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To assess the interest of MRI and ultrasonography (US) in identifying early and advanced interphalangeal (IP) OA.We conducted a case-control study including patients with symptomatic hand OA (n=33) and young healthy volunteers (n=26). Proximal and distal IP joints were graded according to Kellgren and Lawrence (KL) grades. In OA patients, we separated IP joints into 2 groups: "at risk of OA" joints (potential early pre-radiographic OA joints, KL=0) and OA joints (KL=2-4). All IP joints from healthy participants were KL=0 and were considered strictly normal IP joints. Concurrently, synovitis, effusion, erosions, osteophytes, bone marrow lesions, cysts and cartilage space loss were graded by MRI and/or US. We assessed their prevalence, severity and diagnostic performance in hand OA and then compared normal IP joints from healthy participants and "at risk of OA" IP joints from OA patients as well as "at risk of OA" and OA IP joints from OA patients.The prevalence and grade of most MRI/US-detected lesions were higher in IP joints from OA patients than healthy participants. Except for osteophyte assessment, MRI seemed more sensitive than US. We found more MRI/US-detected lesions in "at risk of OA" IP joints than normal joints but also in OA than "at risk of OA" joints from OA patients. US appeared both sensitive and specific for detecting osteophytes in joints without radiographic abnormalities.MRI and US give good performance for detecting radiographic and pre-radiographic OA lesions and could be interesting tools to identify early hand OA.

Resume Des etudes precedentes avaient montre que le controle de l’inflammation par les biotherapies avait un effet positif sur l’etat osseux dans les pathologies inflammatoires. L’objectif de cette etude etait d’evaluer les effets sur la densite minerale osseuse (DMO) et sur le remodelage osseux d’un anticorps monoclonal anti-IL-6 (tocilizumab [TCZ]) chez les patients suivis pour une polyarthrite rhumatoide (PR). Methodes Cent trois patients (75 % de femmes, 52 ± 12 ans) atteints d’une PR active ont ete traites par TCZ a 8 mg/kg + methotrexate (MTX) chaque 4 semaines durant 48 semaines. Une DMO du rachis lombaire et de la hanche a ete realisee chez chaque patient, a l’inclusion et a 48 semaines, par absorptiometrie biphotonique a rayons X (DXA). Les taux seriques de propeptide N-terminal de type I du pro-collagene (PINP), de telopeptide C-terminal du collagene de type I (CTX-I), de Dickkopf-1 (Dkk-1) et de sclerostine ont ete evalues a l’inclusion, puis a 12 et 48 semaines. Resultats La DMO a ete disponible chez 76 patients a l’inclusion et a la fin de l’etude. Il n’y avait pas de modification de la DMO lombaire et femorale sur les 48 semaines. Les taux seriques de PINP avaient augmente de 22 % (p ≤ 0,001) et de 19 % (p ≤ 0,001) a la semaine 12 et 48 comparativement a l’inclusion, alors que le CTX-I est reste a des taux stables. Le taux serique de DKK-1 avait baisse significativement compare a l’inclusion, de −31 % (p ≤ 0,001) et de −25 % (p Conclusion Dans cette etude ouverte sur un an, les patients presentant une PR active, recevant du TCZ et du methotrexate n’avaient pas de modification de leur DMO, mais une baisse des taux seriques de DKK-1 et une augmentation des marqueurs de formation osseuse.

