La mélorhéostose

La mélorhéostose est une dysplasie osseuse sclérotique progressive. Son incidence est estimée à 0,9 par million d'habitants. C'est une maladie congénitale, décrite par A. Léri et L. Joanny en 1922. Elle reste méconnue du fait de sa rareté. Elle débute insidieusement dans l'enfance, et touche les os longs des membres inférieurs. Progressivement s'installe une raideur articulaire et une impotence fonctionnelle. La douleur, la raideur et les déformations articulaires constituent le profil évolutif de la maladie. Certaines hypothèses évoquent une mutation du gène du mésoderme et du gène LEMD3. Son diagnostic est posé sur les données caractéristiques des radiographies standards. L'histologie est inutile en cas de forme typique. Nous en rapportons un cas chez une patiente âgée de 44 ans, présentant depuis l'âge de 12 ans, des gonalgies droites mixtes et intermittentes, soulagées par traitements symptomatiques. L'évolution était marquée par la reprise de la même symptomatologie occasionnant progressivement une boiterie à la marche, et apparition d'une tuméfaction et incurvation de la cuisse du même côté. L'examen physique retrouvait; Une attitude du membre inférieur droit en flexion rotation interne et abduction, une tuméfaction de la cuisse et une raideur de la hanche et du genou droit. Le bilan biologique était normal. Les radiographies standard retrouvaient de multiples opacités longilignes en «coulées de bougie» s'étendant le long de la corticale fémorale et tibio-peronière droite et ossifications des tissus mous para articulaire et osseux ( A et B), confirmées au scanner (C) et à la scintigraphie osseuse, fixant les zones d'ostéoformation (D). La patiente était mise sous antalgiques et et bisphosphonates. Le diagnostic différentiel se pose avec l'ostéosarcome paraostéal, la myosite ossifiante, l'hématome calcifié ou une ossification des parties molles. Le traitement fait appel aux antalgiques bisphosphonates, colchicine, vasodilatateurs, corticothérapie. La chirurgie en association avec une rééducation sont proposées pour limiter la maladie

Les syndromes paranéoplasiques en rhumatologie

Les syndromes paranéoplasiques sont un groupe d’affections associées à des tumeurs malignes indépendamment reliés à leurs sièges ou à leurs tailles. L’étiopathogénie incrimine des mécanismes immunitaires. Les syndromes paranéoplasiques en rhumatologie intéressant essentiellement les articulations, les muscles, les os, les fascias ou les vaisseaux. L’apparition des signes rhumatologiques peut précéder ou faire suite au diagnostic d’un cancer, avec un intervalle ne dépassant pas 3 ans

Aseptic necrosis of the femoral head after pregnancy: a case report

A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus ,dyslipidemia espacially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's disease. Among the less established factors, we mention procoagulations abnormalities, HIV infection, chemotherapy. We report a case of osteonecrosis of femoral head after pregnancy. The Pan African Medical Journal 2016;2

Safety of Symptomatic Slow-Acting Drugs for Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis

BACKGROUND: Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are an important drug class in the treatment armamentarium for osteoarthritis (OA). OBJECTIVE: We aimed to re-assess the safety of various SYSADOAs in a comprehensive meta-analysis of randomized placebo-controlled trials, using, as much as possible, data from full safety reports. METHODS: We performed a systematic review and random-effects meta-analyses of randomized, double-blind, placebo-controlled trials that assessed adverse events (AEs) with various SYSADOAs in patients with OA. The databases MEDLINE, Cochrane Central Register of Controlled Trials (Ovid CENTRAL) and Scopus were searched. The primary outcomes were overall severe and serious AEs, as well as AEs involving the following Medical Dictionary for Regulatory Activities (MedDRA) system organ classes (SOCs): gastrointestinal, cardiac, vascular, nervous system, skin and subcutaneous tissue, musculoskeletal and connective tissue, renal and urinary system

Safety of symptomatic slow-acting drugs for osteoarthritis: Outcomes of a systematic review and meta-analysis

