Possible macrophage activation syndrome following initiation of adalimumab in a patient with adult-onset still’s disease

Macrophage activation syndrome (MAS) has been rarely reported in the course of adult-onset Still’s disease (AOSD) and in the majority of cases, it was triggered by an infection. Here, we report, to our knowledge, the first case of MAS occurring after adalimumab treatment initiation and not triggered by an infection. A  26-yearold woman with classical features of AOSD developed persistent fever, severe bicytopenia associated with extreme hyperferritinemia, hyponatremia and abnormal liver function two months after the initiation of adalimumab treatment. The diagnosis of MAS was made without histological proof. The patient was treated with methylprednisolone pulse therapy and her condition improved. During the disease course, extensive studies could not identify any viral infection or other known underlying etiology for the reactive MAS. The  adalimumab was incriminated in this complication. Currently, the patient is in remission on tocilizumab and low-dose prednisoloneKey words: Adult-onset Still´s disease, macrophage activation syndrome, hemophagocytic syndrome, adalimumab

Bilateral Panuveitis at Etanercept Initiation for Juvenile Idiopathic Arthritis

Introduction: Uveitis is a well-known extra-rheumatological manifestation of juvenile idiopathic arthritis (JIA). Tumor necrosis factor has been used to treat uveitis associated with inflammatory diseases. A new onset uveitis under anti-TNF therapy is uncommon. Case presentation: A 12-years-old male, affected since the age of six years, by a severe form of polyarticular JIA. When etanercept was started, he presented panuveitis bilaterally, so we switched to infliximab with good response. Conclusions: The TNF soluble receptor could be considered as a possible promoter in inducing endogenous new onset uveitis in JIA

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

Concurrence of Juvenile Idiopathic Arthritis and Multiple Sclerosis

We report a 21-year-old female patient known to have Juvenile idiopathic arthritis (JIA) who later developed multiple sclerosis (MS). The disease was documented on the brain and cerebral magnetic resonance imaging (MRI) and the visual evoked potential. Our case emphasizes the need to evaluate the symptoms and brain MRI carefully. The concurrence of MS and JIA is uncommon. The possible relationship between the 2 diseases was discussed

Localisation rare de la tuberculose : la ténosynovite des doigts Case report Open Access

Abstract La ténosynovite tuberculeuse est une localisation rare de la tuberculose. Le diagnostic en est souvent tardif en raison de manifestations cliniques souvent pauvres et chroniques. Nous rapportons une observation de ténosynovite tuberculeuse du 2ème rayon de la main droite d'évolution favorable sous traitement antituberculeux

Polyarthritis associated with hydatid disease of the liver

Clinical presentation of hydatid disease is depending on immunological background of the patient. Articular site of the parasite can give rise either to a veritable echinococcal arthritis or to a synovial affection that do not depend on living larva. A 77-year old man who had hydatid disease of the liver since two years, presented with progressive onset arthritis. Laboratory studies showed inflammatory changes but no evidence of immunological disorders was noticed. Abdominal imaging revealed multiple hydatid cysts of the liver. Ankle synovial fluid evaluation was positive of antibodies for hydatid antigen and negative of echinococcal larva. Excision of the hydatid cyst was accompanied by full remission of the arthritis with no recurrence. A reactive immune mechanism triggered by a parasite located at a distant side appears to be responsible for this type of arthritis. This data support the potential of echinococcosis granulosus in inducing a veritable aseptic arthritis as a response to intense immunological disorders

Évaluation des risques pour les consommateurs et les travailleurs agricoles tunisiens exposés aux résidus après l'application de pesticides sur les piments et les tomates

