Validity and responsiveness of the French version of the Örebro Musculoskeletal Pain Screening Questionnaire in chronic low back pain.

PURPOSE: The assessment of a broad range of biopsychosocial aspects is important in the rehabilitation of patients with chronic low back pain (CLBP) for the prediction of outcome as well as for evaluation. The objective of this study was to test the responsiveness, construct validity and predictive value of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) compared to other instruments widely used to assess biopsychosocial aspects in patients with CLBP. METHODS: 111 patients with CLBP admitted to an inpatient rehabilitation completed a set of questionnaires on biopsychosocial aspects at baseline and at discharge. Ninety-eight patients responded at three months for an assessment of the return to work status. Responsiveness of the OMPSQ, the ability to detect change in the construct of interest, was investigated by a set of hypotheses on correlations with widely used questionnaires. We tested the hypothesis that the changes in the OMPSQ would vary along with the responses in the Patient's Global Impression of Change. Prediction of disability at discharge, work status at three months and time to return to work was evaluated with linear, logistic and cox regression models. RESULTS: The OMPSQ showed good predictive values for disability and return to work and construct validity of the instrument was corroborated. Seventy-nine percent of our hypotheses for responsiveness could be confirmed, with the OMPSQ showing the second highest change during the rehabilitation. CONCLUSIONS: The OMPSQ can also be applied in patients with CLBP, but for the assessment of change in psychosocial variables one should add specific questionnaires.

Cross-cultural adaptation, reliability, internal consistency and validation of the Hand Function Sort (HFS©) for French speaking patients with upper limb complaints.

INTRODUCTION: Functional evaluation of upper limb is not only based on clinical findings but requires self-administered questionnaires to address patients' perspective. The Hand Function Sort (HFS©) was only validated in English. The aim of this study was the French cross cultural adaptation and validation of the HFS© (HFS-F). METHODS: 150 patients with various upper limbs impairments were recruited in a rehabilitation center. Translation and cross-cultural adaptation were made according to international guidelines. Construct validity was estimated through correlations with Disabilities Arm Shoulder and Hand (DASH) questionnaire, SF-36 mental component summary (MCS),SF-36 physical component summary (PCS) and pain intensity. Internal consistency was assessed by Cronbach's α and test-retest reliability by intraclass correlation. RESULTS: Cronbach's α was 0.98, test-retest reliability was excellent at 0.921 (95 % CI 0.871-0.971) same as original HFS©. Correlations with DASH were-0.779 (95 % CI -0.847 to -0.685); with SF 36 PCS 0.452 (95 % CI 0.276-0.599); with pain -0.247 (95 % CI -0.429 to -0.041); with SF 36 MCS 0.242 (95 % CI 0.042-0.422). There were no floor or ceiling effects. CONCLUSIONS: The HFS-F has the same good psychometric properties as the original HFS© (internal consistency, test retest reliability, convergent validity with DASH, divergent validity with SF-36 MCS, and no floor or ceiling effects). The convergent validity with SF-36 PCS was poor; we found no correlation with pain. The HFS-F could be used with confidence in a population of working patients. Other studies are necessary to study its psychometric properties in other populations.

[Common lumbago and returning to work: various thoughts about a complex problem]. / Lombalgie commune et retour au travail: quelques réflexions autour d'un problème complexe.

Non specific low back pain (NSLBP) is commonly a persistent or recurrent problem. In general the longer a worker is off work with NSLBP, the more disabling the condition becomes, the less successful any form of treatment, and the greater the probability of long term sickness absence. The obstacles to return to work are diverse. Scientific evidence shows that the development of chronic low back pain and disability depends more on individual and work-related psychosocial issues than on physical or clinical features. There is strong empirical evidence that treatment at the subacute stage (NSLBP lasting for approximately 5-12 weeks) is more effective at preventing chronic pain and disability than attempts to treat chronic intractable pain and disability once it is established. Active rehabilitation programmes should be interdisciplinary, adapted to the local socioeconomic context and include education toward overcoming fear avoidance beliefs and promoting self-care, some kind of active exercises, some behavioural principles of pain management, and some intervention at the workplace to help and assist the worker in early return to work. Some of these programs have produced desirable occupational outcomes when all the stakeholders in the disability problem (worker, employer, insurer, attending physician) worked together.

[Evaluation of functional capacity]. / Evaluation de la capacité fonctionnelle.

A functional capacity evaluation (FCE) is a detailed examination and evaluation that objectively measures the individual's current level of safe functional abilities, primarily within the context of the demands of competitive employment. It measures the ability to perform functional or work-related tasks and predicts the potential to sustain these tasks over a defined time-frame. Measurements of function from an FCE are compared to the physical demands of a job or other functional activities, and are used to make return-to-work/activity decisions, disability determinations, or to generate a rehabilitation plan. Scientific evidence on validity and reliability is limited so far. An FCE is time-consuming and cannot be recommended as a routine evaluation.

