Detection of Shigella spp. nucleic acids in the synovial tissue of Tunisian rheumatoid arthritis patients and other forms of arthritis by quantitative real-time polymerase chain reaction.

Enterobacterial components in the joints of patients are believed to contribute to a perpetuating inflammation leading to a reactive arthritis (ReA), a condition in which microbial agents cannot be recovered from the joint. At present, it is unclear whether nucleic acids from Shigella spp. are playing a pathogenic role in causing not only ReA but also other forms of arthritis. Quantitative real-time polymerase chain reaction assay (qPCR) is the method of choice for the identification of bacteria within the synovium. The aim of our study was to detect the presence of Shigella spp. nucleic acids in the synovial tissue (ST) of Tunisian arthritis patients. We investigated 57 ST samples from rheumatoid arthritis (RA) n = 38, undifferentiated oligoarthritis (UOA) n = 12, and spondyloarthritis (SpA) n = 7 patients; 5 ST samples from healthy individuals were used as controls. Shigella spp. DNA and mRNA transcripts encoding the virulence gene A (VirA) were examined using an optimized qPCR with newly designed primers and probes. Using qPCR, Shigella spp. DNA was found in 37/57 (65%) ST samples (24/38, i.e., 63.2% of RA, 8/12, i.e., 67% of UOA, and 5/7, i.e., 71.4% of SpA patients). Paired DNA and mRNA were extracted from 39 ST samples, whose VirA cDNA was found in 29/39 (74.4%) patients. qPCR did not yield any nucleic acids in the five healthy control ST samples. The qPCR assay was sensitive and showed a good intra- and inter-run reproducibility. These preliminary findings generated by an optimized, highly sensitive PCR assay underline a potential role of past gastrointestinal infections. In Tunisian patients, a bacterial etiology involving Shigella spp. in the manifestation of arthritic disorders including RA might be more common than expected.

Bone Turnover Markers and Lean Mass in Pubescent Boys: Comparison Between Elite Soccer Players and Controls.

The aim of this study was to examine the relationship between bone mass and bone turnover markers with lean mass (LM) in pubescent soccer players. Two groups participated in this study, which included 65 elite young soccer players who trained for 6-8 hours per week and 60 controls. Bone mineral density; bone mineral content in the whole body, lower limbs, lumbar spine, and femoral neck; biochemical markers of osteocalcin; bone-specific alkaline phosphatase; C-telopeptide type I collagen; and total LM were assessed. Young soccer players showed higher bone mineral density and bone mineral content in the whole body and weight-bearing sites (P < .001). Indeed, the total LM correlated with whole-body bone mineral density and bone mineral content (P < .001). There were significant differences within the bone formation markers and osteocalcin (formation)/C-telopeptide type I collagen (resorption) ratio between young soccer players compared with the control group, but no significant difference in C-telopeptide type I collagen was observed between the 2 groups. This study showed a significant positive correlation among bone-specific alkaline phosphatase, osteocalcin, and total LM (r = .29; r = .31; P < .05) only for the young soccer players. Findings of this study highlight the importance of soccer practice for bone mineral parameters and bone turnover markers during the puberty stage.

WNT signaling and chondrocytes: from cell fate determination to osteoarthritis physiopathology.

CONTEXT: Osteoarthritis (OA) is an articular disorder leading to the degradation of articular cartilage phenotypical chondrocytes modifications, including the acquisition of a fibroblast-like morphology, decreased expression of collagen type II, and increased expression of fetal collagen type I, metalloproteinase 13 and nitric oxide synthase. This promotes matrix degradation and unsuccessful cartilage repair. WNT signaling constitutes one of the most critical biological processes during cell fate assignment and homeostasis. OBJECTIVES: This review aims to give an insight on results from the studies that were interested in the involvement of WNT in OA. METHODS: Studies were selected through a pubmed search. RESULTS: Recent genetic data showed that aberration in WNT signaling may be involved in OA. WNT signals are transduced through at least three cascades: the canonical WNT/ß-catenin pathway, the WNT/Ca(2+) pathway and the WNT/planar cell polarity pathway. Most of the studies used in-vitro models to elucidate the involvement of WNT in the physiopathology of OA. These studies analyzed the expression pattern of WNT pathway components during OA such as WNT5, WNT7, co-receptor LRP, ß-catenin, WNT target genes (c-jun, cyclins) and/or the interaction of these components with the secretion of OA most important markers such as IL-1, collagens, MMPs. Results from these studies are in favor of a deep involvement of the WNT signaling in the physiopathology of OA either by having a protective or a destructive role. CONCLUSION: Deeper researches may eventually allow scientists to target WNT pathway in order to help develop efficient therapeutic approaches to treat OA.

