[Musculoskeletal hand disorders in musicians]. / Les pathologies musculo-squelettiques de la main chez les musiciens.

Music is often associated with joy, pleasure and leisure. However, like any other profession, it has its constraints and risks.The purpose of this update is to present a non-exhaustive inventory of musculoskeletal hand disorders most frequently associated with music practice.All music instruments are concerned. The difference lies in damage location as well as in the frequency of specific pathologies according to the used instrument. The most feared disorder by musicians is focal dystonia, which is characterized by a painless and repetitive coordination disorder. It only appears in the realization of specific professional movements. The overuse syndrome and the nerve entrapment syndrome constitute other dreaded disorders. Specific and multidisciplinary care is often necessary.

La musique rime souvent avec joie, plaisir et loisir. Cependant, comme toute autre profession, elle a ses contraintes et ses risques. Cette mise au point a pour objectif de faire un inventaire, non exhaustif, des pathologies musculo-squelettiques de la main les plus fréquemment associées à la pratique de la musique. Aucune famille d'instruments n'est épargnée. La différence réside dans la localisation de l'atteinte ainsi que dans la fréquence de l'association entre certains instruments et une pathologie précise. La dystonie de fonction, caractérisée par un trouble de la coordination indolore mais répétitif, est une pathologie redoutée par les musiciens. La symptomatologie ne se manifeste que lors de la réalisation de certains gestes professionnels précis. Le syndrome de surmenage ainsi que les syndromes canalaires peuvent également se rencontrer. Une prise en charge spécifique et multidisciplinaire est souvent nécessaire.

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.

Metastasizing pleomorphic adenoma of the submandibular gland: a case report.

Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands. It is usually a benign, slow-growing and well-circumscribed tumour. However, PA may occasionally give rise to metastases that usually occur after a previous recurrence. These tumours display benign histological features in both primary tumours and metastases. Such tumours have been termed metastatic PA or metastatic mixed tumours. We report a case of metastatic PA of the submandibular gland with metastasis to the cervical lymph nodes.

In vitro antiviral activities of extracts derived from Daucus maritimus seeds.

The antiviral activities of extracts from Daucus maritimus seeds were investigated against the reverse transcriptase of human immunodeficiency virus (HIV) type 1 and a panel of RNA-dependent RNA polymerases of dengue virus, West Nile virus (WNV) and hepatitis C virus (HCV). The extracts showed moderate to potent inhibition rates against the four viral polymerases. The ethyl acetate extract exhibited a potent inhibitory effect against WNV's RdRp, with an IC50 value of 8 µg mL⁻¹. The F2 fraction exhibited potent inhibitory activity against WNV and HCV's RdRps, with IC50 values 1 and 5 µg mL⁻¹, respectively. The P2 fraction also showed potent inhibitory effects on WNV and HCV's RdRps, with IC50 values 2.7 and 4 µg mL⁻¹, respectively. The results suggest that these extracts are candidates for the development of new anti-WNV RpDp and anti-HCV RpDp agents.