[Reactive arthritis]

Study the frequency of the reactive arthritis, and specify its clinico-biological and therapeutic characteristics with a review of the literature. We conducted a retrospective study including 22 cases of reactive arthritis. All patients had a clinical exam and serology of the germs accused according to clinical data. Urethral prelevement and coprocultures were carried out in the event of sign of orientation. Eighteen men and four women were included, whose mean age was 34 +/- 11, 79 years. The mean duration of reactive arthritis was of 7,95 +/- 5,89 years with a diagnostic delay of 0,79 +/- 1,55 years. Origin of infection was identified in 12 cases [genital in 10 cases and digestive in two cases]. The clinical presentation was as follows: monoarthritis in six cases, oligoarthritis in 11 cases, polyarthritis in four cases. The heel pain was present in six cases, and the ocular manifestation in form of iritis was noted in four cases. Serology of Chlamydia was positive in 16 cases. Genital taking had isolated a Chlamydia and a mycoplasma in two cases. The corproculture had isolated a shigella in two cases. The treatment comprised anti-inflammatory drugs in 22 cases, antibiotics in 18 cases and intra-articular steroids in 10 cases. Evolution to ankylosing spondylitis was notes in 12 cases [10 men and 2 women]. Reactive arthritis with Chlamydia seems more frequent at the men. The evolution is often towards to ankylosing spondylitis. A prospective study on a large scale could be able to confirm these data

[Early diagnosis of rheumatoid arthritis: importance of ultrasonography]

Early diagnosis of rheumatoid arthritis needs collaboration between primary care doctors and rheumatologist. Three signs evoke this diagnostic more than three swollen joints; squeeze test positive for metacarpophalangeal and metatarsophalangeal and morning stiffness of >/= 30 minutes. The patient must be referred o rheumatologist for better assessment if there is one of this signs. The specific test as auto-antibodies to citrullinated proteins and joint ultrasonography are used for etiologies and retraining early rheumatoid arthritis diagnosis. Anti ccp are early positive and have a high specificity [99%]. The new generation tests with ELISA can give better sensibility [70%]. Osteoarticular ultrasonography can visualize synovitis, joint effusin, erosions in joints which are difficult to be assessed clinically. Also ultrasonography can visualize erosions and narrow joint space before radiological stade and synovitis activity with Doppler. It can also guide local intervention and assess evolution of rheumatoid arthritis under treatment. Early prescription of treatment can decrease and even stop articular destruction which is the principal factor of functional handicap in rheumatoid arthritis