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Aims: To investigate the association between type II collagen fragments and the presence of knee osteoarthritis (OA) in the Tunisian population and to determine whether this biomarker can predict X-ray progression of this disease., Methods: Type II collagen C-telopeptide (uCTX-II) and helical peptide (sHelix-II) were assessed in 125 female patients with knee osteoarthritis aged 54 ± 8 years over 2 years and 57 female age-matched controls. The markers were measured at baseline, 1 and 2 yrs' follow-up corresponding to x-ray time points., Results: Only urinary CTX-II values were significantly 48% higher in knee OA patients compared with controls (p=0.001). The longitudinal changes over 2 yrs in Helix-II were also significantly associated with Joint Space Narrowing: JSN (p=0.03). Over the 2-yr study period average CTX-II levels were not significantly higher in progressor compared with non-progressor (339.96 vs 256.00; NS)., Conclusion: The data presented here suggest that CTX-II may be useful to identify patients with knee OA. These results demonstrate significantly association between progression of this disease and alterations levels of Helix-II.

Background: Celiac disease (CD) is characterized by a malabsorption syndrom. The bone anomalies are one of the principal complications of this disease. The osteoporosis frequency is high: 3.4% among patients having with CD versus 0.2% in the general population., Aim: To study the bone mineral density during the CD, to compare it to a control group and to determine the anomalies of biochemical markers of bone turn over and level of interleukin 6 cytokin (IL6) in these patients., Methods: All patients with CD have a measurement of bone mineral density by dual-energy x-ray absorptiometry (DXA), a biological exam with dosing calcemia, vitamin D, parathormone (PTH), the osteoblastic bone formation markers (serum osteocalcin, ALP phosphates alkaline), bone osteoclastic activity (C Télopeptide: CTX) and of the IL6., Results: 42 patients were included, with a median age of 33.6 years. 52. 8% of the patients had a low level of D vitamine associated to a high level of PTH. An osteoporosis was noted in 21.5% of patients. No case of osteoporosis was detected in the control group. The mean level of the CTX, ostéocalcine and the IL6 was higher among patients having an osteoporosis or ostéopenia compared to patients with normal bone (p = 0,017). The factors associated with an bone loss (osteopenia or osteoporosis) were: an age > 30 years, a weight <50 kg, a level of ALP phosphates alkaline > 90 UI/ml, an hypo albuminemia < 40 g/l and a level of CTX higher than 1.2., Conclusion: Our study confirms the impact of the CD on the bone mineral statute. The relative risk to have an osteopenia or an osteoporosis was 5 in our series. The measurement of the osseous mineral density would be indicated among patients having a CD.

Background: If the pathophysiology of complex regional pain syndrome (CRPS) type 1 remains controversial, most authors agree on a combination in varying proportions, a sensitization of peripheral nerves., Aim: To describe the state of advances in the physiopathology of complex regional pain syndrome type 1., Methods: Bibliographic research and literature review performed by referring to databases (Medline, Science Direct), Results: The physiopathology of complex regional pain syndrome type 1 remains still poorly understood and controversial. Several arguments demonstrated both peripheral (inflammation, abnormal sympathetic ...) and central (neurological and cognitive) mechanisms., Conclusion: A better knowledge of the physiopathology of complex pain syndrome type 1 is necessary in order to adapt efficient curative therapy or to a better prevention of this syndrome.

Background: Diagnosing early rheumatoid arthritis is difficult and radiographic signs are often late. MRI detects erosions at an early stage and visualizes synovitis, bone edema and tenosynovitis., Aim: To assess the value of MRI for diagnosis of early forms of rheumatoid arthritis., Methods: Prospective study involving 20 patients who had non erosive rheumatoid arthritis lasting for less than 2 years. MRI of the hand was performed by sequences coronal and axial T1-weighted, T2 with saturated fat signal (FatSat) FatSat and T1 with gadolinium injection., Results: The median age of patients was 52 years and sex ratio M/F of 0.05. The median disease duration was 9 months. Ten patients had antibodies Anti-Cyclic citrullinated protein positive. The MRI was abnormal in 75% of patients. This review found 36 erosions which 50% were in carpal bones, 55 joints with synovitis mainly localized midcarpal and metacarpophalangeal. Bone edema was found mainly in carpal bones. Tenosynovitis affected most frequently the flexor tendons. Seventy percent of patients without anti-Cyclic citrullinated protein had a pathological MRI., Conclusion: MRI has an important role in detecting infraradiological lesions in early RA. This contributes to early diagnosis and initiation effective treatment.

