[Erosive hand osteoarthritis]. / L'arthrose érosive des doigts.

Erosive hand osteoarthritis is common and debilitating. Diagnosis is based on the presence of bone erosions which can appear late. Ultrasonography allows earlier diagnosis. The presence of apatite deposits could be of poor prognosis. Non pharmacological treatment includes the explanation of the inflammatory phenomena involved and the use of splints and physical therapy. Drug therapy includes analgesics, NSAIDs and infiltration of a steroid. Chondroitin sulfates have an analgesic and functional effect proven. DMARDs such as hydroxychloroquine and methotrexate have been used successfully. Some patients also benefited from isotope synoviortheses. New therapeutic ways, based on the pathophysiology of the disease, are new under evaluation.

[Liquid lipid crystals-induced arthritis]. / L'arthrite à cristaux de lipides tiquides.

Liquid lipid crystals-induced arthritis crystals are a frequent cause of arthritis. They are disclosed by the microscopic examination of the synovial fluid. They are usually made of monosodium urate, calcium pyrophosphate or apatite. Liquid lipid crystals have a spherical shape with an aspect of Maltese crosses and a positive birefringence. They are sometimes observed outside the leukocytes in rheumatoid or post-traumatic effusions. In some cases, they constitute the solely cause explaining the arthropathy. Then, they are numerous and located in and outside the cells. This observation reports on the case of a 50 year-old woman having developed this type of arthritis related to a right knee hemarthrosis. Awareness of this pathology may be useful because its evolution is usually good with a non-steroidal anti-inflammatory drug or a local steroid infiltration after exclusion of an infectious origin of the effusion.

[Evaluation of the adhesion to the EULAR and OARSI recommendations for the treatment of knee and hip osteoarthritis in current practice]. / Evaluation de l'adhésion aux recommandations de l'EULAR et de l'OARSI pour le traitement de l'arthrose du genou et de la hanche en pratique quotidienne.

Recommendations for the treatment of hip and knee osteoarthritis (OA) have been recently published by international scientific societies (EULAR, OARSI). The aim of this study was to evaluate, in real life, the acceptance of these recommendations in the two districts of the Neuchâtel mountains. In March 2008, a questionnaire was sent to all the general practitioners (GP = 23), internists (IM = 22), orthopedic surgeons (ORTHO = 8) and rheumatologists (RHEUMATO = 3) of the districts of Le Locle and La Chaux-de-Fonds (population of 55000 people). The anonymous questionnaire, presenting the 10 EULAR and 25 OARSI recommendations for the treatment of hip and knee OA, asked for some demographic data of the physicians and for the knowledge and acceptance of the presented recommendations. Results were expressed as a <> (SoA), based on a semi-quantitative evaluation (15 to 55) and expressed in percent for comparison to the <> (SoR) reported by EULAR and OARSI. Twenty-three questionnaires (41%) were returned. Seven of the ten GP, one of the six IM, one of the four ORTHO who responded and the three RHEUMATO knew and applied some of the EULAR recommendations. Only one GP, one ORTHO and one RHEUMATO knew the OARSI recommendations. The SoA was a little less for the primary care physicians (PCP = GP + IM) than for the specialists in the musculo-skeletal diseases (SMD = ORTHO + RHEUMATO) for the EULAR (85 versus 89%) and for the OARSI (73 versus 78%) recommendations. None of the EULAR or OARSI recommendations gained a full SoA by the PCP although two EULAR and one OARSI recommendations obtained a complete SoA by the SMD. In this sample of physicians, most IM and ORTHO ignored the EULAR and OARSI recommendations for the treatment of hip or knee OA. Nonetheless, a majority of PCP and SMD adhered to the most of them with occasionally a greater SoA than the proposed SoR. An effort for a better diffusion of these recommendations is justified among IM and ORTHO.

[Tophaceous calcium pyrophosphate dihydrate deposits in a finger]. / Tophus digital de cristaux de pyrophosphate de calcium.

Calcium pyrophosphate dihydrate (CPPD) deposits are frequently observed in joint tissues. They can also occur in other tissues and present as a tophus. Contrarily to gout, a CPPD tophus is exceptionally localized in a finger. This presentation concerns a 81-year-old man who developed a huge tumor-like tophus of CPPD crystals on the antero-lateral side of his 3rd right finger, reducing superficial sensibility and eroding the proximal phalanx. Similarly to the majority of the rare previous reported cases, there was no associated chondrocalcinosis and the diagnosis was only made by the histological examination of the resected tissues. Better knowledge of this entity could avoid enlarged surgery as it has been done on some occasion.

[Dry cough, chest pain and difficult breathing in a patient with rheumatoid arthritis]. / Toux sèche, douleurs thoraciques et dyspnée chez un patient atteint d'une polyarthrite rhumatoïde.

Pulmonary involvement is the most frequent extra-articular manifestation of rheumatoid arthritis. The occurrence of a chronic hydro-pneumo-thorax associated with pulmonary nodules is rare. Cavitation of the most superficial nodules and their rupture into the pleural cavity are most likely involved in this complication. The presence of broncho-pleural fistulae may be responsible for the persistence of the phenomenon in our patient.

[Patellar hypertrophy: rare abnormality associated with a multiple epiphyseal dysplasia]. / Hypertrophie rotulienne: rare anomalie associée a une dysplasie polyépiphysaire.

Multiple epiphyseal dysplasia is a genotypic chondrodystrophy characterized by an abnormal shape of numerous epiphyses. Diagnosis is usually made during childhood on an abnormal gait and a reduction of joint mobility associated with radiological changes of the ossification centres. This observation reports on a woman who only consulted at adulthood. Diagnosis was based on a short stature, slight shortening of the extremities and precocious osteoarthritis on the radiographs. Lateral x-rays of the knees revealed a globular hypertrophy of both patellae. This association has rarely been mentioned. A late fusion of an antero-posterior duplication of the ossification centre of the patella seems to be the most plausible physiopathologic hypothesis. Persistence of both ossification centres could result in a coronal double-layered patella, which is also occasionally observed in patients with multiple epiphyseal dysplasia.

[Intensification of a diffuse chronic pain syndrome by the introduction of an aromatase inhibitor]. / Exacerbation d'un syndrome douloureux chronique diffus par l'introduction d'un inhibi- teur de l'aromatase.

A case of a menopausal woman known for a chronic diffuse pain syndrome and breast cancer positive for estrogen receptors is presented. She developed an increase of her diffuse pain syndrome and joint aches after the introduction of an aromatase inhibitor. Soreness quickly improved after the interruption of the drug. We emphasize some etiological hypotheses concerning the painful symptoms, especially the role of aromatase and estrogens.

[Concomitant septic and gouty olecranon bursitis]. / Bursite olécranienne d'origine simultanément goutteuse et septique.

A case of coexistent acute gout and septic olecranon bursitis is presented. Our hypothesis is that asymptomatic monosodium urate crystals, possibly present in the bursa could secondarily been triggered by the infection.