BackgroundOsteoarticular tuberculosis (OAT) is still common and represents 2-5% of all tuberculosis and 11 to 15% of extrapulmonary tuberculosis. It rather affects spine and weight-bearing joints.ObjectivesThe objective of our study was to describe the clinical, biological, radiological and therapeutic aspects of osteoarticular tuberculosis.MethodsThis is a retrospective study of 42 cases of OAT collected in the Department of Rheumatology over a period of 16 years [1998-2014].ResultsOur population consists of 23 men and 19 women. The mean age was 52 years [18-83]. Comorbidities noted were diabetes in 4 cases and chronic renal failure in 2 cases. Tuberculous contact was found in 4 cases. Alteration of the general state and night sweats were found in 5 cases. Tuberculous spondylodiscitis was diagnosed in 29 patients which interested lumbar spine in 16 case, thoracic spine in 10 cases and cervical spine in 3 cases. An extra-spinal bone tuberculosis was observed in 13 cases touching knees in 5 cases, hip in 5 cases, wrist in one case, sacroiliac in one case and greater trochanter in one case. A multifocal osteoarticular tuberculosis was observed in 3 patients. Symptoms were dominated by inflammatory pain found in 34 cases. Psoas abscess was noted in 3 cases, paravertebral abscess in 9 cases and multiple abscesses in one case. A biological inflammatory syndrome was present in 35 patients. Plain radiographs were abnormal in 23 cases. They objectified disc space narrowing in 18 cases and erosion of the vertebral endplates in 3 cases. CT was performed in 12 cases and MRI in 22 cases having confirmed bone disease in all cases. The tuberculin test was positive in 7 cases. The search of koch bacillus in the sputum was positive in 4 cases, in the urine in 2 cases and in joint fluid in 11 cases. An histological confirmation was obtained in 11 cases. The tuberculous origin was retained in other cases based on clinical and radiological data. All patients were put on anti tuberculosis treatment with a total treatment duration of 12 months on average. Surgical drainage of abscesses was performed in 5 cases.ConclusionsOAT still common in Tunisia because of the endemicity of tuberculosis. There are still severe forms of the disease. Isolation of Mycobacterium tuberculosis is difficult. The diagnosis is often based on a beam of arguments.Disclosure of InterestNone declared
BackgroundThe pachydermoperiostosis is a rare genetic disorder. This is the primitive and idiopathic form of the hypertrophic osteoarthropathy (HOA). The disease is characterised clinically by digital clubbing and hypertrophic skin changes, seborrhoea with hyperhidrosis, and arthralgia or arthritis. This disease can be a differential diagnosis with secondary HOA and chronic inflammatory rheumatism.ObjectivesThe objective of our study was to describe the clinical and radiological aspects of pachydermoperiostosis.MethodsThis is a retrospective study of 6 cases of pachydermoperiostosis collected in the Department of Rheumatology over a period of 14 years [2000-2014].ResultsOur population consists of 6 men. The mean age was 27.5 years. Five patients complained of inflammatory arthralgias and one patient of polyarthritis. Skin thickening (pachyderma) was observed in all cases. The skin of the hands and feet showed excessive sweating in 4 cases. Finger clubbing was noted in 5 cases. Excessive sebaceous secretions was observed in 2 cases. Inflammation tests were disturbed in 4 cases. Hypergammaglobulinemia was present in one case. The skeletal X-ray documented marked periosteal thickening of the long bones and sacro-iliac osteosclerosis (periostosis) in all cases. Bone scintigraphy showed intense hyperfixation of the long bones and sacro-iliac joints. After excluding secondary causes, primary HO diagnosis was established. The treatment consisted of analgesics in all cases, NSAIDs in 2 cases and tamoxifen in 2 cases.ConclusionsPachydermoperiostosis is a rare hereditary disorder, which affects both bones and skin. It is characterized by a combination of dermatologic changes (pachydermia or thickening of the skin) and rheumatologic manifestations (periostosis and finger clubbing).Disclosure of InterestNone declared
BackgroundInfectious spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebral bodies. Imaging has a key role in the diagnosis orientation, lesions assessment and bacteriological investigation.ObjectivesThe objective of this study was to provide an overview of the radiological features of infectious spondylodiscitis.MethodsThis is a retrospective study of 78 cases of infectious spondylodiscitis collected in the Department of Rheumatology over a period of 16 years [1998-2014]. The diagnosis was made based on clinical, biological, radiological and bacteriological arguments.ResultsSeventy eight patients were included. Our population consists of 50 men (64.1%) and 28 women (35.9%) with a mean age of 59.2 years [18-84 years]. Inflammatory low back pain, fever and deterioration of the general status were the most common symptoms. Neurological impairment was objectified in 55.9% of cases. Inflammatory biological syndrome was present in 89.7% of cases. Spondylodiscites was suspected according to X-ray findings in 59 cases, showing disc space narrowing and irregularity of the end-plates. MRI and spinal CT performed respectively in 76.9% of cases and 47.4% of cases showed an epiduritis in 52.6%, paravertebral abscess formation in 34.6%, and an epidural abscess in 14.2% of cases. CT- guided disco vertebral biopsy was performed in 56% of cases leading to the diagnosis in 27% of cases. The lumbar region was the most common affected (66.6%) followed by dorsal spine (26.9%) and cervical spine (8.5%). Spondylodiscitis was multifocal in 7.7% of cases and multistage in 11.5% of cases. MRI showed spinal cord compression in 15.4% of cases which was symptomatic in 9% of cases. Germs responsible of spondylodiscitis were tuberculosis in 44.9%, brucellosis in 20.5% of cases and pyogenic bacteria in 29.5% of cases. All patients underwent adapted antibiotics.ConclusionsImaging has an important role in the diagnosis of infectious spondylodiscitis. MRI is considered as the imaging technique of choice in infectious spondylodiscitis which can provide a mapping of the lesions and detects potentially serious neurological complications. The importance of whole spine imaging should be also underlined especially in case of multifocal infectious spondylodiscitis.Disclosure of InterestNone declared
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