Objective To assess the ability of ultrasonography (US) to predict radiographic damage in early arthritis. Methods ESPOIR is a multicentric cohort of early arthritis (i.e., ≥2 swollen joints between 6 weeks and 6 months). US synovitis in B mode, power Doppler (PD) mode, and erosions were searched on the second through the fifth metacarpophalangeal and fifth metatarsophalangeal joints according to Outcome Measures in Rheumatology definitions. Structural radiographic progression was assessed using the modified Sharp/van der Heijde erosion score (SHS) at baseline and 1 and 2 years. Predictive factors of erosive arthritis at 2 years and rapid radiographic progression (RRP) at 1 year (defined by change of SHS ≥5) were searched. Results A total of 127 patients were included, with a mean ± SD Disease Activity Score in 28 joints of 5.1 ± 1.3; 37.6% were anti–citrullinated protein antibody positive and 27.6% had typical rheumatoid arthritis (RA) erosions on radiographs. At 2 years, 42 patients (39.2%) had typical RA erosions. US erosions predicted radiographic evidence of erosive arthritis (odds ratio [OR] 1.44, 95% confidence interval [95% CI] 1.04–1.98). PD synovitis score was predictive of RRP at 1 year (OR 1.22, 95% CI 1.04–1.42). US erosions and PD synovitis scores were associated with change of SHS on linear regression. Of the 1,184 analyzed joints, 105 (8.9%) had radiographic erosion at 1 year. At the joint level, baseline US erosions were predictive of the presence of radiographic erosions at 1 year (P < 0.001). The same trend was observed in the joints without radiographic erosions at baseline (P = 0.052). Conclusion US is useful to evaluate the potential severity of early arthritis: US erosions and PD-positive synovitis have prognostic value to predict future radiographic damage.

International audience; Osteoarticular iatrogenic infections may be serious and justify suitable and optimised preventive measures depending on each risk, as much in terms of mortality as of morbidity. Its appreciation has been the subject of more and more studies, which allow the importance of the problem to be better evaluated. The level of iatrogenic infections after arthroscopy is evaluated at 1 to 5‰ on a recent series of knee operations, but they may be much higher for the elbow [1] and [2]. In practice, this examination is no longer used for diagnosis as it was 10 years ago, the progress in imagery means this invasive act is no longer necessary...

Objective Subclinical inflammation and radiographic progression have been described in rheumatoid arthritis (RA) patients whose disease is in remission or is showing a low level of activity. The aim of this study was to compare the ability of ultrasonography and magnetic resonance imaging (MRI) to predict relapse and radiographic progression in these patients. Methods Patients with RA of short or intermediate duration that was either in remission or exhibiting low levels of activity according to the Disease Activity Score (DAS) were included in the study. Over a period of 1 year, patients underwent clinical and biologic assessments every 3 months and radiographic assessments at baseline and 12 months. Radiographs were graded according to the modified Sharp/van der Heijde score (SHS). At baseline, patients underwent ultrasonography and MRI, which were graded using binary and semiquantitative scoring systems. Relapse was defined as a DAS of ≥2.4, and radiographic progression was defined as an increase in the SHS of ≥1. We tested the association of values by multivariate logistic regression. Results A total of 85 RA patients with a mean disease duration of 35.3 months were studied. RA was in remission in 47 of these patients, and 38 had low levels of disease activity. At 1 year, 26 of the 85 patients (30.6%) showed disease relapse, and 9 of the 85 patients (10.6%) showed radiographic progression. The baseline PD synovitis count (i.e., the number of joints at baseline for which the power Doppler [PD] signal indicated synovitis) predicted relapse (adjusted odds ratio [OR] 6.3; 95% confidence interval [95% CI] 2.0–20.3), and the baseline PD synovitis grade predicted disease progression (adjusted OR 1.4 [95% CI 1.1–1.9]). MRI was not predictive of outcomes. Conclusion For RA patients whose disease is in remission or who have low levels of disease activity, PD signals on ultrasonography could predict relapse or radiographic progression and identify those whose disease is adequately controlled, which is especially helpful when considering treatment tapering or interruption.

