Etanercept in the treatment of SAPHO syndrome: Which place?

Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (SAPHO) is a rare disease combining skin, bone, and joint manifestations. Its treatment remains a debated issue in the absence of a valid therapeutic strategy. The experience with tumor necrosis factor alpha (TNF alpha)-blocking agents is still small but encouraging. This therapy is reserved for refractory cases. The most commonly used agent is infliximab. Only few cases treated by etanercept have been reported in the literature. We report a new case treated by this biologic therapy and discuss its place in the treatment of SAPHO syndrome. A 30-year-old male, with a history of left clavicular osteitis that required surgical bone biopsy to rule out infection and malignancy, was admitted to the rheumatology department because of recurrent anterior chest pain, lower limb arthralgia, and sacroiliac pain. Laboratory findings revealed an inflammatory syndrome. Conventional radiography and computed tomography (CT) scan of the sternocostoclavicular region showed sclerosis and hyperostosis of the left clavicle. Right sacroiliitis was diagnosed based on the radiographic findings. Moreover, the patient reported palmoplantar pustulosis, thereby strengthening the diagnosis of SAPHO syndrome. As conventional treatment based on methotrexate, corticosteroids, and zoledronic acid was not effective, etanercept was initiated with good and rapid clinical and biological improvement. The diagnosis and treatment of SAPHO syndrome are challenging due to the heterogeneity of symptoms and unknown pathogenesis. Etanercept can be an effective therapy, especially in refractory cases. Further studies are needed in order to establish a therapeutic strategy.

Articular and abarticular manifestations in type 2 diabetes mellitus.

OBJECTIVE: Diabetes mellitus (DM), a worldwide high-prevalence disease, is associated with a large variety of rheumatic manifestations. It affects the connective tissues in many ways and causes alterations in the periarticular and the musculoskeletal systems. In most cases, these manifestations are associated with functional disability and pain, affecting the quality of life of the diabetic patient. The aim of our study is to review the different articular and abarticular manifestations in diabetic patients and the associated factors of these rheumatic manifestations. MATERIAL AND METHODS: A cross-sectional study that includes all patients suffering from type 2 DM who present with articular or abarticular manifestations. RESULTS: We included 116 diabetic patients presenting with articular or abarticular manifestations. Our study showed four important findings. First, a large variety of articular and abarticular manifestations were present in patients with type 2 DM. Second, osteoarthritis (OA) of the knee was the most frequent articular manifestations. It was seen in 49% of our patients. Third, the most common manifestations in diabetic Moroccan patients were carpal tunnel syndrome (CTS), adhesive capsulitis of the shoulder, and diabetic cheiroarthropathy (29%, 23%, and 16%, respectively). Fourth, there was a significant association between vascular complications and the development of articular and abarticular manifestations. CONCLUSION: This study shows that the articular and abarticular manifestations in diabetic Moroccan patients are dominated by CTS, adhesive capsulitis of the shoulder, and diabetic cheiroarthropathy, with a significant association between vascular complications and the development of some of these manifestations.

Rheumatic complications of long term treatment with hemodialysis.

Patients undergoing hemodialysis therapy develop serious osteoarticular diseases. The treatment is based on prevention. The aim of our study is to determine the frequency and the associated factors to the rheumatic manifestations in hemodialysis patients. A cross-sectional study was conducted, including all hemodialysed patients in our dialysis unit. Information was obtained from patients' symptoms, examination findings, and biological and radiological signs. The frequency of symptoms was 70% in our patients. It was proportional to the duration of hemodialysis and number of hemodialysis sessions per week. Early transplantation is of course a plausible solution, but other therapies such as improved dialysis must be considered.

[Nasopharyngeal tuberculosis]. / Tuberculose du cavum.

Nasopharyngeal tuberculosis is increasingly frequent and poses a diagnostic and therapeutic problem. Through a retrospective study spread out over 4 years, we brought back six cases of nasopharyngeal tuberculosis, including two men and four women of an average age of 41 years. The diagnosis was made, for all of our patients, after histologic study when we found typical tuberculosis lesions on biopsy specimens. The diagnosis of tuberculosis was established; all patients had an antituberculosis medical treatment in a department of infectious diseases. In all cases, the long-term evolution was favourable, with an average passing of 11 months.

[Langerhans cell histiocytosis of the thyroid]. / Histiocytose langerhansienne de la thyroïde.

INTRODUCTION: Langerhans cell histiocytosis, also known as histiocytosis X, has a broad clinical spectrum and highly variable prognosis. Its localization in the thyroid gland is relatively rare and presents particular diagnostic and therapeutic difficulties. CASE: A 38-year-old man consulted for an anterior cervical mass that dated back to childhood but which had grown substantially in volume over the past seven months. The workup indicated a left thyroid nodule. We performed a thyroid lobectomy with isthmusectomy. Immunohistochemical and pathology analyses showed Langerhans cell histiocytosis of the thyroid. The immediate postoperative course and subsequent outcome were good (follow-up: 34 months). CONCLUSION: Diagnosis and treatment of Langerhans cell histiocytosis in the thyroid gland often require multidisciplinary cooperation to analyze clinical, radiological, and pathology findings.

[Laryngeal chondrosarcoma]. / Chondrosarcome laryngé.

Chondrosarcoma is a malignant tumor relatively rare on the larynx, and raises diagnostic and therapeutic difficulties. Its diagnosis often requires the recourse to a radiological, endoscopic and anatomopathologic confrontation. Its treatment is exclusively surgical. It is based on broad excision sometimes mutilating and requires in this kind of localization a multidisciplinary collaboration between ORL, vascular surgeon and radiotherapy. In the light of a new very conclusive observation and data of the literature, we wanted to give a progress report on the clinical and therapeutic positions of the various authors.