CLINICAL AND IMAGING ASPECTS OF TALAR OSTEOCHONDRITIS: A CASE REPORT FROM GUINEA.

Osteochondral lesions of the dome of the talus are becoming an increasingly frequent problem in sports traumatology, and questioning is a major element in the diagnostic orientation, as these are usually young, athletic patients. The main part of the diagnosis is based on complementary imaging examinations. We report the clinical observation of an adult patient, an athlete, referred to a rheumatology consultation for chronic pain of the right ankle with a mechanical appearance and difficulty in walking. Clinical and paraclinical examinations (standard X-ray, CT scan and magnetic resonance imaging) finally led to the conclusion of an osteochondritis of the talus.

ALZHEIMER'S DISEASE, AN ASSOCIATION OR A COMPLICATION OF PAGET'S DISEASE? STUDY OF AN OBSERVATION IN GUINEA.

If Paget's disease can undermine Alzheimer's disease, there is the possibility of an association between Alzheimer's disease and Paget's disease. We report the observation of an 81-year-old hypertensive patient with Alzheimer's disease, who presented with an isolated increase in alkaline phosphatase, which led to the discovery of Paget's disease. The physician must therefore be careful to distinguish between genuine Alzheimer's disease and a neurological complication of Paget's disease.

[Sjögren's Syndrome: Epidemiological, Diagnostic, Therapeutic and Evolutionary Aspects in the Aristide-Le-Dantec Teaching Hospital of Dakar, Senegal (2012-2016)]. / Le syndrome de Sjögren : aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs au CHU Aristide-Le-Dantec de Dakar, Sénégal (2012‒2016).

Sjögren's syndrome (SS) is an autoimmune epithelitis, rarely described in black Africa. We report its epidemiological, diagnostic, therapeutic and evolutionary aspects in a Senegalese hospital environment. A retrospective, crosssectional study was carried out in the rheumatology and internal medicine departments of Aristide-Le-Dantec University Hospital of Dakar, between January 2012 and September 2016, where the observations of SS whose diagnosis, in line with the American-European consensus criteria of 2002, were enrolled. We collected 370 observations of SS, 327 women and 43 men, a sex-ratio of 1:9. These were 251 primitive forms (pSS) and 119 secondary forms (sSS). The hospital prevalence of pSS was 5%. The mean age was 42 ± 15 years and the time taken for diagnosis was 7 years. The familial forms totaled 47 index cases with a relative risk of occurrence of the disease estimated at 6.3% for firstdegree relatives. The juvenile forms totaled 7 cases of pSS. Dry syndrome was constant: oral (87%) and ocular (84%). Extra glandular manifestations were present in 87%. Arthritis was erosive in 75 cases and secondary to Rheumatoid arthritis. Autoantibodies (rheumatoid factors [49/147], anti-CCP [24/79], Sjögren's syndrome autoantigen A [anti- Ro/SSA] 41/140, Sjögren's syndrome autoantigen B [anti-La/SSB] [22/140], anti-nuclear [14/55] and cryoglobulin 1) were objectified. The histology practiced in 253/370 patients was contributory in 229 of them. According to the ESSPRI score (Eular Sjögren's Syndrome Patient Reported Index), 77% of patients had unbearable symptoms. NHP (Nottingham Health Profile) and SF-36 (Short Form [36] Health Survey) confirmed this deterioration in the quality of life. The ESSDAI score (Eular Sjögren Syndrome Disease Activity Index) showed persistent activity of the disease. The evolution was overall favorable. The hospital prevalence of pSS was 5%. It is predominant in women with an average age of 42 years. Glandular and systemic manifestations are frequent. The functional repercussions and the alteration of the quality of life are notable.

Le syndrome de Sjögren (SS) est une épithélite auto-immune, rarement décrite en Afrique noire. Nous rapportons ses aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs en milieu hospitalier sénégalais au travers d'une étude rétrospective, transversale, réalisée dans les services de rhumatologie et de médecine interne du CHU Aristide-Le-Dantec de Dakar, entre janvier 2012 et septembre 2016. Le diagnostic des observations de SS colligées était en accord avec les critères américano-européens modifiés en 2002 (critères de Vitali). Nous avons colligé 370 observations de SS chez 327 femmes et 43 hommes, soit un sex-ratio de 1/9. Il s'agissait de 251 formes primitives (SSp) et de 119 formes secondaires (SSs). La prévalence hospitalière du SSp était de 5%. L'âge moyen était de 42 ans ± 15. Le délai du diagnostic était de sept ans. Les formes familiales totalisaient 47 cas index, avec un risque relatif de survenue de la maladie estimé à 6,3 % pour les apparentés de premier degré. Les formes juvéniles totalisaient sept cas de SSp. Le syndrome sec était constant : buccal (87 %) et oculaire (84 %). Les manifestations extraglandulaires étaient présentes dans 87 % des cas. Les arthrites étaient érosives dans 75 cas, secondaires à une polyarthrite rhumatoïde. Les autoanticorps (facteurs rhumatoïdes [49/147], anticorps antipeptides cycliques citrullinés [anti-CCP] 24/79, Sjögren's syndrome autoantigen A [anti-Ro/SSA] [41/140], Sjögren's syndrome autoantigen B [anti-La/SSB] [22/140], antinucléaires [14/55] et cryoglobuline [1 cas]) étaient objectivés. L'histologie pratiquée chez 253/370 patients était contributive chez 229 d'entre eux. Selon le score ESSPRI (Eular Sjögren's Syndrome Patient Reported Index), 77 % des patients avaient des symptômes insupportables. Le NHP (Nottingham Health Profile) et le SF-36 (Short Form [36] Health Survey) confirmaient cette altération de la qualité vie. Le score ESSDAI (Eular Sjögren Syndrome Disease Activity Index) objectivait une activité persistante de la maladie. L'évolution était globalement favorable. La prévalence hospitalière du SSp était de 5 %. Il prédominait chez les femmes d'âge moyen de 42 ans. Les manifestations glandulaires et systémiques étaient fréquentes. Le retentissement fonctionnel et l'altération de la qualité de vie étaient notables.