[Practical approach to usual rheumatologic and traumatic diseases in elderly patients]. / Approche pratique des affections rhumatologiques et traumatiques courantes du sujet âgé

Rheumatologic and traumatic pathology is particularly important in elderly patients because it may compromise autonomy. The severity of the loss of autonomy is variable and it may be temporary or permanent. Therefore rapid and suitable care is necessary, old age in itself being an emergency factor. The purpose of this article is to develop an approach that based on presenting symptoms such as pain, mild or severe disability, or a modification of behavior in an elderly patient will enable:--to correctly evaluate the clinical findings which will guide the imaging--to not exclude a traumatic origin even if it doesn't seem obvious--to adapt the radiological examinations depending on the therapeutic possibilities--to demonstrate that plain radiographs are usually sufficient--to not deny access to CT or MRI systematically on the basis of old age. Knowledge of specific geriatric issues and correlation with imaging findings will usually improve the quality and quantity of life of elderly patients.

[Destructive arthritis of the hip in Crohn disease. 10 cases]. / Coxites destructrices de la maladie de Crohn. 10 observations.

OBJECTIVES: Destructive arthritis of the hip joint is a rare manifestation of Crohn's disease. We evaluated its frequency and clinical features in comparison with spondylarthritis and assessed the clinical course. METHODS: One hundred patients with Crohn's disease were followed prospectively in search of destructive arthritis of the hip joint. Patients with both Crohn's disease and manifestations of inflammatory joint disease hospitalized in three rheumatology units were also evaluated retrospectively. RESULTS: The prevalence of destructive hip disease was 2% in patients with Crohn's disease. Ten patients had destructive arthritis of the hip. Three had ankylosing spondylitis, 5 had spondylarthritis not responding to the criteria of ankylosing spondylitis and 2 had no axial joint disease. In all patients, signs of hip joint disease were a narrowed intra-articular space, bone condensation, osteophytosis and features of joint destruction. Manifestations were similar to those in patients with hip joint disease related to idiopathic ankylosing spondylarthritis. The clinical course was poorly controlled by anti-inflammatory drugs or treatment of the inflammatory bowel disease. Synoviorthesis were required and were effective in most cases. Total hip replacement was required in 3 cases. CONCLUSION: Destructive arthritis of the hip in patients with Crohn's disease is a rare complication causing severe functional impairment further handicapping the patient with a chronic bowel disease.

[Persistent pain following discal sciatica: reflex sympathetic dystrophy, an unusual complication to be examined. Apropos of 4 cases]. / Douleurs persistantes après sciatique discale: l'algodystrophie, une complication inhabituelle à rechercher. A propos de quatre cas.

Four patients who developed unilateral reflex sympathetic dystrophy of a lower limb associated with a bout of sciatica due to lumbar disc herniation are reported herein. In two cases, reflex sympathetic dystrophy developed after resolution of the sciatica, whereas the two conditions were concomitant in the two other patients. In all four patients, the diagnosis of reflex sympathetic dystrophy was missed. Surgery to release the root was considered in two cases. The reflex sympathetic dystrophy resolved within 1 to 3 months in every case. In view of the incidences of these two conditions, their concomitant occurrence seems rare. To avoid unwarranted therapeutic procedures, reflex sympathetic dystrophy should be considered in patients with chronic painful manifestations accompanying root involvement.

Chronic erosive arthritis associated with an unusual intestinal bypass.

We describe an unusual intestinal bypass arthritis in a 37-year-old man. The intestinal bypass was unusual because the intestinal blind loop was entirely composed of colon. The arthritis was first a typical bypass arthritis but later resembled rheumatoid arthritis. In spite of this resemblance, all rheumatic symptoms disappeared after jejunocaecal reanastomosis.

Drug-induced myopathies.

Myopathies are not an unusual complication of drug therapy. The major symptoms in drug-induced myopathies are proximal muscle weakness, increased muscle enzyme levels, electromyographic changes and histological lesions. Some drug-induced myopathies are associated with neuropathy. Drug-induced myopathies can be classified according to the presence or absence of muscular pain and associated neuropathy. Among painless myopathies, we can distinguish myopathies without neuropathy (corticosteroids), myopathies with neuropathy (colchicine, chloroquine and hydroxychloroquine) and myasthenic syndromes (D-penicillamine, antibiotics, beta-blockers). Among painful myopathies, the classification is similar: painful myopathies may or may not be associated with neuropathies. Painful myopathies include polymyositis (D-penicillamine, cimetidine, zidovudine) and other myopathies without polymyositis (clofibrate, statines, cyclosporin). Among the painful neuromyopathies, eosinophilia-myalgia syndrome is a recently described disorder associated with the use of L-tryptophan. Combinations of drugs (for example, a fibrate and a statine or cyclosporin and colchicine) can induce severe myopathies. If such drugs are used together a vigorous surveillance to detect any sign of myopathy is warranted. Instead of classifying drug-induced myopathies according to clinical features, a histological classification can be proposed. Many drugs can induce vacuolar myopathy (colchicine, chloroquine, amiodarone, cyclosporin, drugs causing hypokalaemia and lipid-lowering agents), some others cause a mitochondrial myopathy (zidovudine) or a necrotizing myopathy as seen with vincristine. Overall, several criteria for reporting drug-induced myopathy can be recommended: lack of pre-existent muscular symptoms, a free period between the beginning of the treatment and the appearance of symptoms, lack of another cause accounting for the myopathy, and complete or incomplete resolution after withdrawal of the treatment. Rechallenge of the treatment is not advisable because of the risk of a serious relapse. The exact mechanisms by which drugs cause myopathies are unknown. Some cases may be due to metabolic changes, whereas others may be immune mediated. Nevertheless, the aspect these conditions have in common is the regression of the myopathy with the discontinuation of the drug.