Notch signaling is involved in human articular chondrocytes de-differentiation during osteoarthritis.

CONTEXT: During osteoarthritis (OA), chondrocytes undergo de-differentiation, resulting in the acquisition of a fibroblast-like morphology, decreased expression of collagen type II (colII) and aggrecan, and increased expression of collagen type I (colI), metalloproteinase 13 (MMP13) and nitric oxide synthase (eNOS). Notch signaling plays a crucial role during embryogenesis. Several studies showed that Notch is expressed in adulthood. OBJECTIVE: The aim of our study was to confirm the involvement of Notch signaling in human OA at in vitro and ex vivo levels. MATERIALS AND METHODS: Normal human articular chondrocytes were cultured during four passages either treated or not with a Notch inhibitor: DAPT. Human OA cartilage was cultured with DAPT for five days. Chondrocytes secreted markers and some Notch pathway components were analyzed using Western blotting and qPCR. RESULTS: Passaging chondrocytes induced a decrease in the cartilage markers: colII and aggrecan. DAPT-treated chondrocytes and OA cartilage showed a significant increase in healthy cartilage markers. De-differentiation markers, colI, MMP13 and eNOS, were significantly reduced in DAPT-treated chondrocytes and OA cartilage. Notch1 expression was proportional to colI, MMP13 and eNOS expression and inversely proportional to colII and aggrecan expression in nontreated cultured chondrocytes. Notch ligand: Jagged1 increased in chondrocytes culture. DAPT treatment resulted in reduced Jagged1 expression. Notch target gene HES1 increased during chondrocyte culture and was reduced when treated with DAPT. CONCLUSION: Targeting Notch signaling during OA might lead to the restitution of the typical chondrocyte phenotype and even to chondrocyte redifferentiation during the pathology.

Association of LRP5 genotypes with osteoporosis in Tunisian post-menopausal women.

BACKGROUND: Osteoporosis is a highly heritable trait. Among the genes associated with bone mineral density (BMD), the low-density lipoprotein receptor-related protein 5 gene (LRP5) has been consistently identified in Caucasians. However LRP5 contribution to osteoporosis in populations of other ethnicities remains poorly known. METHODS: To determine whether LRP5 polymorphisms Ala1330Val and Val667Met are associated with BMD in North Africans, these genotypes were analyzed in 566 post-menopausal Tunisian women with mean age of 59.5 ± 7 .7 years, of which 59.1% have low bone mass (T-score<-1 at spine or hip). RESULTS: In post-menopausal Tunisian women, 1330Val was weakly associated with reduced BMD T-score at lumbar spine (p=0.047) but not femur neck. Moreover, the TT/TC genotypes tended to be more frequent in women with osteopenia and osteoporosis than in women with normal BMD (p=0.066). Adjusting for body size and other potential confounders, LRP5 genotypes were no longer significantly associated with aBMD at any site. CONCLUSIONS: The less common Val667Met polymorphism showed no association with osteoporosis. The Ala1330Val polymorphism is weakly associated with lower lumbar spine bone density and osteopenia/osteoporosis in postmenopausal Tunisian women. These observations expand our knowledge about the contribution of LRP5 genetic variation to osteoporosis risk in populations of diverse ethnic origin.

Anomalies of intra-synovial citrullination: is there any interest in the diagnosis of early rheumatoid arthritis?

Autoantibodies to citrullinated proteins (ACPA) are specifically associated with rheumatoid arthritis (RA) and seem to play an important role in its pathogenesis. The specific immunological conflict between ACPA and citrullinated fibrin plays a major role in the self-maintenance of synovial inflammation by forming fibrin deposits in the synovial tissue. These deposits, secondarily citrullinated by a local peptidylarginine deiminase (PADI) enzyme activity, seem to maintain the immunological conflict and the inflammation. Our objective in this work is to study the anomalies of citrullination in a group of patients with early RA, in comparison with a control group of patients suffering from undetermined inflammatory arthritis, osteoarthritis and spondyloarthropathy. For this purpose, we used an enzyme-linked immunosorbent assay (ELISA) to determine the levels of ACPA in serum and synovial fluid. By immunohistochemistry, subtype 4 of PADI was also sought in the synovial biopsies taken from all our patients. We found that the ACPA levels in serum and synovial fluid were significantly higher in patients with RA. The enzyme PADI4 was found only in the group with RA and was statistically correlated with ACPA mean levels in sera and synovial fluid. The expression of PADI4 seems to correlate with intra-synovial deposits of fibrin in RA. However, determination of synovial ACPA levels and detection of intra-synovial PADI4 deposits are of no additional benefit compared with assessment of ACPA levels in serum for the diagnosis of early RA.