Molecular analysis of HLA-DR polymorphism in polymyalgia rheumatica. Swiss Group for Research on HLA in Polymyalgia Rheumatica.

OBJECTIVE: To analyze by molecular typing possible associations of HLA-DRB1 alleles with polymyalgia rheumatica (PMR) compared to controls and patients with rheumatoid arthritis (RA) in Switzerland. METHODS: In a multicenter survey, we recruited 100 patients with PMR with and without signs of giant cell arteritis (GCA), 198 with RA, and 200 controls (volunteer bone marrow donors). HLA-DR generic typing was performed by microtiter plate oligotyping and DR4 subtypes analyzed by dot blot hybridization with sequence specific oligonucleotides or by polymerase chain reaction sequence specific primers. RESULTS: DR4 and DR1 tended to be increased in PMR, compared to controls (36 vs 30%, p = 0.30; and 19 vs 12%, p = 0.16, respectively). Frequencies of all RA associated DR4 and DR1 subtypes tended to be increased in PMR as well. Frequency of the HLA-DR beta 1 70-74 shared motif (QK/RRAA) was significantly higher in PMR than in controls [50 vs 36%, odds ratio (OR) = 1.8, p = 0.018], although lower than in RA (77 vs 36%, OR = 6.0, p < 0.0001), and slightly out of the range of significance if a Bonferroni correction was applied (p = 0.1). At double dose, this epitope was also increased in PMR, but not significantly (5 vs 2%, OR = 2.6, p = 0.17), while it was markedly augmented in RA (22 vs 2%, OR = 14, p = < 0.0001). In patients with the shared epitope, the frequency of clinical signs of GCA tended to be increased (19 vs 10%, p = 0.25). Frequency of the HLA-DR beta 1 DRYF 28-31 motif was identical in PMR (95%) and controls (93%). CONCLUSION: PMR may be associated with the HLA-DR beta 1 70-74 shared epitope. This association, however, would be much weaker for PMR than for RA, particularly with the shared epitope at double dose. PMR is clearly not associated with the HLA-DR beta 1 DRYF 28-31 motif.

Propionibacterium avidum sacroiliitis and osteomyelitis.

The anaerobic Gram-positive bacterium Propionibacterium avidum is a common inhabitant of the skin with low pathogenicity. We report a case of P. avidum sacroilitis, psoas abscess and osteomyelitis in a 67-year-old male who had recently undergone surgical repair of an inguinal hernia. The organism was recovered from blood cultures, a bone biopsy specimen and specimens from the abscess. The spectrum of bone and joint infections caused by Propionibacterium is discussed. Infection by Propionibacterium spp. should be considered in patients with bone and joint infections.

Enthesopathy and tendinopathy in gout: computed tomographic assessment.

OBJECTIVE: To establish if computed tomography (CT) imaging, which has proved helpful in detecting intra-articular tophi in gout, can also be used to document gouty enthesopathy and tendinopathy. METHODS: Three patients with tophaceous gout and clinical involvement of the Achilles tendon (two cases) or patellar tendon (one case) were assessed with CT examination and plain radiographs. RESULTS: In the first two cases, CT images revealed linear or nodular high attenuation opacities within the substance of the Achilles tendons and their calcaneal insertion. In case 3, dense linear opacities were seen within the patellar tendon and within its tibial insertion. No such opacities of the tendons and entheses were seen on standard radiographs of these patients. CONCLUSIONS: CT appears to be the imaging method of choice for demonstrating monosodium urate deposits in entheses and tendons in tophaceous gout.

[Anti-synthetase syndrome: a special subgroup of idiopathic inflammatory myopathies. Apropos of 3 case reports]. / Le syndrome antisynthétase: un sous-groupe particulier des myopathies idiopathiques inflammatoires. A propos de trois observations.

Anti-synthetase antibodies are found in 20 to 25% of all idiopathic inflammatory myopathies and allow identification of a syndrome associating myositis with interstitial pulmonary disease (50 to 70%), polyarthritis, Raynaud's phenomenon and mechanic's hands. Anti-Jo-1 is the most common anti-synthetase antibody. If anti-Jo-1 is present, interstitial lung disease must be looked for, because this is the most important determinant of the outcome. Treatment with high doses of corticosteroids is required. Immunosuppressive drugs are added in resistant cases or as corticosteroid-sparing agents.

Parvovirus B19 associated monoarthritis in a 5-year-old boy.

We describe the case of a 5-year-old boy who presented with parvovirus B19 associated arthritis of the left knee lasting for 6 weeks. Other features included flu-like symptoms, a mild "slapped cheek" sign, and a macular, erythematous, lace-like rash over the chest and limbs. The analysis of the synovial fluid showed a high white cell count with a predominance of polymorphonuclear cells. The characteristic features related to parvovirus B19 associated arthropathy in children are reviewed.

Association between antiphospholipid antibodies and epilepsy in patients with systemic lupus erythematosus.

