RESUMEN
Data are still scarce regarding the prevalence and the associated factors of vertebral fractures (VF) in the North Africa and the Middle East region. In this study, VF were common in at risk Tunisian women with a prevalence of 26.19%. Lower total hip T-score, having severe back pain, and being physically inactive were independently associated with VF. INTRODUCTION: Vertebral fractures are related to a marked increase in morbidity and mortality and they are associated with a definite risk of subsequent fracture. Nevertheless, they remain underdiagnosed and little is known about their epidemiology in the African countries. In this first Tunisian study, we aimed to assess the prevalence and the associated factors of asymptomatic VF among at risk Tunisian post-menopausal women. METHODS: In this cross-sectional study, we included post-menopausal women without a previous diagnosis of VF and who were referred for bone mineral density (BMD) measurement. Each participant had had an extensive medical history investigation, a BMD assessment, and a vertebral fracture assessment (VFA) scan using a dual energy X-ray absorptiometry. VF were defined using Genant semi-quantitative method. RESULTS: Two hundred and ten post-menopausal women were included. The overall prevalence of VF was 26.19% and 9.52% of our participants had multiple VF. The prevalence of VF was significantly higher in older participants, those having a history of prior severe fragility fracture, or having at least one intrinsic fall. The percentage of low bone mineral density and osteoporosis were significantly higher in women with VF. After binary logistic regression analysis, severe back pain (OR = 3.016; 95% CI 1.304-6.974), regular physical activity (OR = 0.065; 95% CI 0.02-0.213), and total hip T-score (OR = 0.56; 95% CI 0.383-0.820) were independently associated with VF. CONCLUSION: VF are very prevalent among at risk Tunisian post-menopausal women and their incorporation in a clinical and densitometric tool might identify more effectively subsequent fracture.
Asunto(s)
Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Absorciometría de Fotón , Anciano , Densidad Ósea , Estudios Transversales , Femenino , Humanos , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/epidemiología , Posmenopausia , Prevalencia , Factores de Riesgo , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/epidemiologíaRESUMEN
OBJECTIVES: The aim of the study was to assess ultrasound (US) remission in patients with rheumatoid arthritis (RA) in clinical remission using different definitions. MATERIAL AND METHODS: This was a cross-sectional study including patients with RA in clinical remission defined by disease activity score (DAS28)-erythrocyte rate (ESR) ≤ 2.6 for at least 6 months. Each patient underwent B-mode and power Doppler (PD) assessments of 42 joints and 20 tendons. B-mode and PD signal for synovitis and tenosynovitis (TS) were defined and graded semi-quantitatively (0-3) according to the outcome measures in rheumatology clinical trials (OMERACT). Several different definitions of US remission were examined: the absence of synovial hypertrophy (SH), TS on B-mode and PD signal, the absence of SH and PD signal, a grade ≤ 1 of SH and the absence of PD, a grade ≤ 1 of SH and PD, the absence of PD, or a grade of PD ≤ 1. The DAS28, clinical disease activity index (CDAI), simple disease activity index (SDAI), and the Boolean American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were compared. RESULTS: Thirty-seven patients were enrolled. The rate of remission according to the different composite indices was 70.2% for the SDAI, 64.8% for the CDAI, and 54% for the ACR/EULAR Boolean criteria. Synovial hypertrophy and TS in B-mode were detected in 94.6% and 40.5% of patients, respectively. Synovitis with PD signal was found in 59.5% and 13.5% of patients had TS with PD, respectively. Ultrasound remission at joints and tendons was found in 5.4-62.2% of patients. For the other remission criteria: CDAI, SDAI, and ACR/EULAR Boolean criteria, 7.7-60% of patients showed US remission at joints and tendons. CONCLUSIONS: Clinical remission, even classified by strict composite indices, does not seem to be the closest method to the concept of absence of inflammatory activity; hence the interest of integrating US in assessing remission in practice.
RESUMEN
BACKGROUND: A distal interphalangeal (DIP) joint involvement in the adult-onset Still's disease (AOSD) has been described in some publications but is rarely reported to be severe. We report severe DIP joints damages in a young patient with AOSD. CASE REPORT: A 22 years old patient presented to our department complaining of inflammatory joints pain associated with prolonged fever and cutaneous rash. Physical examination identified polyarthritis and hepatosplenomegaly but no lymphadenopathies. After an extensive screening for neoplastic, infectious or hematologic diseases, the patient was finally diagnosed with AOSD. Treatment based on corticosteroids was then initiated with a good response on systemic signs. However, the patient continued to have recurrent arthritis affecting wrists and proximal interphalangeal joints. A Few years later, he developed a severe and disabling DIP arthritis with signs of joint destruction on conventional radiographs and MRI. Despite the initiation of methotrexate with optimal dosage, the patient continued to have polyarticular flares. The combination of methotrexate and sulfasalazine was responsible for drug-induced hepatotoxicity and this treatment was stopped. Anti-TNFα treatment was then indicated as general signs improved but severe joints damage persisted. Unfortunately, and due to healthcare system considerations, the patient was not able to benefit from TNFα inhibitors, and remained on methotrexate treatment only. Conculsion: The distal destructive arthritis during AOSD is rare and controversial. Our patient had a severe form with resistance to conventional therapies.