[Study of bone mineral density in adolescent handball players: a study of 20 cases]. / Etude de la densité minérale osseuse chez les adoloescentes handballeuses: a propos d'une étude de 20 cas.

BACKGROUND: The physical activity during adolescence seems to correlate with bone mass at the end of the growth period. aim : To determine the effect of handball regularly practiced by teenage girls on the anthropometric parameters and bone mineral density. METHODS: Cross-sectional case-control, made in the rheumatology department of the Rabta hospital, has enrolled adolescent handball players of high level, which were compared to a control group matched by age and sex, but sedentary. We evaluated our two groups for anthropometric parameters and BMD. RESULTS: The lean mass (LM), fat mass (FM), the mean values of BMD at the lumbar spine and femur of our sports were significantly higher than that of sedentary controls. On bone mineral content (BMC), a statistically significant difference was observed between groups of sedentary and athletic teenagers. Positive and significant correlations were found between anthropometric parameters and measurements of BMD, BMC and of bone area. CONCLUSION: The regular practice of handball seems to be an osteogenic factor. It may be advisable in adolescents during the growth period to optimize the bone.

[Pathophysiology of complex regional pain syndrome (CRPS) type 1]. / Physiopathologie du syndrome douloureux regional complexe de type 1: Quoi de neuf en 2011.

BACKGROUND: If the pathophysiology of complex regional pain syndrome (CRPS) type 1 remains controversial, most authors agree on a combination in varying proportions, a sensitization of peripheral nerves. AIM: To describe the state of advances in the physiopathology of complex regional pain syndrome type 1. METHODS: Bibliographic research and literature review performed by referring to databases (Medline, Science Direct) RESULTS: The physiopathology of complex regional pain syndrome type 1 remains still poorly understood and controversial. Several arguments demonstrated both peripheral (inflammation, abnormal sympathetic ...) and central (neurological and cognitive) mechanisms. CONCLUSION: A better knowledge of the physiopathology of complex pain syndrome type 1 is necessary in order to adapt efficient curative therapy or to a better prevention of this syndrome.

[Usefulness of magnetic resonance imaging in the diagnosis of early rheumatoid arthritis: a prospective study of 20 cases]. / Intérêt de l'Imagerie par Résonance Magnétique dans le diagnostic des formes débutantes de la Polyarthrite Rhumatoïde : Etude prospective à propos de 20 cas.

BACKGROUND: Diagnosing early rheumatoid arthritis is difficult and radiographic signs are often late. MRI detects erosions at an early stage and visualizes synovitis, bone edema and tenosynovitis. AIM: To assess the value of MRI for diagnosis of early forms of rheumatoid arthritis. METHODS: Prospective study involving 20 patients who had non erosive rheumatoid arthritis lasting for less than 2 years. MRI of the hand was performed by sequences coronal and axial T1-weighted, T2 with saturated fat signal (FatSat) FatSat and T1 with gadolinium injection. RESULTS: The median age of patients was 52 years and sex ratio M/F of 0.05. The median disease duration was 9 months. Ten patients had antibodies Anti-Cyclic citrullinated protein positive. The MRI was abnormal in 75% of patients. This review found 36 erosions which 50% were in carpal bones, 55 joints with synovitis mainly localized midcarpal and metacarpophalangeal. Bone edema was found mainly in carpal bones. Tenosynovitis affected most frequently the flexor tendons. Seventy percent of patients without anti-Cyclic citrullinated protein had a pathological MRI. CONCLUSION: MRI has an important role in detecting infraradiological lesions in early RA. This contributes to early diagnosis and initiation effective treatment.

