BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by the presence of rheumatoid factor (RF) and anti-cyclic citrullined peptide (ACPA). ACPA have higher specificity than RF for RA, and are associated with joint radiographic damage and extra-articular manifestations.ObjectivesThe aim of this study was to evaluate the US RA activity whether the ACPA were present or not.MethodsA cross-sectional study of patients followed-up for RA was conducted. Demographic, clinical and biological data were collected. RF and ACPA mesures were collected from medical records. We calculated the US-DAS28 in order to evaluate accurate activity of RA. All patients had an ultrasound (US) examination of 22 joints of hands (wrists, metacarpophalangeal, proximal interphalangeal). US was performed by an operator blinded to clinical and laboratory data. RA activity was evaluated by US-DAS28 by replacing swollen joints of the hands by joints expressing synovial hypertrophy or hyper vascularization in US.ResultsOne hundred and eighteen patients were enrolled, 83% were females. The mean age was 53 years-old. The mean duration of the disease was 11.6 months. The RF was positive in 64 (55%) patients and the ACPA was positive in 31 (26%) patients. The median DAS28 was 5,52 [2,91-7,81]. The medianUS-DAS28 was 5.29 [1.98- 7.83]. The comparison between US-DAS28 according to immunological status is showed in table 1.Table 1.US-DAS28 depending on RF and ACPA statusUS-DAS28pRF (+)5,290,90RF (−)5,26ACPA (+)5,310,80ACPA (−)5,29ConclusionsWe conclude that there was no significant difference of RA activity between seropositive or seronegative RA and also whether ACPA was positive or not. The analysis of bone damages should be compared in another study order to determinate the prognostic value of ACPA.ReferencesJung C, Jisuk B. Relation of rheumatoid factor and anti cyclic citrullined peptide antobody with disease activity in rheumatoid arthritis: cross sectional study. Rheumatol Int 2013.Disclosure of InterestNone declared
Brown tumors (BTs) are due to a proliferation of multinucleated giant cells in osteolytic lesions. They complicate the course of hyperparathyroidism. Thanks to an early screening of bone metabolism disorders; BTs are nowadays rare bone manifestations. We demonstrate through these two cases reports unusual locations of BTs in hyperparathyroidism.
BackgroundIn rheumatoid arthritis (RA), tendon pathology is a well-recognized, but underestimated aspect of the disease, which may lead to irreversible functional impairment and consequent disability. Clinical joint examination is less time-consuming than ultrasound (US) but it may misdiagnosis tenosynovitis (TS).ObjectivesThe aim of this study was to compare clinical assessment of tenosynovitis detection with US examination.MethodsA cross sectional study was performed including patients followed-up for active recent RA (RA <2 years, DAS28 >2,6). Clinical examination was performed by a rheumatologist seeking signs suggestive of flexor of extensor TS. US was performed by an experienced radiologist blinded to clinical data. All tendons of the hands were scanned in the transverse view from the more proximal to the more distal portion at the tracts surrounded by synovial sheath. Totally 140 hands were assessed. Results of clinical examination were compared to US findings. The difference is considered significant if the P>0,05.ResultsSeventy patients were recruited, (56 females, 14 males). The mean age was 53 years-old [24-74 years-old]. The mean duration of the disease was 10 months [3-24 months]. The RA was active with a median DAS28 5,46 ranging from 2,91 to 7,81. Physical examination highlighted TS in 53 (38%) hands, it was bilateral in 50%. Flexor tendons were the most affected (52 hands). Both flexor and extensor tendons were detected affected in 4 hands. US showed TS in 89 (65%) patients. Flexor tendons showed US activity in 80 hands and extensor tendons in 78 hands. US revealed a significant high frequency of TS over clinical examination (p=0,02). The sensitivity of US to detect TS was 80.3% and the specificity was 50,4%.ConclusionsThe rationale of using US relies on the fact that physical examination provides only limited information on the presence of tenosynovitis. Since TS can be source of functional disagreement, US should be focused, in addition to analyze synovitis, on tendons in RA.ReferencesEmilio Filippucci, Alessandra Gabba and al. Hand Tendon Involvement in Rheumatoid Arthritis: An Ultrasound Study. Seminars in Arthritis and Rheumatism 2012;41:752-60.Backhaus M, Kamradt T and al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rhem. 1999;42:1232-45.Szkularek M, Court-Payen M and al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum.2003;48:955-62.Disclosure of InterestNone declared
