Angiotensin-converting enzyme insertion/deletion gene polymorphisms and the risk of glioma in an Algerian population

Introduction: just recently, it has been established that the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is linked to the pathogenesis and to the evolution of human cancers. Therefore, the present study was concerned with the investigation of an eventual association between glioma and I/D polymorphism of the ACE gene. Methods: the expression of ACE gene was detected by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis in 36 Algerian patients with glioma and 195 healthy controls. Results: in glioma cases, allelic frequencies and genotypes distribution of the ACE I/D polymorphism were different from controls cases. ACE DD genotype were highly presented in glioma cases (63.9%) than controls (33.8%) and conferred 3.64-fold risk for predisposition in glioma cases (vs ID genotype, p<0.001). Recessive model (ACE II + ID genotypes vs DD) was associated with a 72% reduced risk of glioma (OR = 0.28, 95% CI: 0.13-0.60, p <0.001). Per copy D allele frequency was found higher in glioma cases (79.2%) than in controls (63.3 %), OR = 2.20, 95% CI: 1.20 - 4.03, p = 0.009. Conclusion: the obtained data showed that the presence of the D allele might be a risk factor for the development of glioma. Further studies considering different ethnic groups with large samples are required to confirm this finding

Collagenous Colitis and Spondylarthropathy

Collagenous colitis is a recent cause of chronic diarrhea. Cooccurrence with spondylarthropathy is rare. We describe two cases: one man and one woman of 33 and 20 years old were suffering from spondylarthropathy. They then developed collagenous colitis, 4 and 14 years after the onset of spondylarthropathy. The diagnosis was based on histological features. A sicca syndrome and vitiligo were observed with the female case. The presence of colitis leads to therapeutic problems. This association suggests a systemic kind of rheumatic disease of collagenous colitis

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

The epidemiology of tuberculous dactylitis: A case report and review of literature

The literature on tuberculous dactylitis is poor, and most literature consists of isolated case reports. The aim of this case series is to study the particularities and the epidemiological aspects of tuberculous dactylitis in Tunisian patients. Google and Medline search was done using key words “tuberculous dactylitis” and “spina ventosa.” Only Tunisian reports in adult patients were included. Eleven cases including this mentioned case were included in this review. There was a female predominance, high frequency of trauma before disease installation, rarity of predisposing factors, and less inflammation in blood tests when comparing with other cases in literature

Osteoarticular tuberculosis dactylitis: Four cases

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country

Analysis of referral letters to rheumatology consultation in Tunisia

Aim of the work: Our objective was to analyze the content and quality of referral letters to rheumatology consultation. Patients and methods: This is a cross-sectional study conducted on the rheumatology consultations in a tertiary hospital over six months (April-October 2014). Patients were interviewed and their rheumatology consultation referral letters analyzed. The relevance of referent reasons, suggested diagnosis and additional tests requested prior to recruitment were studied. Results: We studied 302 referral letters for rheumatology consultation. The average age of patients was 55.34 ± 15 years (13–85). The sex ratio M/F was 0.3. All patients consulted for painful symptoms affecting mainly the lumbar spine (20%) and knees (20%). The current clinical problem was appropriately presented in 43% of the referral letters. Only 6 letters (2%) were illegible, 28 letters did not contain the consultation date (9%). General practitioners represented 59% of referring physicians. The age and patient history were more detailed in the letters written by physician specialists (p = 0.002 and p < 0.001 respectively). The complementary investigations were more requested by private sector physicians (p = 0.04) and physician specialists (p = 0.011). Of the 76 doctors who had proposed a diagnosis, 42 (55%) had proposed a correct one. The relevance of diagnoses showed no significant difference between GPs and specialists. Conclusion: Referral letters deserve more attention in order to improve communication between physicians and rheumatologists. Analysis of the quality of referral letters can be part of initial and continuing medical education. The referral letters have several shortcomings. A model referral letter has been proposed in this study

Familial Mediterranean fever and spondyloarthritis: Case report, diagnostic and therapeutic difficulties