Background: Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are an important drug class in the treatment armamentarium for osteoarthritis (OA). Objective: We aimed to re-assess the safety of various SYSADOAs in a comprehensive meta-analysis of randomized placebo-controlled trials, using, as much as possible, data from full safety reports. Methods: We performed a systematic review and random-effects meta-analyses of randomized, double-blind, placebo-controlled trials that assessed adverse events (AEs) with various SYSADOAs in patients with OA. The databases MEDLINE, Cochrane Central Register of Controlled Trials (Ovid CENTRAL) and Scopus were searched. The primary outcomes were overall severe and serious AEs, as well as AEs involving the following Medical Dictionary for Regulatory Activities (MedDRA) system organ classes (SOCs): gastrointestinal, cardiac, vascular, nervous system, skin and subcutaneous tissue, musculoskeletal and connective tissue, renal and urinary system. Results: Database searches initially identified 3815 records. After exclusions according to the selection criteria, 25 studies on various SYSADOAs were included in the qualitative synthesis, and 13 studies with adequate data were included in the meta-analyses. Next, from the studies previously excluded according to the protocol, 37 with mainly oral nonsteroidal anti-inflammatory drugs (NSAIDs) permitted as concomitant medication were included in a parallel qualitative synthesis, from which 18 studies on various SYSADOAs were included in parallel meta-analyses. This post hoc parallel inclusion was conducted because of the high number of studies allowing concomitant anti-OA medications. Indeed, primarily excluding studies with concomitant anti-OA medications was crucial for a meta-analysis on safety. The decision for parallel inclusion was made for the purpose of comparative analyses. Glucosamine sulfate (GS), chondroitin sulfate (CS) and avocado soybean unsaponifiables (ASU; Piascledine ® ) were not associated with increased odds for any type of AEs compared with placebo. Overall, with/without concomitant OA medication, diacerein was associated with significantly increased odds of total AEs (odds ratio [OR] 2.22; 95% confidence interval [CI] 1.58–3.13; I 2 = 52.8%), gastrointestinal disorders (OR 2.85; 95% CI 2.02–4.04; I 2 = 62.8%) and renal and urinary disorders (OR 3.42; 95% CI 2.36–4.96; I 2 = 17.0%) compared with placebo. In studies that allowed concomitant OA medications, diacerein was associated with significantly more dermatological disorders (OR 2.47; 95% CI 1.42–4.31; I 2 = 0%) and more dropouts due to AEs (OR 3.18; 95% CI 1.85–5.47; I 2 = 13.4%) than was placebo. No significant increase in serious or severe AEs was found with diacerein versus placebo. Conclusions: GS and CS can be considered safe treatments for patients with OA. All eligible studies on ASU included in our analysis used the proprietary product Piascledine ® and allowed other anti-OA medications; thus, the safety of ASU must be confirmed in future studies without concomitant anti-OA medications. Given the safety concerns with diacerein, its usefulness in patients with OA should be assessed, taking into account individual patient characteristics. </p

Guidelines for the conduct of pharmacological clinical trials in hand osteoarthritis: Consensus of a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)

Objectives:To gather expert opinion on the conduct of clinical trials that will facilitate regulatory review and approval of appropriate efficacious pharmacological treatments for hand osteoarthritis (OA), an area of high unmet clinical need.Methods:The European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) organized a working group under the auspices of the International Osteoporosis Foundation (IOF) and the World Health Organization (WHO).Results:This consensus guideline is intended to provide a reference tool for practice, and should allow for better standardization of the conduct of clinical trials in hand OA. Hand OA is a heterogeneous disease affecting different, and often multiple, joints of the thumb and fingers. It was recognized that the various phenotypes and limitations of diagnostic criteria may make the results of hand OA trials difficult to interpret. Nonetheless, practical recommendations for the conduct of clinical trials of both symptom and structure modifying drugs are outlined in this consensus statement, including guidance on study design, execution, and analysis.Conclusions:While the working group acknowledges that the methodology for performing clinical trials in hand OA will evolve as knowledge of the disease increases, it is hoped that this guidance will support the development of new pharmacological treatments targeting hand OA