[The new classification criteria for spondylarthritis: implications in clinical practice]. / Place des nouveaux critères de classification des spondyloarthrites en pratique Clinique.

" Spondyloarthritis" consists of a group of several diseases sharing clinical, radiological and genetic similarities. Ankylosing spondylitis is the main representative of this group and is characterized by a predominant axial involvement. The presence of radiographic sacroiliitis is essential for the diagnosis of ankylosing spondylitis according to the modified New York criteria. Because the occurence of radiographic sacroiliitis takes 8 to 11 years, the diagnosis of spondyloarthritis is often delayed. Magnetic resonance imaging can depict sacroiliac joint inflammation before the appearance of radiographic damage thereby defining the concept of " non-radiographic axial spondylo-arthritis". This entity was defined by the axial spondyloarthritis classification criteria published by the Assessment of SpondyloArthritis international Society (ASAS). Some factors, such as elevated levels of C-reactive protein at baseline, have been identified as predictors of radiographic sacroiliitis progression, leading to a definite diagnosis of ankylosing spondylitis. These two entities show similar clinical expression (clinical features and activity levels), suggesting continuity between the two diseases. Non-radiographic forms most often affect women and patients with recent symptoms, and are therefore considered as a pre-radiographic status. If the use of magnetic resonance imaging is necessary for the identification of non-radiographic axial spondyloarthritis according to the ASAS criteria, the presumptive diagnosis is mainly based on complaints of inflammatory back pain. The presence of other typical clinical features, such as HLA B27 positivity and/or radiographic sacroiliitis increases the diagnostic probability and indicates the need for referral to a specialist.

[Multifocal diabetic myonecrosis]. / Infarctus musculaire multifocal diabétique.

Diabetic muscle infarction is a rare and often unrecognized complication of diabetes. It typically occurs in patients with poorly controlled and multi-complicated diabetes. Typical clinical presentation is an indurate muscle pain, mainly localized in the lower limb with an acute onset. In most cases, diabetes myonecrosis is focal and sometimes can be recurrent. Diagnosis is clinical but can used magnetic resonance imaging (MRI). Muscle biopsy is sometimes necessary in cases of doubt or to confirm the imaging diagnosis. Elevation of muscle enzymes (CPK) is present in half of cases. Management is conservative and the clinical and imaging evolution is usually favourable. We report the case of a patient presenting a subacute hyperalgesic lomboradiculopathy.

[Anti-CCP antibody test: diagnostic and pronostic values in rheumatoid arthritis]. / Les anticorps anti-peptides cycliques citrullinés (anti-CCP): intérêt diagnostique et pronostique dans la polyarthrite rhumatoïde.

Rheumatoid arthritis is an auto-immune disorder which diagnosis is based on clinical, radiological and biological criteria. Disease progression is characterized by appearance of bone erosions and progressive articular deformations which attenuate functional mobility. Only rheumatoid factor is actually considered as biological factor among recognized diagnostical criteria despite its weak sensibility and specificity rates. Anti-cyclic citrullinated peptides antibodies are directed toward citrullinated isoforms of some filaggrin's epitopes. Their sensitivity and specificity reach respectively 80 and 99%. Their presence is correlated to disease activity and to bone erosions development. They allow early identification and treatment of rheumatoid arthritis affected patients which is actually considered as a priority.

[Mandibular ameloblastic fibro-odontoma]. / Fibro-odontome ameloblastique mandibulaire.

Ameloblastic fibro-odontoma is a rare and benign tumor. It usually affects young patients. This report describes the case of a ten year old child presenting an asymptomatic and slow-growing tumor located in the posterior region of the mandible. The course was normal and no recurrence was found after simple enucleation of the tumor.

Evaluation of technetium-99m-ciprofloxacin (Infecton) for detecting sites of inflammation in arthritis.

OBJECTIVE: To study the frequency of technetium-99m-positive ciprofloxacin scans (Infecton scintigraphy) thought to be specific for bacterial DNA in patients with arthritis and to assess the clinical relevance of positive scans. METHODS: Four groups of adults with arthritis were studied. Group 1: 53 patients with inflammatory arthritis, 36 with spondylarthropathy (SpA) and 17 with rheumatoid arthritis (RA); group 2: five patients with crystal arthropathy; group 3: those patients with osteoarthritis (OA) of the knee, wrist or spine; and group 4: 28 patients who had no arthritis but were being investigated for renal infection. Patients were injected with 10 mCi 99Tcm-ciprofloxacin with isotope uptake analysis at 4 h. Clinically swollen joints were assessed by a rheumatologist and the positive scans assessed by a physician in nuclear medicine. RESULTS: Increased Infecton uptake was noted in inflamed joints independent of the pathology. It was seen in 10 of 17 patients with SpA, 12 of 17 with RA, all five with crystal arthropathy, eight with knee OA, two with wrist OA, none with spinal OA and none in uninflamed joints. A close correlation between clinically swollen joints and articular Infecton uptake was noted (P = 0.0003), with the uptake being in the distribution of the synovial perimeter. Additional uptake was noted in the abdomen (n = 9) and pulmonary region (n = 2) of SpA patients. CONCLUSION: The Infecton scan is not specific for infection but may be a reliable procedure for identifying the presence and distribution of the inflammation within joints. It has the potential for monitoring the response of inflamed joints to treatment.

[Necrotizing sialometaplasia: apropos of a case and review of the literature]. / La sialométaplasie nécrosante: à propos d'une observation et revue de la littérature.

Necrotizing Sialometaplasia is an inflammatory, self-healing, reactive process of probable vascular origin, that most commonly involves the minor salivary glands of the palate but can bee seen in all salivary glands. As its clinical and pathological features may suggest malignancy, knowledge of histologic criteria indicating the benign nature of the lesion and the integration of clinical and pathologic elements are required to obviate this mistake. We review the literature reporting to one case.