In Tunisia, to prevent and control pests and diseases during cultivation under greenhouses, chili pepper and tomato require the use of a wide range of pesticides potentially toxic and thus presenting a possible risk for farm operators, workers or consumers. A study has been carried out in the Sahel region of Tunisia to assess the risk for farm operators and workers exposed, by contact during harvest tasks, to possible pesticide residues remaining in tomato and chili pepper cultures, and for the Tunisian consumers (adults and children) after intake. A questionnaire was addressed to a group of 73 market gardeners to better understand the local professional practices and to determine the main route of exposure to pesticide. Twenty samples of cotton gloves (2 pairs / sample) were distributed to 20 volunteers who worn them for two consecutive half-days during the harvest of chili peppers or tomatoes before analysis of the dislodgeable pesticide residues which could be transferred from crops to hands. Using models predictive exposures values were calculated for consumers and farm workers. The highest exposure of consumers was observed for chlorpyrifos residues on tomatoes (with 82% and 312% of the Acute Reference Dose (ARfD), for adults and children respectively). The systemic exposure (SE) of farm workers was estimated for the average, the 90th percentile and the maximum concentration. At the highest observed concentrations, 15 pesticide residues (active substance and metabolites) used in pepper greenhouses, and 9 in tomato crops, exceed the Acceptable Operator Exposure Level (AOEL). Exposure appeared to be particularly critical for chlorothalonil sprayed in chili pepper greenhouses with SEMAX values 113 times higher than the AOEL (11285%). Long task duration (8 hours/day) after re-entry in greenhouse, limited access to personal protective equipment (PPE), lack of hygiene and bad habits (eating, drinking, or smoking at work) have also been observed and discussed as risk factors.En Tunisie, pour prévenir et contrôler les ravageurs et les maladies lors de la culture sous serres, le piment et la tomate nécessitent l'emploi d'une large gamme de pesticides potentiellement toxiques et pouvant donc présenter un risque pour les exploitants agricoles, travailleurs ou consommateurs. Une étude a été menée en Tunisie dans la région du Sahel pour évaluer le risque pour les exploitants agricoles et les travailleurs exposés, lors des récoltes, aux éventuels résidus de pesticides restant dans les cultures de tomates et de piments et pour les consommateurs tunisiens (adultes et enfants) après ingestion de ces légumes. Un questionnaire a été adressé à un groupe de 73 maraîchers pour mieux comprendre les pratiques professionnelles locales et déterminer la principale voie d'exposition. Vingt échantillons de gants en coton (2 paires / échantillon) ont été distribués à 20 volontaires qui les ont portés pendant deux demi-journées consécutives lors de la récolte de piments ou de tomates avant l'analyse des résidus de pesticides délogeables qui pourraient être transférés des cultures aux mains. En utilisant des modèles d'exposition prédictive, les valeurs ont été calculées pour les consommateurs et les travailleurs agricoles. L'exposition la plus élevée des consommateurs a été observée pour les résidus de chlorpyrifos-éthyl dans les tomates (avec 82% et 312% de l’ARfD (dose de référence aiguë), respectivement pour les adultes et les enfants). L'exposition systémique (SE) des travailleurs agricoles a été estimée pour la moyenne, le 90th percentile et la concentration maximum. Aux concentrations observées les plus élevées, 15 résidus de pesticides (substances actives et métabolites) utilisées dans les serres de piment, et 9 dans les cultures de tomates, dépassent le niveau d'exposition acceptable pour l'opérateur (AOEL). L'exposition semble particulièrement critique pour le chlorothalonil pulvérisé dans des serres de piment avec des valeurs de SEMAX 113 fois plus élevées que l’AOEL (11285%). La durée prolongée du travail (8 heures / jour) après rentrée dans la serre, l'accès limité aux équipements de protection individuels (EPI), le manque d'hygiène et les mauvaises habitudes (manger, boire ou fumer au travail) ont également été observés et discutés en tant que facteurs de risque

Risk Assessment of Tunisian Consumers and Farm Workers Exposed to Residues after Pesticide Application in Chili Peppers and Tomatoes

In Tunisia, to prevent and control pests and diseases during cultivation under greenhouses, chili pepper and tomato require the use of a wide range of pesticides potentially toxic and thus presenting a possible risk for farm operators, workers or consumers. A study has been carried out in the Sahel region of Tunisia to assess the risk for farm operators and workers exposed, by contact during harvest tasks, to possible pesticide residues remaining in tomato and chili pepper crops, and for the Tunisian consumers (adults and children) after intake. A questionnaire was addressed to a group of 73 market gardeners to better understand the local professional practices and to determine the main route of exposure to pesticide. Twenty samples of cotton gloves (2 pairs / sample) were distributed to 20 volunteers who worn them for two consecutive half-days during the harvest of chili peppers or tomatoes before analysis of the dislodgeable pesticide residues which could be transferred from crops to hands. Using models, predictive exposures values were calculated for consumers and farm workers. The highest exposure of consumers was observed for chlorpyrifos residues on tomatoes (with 82% and 312% of the Acute Reference Dose (ARfD), for adults and children respectively). The systemic exposure (SE) of farm workers was estimated for the median, the 90th percentile and the maximum concentration. At the highest observed concentrations, 15 pesticide residues (active ingredients and metabolites) used in pepper greenhouses, and 9 in tomato crops, exceeded the Acceptable Operator Exposure Level (AOEL). Exposure appeared to be particularly critical for chlorothalonil sprayed in chili pepper greenhouses with SEMAX values 113 times higher than the AOEL (11285%). Long task duration (8 h/day) after re-entry in greenhouse, limited access to personal protective equipment (PPE), lack of hygiene and bad habits (eating, drinking, or smoking at work) have also been observed and discussed as risk factors

Lower urinary tract symptoms in rheumatoid arthritis and spondyloarthritis male patients versus controls

Background. We aimed to evaluate the severity of lower urinary tract symptoms (LUTS) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) male patient versus control, then to determine the relation of LUTS with rheumatic diseases (RD) characteristics and with erectile dysfunction (ED)