[Study of bone mineral density in adolescent handball players: about a study of 20 cases]

The physical activity during adolescence seems to correlate with bone mass at the end of the growth period. To determine the effect of handball regularly practiced by teenage girls on the anthropometric parameters and bone mineral density. 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. 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. 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

[Usefulness of magnetic resonance imaging in the diagnosis of early rheumatoid arthritis: a prospective study about 20 cases]

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. To assess the value of MRI for diagnosis of early forms of rheumatoid arthritis. 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. 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. MRI has an important role in detecting infraradiological lesions in early RA. This contributes to early diagnosis and initiation effective treatment

[Pathophysiology of complex regional pain syndrome [CRPS] type 1]

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. To describe the state of advances in the physiopathology of complex regional pain syndrome type 1. Bibliographic research and literature review performed by referring to databases [Medline, Science Direct]. The physiopathology of complex regional pain syndrometype 1 remains still poorly understood and controversial. Several arguments demonstrated both peripheral [inflammation, abnormal sympathetic ...] and central [neurological and cognitive] mechanisms. 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

[Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: a 20 cases study]

Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial. To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density. 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. 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. Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density

[Rheumatic manifestations of genetic hemochromatosis]

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. To review the rheumatic manifestations of genetic hemochromatosis. A narrative review of literature. 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]. 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

C telopeptides of type I collagen inpostmenopausal women: an experience in a Tunisian clinical laboratory

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. 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 followmg 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]. 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/mi was the best; it associated best sensitivity and specificity. 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/mi may improve the sensitivity and specificity of prediction of future fractures

[Stress facture: epidemiology, physiopathology and risk factors]

The aim of this paper is to give an overview on the scientific information related to stress fracture risk factors. 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. 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 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

[ interest of biochemical markers of bone turnover for monitoring treatment of postmenopausal osteoporosis]

Postmenopausal osteoporosis is especially female pathology, whose incidence increases with age. 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 in therapeutic monitoring after 6 months of antiresorptive treatment. 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 G[1] [n=102] with fractures, were treated by the bisphosphonates [risedronate], whereas the ones of the second group G[2] [n=32] without fractures, were submited to calcic supplementation and vitamin D. 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 G[1] group compared to those of the G[2] group [0,708 +/- 0,332 mg/ml versus 0,514 +/- 0,225 mg/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 osteoporotic 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 G[1] group. The biochemical markers of bone turnover, in particular those of the resorption [CTX], can predict the post-menopausal woman's bone loss evaluated by BMD, the risk of fractures and the efficiency of the bone treatments

[Osteomalacia and giant cell tumor: a rare case]

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. We have investigated the mechanism by which a giant cell tumor of bone caused biopsy-proved osteomalacia in a 50-year-old woman. 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. oncogenic osteomalacia can be a form of vitamin-D-refractory osteomalacia due to altered vitamin D3 metabolism

[Osteopenia for patients with crohn diseas]

Osteoporosis and osteopenia are frequently reported during chronic inflammatory bowel diseases, particularly in Crohn disease [CD]. To determine the frequency of osteoporosis and osteopenia of patients with CD and to study associated risk factors. A forward-looking study was performed about 56 cases of CD, 34 men and 22 women, aged 32+10.4 years [18-54 years], with no other disorders affecting osseous metabolism. A biphotonic X-rays absorptiometry densitometry [DEXA] was performed at femoral neck and lumbar spine. A multivariate statistical analysis was performed to check for factors contribiuting in lowing osseous mineral density. Osteoporosis and osteopenia are noticed with respective frequency of 35.7%and 23.2%. A statistically significant association is found between low osseous density on one hand and physical mass index [IMC], localisation on large bowel of the disease and corticotherapy on the other hand. The IMC was a risk factor independant from the two other factors. Under nutrition, with IMC<18 kg/m c, was observed at 21 patients. It was associated to a pathological densitometry in 76.2%of cases, versus 48.6%in patients having an IMC>18 kg/m c [p=0.03, Odds ratio 3.4]. Among risk factors involved in the osteoporosis during CD, the nutritional status plays an important role which must be taken into account in the treatment of these patients

Rheumatoid arthritis: current status of therapy

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-a [TNF alpha], interleukin [IL]1 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 of the elderly. about 67 cases

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. 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 31st, 2004. 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 schober index is of 2.4 cms + 1.18. Lasegue 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 10,2% of the non operated patient had pain recurrence. Nowadays sciatica is a frequent pathology either in young 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

[Juvenile idiopathic arthritis and lyme disease: a case report]

Lyme disease is a systemic infection due to Borrelia burgdor-feri. Joint involvement in children, when primary phase is unknown, can be confounded with juvenile idiopathic arthri-tis. We report a case of a 16 years old girt. who developed at the age of 14 a bilateral and symetrical polyarthritis of big and small joints with fever and cutaneous eruption of trunk. No clinical improvement was seen under disease modified treatment. More biological investigations were performed. leading to the diagnosis of Lyme disease. Clinical recovery was obtained under adapted antibiotherapy, Hence Lyme serology must be performed when atypical polyarthritis appears in a child especially in an endemic region of borrelia. burdogferi

[Thyrotoxicosis revelated by bilaterel Hip fracture]

Hyperthyroidism is an important cause of secondary osteoporosis and therefore of fractures. Nevertheless, facing an osteoporotic fracture, we do not systematically seek after such thyroid disorder in our daily practice. In this purpose, we report the case of 73 year old women, presented with a bilateral pathological femoral neck fracture. Investigations find a hyperthyroid related osteoporosis. Beyond orthopaedic treatment, radioiodine and bisphosphonate drugs were prescribed

[Septic oligoarthritis as a complication of rhumatoid arthritis - a case report]

We present the case a 53-year-old patient followed-up since 1999, for erosive AR treated with methotrexate and glucocorticoids. In April 2000, he had an arthritis of the right knee. The identification of an enterobacter in blood culture, and synovial biopsy results permitted the diagnosis of septic arthritis. After 23 days of antibioterapy treatment, the patient had an arthritis of the left knee. The infectious origin was confirmed by synovial biopsy. The course was better after adaptation of the antibiotics. Septic arthritis is then a serious complication of AR. It requires a fast and multidisciplinary management. It can be threatenig in fragile and immunocompromised patients. The functional prognosis is especially compromised in polyarticular septic arthritis