Achilles tendinitis in systemic lupus erythematosus: search for an associated inflammatory disease.

OBJECTIVES: Except for traumatic and iatrogenic causes, Achilles tendinitis (AT) is mostly encountered in the context of inflammatory rheumatic diseases. This study aimed to describe AT in systemic lupus erythematosus (SLE). PATIENTS AND METHODS: Among 158 SLE patients who fulfilled the SLE criteria of the ACR classification followed between 1980 and 2013, we selected those who experienced at least one episode of AT not caused by traumatic or toxicity factors. RESULTS: Eight patients (one male, seven females), median age 52 years (range: 35-68), presented with 11 episodes of AT within an average of 10.5 (0-21) years after SLE diagnosis. Clinical presentation of SLE was mainly cutaneous (eight of eight), and articular (seven of eight). Axial symptoms were reported in six patients, two of whom had HLA-B27-positive status, and fulfilled the Amor and European Spondylarthropathy Study Group criteria. Resolution of AT was good with nonsteroidal anti-inflammatory topical or systemic drug therapies, which kept SLE quiescent and avoided any increase of specific treatment. CONCLUSION: Although the association is rare, when AT occurs in SLE patients, physicians should look for associated spondylarthritis.

[Vertebral sarcoidosis. Spontaneous favorable outcome: A case report and literature review]. / Sarcoïdose vertébrale. Évolution spontanément favorable : une observation et revue de la littérature.

INTRODUCTION: The prevalence of vertebral sarcoidosis is highly variable (1 to 36% of reported case series). Because of limited clinical expression, its frequency is probably underestimated. Its proper management is not clearly defined. CASE REPORT: A 42-year-old woman who had a past medical history of cutaneous and pulmonary sarcoidosis presented with low back pain that was refractory to usual medical treatment. A diagnosis of vertebral localisation of sarcoidosis was considered on the history of proven sarcoidosis, radiological features, and the absence of evidence of an alternative diagnosis. In the absence of other clinical or biological evidence of active sarcoidosis, a simple follow-up was planned. MRI control at 1 year showed the resolution of vertebral sarcoidosis lesions. CONCLUSION: Spontaneous regression is a possible outcome of vertebral sarcoidosis. Initiation of a specific treatment should be discussed in the absence of other visceral involvement.

[Treatment of psoriasis with biologics: a survey of dermatological and rheumatological practice at Reims University Hospital]. / Traitement du psoriasis par biothérapies : enquête de pratique en dermatologie et en rhumatologie au CHU de Reims.

BACKGROUND: Biological drugs have become a major treatment for moderate-to-severe forms of psoriasis. We sought to evaluate the characteristics of patients treated with biotherapies for psoriasis in daily practice in the dermatology and rheumatology departments of the University Hospital of Reims. PATIENTS AND METHODS: This retrospective study included all psoriasis patients treated with biological agents in the dermatology or rheumatology departments between March 2005 and June 2009. Data concerning the characteristics of psoriasis patients and treatments were collected using a standardized form. In June 2010, we evaluated therapeutic efficacy after at least 1 year of treatment with the first prescribed biotherapy. RESULTS: We note that 109 patients were included in the study (70 in dermatology and 39 in rheumatology). In dermatology, the mean age at diagnosis of psoriasis was 27 years. The sex ratio was 2.5. Of these patients, 26% were smokers, 19% were obese and 29% had dyslipidaemia. In most patients, psoriasis affected between 10% and 50% of body surface area. Thirty percent had associated psoriatic arthritis (confirmed by a rheumatologist in 17% of cases). The mean time from diagnosis to initial systemic treatment was 7 years, and 21 years to use of the first biotherapy. On average, patients received three systemic treatments before the introduction of biological drugs. In rheumatology, the mean age at diagnosis was 37 years. In 95% of patients, psoriasis affected less than 10% of the body surface area. The mean time from diagnosis to initial systemic treatment was 5 years, and 9 years to use of the first biotherapy; 41% of patients were referred to a dermatologist. There was no significant difference between the groups in terms of comorbidities except for dyslipidaemia, which was noted more frequently by dermatologists. DISCUSSION: This study shows little difference between patients treated in the dermatology and in the rheumatology departments in terms of psoriasis characteristics or comorbidities. However, patients in both groups exhibit more cardiovascular risk factors than the general population and 30% had psoriatic arthritis. These two points highlight the importance of the interaction between dermatologists and rheumatologists and the sentinel role of dermatologists in the management of comorbidities. In terms of efficacy, more than 70% of patients were satisfactorily controlled by biotherapy after 1 year of treatment. Therapeutic failures were more common in dermatology than in rheumatology.

[Chronic urticaria-macroglobulinemia (Schnitzler syndrome): developing to IgM myeloma. Apropos of a case]. / Urticaire chronique-macroglobulinémie (syndrome de Schnitzler): évolution vers un myélome à IgM. A propos d'un cas.

Schnitzler's syndrome has been described in 1972. It associates a chronic urticaria with leukocytoclastic vasculitis, a macroglobulinemia, bone pains, hyperostosis. In the twenty three cases reported, the evolution is benign but three patients including the princeps case developed a Waldenström's disease or a lymphoplasmocytic lymphoma. We present the case of one patient, aged 65, with Schnitzler's syndrome, who, after 6 years evolution, presents a IgM myeloma. Schnitzler's syndrome appeared as a pre-hemopathic state which has to be taken care of regularly and for a long time.

[Vertebral compressions revealing Cushing's syndrome. 3 cases]. / Tassements vertébraux révélateurs d'un syndrome de Cushing. Trois observations.

The authors report three cases of osteoporotic vertebral fractures in the Cushing Syndrome. This osteoporosis is partially reversible after treatment of the cause. Laboratory findings must comport a cortisonuric and a 17 hydroxycorticosterone cycle.

[A case of Whipple's disease with ankylosing spondylarthritis treated with trimethoprim-sulfamethoxazole]. / Un cas de maladie de Whipple avec spondylarthrite ankylosante traité par triméthoprime-sulfaméthoxazole.

We report the case of a patient, suffering from Whipple's disease and HLA B27 positive ankylosing spondylitis with syndesmophytes and erosive discopathy. Since spinal radiographic aspects of spondylitis due to Whipple's disease are unusual, we are debating on their relation. We, then, took an interest in the treatment given to this patient: trimethoprim-sulfamethoxazole which would now appear to be the best antibiotic for Whipple's disease.