RESUMO
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
RESUMO
We present the case a 53-year-old patient followed-up since 1999, for erosive AR treated with methotrexate and glucocorticoids. In April 2000, he had an arthritis of the right knee. The identification of an enterobacter in blood culture, and synovial biopsy results permitted the diagnosis of septic arthritis. After 23 days of antibioterapy treatment, the patient had an arthritis of the left knee. The infectious origin was confirmed by synovial biopsy. The course was better after adaptation of the antibiotics. Septic arthritis is then a serious complication of AR. It requires a fast and multidisciplinary management. It can be threatenig in fragile and immunocompromised patients. The functional prognosis is especially compromised in polyarticular septic arthritis