Resume Objectifs Decrire les lesions echographiques (epanchements, synovites, signal Doppler) des articulations interphalangiennes proximales (IPP) et distales (IPD) de patients souffrant d’arthrose digitale et les comparer a celles retrouvees chez des sujets sains. Methodes Des patients issus de la consultation d’un service hospitalier de rhumatologie, repondants aux criteres ACR pour l’arthrose digitale, ont ete inclus ainsi que des sujets sains. Les criteres d’exclusion etaient les memes pour les deux groupes. Les donnees sociodemographiques etaient collectees de meme que les caracteristiques des symptomes. Chaque participant avait beneficie d’une echographie. Des radiographies etaient demandees uniquement pour les patients. Les echographies etaient realisees sur un appareil ESAOTE TECHNOS par deux operatrices. Les IPP et IPD 2 a 5 ont ete etudiees. Les donnees echographiques ont ete comparees entre les deux groupes. Resultats Cinquante-cinq patients, dont 51 femmes, ont ete inclus et 46 sujets sains. Quatre cent quarante IPP et IPD arthrosiques et 368 IPP et IPD saines ont ete etudiees. Il n’a pas ete observe de difference significative entre les patients et les temoins concernant la frequence des epanchements intracapsulaires des IPP : 2,05 ± 2,03 versus 1,6 ± 1,7 ( p > 0,05), en revanche leur nombre etait significativement plus eleve sur les IPD en cas d’arthrose : 2,09 ± 1,87 versus 0 ± 0,6 ( p

To describe the ultrasound features of nonstructural damage (effusions, synovitis, Doppler signal abnormalities) in the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the fingers in patients with finger osteoarthritis compared to healthy controls.We included patients at a hospital-based outpatient rheumatology clinic who met American College of Rheumatology criteria for finger osteoarthritis and we compared them to healthy controls. Exclusion criteria were the same in both groups. We collected demographic data and symptoms. Ultrasonography (Esaote Technos machine, two sonographers) was performed in all participants in both groups and plain radiography in the patients only. The PIP and DIP joints on fingers 2 to 5 were evaluated. Ultrasound features were compared between the two groups.We included 55 patients (51 women; 440 PIPs and 440 DIPs) and 46 healthy controls (368 PIPs and 368 DIPs). The rate of PIP joint effusion was similar in the two groups (patients, 2.05±2.03; controls, 1.6±1.7; P0.05), whereas the rate of DIP effusion was significantly higher in the patients (2.09±1.87 versus 0±0.6 in the controls; P0.05). Increased vascularization by Doppler evaluation was rare and occurred chiefly in the DIP joints of the patients. None of the participants in either group had synovitis. The ultrasound abnormalities were not significantly different between right- and left-handed individuals, and neither did they correlate with clinical disease expression or severity of the radiographic damage.

Resume L’amelioration des moyens d’evaluation de l’activite inflammatoire et de l’atteinte structurale ainsi que la mise en evidence de facteurs predictifs d’evolution structurale contribuent a une meilleure prise en charge des patients atteints de polyarthrite rhumatoide (PR). L’echographie et l’IRM sont plus sensibles que l’examen clinique pour la detection de synovites et que les radiographies standard pour la detection d’erosions. Leur validite externe, reproductibilite et sensibilite aux changements dans la PR apparaissent satisfaisantes. Alors que le score Rheumatoid Arthritis MRI Score (RAMRIS) en IRM a ete valide et apparait comme le score de reference pour la lecture IRM des PR, aucun score echographique ne fait consensus a l’heure actuelle, meme si plusieurs scores echographiques ont deja ete proposes.

