Sexual dysfunction and its determinants in women with rheumatoid arthritis.

OBJECTIVES: To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to examine factors that are predictors of female sexual dysfunction including sociocultural factors, disease activity, and psychological status. METHODS: We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria. Clinical and sociodemographic characteristics were collected. The participants were asked to complete the Female Sexual Function Index (FSFI), which contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. Sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The psychosocial status was evaluated by the Hospital Anxiety and Depression (HAD) scale. Prevalence of sexual dysfunction and predictors of sexual difficulties were assessed. RESULTS: The prevalence of female sexual dysfunction in women with RA was 49.3%. All areas were altered especially desire (2.92 ± 1.3), arousal (3.27 ± 1.5), and orgasm (3.77 ± 1.5). In univariate analysis, sexual dysfunction was correlated with the age of patients (p = 0.049), the age of partners (p = 0.013), pain (p = 0.001), number of night awakenings (p = 0.02), morning stiffness (p = 0.010), tender joints (p = 0.05), disease activity score (DAS28 ESR) (p = 0.043), fatigue (p = 0.028), and Health assessment questionnaire (HAQ) (p = 0.02). In multivariate analysis, the age of patients and pain were predictive factors of sexual dysfunction. By analyzing each area of the FSFI score, the age of patients was the independent variable associated with desire. Tender joints were associated with lubrication and the age of partners with arousal, orgasm, and satisfaction. CONCLUSION: Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.

[The changing face of rheumatoid arthritis]. / La polyarthrite rhumatoïde a-t-elle changé de visage au fil du temps ?

Rheumatoid arthritis (RA) is a heterogeneous disease in terms of presentation and evolution. In recent years, a change in the face of this disease has been noticed. RA appears to be less lethal than before, with a larger decline in cardiovascular mortality. Patient hospitalization and orthopedic surgery appear to be declining. Today's RA also seems less active and less destructive. These documented changes, especially over the last decade, are attributable not only to the emergence of biotherapies, but also to more rigorous management strategies by rheumatologists as well as increased patient awareness.

La polyarthrite rhumatoïde (PR) est une pathologie hétérogène dans sa présentation et son évolution. Au cours des dernières années, un changement du visage de cette maladie a été remarqué. Cette maladie semble être moins mortelle qu'avant, avec une baisse plus importante de la surmortalité cardiovasculaire. Le recours aux hospitalisations des patients et à la chirurgie orthopédique semble aussi en baisse. Les PR d'aujourd'hui paraissent aussi moins actives et moins destructrices. Ces changements, attestés surtout au cours de la dernière décennie, seraient attribuables non seulement à l'émergence des biothérapies, mais aussi à des stratégies de prise en charge des rhumatologues plus rigoureuses et une meilleure prise de conscience de la part des patients.

Efficacy of local injection therapy for heel pain in rheumatic inflammatory diseases: A systematic review.

Heel pain or achillodynia is one of the most common manifestations in patients with rheumatic inflammatory diseases (RID) and particularly spondyloarthritis (SpA). It can be associated with inflammation at the bone insertion of tendon, ligament, bursa or fascia. However, treatment is still a challenge for rheumatologists. Several findings highlighted the proven benefit of nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and recently, tumor necrosis factor (TNF)-α inhibitors. However, only limited data about the efficacy of local therapy such as glucocorticoid and anti-TNF injections are available. The aim of this systematic review was to assess the efficacy and safety of local therapies in heel pain and to make recommendations for further studies. Five studies discussing the effectiveness of local treatments of heel pain in RID were included. All studies recognized that the ultrasonography (US)-guided local corticosteroid or etanercept injections were effective and safe modalities for the treatment of inflammatory heel enthesitis, tendinitis, and retrocalcaneal bursitis (RCB) in patients with RID. Pain relief at the local site was associated with a reversion of the acute inflammatory changes in the heel. Furthermore, US-guided injection in RCB with a lateral approach was beneficial in terms of preventing side effects.

Comparison of sexual function in Tunisian women with rheumatoid arthritis and healthy controls.

