[Complete heart block as a rare complication of rheumatoid arthritis a case report]

We report the case of a 32 years old men with a 5 years history of rheumatoid arthritis treated by prednisone and methotrexate, admitted because of syncope. Cardiac explorations revealed a complete atrioventricolar block. A permanent pace maker was inserted. The patient made an uneventful recovery. Complete atrioventricular block is a severe conduction defect which is particularly rare in the course of rheumatoid arthritis. The relevant literature is briefly reviewed

[Paget's disease associated with vertebral hyperostosis about two cases]

The coexistence of Paget's bone disease [PBD] and diffuse idiopathic skeletal hyperostosis [DISU] of the spine is controversial and may have implications for the pathogenic mechanisms involved in these disorders. This association is illustrated by the following two cases. One of them presented a bilateral sciatica. The other case had a coxopathy and sciatica complicated by a cauda equina. The radiologtcal Investigations permitted the diagnosis as the two cases. The coexistence of Paget's disease and diffuse idiopathic skeletal hyperostosis is controversial and can have implications for the pathogenic mechanisms involved in these disorders. Diffuse idiopathic skeletal hyperostosis may facilitate extension of pagetic lesions

[Management of Pott's disease nowadays in Tunisia about a series of 45 cases]

To investigate the characteristics of patients managed for Pott's disease at the rheumatology department of CHARLES NICOLLE teaching hospital, Tunisia between 1994 and 2004. Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded. Diagnosis of spinal tuberculosis was based on: positive culture for Mycobacterium tuberculosis, percutaneous vertebral biopsy showing granulomas with caseating necrosis or on strong clinical suspicion. There were 45 patients, 21 women and 24 men with a mean age of 51 years [15-85y]. None of our patients had either AIDS or treatment by TNF alpha blockers. Mean time from symptom onset to diagnosis was 8.6 months [1.5-24]. Neurological impairement was present in 7 cases: a spinal cord compression in 5 cases, and an equina cord syndrome in 2 cases. The vertebral area involved was cervical in one case, thoracic in 21 and lumbar in 24 cases. The most common imaging findings were disk space nanowing [visible on plain radiographs in 44 of the 45 patients] and paraspinal abscesses [visible by CT in 28 of 45 patients]. Centro-somatic tuberculous osteitis of the vertebra have been diagnosed in only one case. Percutaneous vertebral biopsy was positive in 12 out of 36 cases. Anti-tuberculosis treatment has been administrated in all cases associated to vertebral immobilization when indicated. Surgery has been performed in only 3 cases in front of neurological manifestations. Pott's disease is still a public health problem in Tunisia because tuberculosis is endemic in our country. Atypical presentation and insidious evolution are responsible for long diagnosis delay. Treatment is now medical. Early diagnosis and treatment are mandatory for a good outcome

[Arthritis of the hip in spondylarthorpathy retrospective study about 126 cases]

To determine epidemiological and clinical features of arthritis of the hip in a Tunisian population of spondlarthrpathy [SA].This is a retrospective study about patients suffering from SA treated in a rheumatology unit. A radiological investigation of the pelvis was systematically performed on each patient.The study involved 126 cases of SA [83 men and 43 women], with a middle age of 32.6 years. Arthritis of the hip showed within 3.8 years. Total hip arthroplasty was indicated in 18% of cases. Arthritis of the hip in spondylarthropathy is an important cause of functional disability. We insist in our study on the frequency of arthritis of the hip in North Africa and particularly in patients aged under 16 years

[Research on Parvovirus B19 infections and chronic articular manifestations in a Tunisian hospital]

Parvovirus B19 infection is often associated with acute and chronic joint diseases thus suggesting an etiologic role for the virus in these pathologies. In this work, we looked for a possible correlation between Parvovirus B19 infection and certain types of chronic inflammatory rheumatisms. We therefore, screened a population of 100 patients with different chronic inflammatory rheumatismal affections for serological markers of Parvovirus B19 infection. All patients were Tunisians of both sexes, who presented at the service of Rheumatology of the Charles Nicolle Hospital, Tunis. One hundred blood donors were taken as controls. Specific Immunoenzyme Assays of the ELISA type [Biotrin International, France] were used to detect anti-Parvovirus IgG and IgM. On the other hand, viral DNA was sought by nested PCR in synovial fluid from 14 patients. The data obtained indicate that specific anti-Parvovirus B19 IgG was detectable in the sera of 80.7% of patients and 43% of controls. In contrast, none of the sera was found positive for specific IgM antibodies. Synovial fluid samples could be collected from 14 anti-Parvovirus B19 seropositive patients and were tested for the presence of viral DNA. None of the samples was found positive. The results of our serological study reinforce the hypothesis that Parvovirus B19 infection is associated with rheumatismal joint affections. However, the lack of detectable viral DNA in synovial fluid of the tested seropositive patients points to an indirect role of the virus in these joint disorders