OBJECTIVE: To determine whether the occurrence of seizures is correlated with the presence of serum antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE) patients. METHODS: The study included 221 unselected patients with SLE. Of these, 21 patients with epileptic seizures not attributed to any cause other than SLE were identified. Epilepsy was diagnosed by clinical history and electroencephalography. Blood samples were tested for the presence of antibodies to cardiolipin (aCL, IgG and IgM isotypes) and lupus anticoagulant (LAC). RESULTS: LAC was detected in 43.8% of the patients with epilepsy and in 20.8% of controls (P = 0.057). A statistically significant association was found between moderate-to-high titers of IgG aCL and the presence of seizures (P = 0.02). Brain computed tomography and/or magnetic resonance imaging scanning was performed in 14 patients. All patients with abnormal features found on these tests had positive aPL (P = 0.03). Nine patients (42.9%) had at least 1 of the classic features associated with the aPL syndrome. CONCLUSION: We confirmed that epilepsy as a primary neuropsychiatric event is significantly associated with moderate-to-high titers of IgG aCL in SLE patients. Our results suggest that aPL could have a role in the etiopathogenesis of epilepsy in SLE.

Thrombosis and antiphospholipid syndrome: a preliminary assessment of three antithrombotic treatments.

To assess retrospectively three antithrombotic treatments in the secondary prevention of thrombosis in the antiphospholipid syndrome (APS), 23 patients (six systemic lupus erythematosus, seven lupus-like disease and 10 primary antiphospholipid syndrome) were included in this study. Treatments assessed were: (1) aspirin 75 mg daily, (2) warfarin (international normalised ratios (INRs) 2.0-2.9) +/- aspirin 75 mg daily, and (3) warfarin (INRs > 2.9) +/- aspirin 75 mg daily. Where patients had received two or three of these treatments successively, the periods of time on each treatment were added and the number of patients with recurrence(s) on each treatment were compared by Fisher's exact probability test. 'High' anticoagulation (INRs > 2.9) +/- aspirin 75 mg daily was more effective than aspirin 75 mg daily, there was a trend in favour of 'high' anticoagulation (P = 0.066). No statistically significant difference could be demonstrated when comparing 'low' anticoagulation +/- aspirin 75 mg daily with aspirin 75 mg daily (P = 0.092). These results suggest that aggressive anticoagulation with or without low-dose aspirin is effective in preventing further thromboembolic events in APS.

[Stress fracture of the distal end of the tibia simulating ankle arthropathy]. / Fracture de contrainte de l'extrémité distale du tibia simulant une arthropathie de la cheville.

The authors report four cases of stress fracture of the distal tibia simulating acute arthritis of the ankle. Two patients had a noninflammatory tibiotarsal joint effusion whose cause is discussed.

[Lesional pulmonary edema associated with tocolysis by hexoprenaline sulfate]. / Oedème pulmonaire lésionnel associé à une tocolyse par le sulfate d'hexoprénaline.

We report the case of a 24-year-old white female in need of tocolysis during the 25th week of pregnancy with i.v. hexoprenaline, while suffering from a discrete influenza-like syndrome with nasal discharge and sinusitis. A few hours later fulminant acute adult respiratory distress syndrome (ARDS) developed. ARDS is a rare (0.5-5%) but feared complication of tocolysis with beta-2 mimetic agents and magnesium sulfate. Its physiopathology is obscure, but iatrogenic hyperhydration and lesions of the alveolar-capillary membrane are suspected. In this case both factors were involved, but lesions of the alveolar-capillary membrane were predominant. A direct toxic effect of beta-2 mimetic agents on the alveolar-capillary membrane has not been demonstrated and other factors favoring pulmonary edema during tocolysis with beta-2 mimetic agents, especially infections, are discussed.

[A case of severe rarefaction osteopathy associated with tabes dorsalis]. / Un cas d'ostéopathie raréfiante sévère associée à un tabès dorsal.

The authors report the case of a 63 years old man who presented 13 years after a diagnosis of a tabes dorsalis, stress fractures of the lower limbs and Charcot's joints (knees). 7 years later, he had multiple stress fractures of the sacrum and pelvis and of the ribs following a minor trauma. Laboratory investigations revealed a major osteoporosis probably related to the neurochirurgical complications of the tabes dorsalis.

[Metastasis of pulmonary origin in a metatarsal head: differential diagnosis of an attack of gout. Literature review of bony metastases of hands and feet]. / Métastase d'origine pulmonaire d'une tête métatarsienne: diagnostic différentiel d'une crise de goutte. Revue de la littérature des métastases osseuses des mains et des pieds.

The osseous metastasis in our patient's first toe has been the initial clinical manifestation of a pulmonary neoplasm and the clinical picture was that of a gout-attack or an other osteoarticular affection. As a rule, primary supradiaphragmatic neoplasia tend to metastasize to the hands whereas primary infradiaphragmatic neoplasia tends to metastasize to the feet. Our patient, who presented a pulmonary tumor with a metastasis in the right foot, did not fit into this schedule.