[Description of French general practitioners' practices regarding long term systemic corticosteroid therapy-associated measures]. / Mesures adjuvantes à une corticothérapie systémique prolongée. Pratiques des médecins généralistes français.

BACKGROUND: Except for the prevention of osteoporosis, no consensual recommendations are available regarding the therapeutic measures associated with the prescription of a long term corticosteroid therapy. We assessed the French general practitioners'practices regarding the prescription of these measures. METHODS: In September 2007, we sent by e-mail a questionnaire to 860 general practitioners members of the reseau Sentinelles, a national survey system which collect data from volunteers French general practitioners. We assessed the frequency of prescription of measures associated with systemic corticosteroids and for whom no consensual recommendations were available (dietary advices, physical training, potassium supplementation, gastric protection, influenza vaccination, prescription of hydrocortisone). RESULTS: 293 out of 860 general practitioners completed the questionnaire (response rate: 34%). The practitioners were predominantly male (87%). Regarding the dietary measures, low sodium diet was recommended by most of the physicians, 68% of them prescribing such dietary regimen in more than 80% of their corticosteroid-treated patients. The concomitant prescription of caloric restriction, low carbohydrate diet or high protein diet was not consensual. Prescriptions of muscular physiotherapy and gastric protection were unusual (80% and 67% of physicians prescribing these measures in less than 20% of their patients, respectively). Recommendations for daily physical training, potassium supplementation, influenza vaccination or hydrocortisone prescription were not consensual. CONCLUSION: There is no consensus in the French general practitioners community regarding most of the measures associated with a long term systemic corticosteroid therapy.

[Management of digital ulcers from systemic scleroderma]. / Prise en charge des ulcères digitaux de la sclérodermie systémique: recommandations d'un groupe pluridisciplinaire d'experts.

Digital ulcers are a frequent event in systemic scleroderma. Despite their frequency, there is currently no consensus about their management. Curative treatment is based on local care and vasodilatating agents, together with the prevention of superinfection. Preventive measures require the elimination of risk factors and reeducation. For multiple recurrent ulcers, endothelin receptor inhibitors or prostacyclin derivatives are also prescribed. Surgery is useful in the case of substantial retraction or bothersome calcifications. In all cases, calcium channel blockers are continued.