[Carpal tunnel syndrome. A Tunisian series]. / Le syndrome du canal carpien : A propos d'une série hospitalière Tunisienne.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent ductal syndrome. Few epidemiological studies in Tunisia exist. AIM: To describe clinical, biological and electromyographic data of Tunisian patients with CTS METHODS: A retrospective study including 80 patients with CTS, during the period going from 2009 to 2010. RESULTS: A female predominance was observed with an average age of 52 years. Acroparesthesia was the main complaint, followed by night awakenings and muscular weakness. Physical examination showed a positive Tinel (91.2%) and Phalen (82.5%) tests, a decrease of tactile sensitivity (26.2%) and a thenar amyotrophy (10%). The Electromyography was abnormal in 85% cases. The most revealing lesions were demyelinating, sensitivo-motor predominance (66%) abnormalities. on Biology, hyperglycemia (12.5%), hyperuricemia (8.7%) and renal failure (7.5%) were the most observed. Medical treatment was drawn on analgesics and anti-inflammatory for 90% of our patients. Local steroid injections were indicated for 35% of patients, leading to a clinical improvement in 90% of cases. Surgery was made in only 13.8% patients. CONCLUSION: Tunisian patients with CTS were female patients, housewifes with obesity or overweight. No other differences were observed in comparison with the literature.

[Rheumatic manifestations of genetic hemochromatosis]. / Les manifestations ostéo-articulaires de l'hémochromatose.

BACKGROUND: Rheumatic manifestations of genetic hemochromatosis are frequent with axial or peripheral arthropathies (mono-, oligo- or polyarticular). These manifestations are characterized by articular damage and osteoporosis. AIM: To review the rheumatic manifestations of genetic hemochromatosis. METHODS: A narrative review of literature. RESULTS: The diagnosis should be brought to mind when we discover arthropathy resembling degenerative joint disease with involvement of unusual articular sites, almost identical to the arthropathy in calcium pyrophosphate dihydrate crystals deposition disease (chondrocalcinosis). CONCLUSION: There is a significant bone loss in HC that cannot solely be explained by hypogonadism or cirrhosis and must lead to measure bone mass density to each patient with HC.

[Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: a 20 cases study]. / Effet de la corticothérapie inhalée sur la densité minérale osseuse chez l'adulte jeune asthmatique : a propos de 20 patients.

BACKGROUND: Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial. AIM: To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density. METHODS: Prospective study including 20 asthmatics, aged from 20 to 45 years, treated with inhaled corticosteroids for 12 months or more, with no risk factors for osteoporosis. We compared osteodensitometric parameters in our patients, bone mass and T-score at vertebral and femoral witness to a population matched by age and sex. RESULTS: The average age of our patients was 35.45 ± 5.43 years and the average BMI was 30.03 ± 5.77 kg/m2. The average daily dose of corticosteroid was 925 ± 133.27g of equivalent of beclometasone with an average take of 33.5 ± 21.3 months. The vertebral site bone mass average was 1216 ± 0106 g/cm2 in the studied group and 1201 ± 0099 g/cm2 in the control group without significant difference (p = 0380). At femur, the bone mass average was 1037 ± 0143 g/cm2 in the patient group and 1056 ± 0107 g/cm2 in the control group (p = 0380). We did not find a significant link between bone mineral density and cumulative dose or the duration of taking inhaled corticosteroids, BMI and tobacco. CONCLUSION: Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density.

C-telopeptides of type I collagen in postmenopausal women: an experience in a Tunisian clinical laboratory.

AIM: The purpose of study was to evaluate the interest of C-telopeptides of type I collagen (CTX) in the diagnosis of osteoporosis in postmenopausal women and to define its cut-off value. METHODS: A transverse descriptive study enrolled postmenopausal women: 139 osteoporotic (G1) and 39 non osteoporotic (G2). The 2 groups were defined by bone density measurement. The following markers were measured: serum alkaline phosphatase (ALP), bone alkaline phosphatase (bone ALP), serum C-terminal telopeptide of type I collagen (CTX). Statistical analyses were performed using SPSS 10.5. The corresponding estimation of sensitivity and specificity of CTX have been presented as 'receiver Operating Curve' (ROC). RESULTS: There was no difference in the measurement of ALP and bone ALP in the 2 groups but CTX was statistically higher in G1 compared to G2 (p <0.001). The percentage of osteoporotic women (G1) with CTX values > 0.500 ng/ml was higher than that of non osteoporotic women (G2). We have established a ROC curve to find the cut-off value of CTX that enables the distinction between osteoporotic women with high level of bone remodelling, and non osteoporotic women. The cut-off value of CTX 0.55 pg/ml was the best; it associated best sensitivity and specificity. CONCLUSION: The total increase and significance for CTX was greater in the group of osteoporotic women and appeared therefore to be a good bone turnover marker in the diagnosis of osteoporosis in comparison with ALP and bone ALP. The cut-off value of CTX 0.55 pg/ml may improve the sensitivity and specificity of prediction of future fractures.

