Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features.

BACKGROUND: The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. METHODS: We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. RESULTS: Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). CONCLUSION: In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.

The epidemiology of tuberculous dactylitis: A case report and review of literature.

The literature on tuberculous dactylitis is poor, and most literature consists of isolated case reports. The aim of this case series is to study the particularities and the epidemiological aspects of tuberculous dactylitis in Tunisian patients. Google and Medline search was done using key words "tuberculous dactylitis" and "spina ventosa." Only Tunisian reports in adult patients were included. Eleven cases including this mentioned case were included in this review. There was a female predominance, high frequency of trauma before disease installation, rarity of predisposing factors, and less inflammation in blood tests when comparing with other cases in literature.

Etude de la densité minérale osseuse et du risque de fracture chez les adultes diabétiques de type I

Introduction : L'impact du diabète de type 1 sur la masse osseuse et le risque de fracture reste un sujet de débat. Le but de ce travail est d'étudier la densité minérale osseuse et le risque de fracture au cours du diabète de type 1.Méthodes : Étude transversale cas-témoins incluant 40 patients diabétiques de type I et 40 témoins appariés selon l'âge et le sexe. Ont été exclus les sujets présentant une pathologie ou consommant un traitement pouvant être à l'origine d'une ostéoporose. La mesure de la densité minérale osseuse a été réalisée par la méthode DEXA au rachis lombaire et au col fémoral.Résultats : La densité minérale osseuse était diminuée de façon significative au rachis (p< 0,001) et au fémur (p = 0,001) chez les diabétiques de type 1 par rapport aux non diabétiques. La perte de masse osseuse chez les diabétiques était corrélée à un indice de masse corporelle plus bas (p = 0.018) ainsi qu'au déséquilibre du diabète (p= 0.012). Les fractures non traumatiques étaient plus fréquentes chez les diabétiques par rapport aux témoins (p < 0,001). Les facteurs de risque de fractures étaient les antécédents familiaux de fracture du col du fémur, l'existence d'une ostéoporose à la densitométrie, le tabagisme et l'existence d'une néphropathie. Conclusion : La perte osseuse ainsi que les fractures non traumatiques sont fréquentes au cours du diabète type I

[Safety and Efficacy of Etanercept in Rheumatoid Arthritis With End-stage Chronic Renal Failure]. / Inocuité et efficacité de l'étanercept lors d'une polyarthrite rhumatoïde compliquée d'insuffisance rénale terminale à propos d'un cas.

The use of etanercept in rheumatoid arthritis patients with end-stage renal failure has not been well reported. We report here the case of 58-years-old patient who was treated with 50 mg of etanercept once a week to control the activity of her disease. The patient improved after starting the treatement. No serious infectious complication or side effects were seen. The follow-up was 18 months. Our case showed the safety and efficacity of etanercept rheumatoid arthritis in patient with end-stage renal failure.

Osteoarticular tuberculosis dactylitis: Four cases.

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country.

Collagenous colitis and spondylarthropathy.

Collagenous colitis is a recent cause of chronic diarrhea. Cooccurrence with spondylarthropathy is rare. We describe two cases: one man and one woman of 33 and 20 years old were suffering from spondylarthropathy. They then developed collagenous colitis, 4 and 14 years after the onset of spondylarthropathy. The diagnosis was based on histological features. A sicca syndrome and vitiligo were observed with the female case. The presence of colitis leads to therapeutic problems. This association suggests a systemic kind of rheumatic disease of collagenous colitis.

[Procedural pain assessment after spinal injections of corticosteroid]. / Douleur induite: complication méconnue des infiltrations péridurales aux corticoïdes chez l'adulte.

BACKGROUND: Spinal injections of corticosteroid are commonly performed by rheumatologists in their daily practice but little is known about the frequency, the intensity and the management of procedural pain observed in these osteoarticular injections in daily practice. AIM: To evaluate the prevalence and intensity of pain caused by spinal injections. METHODS: In this observational prospective study, data were collected over 6 months, for up to 44 procedures (corticosteroid spinal injection). Evaluation of the pain was evaluated immediately before and after the injection using Huskisson's visual analogue scale (VAS). Statistical analysis was carried out in order to compare patients who had suffered from pain whilst undergoing the procedure to those who had not. RESULTS: Data were analyzed for 17 patients (12 female, mean age 53.6 ± 10.5 years). Over 50% of patients experienced procedural pain. Significant predictive factors of genesis of the procedural pain were the young age (p=0.022) and the intensity of the initial pain (p < 0.001), while the existence of a co morbidity is rather a protective factor (p = 0.006). Others factors such us sex, origin, level of studies, socioeconomic conditions, didn't seem to have of effect on the procedural pain. CONCLUSION: Most patients undergoing spinal injections suffer from procedural pain. Specific research and guidelines for the management of procedural pain related to rheumatologic care should be established to improve the quality of care provided by physicians.

[Obesity has a protective effect on radiographic joint damage in rheumatoid arthritis]. / L'obésité est un facteur protecteur contre l'atteinte structurale au cours de la polyarthrite rhumatoïde.

BACKGROUND: Obesity is a state of chronic low-grade inflammation that predisposes people to several diseases and that is increasingly prevalent. Rheumatoid arthritis (RA) is marked by the presence of proinflammatory cytokines and, in general, the presence of high levels of inflammatory markers is associated with a severe disease course and joint damage. AIM: To assess the impact of obesity on disease activity, quality of life and articular damage in patients with established RA. METHODS: Between July 2009 to December 2009, 119 RA patients were included and divided in two groups according to the body mass index (obeses and controls). RA activity was assessed by the Disease Activity Score (DAS) 28, quality of life by the Health Assessment Questionnaire (HAQ) and radiographic joint damage by the modified Sharp score. RESULTS: Obesity was not correlated with worsen RA activity (p=0.71) nor quality of life impairment (p=0.51). The obese group had a lower modified Sharp score than the control group (64.97versus113.64; p < 0.032) and this association remained significant after adjustment for age, sex, disease activity, extraarticular manifestations, comorbidities, presence of rheumatoid factor, and disease duration. CONCLUSION: Obesity does not have an impact on disease activity nor changes in quality of life, but it has a protective effect on the amount of joint destruction in established rheumatoid arthritis.