Sarcoidosis and spondyloarthritis: A coincidence or common etiopathogenesis?

Background: Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column. Case Presentation: A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes. Conclusions: Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidence

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey

Objectives: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.Methods: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.Results: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.Conclusion: Impairment in the quality of life can be significantwhen suffering from AS, affecting mental health more than physicalhealth. Among disease parameters, functional impairment,disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life

Sarcoidosis and spondyloarthritis: A coincidence or common etiopathogenesis?

Background: Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column. Case Presentation: A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes. Conclusions: Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidenc

Risk factors associated with bone loss and occurrence of fragility fractures in rheumatoid arthritis patients

Aim of the work: To investigate the bone mineral density (BMD) in rheumatoid arthritis (RA) Tunisian patients, to identify the risk factors associated with its decrease and to assess the fracture risk. Patients and methods: The study included 173 patients and 173 matched healthy controls. BMD was assessed by the dual-energy X-ray absorptiometry. The risk of hip fracture (HF) and major osteoporotic fracture (MOF) were assessed using the fracture risk assessment tool (FRAX). The disease activity, radiological severity and functional status were investigated. Results: The mean age of patients was 54.1 ± 11.04 years and 141 were females; 71.6% menopausal. Disease duration was 8.2 ± 8 years and disease activity score was 5.54 ± 1.26. Sharp van-der-Heijde (SvdH) score was 113.9 ± 106.8, health assessment questionairre (HAQ) score 1.03 ± 0.9. The BMD was significantly reduced in 138 (79.8%) patients and FRAX was higher compared to control (p < .001). The frequency of osteoporosis (48% vs. 18.5%), the risk of MOF (1.8 ± 2.6 vs. 0.6 ± 0.3) and HF (0.7 ± 1.7 vs. 0.08 ± 0.1) were significantly higher in RA patients than in controls. Bone loss in RA was significantly associated with age, low body mass index (BMI), longer disease duration, rheumatoid factor, SvdH, atlantoaxial subluxation and corticosteroids use. Menopause, low calcium intake, erythrocyte sedimentation rate and HAQ were risk factors for reduced BMD. The risk of MOF and HF was associated with age, menopause, calcium intake, BMI, disease duration, HAQ, SvdH, cumulative dose and duration of corticosteroids. Conclusion: bone loss and fragility fracture are frequent in RA and related to disease severity, function impairment and corticosteroids use. Keywords: Rheumatoid arthritis, Osteoporosis, Fracture, FRAX, Bone mineral densit

Caplan’s syndrome in an elderly-onset rheumatoid arthritis patient: About a new case

Introduction: The association of silicosis and RA is rare compared to pulmonary manifestations of rheumatoid arthritis (RA). A history of lung disease or a long exposure at work to silica and typical radiographic lesions on chest X-ray suggest the diagnosis of Caplan’s syndrome. We describe the case of an elderly Tunisian male RA patient with the Caplan’s syndrome diagnosed after prolonged exposure to silica. Case report: A 62-year old patient was referred for exploration of a chronic symmetrical polyarthritis for 2 years involving the hands, elbows, forefeet, and knees and accompanied by prolonged morning stiffness. He had no history of lung disease but had worked in a ceramic plant for 20 years. He presented with arthritis of the wrists and knees with a rheumatoid nodule of the left elbow. Joint destruction was present in both hands and feet. Rheumatoid factor and anti-cyclic citrullinated peptide antibodies were highly positive (135 UI/L and 363 UI/L respectively). The patient was diagnosed as RA and the disease activity score (DAS-28) was up for 6.87. His breathing was normal, pulmonary auscultation and spirometry were normal. Chest X-rays revealed a multiple micro-nodules distributed throughout the lungs but predominantly in the upper and middle zones. Bronchoalveolar lavage showed a pauci-cellular liquid and chest CT scan showed bilateral, round, well-delimited small centri-lobular nodules which predominate the upper lobes. There was infra-centimetrical adenopathy with mediastinal calcification. Conclusion: Prolonged exposure to silica dust has a remarkable influence on the development of RA with a suggested intricacy in to its pathogenesis

Wrist synovectomy confirmed tuberculous tenosynovitis in 8 cases: A follow-up study

AbstractAim of the workTuberculosis is still one of the important health problems. Because of its insidious evolution, tuberculous (TB) tenosynovitis (TS) is usually misdiagnosed and undertreated. The aim of this study was to investigate clinical and therapeutic outcomes of TB TS.Patients and methodsA retrospective study of 8 patients followed-up for TB TS was conducted. Clinical and therapeutic data were collected.ResultsThe median age was 45years (range 33–59years), they were 5 females and 3 males with a median duration till diagnosis of 15months. Fever, night sweats, and weight loss were reported by 3 patients. Physical examination showed swelling of the wrist and crepitation of the palmar side with affected fingers movements in 7 cases. A carpal tunnel syndrome was found in another case. The median erythrocyte sedimentation rate was 15mm/1st hour and the C-reactive protein 5mg/dl. Plain radiographies of the wrists were normal. Ultrasonography showed flexor TS in all cases. Since tuberculin skin tests were positive in all patients, TB TS was suspected. Surgical synovectomy was conducted and histological examination confirmed TB. In addition to surgical synovectomy, patients were treated with anti-TB drugs for 12months. No relapse was noted for a mean follow-up duration of 2years.ConclusionsTB TS can be misdiagnosed because of its insidious evolution. Histological examination confirms the diagnosis. Surgical synovectomy could confirm the diagnosis rapidly by the histological examination and be part of the treatment. Medical treatment should be well-conducted and maintained to avoid relapse and future complications