[Human immunodeficiency virus associated arthritis in Congo Brazzaville]. / Les arthrites liées au virus de l'immunodéficience humaine au Congo Brazzaville.

OBJECTIVE: The authors report epidemiologic, clinical, para clinical, and evolutive aspects of arthritis related to HIV in an AIDS endemic country. MATERIAL AND METHODS: A retrospective study was made in the rheumatology department of the Brazzaville University Teaching Hospital during 15 years and 6 months, on 3.042 in-patients among whom 306 (10%) were positive for HIV, 220 (7.2%) presented with a rheumatologic manifestation, and 158 (71.8%) with HIV related arthritis. RESULTS: The 158 patients included 91 men (57.6%), 67 women (42.4%), average 34.5 years of age, ranging from 15 to 61, all heterosexual. 99 patients (62.7%) were in the B stage, 40 (25.3%) in the C stage, and 19 (12.2%) in the A stage. Arthritis was polyarthritis (83.5%) or oligoarthritis (16.5%), symmetrical (97.5%), prevailing on the lower limbs (99.3%) with involvement of the great toe in 23% of cases. There was an important inflammatory syndrome with an erythrocyte sedimentation rate exceeding 100 mm for the 1st hour in 63.3% of the cases. Rhumatoid factors were negative. Synovial fluid was sterile, without microcrystals, and inflammatory. X-rays were normal. This non-destructive arthritis, evolved by successive bouts, and resolved in 2 to 5 weeks with NSAIDs and did not meet Amor nor European spondyloarthropathy criteria. CONCLUSION: Arthritis related to HIV represents the principal expression of nonseptic rheumatologic HIV manifestations in Congo.

[Septic arthritis in tropical environment. 176 cases report in Brazzaville]. / Les arthrites septiques en zone tropicale. a propos de 176 cas observes a Brazzaville.

OBJECTIVE: We report epidemiologic, clinic, para clinic, therapeutic and evolution aspects of septic arthritis in African tropical zone. MATERIAL AND METHODS: Retrospective survey in rheumatologic department of Brazzaville University Teaching Hospital over a period of 15 years and 6 months carrying on 176 septic arthritis observed among 3042 hospitalized patients. RESULTS: 70 men (39.77%) and 106 women (60.23%) average 35.25 years old, extremes 6 and 81 years. It was 158 cases of banal germ arthritis (89%) and 18 cases of tuberculosis arthritis (11%). The arthritis localised on knee in 42% of cases, hip 30%, sacroiliac joint 17% and shoulder 7%. Localization was multiple in 12%. A portal of entry was identified in 54% of cases. It was cutaneous in 21.5% and obstetrical in 16.5%. Risk factors were alcohol and tobacco (5.6%), diabetes mellitus (4%), sickle cell anaemia (4%) and HIV (3%). The diagnosis delay beyond of one month has been noted in 2/3 of cases. The causal germ can be isolated only in 30% of cases. It was staphylococcus aureus in 46.4% of cases, streptococcus in 10,7% and enterobacteria in 10.7% of cases. Koch bacillus has been isolated in 32% of cases. Inflammatory syndrome was important with an erythrocyte sedimentation rate upper 50 mm in 71% of cases. On X-ray, we noted in 64% of cases cartilaginous destruction signs and erosions in mirror. Antibiotics treatment associated to plastered immobilization were successful in 78% of cases but with functional prognostic in half of cases. The middle length of hospitalization was 25 days. Four patients died. CONCLUSION: Septic arthritis are very frequent in African tropical environment, localized to knee, hip and sacroiliac joint. Staphylococcus is recovered in the half of cases and Koch bacillus in 1/3 of cases. Late diagnosis explains cartilaginous destructions and ulterior functional prognostic.

Multiple stress fractures in a scleroderma patient on methotrexate therapy.

A patient on methotrexate therapy for scleroderma developed four stress fractures within a period of 13 months. She was not on steroid therapy and had no risk factors for osteoporosis. A review of the literature found 13 cases of stress fractures under methotrexate therapy. Whether methotrexate can induce bone changes remains controversial.

Circulating levels of IL-11 and leukaemia inhibitory factor (LIF) do not significantly participate in the production of acute-phase proteins by the liver.

To investigate the contribution of IL-11 and LIF to acute-phase protein (APP) production, we first analysed the effects of IL-11 and LIF on production of C-reactive protein (CRP), fibrinogen, and haptoglobin by human primary hepatocytes. We also measured the serum levels of IL-11, LIF, and CRP in serum from patients with inflammatory rheumatic diseases to assess the role of these cytokines in the APP response in vivo. We included patients with conditions associated with a high APP response such as rheumatoid arthritis (RA) or spondylarthropathy (SpA), and others usually associated with a weak APP response such as systemic lupus erythematosus (SLE), in order to investigate whether these cytokines could account for the differences in APP responses. Our results showed that IL-11 and LIF induced only minimal stimulation on production of APP by human primary hepatocytes compared with IL-6, known as the major inducer. Serum levels of CRP were elevated in RA and SpA, and significantly higher than in SLE patients. Despite the presence of a high APP response in some of our patients and despite the fact that we used sensitive assays to measure IL-11 and LIF, serum levels of both cytokines were not detected in any of the tested sera. In conclusion, our results show that circulating levels of IL-11 or LIF do not contribute significantly to the production of APP in vivo, and that they do not account for the difference in APP response between SLE and other inflammatory rheumatic diseases.