chemokines and metalloproteases contributing clearly to osteoarticular damage. The result of this knowledge is the development of treatments targeting molecules incriminated in the pathogenesis of rheumatoid arthritis and blocking the destructive and evolutionary disease mode

Neuromyelitis optica and tuberculosis

Neuromyelitis optica [NMO] or Devic's syndrome is defined by Gault and Devic as a retrobulbar neuritis or papillitis accompanied by acute myelitis and occasionally other neurological symptoms or sings not restricted to the spinal cord or optic nerves. Infectious aetiology was suggested but never recognised. We report a 36-year-old woman with NMO which revealed a multisystemic tuberculosis with fatal issue. We discuss this case with review of literature and try to demonstrate that tuberculosis can be considered as NMO's aetiology directly by Mycobacterium Tuberculosis [BK] infestation, or indirectly by immune mediated response to BK. We conclude to search tuberculosis in patients with NMO, especially in countries where tuberculosis is endemic and a great problem of public health, and not to consider it only as a variant of multiple sclerosis because of different therapeutical options