Asunto(s)
Artritis/diagnóstico por imagen , Articulaciones de los Dedos/diagnóstico por imagen , Enfermedad de Still del Adulto/diagnóstico por imagen , Corticoesteroides/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis/tratamiento farmacológico , Artritis/etiología , Articulaciones de los Dedos/efectos de los fármacos , Humanos , Masculino , Metotrexato/uso terapéutico , Enfermedad de Still del Adulto/complicaciones , Enfermedad de Still del Adulto/tratamiento farmacológico , Sulfasalazina/uso terapéutico , Resultado del Tratamiento , Adulto JovenAsunto(s)
Artritis Juvenil/tratamiento farmacológico , Apófisis Odontoides/diagnóstico por imagen , Membrana Sinovial/diagnóstico por imagen , Tuberculosis de la Columna Vertebral/diagnóstico , Artritis Juvenil/complicaciones , Articulación Atlantoaxoidea , Humanos , Masculino , Dolor de Cuello/microbiología , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/terapia , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto JovenRESUMEN
Crystalline silica-associated systemic sclerosis can occur in people operating arc welding. Diffuse scleroderma was diagnosed in a 57-year old plumber-welder suffering from inflammatory polyarthralgias, Raynaud's phenomenon, sclerodactyly, diffuse cutaneous scleroderma, telangiectasias, esophageal damage, pulmonary arterial hypertension and pulmonary fibrosis associated with the presence of anti-nucleosome antibodies. During his professional activity the patient was frequently exposed to high atmospheric concentrations of crystalline silica generated by arc-welding. The diagnosis of Erasmus syndrome associated with systemic sclerosis and pulmonary silicosis was retained. A report of work-related illness (table 17 in Tunisia) was made.
Asunto(s)
Enfermedades Profesionales/fisiopatología , Exposición Profesional/efectos adversos , Esclerodermia Sistémica/etiología , Silicosis/diagnóstico , Humanos , Masculino , Enfermedades Profesionales/diagnóstico , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/fisiopatología , Dióxido de Silicio/toxicidad , Silicosis/fisiopatología , Túnez , SoldaduraAsunto(s)
Enfermedades Óseas Metabólicas/etiología , Enfermedades Inflamatorias del Intestino/complicaciones , Osteoporosis/etiología , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Glucocorticoides/efectos adversos , Humanos , Masculino , Factores de Riesgo , Conducta SedentariaRESUMEN
We report a case of an association of four autoimmune diseases in a 15-year-old girl and we discuss the etiopathogenic of this association and difficulties of treatment.
Asunto(s)
Enfermedades Autoinmunes/fisiopatología , Enfermedad Celíaca/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Esclerodermia Sistémica/complicaciones , Adolescente , Enfermedades Autoinmunes/inmunología , Autoinmunidad/fisiología , Causalidad , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/inmunología , Comorbilidad , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/inmunología , Dieta Sin Gluten , Femenino , Humanos , Lupus Eritematoso Sistémico/inmunología , Prednisona/uso terapéutico , Esclerodermia Sistémica/inmunología , Edulcorantes/efectos adversos , Resultado del Tratamiento , TúnezRESUMEN
We describe three cases of osteomalacia presenting in Tunisian women, all of whom had previously-undiagnosed coeliac disease (CD). Direct enquiry revealed an important weight loss and a history of diarrhoea in two patients, and a 15-year history of anaemia in one patient. Laboratory tests showed severe anaemia in the three cases. Reduced calcium was found in two cases, and corrected calcium was found in one case. Radiological examination showed fissure in two cases. The diagnosis of osteomalacia was made by clinical, biochemical and radiological features. Antigliadin, antireticulin, antiendomysial and anti-tissue transglutaminase antibodies were all positive in the three cases, and a small-bowel biopsy confirmed the diagnosis of CD. Treatment with gluten-free diet (GFD), supplemental calcium and vitamin D was initiated for the three patients, but only one patient complies strictly with the GFD; she showed a marked resolution of her symptoms.