OBJECTIVES: To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to compare it with that in voluntary healthy controls. METHODS: We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 Criteria and 71 healthy age-matched controls. Clinical and sociodemographic characteristics were collected. Patients and controls were asked to complete the Female Sexual Function Index (FSFI). It contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. The sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The patients' self-perception of their sexuality was assessed, and the frequency of sexual intercourse was noted. RESULTS: The prevalence of female sexual dysfunction in women with RA was 49.3% versus 23.9% in controls, with a significant difference (p = 0.002). Comparison between both groups as regards the mean of area scores of FSFI revealed that desire, arousal, and satisfaction in patients with RA were significantly lower than those in the control group (p = 0.05, p = 0.038, and p = 0.024, respectively). The score of lubrification, orgasm, and pain was comparable between the two groups. In univariate analysis, a significant association was found between sexual dysfunction and pain (p = 0.001), tender joint counts (p = 0.04), DAS28 ESR (p = 0.043), fatigue (p = 0.028), and functional disability (p = 0.02). No association was found between sexual dysfunction and treatment. In multivariate analysis, only pain was a predictive factor of sexual dysfunction in patients (p = 0.05, OR = 1.26 [1.16-1.3]). Based on patients' self-perception of their sexual function, 26.1% of patients reported a negative impact of RA on their sex life. According to them, the main factors influencing sexuality were joint pain (60.6%) and fatigue (51%). Moreover, 59% of patients reported a decrease in the frequency of sexual intercourse after the diagnosis of RA. However, no statistically significant difference was found between patients and controls in the frequency of sexual intercourse (p = 1). CONCLUSION: Our study suggests that patients with RA experience high level of impairment of sexual function in comparison with a control group. Health providers must consider sexual function as an important part of quality of life. A therapeutic education directed towards a patient could be proposed to approach sexuality.Key Points• The prevalence of female sexual dysfunction is higher in women with rheumatoid arthritis than in controls.• In multivariate analysis, the global pain intensity visual analog scale was the only predictive factor of sexual dysfunction in patients.• Based on patients' self-perception, joint pain and fatigue are the main factors influencing sexuality.

Role of ultrasound in assessing remission in rheumatoid arthritis.

INTRODUCTION: Remission is the ultimate goal of the treatment of rheumatoid arthritis (RA). However, the diagnosis of remission might still be vague. Musculoskeletal ultrasound (US) seems to effectively assess synovitis, effusion and bone damage. Thus, its role could be relevant for the diagnosis, monitoring or detection of relapse in the follow-up of RA in remission. The goal of this review of the literature was to clarify the added value of ultrasonography during remission. METHODS: A systemic search of the literature was performed on Medline and Scopus. The following key words were used: rheumatoid arthritis, remission, US. Fifty-six papers were collected, then after an in depth analysis, twelve articles were selected for analysis. RESULTS: Twelve papers were identified that assessed remission in RA. Remission criteria varied from one author to another. The number of joints assessed by US varied from six to 44 with the wrist and metacarpo-phalangeal joints of the dominant hand scanned at least. Irrespective of remission criteria, all authors demonstrated that US detected Doppler positive synovitis in patients in clinical remission. Also, power Doppler synovitis predicted structural damage and future flares of RA. CONCLUSION: US seems to be more effective than a clinical exam. True remission in RA must be defined. Moreover, the inclusion of this technique in the new definition of remission is being validated.

Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial.

OBJECTIVE: To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA). METHODS: Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint. RESULTS: Two hundred and forty patients were included (February-June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6±15 at day 0 versus 46.5±22.4 at 12months, P<0.001), but not in the non-thermal group (64.1±15 at day 0 versus 62±29 at 12months, P=0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P=0.08). However, at 12months, the thermal cure group was significantly more improved (P=0.000). CONCLUSION: In our study, crenobalneotherapy had resulted, at 12months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.

[Intraosseous capillary hemangioma of the radial bone]. / Une tumeur osseuse rare au radius : hémangiome capillaire.

Hemangioma is a rare benign vascular tumor composed of dystrophic capillaries, preferentially located in the spinal region (70 %). Bony localizations are exceptional, less than 1 % of cases in large series of bone tumors. We report the case of a 35-year-old male who complained of pain the right forearm for two months. The pain was of an inflammatory type and was triggered by palpation and mobilization. The plain x-ray revealed a bony defect involving the posterior cortical of the mid-third of the radius. Magnetic resonance imaging revealed a defect of the shaft cortex without involvement of the central part of the bone, the endostium or the soft tissue. Surgical resection was limited to the tumor. Histology reported intraosseous capillary hemangioma. The course was favorable with bone healing and gap filling, with normal elbow and wrist function. The patient resumed occupational activities three months after surgery. This case illustrates a rare localization of this tumor rarely reported in major series.

[Juvenile idiopathic arthritis treated by methotrexate: result of treatment and tolerance]. / Les arthrites juvéniles idiopathiques traitées par méthotrexate. réponse au traitement et tolerance à moyen terme.

The MTX has a place of choice in the treatment of the AJI with good observance and the absence of grave side effects. In a retrospective study, 14 cases of AJI having benefited from a treatment by MTX were included in the study. Answer to the treatment was estimated at the 6-th month on the criteria of RINTO. The group included in the therapeutic evaluation, is formed by 10 boys and by 4 girls. The average age of the beginning of the disease is of 6 years (2 - 11). The shape of the beginning is systematic in 7 cases and polyarticular in 5 cases and oligoarticular in 2 cases.. The average duration of the treatment by MTX is of 36 months (9 - 66). Answer to the MTX in the 6-th month was noted in 7 cases, under a MTX's average dose of 7, 14mg / m2 / week. Unwanted effects were observed in 7 cases and have not in any case led to the stop of the treatment