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.

[Erosive spondylarthropathy in hemodialysis. A case report]. / La spondylarthropathie erosive des hemodialyses. A propos d'un cas.

We report a case of 67-year-old woman with 11-year history of hemodialysis that complain of neck pain associated with cervico-brachial neuralgia. Imaging finding simulate infectious spondylitis. We consider the diagnosis of destructive spondylarthropathy in hemodialyzed patient since etiologic investigation was negative and RMN finding was suggestive. Our patient was partially improved with symptomatic treatment.

[Systemic manifestations of chronic hepatitis C]. / Les manifestations systemiques des hépatites virales C chroniques.

It's well known that hepatitis C virus (HCV) related chronic liver disease may be associated with various extra hepatic disorders. These manifestations can revealed the hepatic disease. We review the available data on the conditions and asses their clinical implications: vascular, cutaneous, articular, neurological or renal disorders. There is no correlation between these extra hepatic manifestations and the severity of liver disease. Several recent studies have established a strong link between HCV infection and essential mixed cryoglobulinemia but some other extra hepatic associations are just fortuitous. Others datas are necessary to better analyze these extra hepatic disorders and to offer the beneficial treatment of patients with chronic hepatitis C.

[Rheumatic spondylodiscitis in spondylarthropathies]. / Spondylodiscite rhumatismale au cours des spondylarthropathies.

The involvement of enthesis like disc space is the typical lesion of spondylarthropathies. Out of 240 patients with spondylarthropathies, 10 (7 M, 3 W; mean age: 37 years) have spondylodiscitis, affecting a total of 13 disc spaces: 1 cervical, 2 thoracic, 10 lumbar. The mean duration of spondylarthropathy at the time of diagnosis of spondylodiscitis is 10 years. Spondylodiscitis has a variable clinical presentation: painful (6 cases), asymptomatic (4 cases). Its coexistence with typical radiographic signs of spondylarthropathy added to the exclusion of bacterial origin, permit to link it to spondylarthropathy. Its evolution is generally favourable.

[Synovitis caused by plant thorn and chronic polyarthritis. Apropos of a case and review of the literature]. / Synovite à piquant végétal et polyarthrite chronique. A propos d'un cas et revue de la littérature.

A 54 year old male developed plant thorn synovitis of the knee followed five months later by nonerosive seronegative polyarthritis. The occurrence of chronic inflammatory joint disease shortly after plant thorn synovitis is exceedingly rare. The relationship between the two events remains to be clarified.

Bronchoalveolar lavage and transbronchial biopsy in spondyloarthropathies.

Fourteen patients (12 men, 2 women) with spondyloarthropathies underwent bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and other respiratory investigations. BAL revealed lymphocytosis and increased nonaltered neutrophil polynuclears in a smoker and an isolated lymphocytosis in one patient with restrictive syndrome and radiographic apical fibrosis. TBB showed interstitial fibrosis in the 2 patients and in 3 others who are all nonsmokers and among whom 2 had a restrictive syndrome. Subclinical alveolitis in spondyloarthropathies is absent. Interstitial fibrosis is not rare and its frequent association in a restrictive syndrome suggests a mechanical origin.

[Destructive polyarthritis in Behcet's disease. Apropos of a case and review of the literature]. / Polyarthrite destructice au cours de la maladie de Behçet. A propos d'un cas et revue de la littérature.

The authors report a case of a 37 years old man with Behçet's disease since 7 years who develops a destructive chronic polyarthritis involving wrists, hands and one knee. The parallel evolution between recurrent orogenital ulceration and arthritis added to the absence of other associated destructive rheumatism permit to link this polyarthritis to Behçet disease. In spite of the few reports, the occurrence of destructive arthritis can't exclude absolutely the diagnosis of this affection.