[Non-steroidal anti-inflammatory drugs : clarification for the practitioner]. / Anti-inflammatoires non stéroïdiens : mise au point pour le praticien.

NSAID represent a widely used therapeutic class, but their side- effects profile can significantly limit their use. Introduction of selective cyclooxygenase-2 inhibitor has provided an alternative to non-selective NSAIDs, with a better digestive tolerance for similar efficiency. Nevertheless, introduction of these molecules has been associated with emergence of major cardiovascular events, motivating further studies on their safety profile. Numerous adverse effects, mainly gastrointestinal, renal and cardiovascular, have been more clearly characterized. This article intends to review some of the basic principles and main side effects of NSAIDs.

Les anti-inflammatoires non stéroïdiens représentent une classe thérapeutique largement utilisée, mais leurs profils d'effets secondaires peuvent limiter leur utilisation. Le développement des inhibiteurs sélectifs de la cyclo-oxygénase 2 a permis d'offrir une meilleure tolérance digestive pour une efficacité similaire. Néanmoins, ces substances sont associées à une recrudescence d'événements cardiovasculaires majeurs, motivant la réalisation de nouvelles études sur le profil sécuritaire. De nombreux effets indésirables, essentiellement gastro-intestinaux, rénaux et cardiovasculaires, ont dès lors été plus clairement caractérisés. Cet article propose une revue de quelques notions de base et des principaux effets secondaires liés à la prescription d'AINS.

[Complex regional pain syndrome]. / Syndrome douloureux régional complexe.

The Complex Regional Pain Syndrome (previously algodystrophy) is a rare affliction that usually affects a distal extremity (hand, foot). It occurs most frequently within weeks following a traumatic injury or stroke. It is a syndromic entity whose diagnosis is based on precise criteria, known as the Budapest criteria, excluding any disease that better explains the symptoms. The treatment must be given early. Functional restoration (physiotherapy, occupational therapy) is at the heart of the treatment, along with psychoeducation. Inappropriate disuse and avoidance, often encountered, must be combated. Bisphosphonates or steroids are first-line drugs at early stages. The evolution is often long, but the prognosis is favorable in about 75 % of cases (≤ 1 year).

Le syndrome douloureux régional complexe (anciennement algodystrophie) est une affection rare qui touche préférentiellement une extrémité (main, pied). Il se développe le plus souvent dans les semaines qui suivent un traumatisme ou un accident vasculaire cérébral. Il s'agit d'une entité syndromique dont le diagnostic repose sur des critères précis, dits de Budapest, excluant toute atteinte expliquant mieux les symptômes. Le traitement doit être précoce. La restauration fonctionnelle en est le cœur (physiothérapie, ergothérapie), associée à une psychoéducation. L'immobilisation inappropriée et l'évitement, souvent rencontrés, doivent être combattus. Bisphosphonates ou corticoïdes sont les médicaments de premier choix des formes précoces. L'évolution est souvent longue, mais le pronostic favorable dans environ 75 % des cas (≤ 1 an).

[Adhesive capsulitis of the shoulder : Update 2017]. / La capsulite rétractile de l'épaule : mise au point en 2017.

A century and a half after its first description, adhesive capsulitis (frozen shoulder) has revealed only part of its secrets. Its definition remains clinical since the imaging technology we have at our dis-posal is insufficiently sensitive and specific. Next to its idiopathic form, the most frequent and the most characteristic, there are numerous situations inducing a functional limitation of the glenohumeral joint and of its environment. The clinical course inexorably takes place in one to two years, and develops in 3 phases where successively pain, retraction, and then recovery, as a rule complete recovery, dominate. No treatment is likely to shorten it. In the absence of clearly established proof, our therapeutic approach must be prudent and conservative.

Un siècle et demi après sa première description, la capsulite rétractile de l'épaule n'a dévoilé qu'une partie de ses secrets. Sa définition reste clinique puisqu'on ne dispose d'aucune méthode d'imagerie suffisamment sensible et spécifique. A côté de la forme idiopathique, la plus fréquente et la mieux caractérisée, il existe une multitude de situations induisant une limitation fonctionnelle de l'articulation gléno-humérale et de son environnement. L'évolution se déroule inexorablement sur un à deux ans et comporte trois phases où dominent successivement la douleur, la rétraction puis la récupération en principe complète. Aucun traitement n'est susceptible de l'écourter. En l'absence de preuve clairement établie, l'approche thérapeutique doit être prudente et conservatrice.

[When should a patient with low back pain/sciatica be referred to the emergency ward?]. / Quand référer aux urgences un patient présentant une lombalgie/ lombosciatalgie aiguë?

Low back pain and sciatica are common causes of medical consultation. The medical history and the physical examination are essential in their management. The primary care physician initiates treatment and relies on his physical examination to identify "red flags" that require further investigations. Regarding sciatica, it is essential to identify 3 clinical entities that require prompt referral to the emergency department for prompt neurosurgical management. These include hyperalgic sciatica, sciatica with motor deficits and the cauda equina syndrome. Sciatica with sensory deficits do not require emergency department referral.

Complex regional pain syndrome and bone marrow oedema syndrome: family ties potentially closer than expected.

Complex regional pain syndrome (CRPS) and bone marrow edema syndrome (BMES) are two rare conditions that are still being discussed. They are generally considered as two distinct entities, yet they share similarities such as a homogeneous bone marrow edema is also often found in the early phase of CRPS. We present the case of a 41-year-old man with CRPS after a foot fracture followed by the development of painful BMES of the ipsilateral knee and hip a few weeks later. The search for another pathology was negative. After pamidronate infusions, the evolution was spectacular: the disappearance of hip pain at 1 month and more than 50% reduction in knee and foot pain at 2 months. At final follow-up (1 year), the patient was asymptomatic. This case reinforces the idea of a possible link between CRPS and BMES probably through similar trabecular bone involvement. Imaging remains useful in diagnosis of CRPS.

[Iatrogenic rheumatic diseases]. / Rhumatismes iatrogènes.

This article reviews, through illustrative cases, five rheumatic diseases associated with drug treatments: statins and myopathy, quinolones and tendinopathy, viscosupplementation and pseudoseptic arthritis, diuretics and gout, barbiturates and adhesive capsulitis. Due to the rarity of such cases, we lack validated therapeutic recommendations. Announcement to the adverse drug reaction reporting system is the best way to enhance our knowledge and to improve the public health.