Background:Rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SA) may occur among women of childbearing age. Adverse events during pregnancy including disease flare, preterm delivery, and neonatal or fetal death have been reported.Objectives:Our aim was to assess the impact of rheumatic diseases on the course of pregnancy.Methods:We conducted a cross-sectional study involving patients with RA (2010 ACR/EULAR criteria) and SA (2009 ASAS criteria) (study group) as well as healthy controls (control group) matched by age and gender. All women included had at least one pregnancy. Data were collected through telephonic interviews. We used the Student t test to compare the study group and the control group.Results:We enrolled 57 patients (30 RA and 27 SA) and 57 controls. The mean age in the study and the control groups were respectively 43.2 ± 8.2 years [26-48] and 37.5 ± 6 years. The mean chronic inflammatory rheumatisms duration was 13.81 ± 6.2 years. A history of primary sterility was found in 3 patients (1 RA and 2 SA) and none in the control group. The mean age during the first pregnancy was significantly higher in the study group (28 ± 6.2 years versus 24 ± 7 years in the control group) (p=0.01). Eight patients (5 RA and 3 SA) had a history of spontaneous miscarriage. A terminated pregnancy was noted in 3 patients (1 RA and 2 SA). Complications during pregnancy in the study group were gestational diabetes (0.3%), premature delivery (0.3), premature rupture of membranes (0.3%), abortion threat (0.3%) and pre-eclampsia (6%). Pregnancy was more associated with complications in the study group (p=0.05). Cesarean section was more used in the study group (28 patients versus 9 in the control group; p= 0.00). The main indications of cesarean section in the study group were macrosomia (11 patients), scar uterus (6 patients), sacroiliitis (4 SA patients), twin pregnancy (2 patients), and undetermined reasons (6 patients). Fetal presentation in the study group was the seat presentation (3%), top presentation (4%), face (2%), and forehead presentation (0.3%) with no significant difference with the control group. Complications of childbirth in the study group were hemorrhage of delivery (10.3%), cord widening (6.6%), perinatal asphyxia (4.9%), and dystocia (1.9%). However, no statistically significant differences were found between the two groups in the prevalence of complications of childbirth. During pregnancy, 5 patients were on salazopyrine, 2 on corticosteroids and, 1 on non-steroidal anti-inflammatories.Conclusion:Our study showed that pregnancies with rheumatic diseases were at increased risk of having maternal complications and adverse neonatal outcomes.Disclosure of Interests:None declared
Background:Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood that may lead to physical disability and reduced quality of life, thus hindering the ability of the patients to achieve a meaningful adult life.Objectives:The aim of this study was to assess the trends of the disease and socio-professional future.Methods:We conducted a retrospective study including adult patients aged > 18 years with a history of JIA according to the International League of Associations for Rheumatology (ILAR). Collected data included age, sex, the characteristics of the disease (subtype of JIA, disease duration). The level of education, marital status as well as the profession were recorded.Results:The study included 32 patients with a female perdominance: sex ratio was 1,5. The mean age was 29,5 years old [18-64]. The mean age of onset of the disease was 6 years and 2 months [2-17]. The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 14), polyarticular without rheumatoid factor (n=9), systemic (n= 2), enthesitis-related arthritis (n=7), oligoarthritis (n= 5). Four patients suffered from bilateral cataract due to corticosteroid intake. Polyarticular RF+ and RF- progressed into an authentic seropositive and seronegative RA in 71.4% and 66.7% respectively. Among oligoarticular subtype, an extension of the disease to a polyarticular FR+ form (n=1) and to a seronegative rheumatoid arthritis (n=1) was noted. Systemic JIA forms remained in remission with an articular involvement. All the patients with ERA developed spondylarthritis. Although forty–two percent of the patients were married, only half of them had children. Ten percent of patients stopped attending school because of disease flares and deformation. A university level was found in 16% of cases. Only Thirty patients had a profession. Of the patients, 74.4% had received disease-modifying anti-rheumatic drugs (DMARDs) and 36.3% of them were still taking a DMARD. Ten patients were on biologics. Severe disability was found in 20% of patients and concerned mainly the hip (57,2%), the wrist (28,5%) and the elbows (14,3%). Prosthetic joint replacement was found in 2% of cases with a revision of the latter in one patient.Conclusion:Adults with JIA often have significant levels of disability, usually related to severe joint complications. There is a clear requirement for a better transition to adulthood and a socio-professional rehabilitation.Disclosure of Interests:None declared
Background:Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.Objectives:Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.Methods:A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.Results:Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.Conclusion:We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.Disclosure of Interests:None declared
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