[The interest of biochemical markers of bone turnover for monitoring treatment of postmenopausal osteoporosis]. / Intérêt des marqueurs biochimiques du remodelage osseux dans le suivi du traitement de l'ostéoporose post-ménopausique.

BACKGROUND: Postmenopausal osteoporosis is especially female pathology, whose incidence increases with age. AIM: The purposes of this study are to evaluate the level of bone turnover by the determination of markers of bone formation (PAL, BAP) and marker of bone resorption (CTX) in the osteoporotic women, to study the correlations between bone biochemical markers, clinical parameters and radiological measurements and to assess the interest of biochemical markers therapeutic monitoring after 6 months of antiresorptive treatment. METHODS: The authors report a prospective study of 134 osteoporotic women classified in two groups according to the presence of osteoporotic fracture. Patients of the first group G1 (n=102) with fractures, were treated by the bisphosphonates (risedronate), whereas the ones of the second group G2 (n=32) without fractures, were submited to calcic supplementation and vitamin D. RESULTS: The analyses showed that the femoral and lumbar BMD were statistically lower in the presence of osteoporotic fractures. However, the values of CTX were statistically higher in the patients of G1 group compared to those of the G2 group (0,708 +/- 0,332 ng/ml versus 0,514 +/- 0,225 ng/ml). The CTX were statistically correlated with the femoral and lumbar BMD (r = -0,21, p<0,05 and r= -0,348, p<0,001). The hypovitminosis were observed in 50,98% (52/102) of women with ostéoporotic fractures, whereas it was only 25% (8/32) in women without fractures. After 6 months of treatment by the bisphosphonates, the PAL, the BAP and the CTX have decreased with an average of, respectively, 19%, 46,5% and 62,9%. These variations were significantly more important in G1 group. CONCLUSION: The biochemical markers of bone turnover, in particular those of the resorption (CTX), can predict the postmenopausal woman's bone loss evaluated by BMD, the risk of fractures and the efficiency of the bone treatments.

[Stress facture: epidemiology, physiopathology and risk factors]. / Fracture de fatigue: epidémiologie, physiopathologie et facteurs de risque.

OBJECTIVE: The aim of this paper is to give an overview on the scientific information related to stress fracture risk factors. METHODS: We searched the Medline and Embase databases using the keywords stress fracture, risk factors and bone microarchitecture. Only French and English articles were included and 52 were chosen because they corresponded to literary reviews, prospective and retrospective studies concerning individuals who participate in athletics, in military recruits or civil. RESULTS: Stress factures are common injuries in individuals who participate in athletics, in military recruits. Stress fractures of the lower extremity most commonly involve the tibia. A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading. To prevent stress fractures, an appreciation of their risk factors is required. Risk factors include intrinsic risk factors such as female gender, amenorrhea, lower bone density, inadequate muscle function and biomechanical features as well as extrinsic risk factors such as overtraining program, inadequate equipment and the energetic nutrition deficit. The coexistence of different risk factors makes so difficult the isolation of etiologic variables CONCLUSION: Several risk factors have been comprehensively assessed in numerous studies. Hence, to date, there is still no general screening tool available to identify individuals at risk. Bone texture analysis seems to offer new prospects in the identification of stress fracture susceptibility.

[Osteomalacia and giant cell tumor: a rare case]. / Ostéomalacie et tumeur a cellule géante: une entité rare.