Introduction: Musculoskeletal involvement is the second common manifestation in Familial Mediterranean Fever patients (FMF). Sacroiliitis and spondyloarthritis (SpA) are a rare condition in this disease. Case report: We present a 52-year-old woman with FMF and SpA and discuss particularities of this link. The patient had FMF since the age of 20 with intermittent inflammatory low back pain since the age of 28 and polyarthralgia of knees, left wrist and shoulders for a year. On examination there was limited extension of the left wrist and range of motion of the spine; pelvic examination and sacroiliac joints were normal. Molecular genetic analysis revealed a homozygous mutation of M649V. Laboratory investigations revealed an elevated C-reactive protein and erythrocyte sedimentation rate (31 mg/dl and 69 mm/1sth respectively). Further investigation showed a negative human leukocyte antigen-B27, antinuclear antibodies, anti-citrullinated peptides antibodies and rheumatoid factor. Pelvic and spine x-rays showed small areas of bilateral increased density and irregularity over the sacroiliac joints indicating grade 3 bilateral sacroiliitis and syndesmophytes. Magnetic resonance imaging of the spine revealed dorsal spondylitis and syndesmophytes. The diagnosis of SpA was retained according to Amor’s criteria. The patient was treated initially with non-steroidal anti-inflammatory drugs, physiotherapy and sulphasalazine which were ineffective after 3 months. The patient then received anti-tumor necrosis factor-α with good response. Conclusion: Spndyloarthritis should be considered in FMF patients with associated sacroiliitis especially when there are leading symptoms and/or imaging abnormalities in the spine. Awareness of this co-existence is important among rheumatologsits for a timely and precise management plan. Keywords: Familial Mediterranean fever, Spondyloarthritis, Sacroiliitis, Anti-TNF-

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

Frequency of axial spondyloarthritis in Tunisian patients with inflammatory bowel diseases

Aim of the work: To determine the frequency, clinical and radiological features of axial spondyloarthritis in patients with inflammatory bowel diseases (IBD) and to characterize differences between patients with and without axial spondyloarthritis. Patients and Methods: Patients included in this cross-sectional study were recruited from the Gastroenterology Department, University of Tunisia over six months. Sixty-four patients with IBD were questioned and examined for axial spondyloarthritis symptoms. Standard pelvic X-rays were performed for all and CT scans and MRI were done for some patients. Results: There were 42 men (65.6%) and 22 women (34.4%) with a mean age of 47 ± 22 years. 32 patients (50%) had Crohn’s disease, 31 had ulcerative colitis and 1 patient has undifferentiated colitis. The disease was confined to the colon among a half of patients with ulcerative colitis. Regarding Crohn’s disease, all lesions were confined to the ileum and the colon. The mean IBD duration was 6.18±7.2 years. The occurrence of axial spondyloarthritis was 26.5% (17 patients who were symptomatic in 16 cases). The bowel disease preceded rheumatic manifestations in all cases. Nine patients (14.1%) had isolated sacroiliitis. The patients with and without axial spondyloarthritis had similar sociodemographic, anthropometric characteristics, comorbidities and bowel disease particularities except a higher percentage of corticosteroids use (p = .013). Conclusions: Due to the high frequency, an early diagnosis of spondyloarthritis in patients with inflammatory bowel disease by thorough clinical exam and standard pelvic X-rays should be recommended. Keywords: Axial spondyloarthritis, Inflammatory bowel disease, Sacroiliiti

Tophaceous hip gouty arthritis revealing asymptomatic axial gout

Background: Hip and axial involvement is uncommon during gout and may raise diagnostic challenges. We describe a rare case of tophaceous hip gout which lead to the diagnosis of asymptomatic axial tophaceous gout at a single rheumatology center. Case presentation: A 35-year-old man, diagnosed with tophaceous polyarticular gout 14 years before presentation, consulted for a gout attack with reduced hip range‐of‐motion on physical examination and an increased serum uric acid level (655 µmol/L). He had been regularly taking colchicine, allopurinol (300 mg/j), and occasionally non-steroidal antiinflammatory drugs. Plain Radiography of the hips revealed bilateral circumferential joint space narrowing, subchondral erosions of the right acetabular, a calcified soft tissue tophus of the left hip and bilateral sacroiliitis grade IV. Computed tomography (CT) showed total ankylosis of the upper segments of both sacroiliac joints and bilateral hip joint space narrowing, subchondral geode eroding the right acetabulum. Moreover, CT revealed soft-tissue tophi involving the major trochanter of the left acetabulum, the right coxofemoral joint and lowest two levels of lumbar facet joints (L4-L5; L5-S1). A spinal and plevis magnetic resonance imaging (MRI) concluded on a gouty tophi, locolized bilaterally intraarticularly in the coxofemoral joints, gluteus medius bursae, lumbar facet joints (L4-L5; L5-S1), and cofirmed bilateral sacroiliitis. Conclusion: The axial and hip gouty arthritis are exceptionnel localisation. Radiographic imaging tools, mainly CT and MRI, may show the monosodium urate crystals and tophi that can contribute to bone and joint lesions of gout. They also allow the exclusion of other possible etiologies such as spondylodiscitis, infection, and neoplasia. Keywords: Gout, Tophi, Hip, Sacroiliitis, Lumbar spin