Background: Carpal tunnel syndrome (CTS) is the most frequent ductal syndrome. Few epidemiological studies in Tunisia exist., Aim: To describe clinical, biological and electromyographic data of Tunisian patients with CTS METHODS: A retrospective study including 80 patients with CTS, during the period going from 2009 to 2010., Results: A female predominance was observed with an average age of 52 years. Acroparesthesia was the main complaint, followed by night awakenings and muscular weakness. Physical examination showed a positive Tinel (91.2%) and Phalen (82.5%) tests, a decrease of tactile sensitivity (26.2%) and a thenar amyotrophy (10%). The Electromyography was abnormal in 85% cases. The most revealing lesions were demyelinating, sensitivo-motor predominance (66%) abnormalities. on Biology, hyperglycemia (12.5%), hyperuricemia (8.7%) and renal failure (7.5%) were the most observed. Medical treatment was drawn on analgesics and anti-inflammatory for 90% of our patients. Local steroid injections were indicated for 35% of patients, leading to a clinical improvement in 90% of cases. Surgery was made in only 13.8% patients., Conclusion: Tunisian patients with CTS were female patients, housewifes with obesity or overweight. No other differences were observed in comparison with the literature.

Background: Rheumatic manifestations of genetic hemochromatosis are frequent with axial or peripheral arthropathies (mono-, oligo- or polyarticular). These manifestations are characterized by articular damage and osteoporosis., Aim: To review the rheumatic manifestations of genetic hemochromatosis., Methods: A narrative review of literature., Results: The diagnosis should be brought to mind when we discover arthropathy resembling degenerative joint disease with involvement of unusual articular sites, almost identical to the arthropathy in calcium pyrophosphate dihydrate crystals deposition disease (chondrocalcinosis)., Conclusion: There is a significant bone loss in HC that cannot solely be explained by hypogonadism or cirrhosis and must lead to measure bone mass density to each patient with HC.

Background: Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial., Aim: To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density., Methods: Prospective study including 20 asthmatics, aged from 20 to 45 years, treated with inhaled corticosteroids for 12 months or more, with no risk factors for osteoporosis. We compared osteodensitometric parameters in our patients, bone mass and T-score at vertebral and femoral witness to a population matched by age and sex., Results: The average age of our patients was 35.45 ± 5.43 years and the average BMI was 30.03 ± 5.77 kg/m2. The average daily dose of corticosteroid was 925 ± 133.27g of equivalent of beclometasone with an average take of 33.5 ± 21.3 months. The vertebral site bone mass average was 1216 ± 0106 g/cm2 in the studied group and 1201 ± 0099 g/cm2 in the control group without significant difference (p = 0380). At femur, the bone mass average was 1037 ± 0143 g/cm2 in the patient group and 1056 ± 0107 g/cm2 in the control group (p = 0380). We did not find a significant link between bone mineral density and cumulative dose or the duration of taking inhaled corticosteroids, BMI and tobacco., Conclusion: Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density.