BACKGROUND: Oncogenic octeomalacia is an unusual and rare clinicopathologic syndrome characterized by mesenchymal tumors that apparently produce osteomalacia and biochemical abnormalities consisting of hypophosphatemia and normocalcemia. AIM: We have investigated the mechanism by which a giant cell tumor of bone caused biopsy-proved osteomalacia in a 50-year-old woman. CASE REPORT: A 50-year-old woman presented with generalized bone and pelvicrural pain, associated with fatiguability and muscle weakness. The diagnosis of osteomalacia was retained, associated with a giant cell tumor. The coexistence of giant cell tumor of bone and osteomalacia suggested the diagnosis of oncogenic osteomalacia. Resolution of the biochemical abnormalities of the syndrome after tumor resection, established this diagnosis. CONCLUSION: oncogenic osteomalacia can be a form of vitamin-D-refractory osteomalacia due to altered vitamin D3 metabolism.

[Rheumatoid arthritis: current status of therapy]. / Actualités thérapeutiques de la polyarthrite rhumatoïde.

Rheumatoid Arthritis (RA) is a frequent chronic inflammatory disease characterized by distal, bilateral and symmetrical lesions, leading to joint distortions and articular destructions. RA can also cause severe extra-articular manifestations associated with a poor prognosis. Recent advances in the field of immunopathology of RA have oriented treatment targeting the pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF alpha), interleukin (IL) and IL6. These biotherapies are considered as an important therapeutic progress in the treatment of RA acting at the level of cellular processes responsible for rheumatoid disease. These new therapies are active not only in controlling the disease inflammatory processes but also to stop the radiological course of RA. These new therapies are however efficient as long as prescribed, their interruption being rapidly followed by a flare-up of RA. Multiple adverse events attributed to anti-TNF-alpha have been described especially severe opportunistic infections and tuberculosis. B cells playing a critical role in sustaining the chronic inflammatory process in RA, targeted depleting B cells therapies have been developed in refractory forms of RA giving promising results. However, before any biotherapy prescription especially of anti-TNF-alpha, an initial screening should be achieved to exclude patients with history of untreated tuberculosis, solid cancers, malignant hemopathies or demyelinating disorders. It is also essential to assure a strict follow-up in patients under biotherapy to detect adverse events that can be sometimes severe. Thus, the ratio benefit/risk must be evaluated before any biotherapy prescription.

[Common lumbosciatic syndrome of the elderly. Report of 67 cases]. / Les lombosciatiques communes du sujet age. A propos de 67 cas.

BACKGROUND: The common lombosciatic is a disease observed at all ages. To the elderly, clinical data, treatment, clinical outcome and prognosis present sometimes some peculiarities. AIM: Report of lombosciatic in the elderly. METHODS: It is a retrospective study including 67 cases of sciatica concerning old patients over 65 years presenting with common lombosciatica, hospitalized between January the 1-st, 2000 and December 31 st, 2004. RESULTS: The mean age of our patients is of 71.2 years, sex ratio female/male of 1.88. A chronic lumbago is found at 16.34% of our patients and a starting factor pains in 14.3% of cases. Pain is of progressive installation in 93.4 % of cases. Mechanical in 77.5 % of cases and impulsive in 55 % of cases. Sciatica was unilateral in 67.3% of cases and interesting the root L 5 in 40.8 % of cases. Physical exam find a painless attitude in 26.5% of cases and a spasm of spinal muscles in 65.3%. The average of schöber index is of 2.4 cms + 1.18. Lasègue is present in 36.7 % of cases. Neurological exam find overdrawn signs in 8 % of cases, sensory signs in 61.2% of cases. No cauda equine syndrome was individualized in our series. Lumbar spine X-rays, made in 98 % of cases, show a L5-S1 disc impairment in 83.6% of cases, a scoliotic attitude in 22.4 % of cases, a spondylolithesis of L4L5 in 26,5 % of cases and lumbar cannal stenosis in 12.2% of cases. Lumbar densitometry, realized in 22.4% of cases, shows a herniated disc in 27.2% of cases, and a lumbar canal stenosis in 27.2% of cases. The MRI, made once, was normal. During their hospitalization, 87.7% of patients received NSAID's, 18.4% of them analgesics drugs (landing I, II , III) and 79.6 % epidurals infiltrations. All our patients observed bed rest. A physiotherapy was prescribed for 44.9 % of them. A good outcome was quickly noticed in 85.7% of the patients. A therapeutic failure was observed at 14.3 %. 6% underwent surgery. Only 102 % of the non operated patient had pain recurrence. CONCLUSION: Nowadays sciatica is a frequent pathology either in oung or in geriatric population. Nevertheless it is necessary to eliminate a tumoral or infectious sciatica that can be misleading by the condition of the old age and by the frequent associated pathologies at such age.