TULUP (TUnisian LUPus): a multicentric study of systemic lupus erythematosus in Tunisia.

AIM: Clinical features of systemic lupus erythematosus (SLE) have been described from different geographical regions around the world. However, data from North African countries, including Tunisia, are scarce. METHODS: The aim of this retrospective multicenter study was to analyze demographic, clinical, laboratory features and outcome of SLE in Tunisia throughout 14 Departments of Internal Medicine and to compare them with those of other ethnic and geographic groups. RESULTS: Seven hundred and forty-nine cases of SLE were recorded (American College of Rheumatology criteria) during a 17-year period (1989-2006). They were 676 women and 73 men with an average age at SLE onset of approximately 30.66 years. Our Tunisian patients were characterized by a high frequency of photosensitivity (67.6%), malar rash (68.7%), renal involvement (49.5%) and anti-Sm antibodies (44.8%). Infections were the main complications. Fifty-six (7.5%) patients died during the study period. CONCLUSION: Potential limitations and biases in our study need discussion. Specific recruitment of patients in tertiary referral centers may be the source of selection bias and adding to the frequency of moderate or even severe diseases. The therapeutic management and outcome monitoring were heterogeneous due to the fact that patients were evaluated by different doctors. However, this study remains the most representative of Tunisian SLE patients recruited from all parts of Tunisia.

[Prevalence of axial manifestations among patients with inflammatory bowel disease: a prospective study about 50 cases]. / Prévalence des manifestations axiales au cours des maladies inflammatoires chroniques de l'intestin: à propos d'une étude prospective de 50 cas.

BACKGROUND: Rheumatologic manifestations occurring during inflammatory bowel disease are the most frequent extra intestinal features. They are dominated by spondyloarthropathies, sacro-iliite and peripheral arthritis. AIM: To identify in a group of inflammatory bowel disease, the frequency of axial manifestations, to describe the clinical and the radiological features and to identify the risk factors of their occurrence and/or worseness. METHODS: We have established a transversal prospective study including 50 cases of inflammatory bowel disease seen in the department of the internal medicine in the interior forces security hospital during a period of 5 years between January 2001 and December 2006. RESULTS: The prevalence of axial involvement in the case of inflammatory bowel disease was 26% especially spondyloarthropathies which were diagnosed in 11 cases according to the criteria of European Spondyloarthropathy study Group (ESSG), 8 of them fulfilled the modified criteria of New York for the diagnosis of spondyloarthropathy. Isolated sacro-iliitis was found in 4% of cases. By univariate study, only the age under 35 years with a relative risk of 5,8 and the colic involvement in Chron's disease was significativelly associated with the presence of spondyloarthropathy. CONCLUSION: Systematic checking of spondyloarthropathies in the course of inflammatory bowel disease through a clinical exam and systematic radiological should be recommended especially if we are in front of a man aged more than 35-years-old with a Chron disease involving the colon. This screening offers an early management and avoid ankylosis.

[Bone loss owing to inflammatory bowel disease: prospective study, 50 cases]. / Perte osseuse au cours des maladies inflammatoires chroniques de l'intestin: etude prospective a propos de 50 cas.

AIMS: To evaluate the prevalence of osteoporosis during inflammatory bowel disease (IBD) and to determine the risk factors. METHODS: We conducted a prospective study that includes IBD patients. For all patients, bone mineral density was measured by dual-energy X-rays absorptiometry. RESULTS: Study has included 50 IBD patients; thirty had Crohn's disease and 20 had ulcerative colitis. The average age of our patients was of 36.4 + 9.9 years. A low osseous mineral density was noted in 21 patients (45%) distributed in 13% of osteoporosis and 32% of osteopenia. Only the age superior to 35 years, the duration of evolution of the disease superior to 10 years and intestinal resection constituted a risk factors of osteoporosis. After adaptation on the age and the intestinal resection the duration of evolution superior to 10 years persisted as risk factor of osteoporosis. The other risk factors: sex, type of IBD, denutrition and corticoids were not incriminated in the low osseous mineral density during IBD. CONCLUSION: These results confirm the necessity of the systematic search of the osteoporosis during IBD with the aim of proposing an early and effective treatment.

[Cardiac amyloidosis]. / Amylose cardiaque.

UNLABELLED: PREREQUIS: Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor. AIM: To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease. METHODS: An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007. RESULTS: Amyloidosis represents 5 to 10% of non ischemic cardiomyoparhies. Cardiac involvement is the first cause of restrictive cardiomyopathy witch must be evoked in front of every inexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggered if some manifestations were associated as a peripheric neuropathy, a carpal tunnel sydrome and proteinuria > 3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has an direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis.

[Ocular findings in megaloblastic anemia associated with diabetes. A case report]. / Complications oculaires de l'association anemie de biermer et diabete. A propos d'un cas.

Ocular involvements of Biermer's anaemia are rarely reported in literature. We present a case of Biermer's anaemia associated with diabetes. Ocular examination showed important conjinctival paleness, diffuse retinal ischemia, Roth's tasks, macular oedema and ischemic optic neuropathy. The patient was treated with vitamin B12 intramusculary. A month later, on examination, we noted a regression of optic neuropathy, the aggravation of ischemic retinopathy and persistence of macular oedema. The patient was treated with laser photocoagulation. The majority of ocular manifestations are reversible if treatment is underlaken early. The combination of diabetes with Biermer's anemia deteriorates the ischemic retinopathy and aggavates its prognosis.

Association of right heart thrombosis, endomyocardial fibrosis, and pulmonary artery aneurysm in Behçet's disease.

A 29-year-old man with a 5-year history of Behçet's disease was admitted for fever, dyspnae, chest pain, and hemoptysis. A diagnosis of right ventricle and atrial thrombosis associated with a pulmonary artery aneurysm was made. The patient was treated with anticoagulants and prednisone. Since hemoptysis persisted, surgical excision of the intracardiac thrombosis was performed and histological findings were consistent with organizing thrombus and endomyocardial fibrosis. Transesophageal echocardiography 6 months later showed recurrence of the right ventricle thrombosis. A course of 6-monthly boluses of intravenous cyclophosphamide was begun. Currently, at 2 years of follow-up, the patient is asymptomatic.