Reparative radiological changes of hip joint after TNF inhibitors in ankylosing spondylitis

Background: Hip involvement in ankylosing spondylitis (AS) is a common extraspinal arthritic manifestation, which is associated to a worse functional outcome. Little data are available on the effectiveness of conservative treatment strategies. The TNF inhibitors have been proven effective on AS activity parameters. Their structural effect on hip disease however, little is studied. Case presentation: We describe four new cases of reparative changes of a damaged hip joint after treatment with TNF inhibitors. The average of age was 32.5 (27- 36) years. There were 3 men and 1 woman. Hip involvement was bilateral in all cases. Etanercept was prescribed in 3 cases and infliximab in 1 case. At baseline, all patients had a painful and limited hip with high disease activity and an important functional impairment. After an average of 5.5 years of treatment with TNF inhibitors, the BASRI hip evaluated in antero-posterior x-rays of the pelvis remained unchanged at 2.4. The average of mean hip joint space was 2.9mm (2.3-3.6). A widening in hip joint space was observed in all cases with less subchondral cysts. Conclusion: TNF inhibitors seem to be effective on hip joint disease in patients with AS

Could omega-3 fatty acids prevent rheumatoid arthritis?

International audienceRheumatoid arthritis (RA) is a systemic inflammatory disease in which both genetics and environment play a role. Diet is an environmental factor that has been studied in other inflammatory conditions [1], [2], [3]. Particularly, omega-3 essential fatty acids (omega-3 FA) have been found to have a suppressive action on inflammation and are thought to modulate immune response [4], [5], [6]. New data showed that omega-3 FA may also interfere in the pathophysiology of rheumatoid arthritis, namely in the steps that lead from the pre-clinical phase to established disease, which may open new perspectives for the prevention of this disease

Factors leading to work absenteeism in Tunisian ankylosing spondylitis patients

Background: The work productivity loss due to ankylosing spondylitis (AS) has a notable socioeconomic impact. Aim of the work: To evaluate the professional characteristics of Tunisian AS patients and determine conditions that lead to absenteeism. Patients and methods: 99 AS patients were included. Disease characteristics and specific AS indices were assessed; Bath AS disease activity index (BASDAI), Bath AS disease functional index (BASFI), Bath AS disease global index (BASG-s), Bath AS radiologic index (BASRI), hospital anxiety and depression (HAD) scale and Shorts Form-36 (SF-36). Visual analogue scale was used to evaluate pain and fatigue. Patients were questioned on their work situation, work sector, work conditions (rhythm, posture, working hours, distance to workplace, duration of rest) and whether they have missed work time during the last three months because of their disease. Results: Mean age of patients was 40.02 ± 11.78 years; 70 men and 29 women. The mean disease duration was 11.87 ± 10.7 years. Absenteeism was present in 23.2% of the cases. Only the deterioration of the mental component of the SF-36 was associated with absenteeism (p = 0.03). Depression and anxiety states seemed not to increase absenteeism, gender and work sector had no influence. Factors significantly associated with absenteeism were increased working hours (p = 0.037), bad posture (p = 0.001), stress at work (p = 0.035) and insufficient day rest duration (p = 0.007). Carrying heavy loads tended to be more frequent in the absenteeism group (p = 0.08). Conclusion: Absenteeism is high amongst Tunisian AS patients. Work conditions were important factors of absenteeism in Tunisian AS patients that directly influence productivity. Keywords: Ankylosing spondylitis, Work, Absenteeism, SF-36, Tunisi

Inocuité et efficacité de l’étanercept lors d’une polyarthrite rhumatoïde compliquée d’insuffisance rénale terminale à propos d’un cas

L’expérience clinique concernant l’utilisation de l’étanercept dans le traitement de la polyarthrite rhumatoïde chez des patients avec insuffisance rénale chronique terminale est limitée. Nous rapportons le cas d’une patiente âgée de 58 ans insuffisante rénale chronique au stade terminal qui avait reçu l’étanercept à la dose de 50 mg par semaine pour contrôler l’activité de sa polyarthrite rhumatoïde. Ce traitement avait permis de contrôler l’activité de la maladie. Aucun effet indésirable ni complication infectieuse grave n’avaient été notés. Le recul était de 18 mois

Pulmonary nodules in a patient with rheumatoid arthritis: Which diagnostic approach is the most appropiate?

