[Musculoskeletal hand disorders in musicians]. / Les pathologies musculo-squelettiques de la main chez les musiciens.

Music is often associated with joy, pleasure and leisure. However, like any other profession, it has its constraints and risks.The purpose of this update is to present a non-exhaustive inventory of musculoskeletal hand disorders most frequently associated with music practice.All music instruments are concerned. The difference lies in damage location as well as in the frequency of specific pathologies according to the used instrument. The most feared disorder by musicians is focal dystonia, which is characterized by a painless and repetitive coordination disorder. It only appears in the realization of specific professional movements. The overuse syndrome and the nerve entrapment syndrome constitute other dreaded disorders. Specific and multidisciplinary care is often necessary.

La musique rime souvent avec joie, plaisir et loisir. Cependant, comme toute autre profession, elle a ses contraintes et ses risques. Cette mise au point a pour objectif de faire un inventaire, non exhaustif, des pathologies musculo-squelettiques de la main les plus fréquemment associées à la pratique de la musique. Aucune famille d'instruments n'est épargnée. La différence réside dans la localisation de l'atteinte ainsi que dans la fréquence de l'association entre certains instruments et une pathologie précise. La dystonie de fonction, caractérisée par un trouble de la coordination indolore mais répétitif, est une pathologie redoutée par les musiciens. La symptomatologie ne se manifeste que lors de la réalisation de certains gestes professionnels précis. Le syndrome de surmenage ainsi que les syndromes canalaires peuvent également se rencontrer. Une prise en charge spécifique et multidisciplinaire est souvent nécessaire.

[Clinical, radiographic and biologic particularities of ankylosing spondylitis in Tunisian patients according to the presence or the absence of the HLA B27 and its sub-types]. / Particularités cliniques, radiologiques et biologiques de la spondylarthrite ankylosante en Tunisie selon la présence ou l'absence du HLA B27 et de ses sous-types.

To assess the clinical, radiographic and biologic particularities of ankylosing spondylitis (AS) in Tunisian patients according to HLA B27 and its sub-types statute. This was a case-control study that included 100 patients (85 males/15 females) with AS according to the modified New York criteria. Demographic, clinical, AS specific indexes, radiographic and biologic parameters were determined. HLA-B and B27 subtypes typing of all subjects were performed by PCR-SSP. Patients mean age was 38.4 years +/- 12.6 HLA-B27 was found in 62% of patients. The comparison of B27 positive and B27 negative patients revealed a correlation of B27 with age, male gender, family history of spondylarthropathies, age at disease onset, acute onset of the disease, inaugural spinal involvement, uveitis, bilateral and destructive hip arthritis as well as a high score of mSASSS. The most frequent sub-types of HLA B27 were B*2702 (49.2%) and B*2705 (36.3%). No significant difference of the clinical presentation of the disease or severity factors was found among these patients. This study confirmed the contribution of the HLA B27 to the determination of the clinical presentation of AS. The variability of factors linked to B27 may be explained by the polygenic model of the disease.

Comparative study of indices of activity evaluation in rheumatoid arthritis.

INTRODUCTION: Choosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-(ESR) and DAS28-(CRP) indices in the evaluation of RA activity. PATIENTS AND METHODS: In this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) "tau" similarity coefficient. RESULTS: The 87 female and 13 male patients (sex ratio: 6.7F/1M) were of a mean age of 52.9±11.6 years (17-77) and have been living with RA for a mean of 8.3±9 years (2 months-41 years). The DAS28-(ESR) mean score was 5.53±1.46 [1.25-8.05]. The DAS28-(CRP) mean score was 5.01±1.44 [1.68-7.81]. The CDAI mean score was 30.72±15.04 [2-62] and that of SDAI was 28.86±15.86 [2.3-71.3]. A positive, statistically significant correlation was noted between the four indices of RA activity. The level of similarity between the different indices was good (K variation between 0.758 and 0.943). DAS28-(ESR) allowed classifying the patients in the same category of disease activity than DAS28-(CRP) in a proportion of 85%. This proportion was 88% when comparing DAS28-(ESR) to CDAI and SDAI, respectively. Regarding DAS28-(CRP) and CDAI, these two indices classified the patients in the same category in a proportion of 80%, compared to 87% regarding DAS28-(CRP) and SDAI. Finally, CDAI and SDAI classified the patients in the same category in a proportion of 92% with an excellent level of similarity. CONCLUSION: Different evaluation indices of RA activity are currently available. DAS28 is the most used. CDAI and especially SDAI have a good level of similarity with DAS28. Their advantage is to be simple and quick, and seem therefore well adapted to the follow-up of outpatients.

[Scapulohumeral hydatidosis: a new case in Tunisia]. / L'hydatidose scapulohumérale: à propos d'une nouvelle observation en Tunisie.

Osseous hydatidosis is reported in only 0.5-2.5% of the cases. The scapulohumeral localization is extremely rare. A 39-year-old woman, born in a rural area of Tunisia, presented swelling and tenderness of the left shoulder with limited motion 7 days after a minor trauma. Plain radiographs, CT and MRI showed osteolytic scapulohumeral lesions, cortical rupture and multiple cysts in the muscles, which were suggestive of hydatidosis. Indirect haemagglutination test using hydatid antigen was positive (1/280). The patient refused radical surgery and underwent resection of axillary cysts. Albendazole was given in the recommended dose but was stopped immediately due to hepatic toxicity. Scapulohumeral hydatidosis is extremely rare, often invasive and behaves like a locally malignant bone tumour. Its treatment is also difficult.

[Infection of a tophaceous nodule of the middle finger]. / Infection d'un tophus goutteux de la main.

Gouty involvement of the hand is uncommon and the complications the most described are bony destruction, digital joint instability, tenosynovitis and double ipsilateral tunnel syndrome of the median and ulnar nerves at the wrist. Septic complications, such as infection of a tophaceous nodule, are a rare entity. The authors report a case of an infection of a tophaceous nodule of the middle finger in a 67-year-old man. The diagnosis was suspected on physical examination and radiological findings but final diagnosis is provided by bacteriological examination. This case is presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.

[Cardiovascular manifestations in ankylosing spondylitis. Concerning 210 cases]. / Manifestations cardio-vasculaires de la spondylarthrite ankylosante. A propos de 210 cas.

BACKGROUND: To analyse and discuss cardiovascular manifestations of ankylosing spondylitis, evaluate the frequency and giving special attention to unusual forms. METHODS: We retrospectively reviewed the medical records of 21 cases with cardiovascular manifestations among 210 cases of ankylosing spondylitis seen over a 25 years period who met the Amor criteria. RESULTS: Cardiovascular complications were found in 21 patients (10%): 5 (2.40%) had aortic insufficiency, 2 (0.95%) had mitral insufficiency, 1 had mitral valve prolapse, 1 had pericarditis, 10 (4.7%) had atrioventricular block and 6 (2.8%) had bundle branch block. Takayasu's disease was diagnosed in one case. Cardiovascular involvement was common In patients longer disease duration. Peripheral arthritis was found in 33% and its prevalence did not differ in patients with or without cardiac involvement. CONCLUSION: Aortic insufficiency and conduction disturbances were the most common cause of cardiovascular involvement in ankylosing spondylitis. The funding of cardiovascular manifestations in 10% of our patients suggests that in this illness evidence of cardiac manifestations should be actively investigated in ankylosing spondylitis.