[Clinical, radiographic and biologic particularities of ankylosing spondylitis in Tunisian patients according to the presence or the absence of the HLA B27 and its sub-types]. / Particularités cliniques, radiologiques et biologiques de la spondylarthrite ankylosante en Tunisie selon la présence ou l'absence du HLA B27 et de ses sous-types.

To assess the clinical, radiographic and biologic particularities of ankylosing spondylitis (AS) in Tunisian patients according to HLA B27 and its sub-types statute. This was a case-control study that included 100 patients (85 males/15 females) with AS according to the modified New York criteria. Demographic, clinical, AS specific indexes, radiographic and biologic parameters were determined. HLA-B and B27 subtypes typing of all subjects were performed by PCR-SSP. Patients mean age was 38.4 years +/- 12.6 HLA-B27 was found in 62% of patients. The comparison of B27 positive and B27 negative patients revealed a correlation of B27 with age, male gender, family history of spondylarthropathies, age at disease onset, acute onset of the disease, inaugural spinal involvement, uveitis, bilateral and destructive hip arthritis as well as a high score of mSASSS. The most frequent sub-types of HLA B27 were B*2702 (49.2%) and B*2705 (36.3%). No significant difference of the clinical presentation of the disease or severity factors was found among these patients. This study confirmed the contribution of the HLA B27 to the determination of the clinical presentation of AS. The variability of factors linked to B27 may be explained by the polygenic model of the disease.

Comparative study of indices of activity evaluation in rheumatoid arthritis.

INTRODUCTION: Choosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-(ESR) and DAS28-(CRP) indices in the evaluation of RA activity. PATIENTS AND METHODS: In this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) "tau" similarity coefficient. RESULTS: The 87 female and 13 male patients (sex ratio: 6.7F/1M) were of a mean age of 52.9±11.6 years (17-77) and have been living with RA for a mean of 8.3±9 years (2 months-41 years). The DAS28-(ESR) mean score was 5.53±1.46 [1.25-8.05]. The DAS28-(CRP) mean score was 5.01±1.44 [1.68-7.81]. The CDAI mean score was 30.72±15.04 [2-62] and that of SDAI was 28.86±15.86 [2.3-71.3]. A positive, statistically significant correlation was noted between the four indices of RA activity. The level of similarity between the different indices was good (K variation between 0.758 and 0.943). DAS28-(ESR) allowed classifying the patients in the same category of disease activity than DAS28-(CRP) in a proportion of 85%. This proportion was 88% when comparing DAS28-(ESR) to CDAI and SDAI, respectively. Regarding DAS28-(CRP) and CDAI, these two indices classified the patients in the same category in a proportion of 80%, compared to 87% regarding DAS28-(CRP) and SDAI. Finally, CDAI and SDAI classified the patients in the same category in a proportion of 92% with an excellent level of similarity. CONCLUSION: Different evaluation indices of RA activity are currently available. DAS28 is the most used. CDAI and especially SDAI have a good level of similarity with DAS28. Their advantage is to be simple and quick, and seem therefore well adapted to the follow-up of outpatients.

[Scapulohumeral hydatidosis: a new case in Tunisia]. / L'hydatidose scapulohumérale: à propos d'une nouvelle observation en Tunisie.

Osseous hydatidosis is reported in only 0.5-2.5% of the cases. The scapulohumeral localization is extremely rare. A 39-year-old woman, born in a rural area of Tunisia, presented swelling and tenderness of the left shoulder with limited motion 7 days after a minor trauma. Plain radiographs, CT and MRI showed osteolytic scapulohumeral lesions, cortical rupture and multiple cysts in the muscles, which were suggestive of hydatidosis. Indirect haemagglutination test using hydatid antigen was positive (1/280). The patient refused radical surgery and underwent resection of axillary cysts. Albendazole was given in the recommended dose but was stopped immediately due to hepatic toxicity. Scapulohumeral hydatidosis is extremely rare, often invasive and behaves like a locally malignant bone tumour. Its treatment is also difficult.

[A Tunisian case of pachydermoperiostosis]. / La pachydermopériostose. Expériences tunisiennes.

Clubbed fingers are classically associated with chronic cardiac and pulmonary affection. Pachydermoperiostosis, a rarer aetiology, is a hereditary affection which is difficult to diagnose in its incomplete form. We relate a Tunisian case report. Our patient consulted for joint manifestations. The diagnosis of Pachydermoperiostosis was set up on 3 out of the 4 Borochowitz criteria. The osteoarticular manifestations mainly led to differential diagnosis with secondary hypertrophic osteoarthropathy. The underlying pathogenic mechanism of this disease still remains unclear.