Background: Pulmonary nodular excavation should firstly evoke tuberculosis or necrosis broncho-pulmonary tumor, particularly: epidermoid carcinoma. The case discussed here illustrated these difficulties in patients with rheumatoid arthritis (RA). Case Presentation: A 63-year-old woman was presented with a-three-year history of RA and a recent discovery of an excavated pulmonary nodule. Initial investigations focused on a rheumatoid origin. The evolution of the disease was worrisome and surgical exploration was deemed mandatory. The result was the discovery of a nodule of a malignant nature. Conclusion: In this paper, we discussed the excavation of the pulmonary nodule, its diagnoses and management of the difficulties we encountered

Dorsal costo-vertebral joint as a rare localization of Staphylococcus aureus sepsis

Background: Septic arthritis of the costovertebral thoracic joint is a rare site infection. We report an isolated case of septic arthritis of the 10th costo-vertebral right joint with osteitis due to Staphylococcus aureus. Case presentation: A 59 year old Tunisian man presented with a 2 months history of dorsal spinal pain with fever, associated with asthenia, anorexia and loss of weight. There was a raised C-reactive protein (176 mg/L) and erythrocyte sedimentation rate (100 mm/1st h). Tests for tuberculosis and brucellosis were negative. In the present patient, the clinical symptoms were unspecific with lack of obvious predisposing factors. He had neither history of taking immunosuppressors nor of any disease indicative of immunodeficiency. Thoraco-abdominal computed tomography (CT) showed a lytic lesion centered on the 10th costo-vertebral right joint and histo-pathologic exam of the costo-vertebral puncture confirmed chronic active osteitis and bacteriologic culture allowed identifying methicillin-sensitive Staphylococcus aureus. The patient was treated with ciprofloxacin 1500 mg/day, associated with daily rifampin (20 mg/kg) for total treatment duration of 12 weeks after consulting infectious disease specialists. After a follow-up of 6 months, the patient remained asymptomatic and the markers of inflammation negative. Conclusion: Septic arthritis of costovertebral joints should be considered when a patient presents with back pain, fever and elevated inflammatory markers. The diagnosis of septic arthritis of costovertebral joints remain a challenge to clinicians. CT is important to confirm a diagnosis and guide costovertebral biopsy and culture. Early and appropriate antibiotic therapy is important for a required outcome. Keywords: Costo-vertebral joint, Staphylococcus aureus, Septic arthritis, Dorsal spine, Computerized tomograph

Unexpected diagnosis of vertebral osteolysis

Abstract This is the case of a 50‐year‐old patient suffering from inflammatory low back pain. Radiological exploration showed posterior vertebral damage compatible with discovertebral pseudo‐tumor tuberculosis. Pathological examination found no malignant cells, but caseous necrosis was present. The patient was put on antitubercular drugs. The evolution was favorable under treatement

Clinical and laboratory characteristics in septic arthritis patients with and without isolated germs

Background: The management of septic arthritis without bacteriological evidence is not well codified. Aim of the work: To compare the features of septic arthritis with and without isolated germs. Patients and Methods: This is a retrospective study including all patients with septic arthritis, discharged from the Rheumatology Department of Charles Nicolle Hospital, Tunisia over a period of 17 years [1998–2014]. The epidemiological and clinical data were evaluated. Patients were grouped according to the presence and absence of isolated germs. Results: Fifty-nine septic arthritis patients were collected with an average of 3.5 cases/year. The mean age of the patients was 54.6 ± 19 years [15–95] without sex predominance: 28 were male and 31 were female. At least one risk factor for SA was founded in 41 patients (69.5%). It was monoarticular in 50 cases (84.7%), oligoarticular in 6 (10.2%) and polyarticular in 3 (5.1%). The knee was the most often affected (49.2%). Germ was isolated in cultures and/or synovial fluids in 27 patients (45.8%). The age tended to be older in those with isolated germs and the elderly were more frequently infected compared to the non-elderly (51.8% versus 21.9%) (p = .01). The synovial fluid analysis, clinical and laboratory characteristics were comparable but the functional disability was significant higher in those without isolated germs (p = .024). Sternoclavicular joint was more common in patients with isolated germs (p = .016). There was no difference between the two groups regarding the course of the infection. Conclusion: Patients with isolated and non-isolated germs have similar epidemiologic, clinical, biological and radiological characteristics. Keywords: Septic arthritis, Isolated germs, Infection, Joint punctur