Background: The evolution of the rheumatologic practice involved a handing-over in question of the place and methods of application of the synoviorthesis. The last innovations, in particular the appearance of the bio-therapies, allowed a better control of inflammatory rheumatism thus making it possible to better select arthritis likely to profit precociously from a synoviorthesis before the installation of major articular destruction., Aim: Through a general review of the literature, we recall in this work the various means of synoviorthesis, their current indications and their results., Methods: An extensive electronic search of the relevant literature was carried out using MEDLINE. Key words used for the final search were: synoviorthesis, osmic acid, radiosynoviorthesis, arthritis, treatment., Results: This systematic review allowed us to conclude that fields of application of the synoviorthesis is in addition widens because of the interesting results to see spectacular this technique in some other affections such as the haemophilia. In addition we have compared the efficiency and the tolerance of the different methods of synoviorthesis., Conclusion: The synoviorthesis constitutes a tempting therapeutic alternative of share its effectiveness and its good tolerance so much so that it constitutes an undeniable factor of articular protection. Its fields of application widened. Thus on the good knowledge of the indications and the precautions necessary to its realization its success.

Gout is one of the oldest and better understood among rheumatic diseases. It is characterized by chronic hyperuricemia and recurrent attacks of acute arthritis provoked by release of sodium urate crystals into joints. The manifestations of Gout can be abolished by lifelong urate-lowering therapy maintainine serum urate levels under 360 mmol/l. The management of a minority of patients, including those with renal impairment, is difficult and often unsatisfactory because of restricted treatment options. In this paper; the current options for treating hyperuricemia are first discussed then followed by new approches.

Unlabelled: The study was aimed to evaluate the frequency and types of articular manifestations in a group of Crohn's disease patients, and to determine the risk factors., Subjects and Methods: We included 68 Crohn's disease patients. All patients had a complete rheumatological examination. Radiographs of the sacroiliac joints and lumbar spine were performed. 40 men and 28 women with a mean age of 31 years were included. Articular manifestations were observed in 41 patients. Twenty two patients suffered of peripheral articular manifestations: arthralgias in 18 patients and arthritis in 10 cases. Peripheral articular manifestation were significatly associated to ileal location of intestinal disease. Their frequency was of 41.3% in ileal location group versus 13.6% in colic location group (p = 0.02). Axial manifestations were observed in 32 patients: ankylosing spondylitis was diagnosed in 11 cases, undifferentiated spondylarthropathy in 7 patients, sacroiliitis in 10 cases, inflammatory back pain in 3 patients and enthesopathy in 1 case. The male sex and long duration of intestinal disease were two independants factors associated to axial manifestations.

We report the case of a 25-years-old man who had an ankylosing spondylitis associated with multiple exostoses. The patient had hip pain of inflammatory origin and back stiffness with x-ray findings suggestive of bilaterral sacroilitis, coxitis as well as exostosis of the humerus, radius, femor and tibia. This is occurred in Turkey, the association was described as a simple concidence due to the difference in the genetic mechanisms involved. A more detailed genetic study of these two entities well be helpful for a better understanding of this association.

Industrial accidents causing lumbar back strain are frequent and are of major causes of absenteeism. For this purpose, we tried in this study to assess the prevalance of such accidents, to determine the circumstances of their occurence and to point out the various risk professions. For this, we analysed 242 files of lumbar back pathology industrial accidents related. The latter files have been examined by the Tunis medical board authorized to set out the permanent disability rate resulting from industrial accidents and occupational diseases. We noticed a marked male predominance 58% of patients were aged between 41 and 50 years. We observed a predisposition in 19% of all cases. The professional category of operators is mainly concerned. These accidents most frequently occur in the morning at the site of work, often due to the handling of heavy loads. They cause lesions of variable importance, such as slipped disc hernia in 40% of cases. The average duration of absenteeism resulting from lumbar strain is of 237 days a year per patient. After-effects are frequent, notably those of spinal pains and lumbar stiffness. The average rate of permanent partial disability is of 8% (0-45%).

Adult onset Still's disease is a rare systemic disorder of unknown etiology occuring in young adults. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hemotologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. We report a retrospective and multicenter study of 26 cases of adult still's disease collected during 10 years. Arthralgia are constant and arthritis are observed in third of the cases. Radiologic joint alterations are found in five cases. A literature review was done with emphasis on clinical and radiological characteristics of articular manifestations.