Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis.

OBJECTIVE: In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA). METHODS: We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique. RESULTS: Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01). CONCLUSION: Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.

Post-traumatic Fibro-Osseous Lesion of the Fourth Rib Simulating a Chest Wall Tumor: A Case Report.

Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.

Acute arthritis following SARS-CoV-2 infection: About two cases.

Joint involvement in COVID-19 may occur at different stages of the disease and maybe represented by non-specific arthralgia or by acute arthritis. We report two cases of COVID-19 infection that were complicated by postviral reactive arthritis. Case 1: A 47-year-old male was presented 20 days after a COVID-19 infection with acute right knee arthritis. On biologic data, erythrocyte sedimentation rate and C-reactive protein were normal, and immunologic data were negative. A joint puncture was performed showing a turbid fluid. Testing for microcrystals was negative, as well as the synovial fluid culture. An infectious investigation was conducted, which was negative. The patient's complaints improved significantly, with analgesics and non-steroidal anti-inflammatory drugs (NSAID). Case 2: A 33-year-old female presented with acute left knee arthritis evolving for 48 h, free of fever, after a COVID-19 infection treated 15 days ago. On examination, besides knee arthritis, the osteoarticular examination was normal. A biological inflammatory syndrome was noted in laboratory tests. A yellow fluid with multiple PNN was detected in the joint fluid aspiration, with a negative culture. The patient was treated by analgesics and NSAID. The follow-up was highlighted by the arthritis resolution. Conclusion: Both of our cases are consistent with what has already been reported in the literature confirming the development of PostCOVID arthritis and strengthen the impending necessity of wider studies to identify rheumatologic manifestations in the short- and long-terms after surviving COVID-19.

[Contribution of dynamic radiographs in atlantoaxial subluxation in rheumatoid arthritis]. / Apport des radiographies dynamiques dans la subluxation atloïdo-axoïdienne au cours de la polyarthrite rhumatoïde.

BACKGROUND: Cervical spine (CS) involvement is common during rheumatoid arthritis (RA) and it is distinguished by its potential gravity. AIM: To determinate the occurrence of atlantoaxial subluxation (AAS) by dynamic incidences X-Ray and to assess its predictive factors. METHODS: Our study included a cohort of 40 patients carrying RA, who fulfilled the American College of Rheumatology criteria, for more than 2 years. All patients had a complete physical and laboratory evaluation. Radiological evaluation included CS radiographs in anteroposterior, lateral, and lateral in full flexion and extension views. RESULTS: The occurrence of CS involvement was about 47.5% by XRay dominated by AAS which found in 42,5% of the cases. Among AAS, anterior AAS was the most frequent with a prevalence of 22,5% followed by lateral AAS in 12,5% then vertical and rotatory AAS in 10% of cases each one and posterior AAS in 2,5% of the cases. Comparison between patients with and without CS involvement indicated the presence of two predictive factors: the sharp modified score and the C - reactive protein (p=0.002 and p=0.004 respectively). CONCLUSION: Our study demonstrated that AAS is frequent in RA particularly in active forms with structural lesions. AAS can be asymptomatic, for this reason systematic diagnosis by X-Ray with dynamic views is important.

[Survival prognosis factors in multiple myeloma]. / Les facteurs pronostiques de survie au cours du myélome multiple.

BACKGROUND: Outcome in multiple myeloma (MM) is very heterogeneous in survival and therapeutic response, constantly fatale despite her therapy progress. AIM: To determine the prognostic factors and survival in MM. METHODS: We carried out a transversal study of 100 patients in the rheumatology department of hospital Monastir between 1991 and 2010. In each case we determinate the survival delay and also the clinical, laboratory, radiological data at diagnosis and therapeutic response. RESULTS: The mean age was 64.4 years and sex ratio H/F=1.27. MM is IgG type in 57%, IgA in 28% and light chain in 11% of cases. The survival mean is 34 months and the survival median is 26 months. Univariate analysis showed five prognostic factors: age (p = 0.016), anaemia (p=0.033), ß2 microglobulin ( p < 0.0001) , CRP (p = 0.0001), albumin (p = 0.002), LDH (p=0.001), plasmocyte proliferation rate (p=0.003) and rapidly therapeutic response (p <0.001). ß2 microgrobulin-CRP classification and the international staging system (ISS) presented a high prognosis signification (p < 0.0001). Multivariate analysis demonstrated two prognostic factors: ß2 microglobulin and CRP. CONCLUSIONS: Our study showed that MM presented many prognostic factors, which easily realised in daly practice. These prognostic factors are essentially to evaluate prognosis and select patients for appropriate therapeutic indication. ß2 microgrobulin- CRP classification and the international staging system (ISS) are more predictive than Durie Salmon classification in MM survival.