Resume Objectifs Le but de notre etude a ete de decrire les anomalies echographiques des articulations interphalangiennes proximales (IPP) et interphalangiennes distales (IPD) chez des sujets sains. Methodes Des sujets temoins, volontaires asymptomatiques, âges de moins de 40 ans, ont ete inclus dans l’etude. L’echographie a ete realisee sur les IPP et les IPD no 2 a 5 par deux operateurs. En mode-B, une hypertrophie synoviale et un epanchement ont ete definis selon les criteres de l’Omeract. L’activite inflammatoire a ete evaluee en mode Doppler energie. Resultats Les 46 sujets inclus dans l’etude etaient âges de 25,5 ans en moyenne et 89 % etaient droitiers. Nous avons etudie 368 articulations IPP et IPD. Un epanchement articulaire a ete mis en evidence dans 19,6 % des IPP du cote dominant et 22,3 % du cote non dominant (p > 0,05). L’epanchement pouvait etre unilateral ou bilateral. L’epanchement etait plus rare (3 %) dans les IPD. La taille de l’epanchement etait de 0,83 ± 0,25 mm pour les IPP et 0,72 ± 0,16 mm pour les IPD. Conclusion Notre etude permet une analyse descriptive des articulations IPP et IPD. Elle confirme, sur un plus grand nombre d’articulations etudiees, l’existence possible a l’etat physiologique d’un epanchement dans une articulation IPP chez le sujet sain. Pour les articulations IPD du sujet sain, il s’agit de la premiere etude descriptive et l’epanchement y est tres rare.

Resume Objectifs Evaluer la concordance inter- et intraobservateur dans l’imagerie echographique statique des articulations metacarpophalangiennes (MCP) de patients atteints de polyarthrite rhumatoide (PR) par deux investigateurs ayant une experience differente en echographie. Methodes L’echographie a ete realisee par le senior sur 386 MCP en mode B et sur 408 en mode Doppler puissance chez 17 patients atteints d’une PR active. Une premiere interpretation etait effectuee et les images etaient sauvegardees au moment de l’examen. Les images statiques etaient ensuite interpretees a deux reprises par deux investigateurs independants ayant une experience differente (respectivement quatre ans et un an d’experience en echographie osteoarticulaire pour le senior et le junior). Resultats Pour la reproductibilite intra-investigateur, les coefficients kappa simple ou pondere etaient compris entre 0,74 et 0,99 pour le junior et pour le senior en modes B et Doppler puissance. Pour la reproductibilite interinvestigateur, les coefficients kappa simple ou pondere etaient compris entre 0,61 et 0,98 en modes B et Doppler puissance qualitatifs et en mode Doppler puissance semi-quantitatif. Le coefficient kappa pondere interinvestigateur etait de 0,49 en mode B semi-quantitatif. Concernant la concordance entre l’examen dynamique et l’examen statique, les resultats etaient tres bons pour les deux investigateurs en mode Doppler puissance (0,89). En mode B, les resultats n’ont pas atteint le seuil de significativite statistique. La concordance pour la mesure de l’epaisseur synoviale etait excellente : rho egal a 0,7609 ( p = 0,00001). Conclusion Un rhumatologue experimente et un junior ont un taux de concordance inter- et intraoperateur eleve pour l’identification des synovites et de l’activite en Doppler puissance a partir de l’imagerie statique. Cette methode pourrait servir de premiere etape d’apprentissage en echographie osteoarticulaire.

Resume Schema de l'etude. – Etude transversale. Objectif. – Estimer l'importance des douleurs rachidiennes au cours de la maladie de Parkinson (MP). Etat de la question. – La MP est une affection frequente et invalidante durant laquelle des douleurs rachidiennes peuvent apparaitre. Paradoxalement, la litterature sur l'epidemiologie des douleurs rachidiennes dans la MP est pauvre. Methodes. – Les patients ayant une MP, vus consecutivement en consultation de neurologie sur une periode de quatre mois, furent interroges sur l'existence de douleurs rachidiennes par l'intermediaire d'un autoquestionnaire et compares a un groupe de temoins ayant une affection chronique, apparies pour l'âge et le sexe. Resultats. – L'etude a concerne 104 patients (âge moyen : 67,3 ans) ayant une MP depuis en moyenne 11,6 ans, et 100 temoins (âge moyen : 65,8 ans) ayant une cardiopathie chronique ou un diabete depuis 14,2 ans en moyenne. Soixante-deux parkinsoniens et 23 temoins ont rapporte avoir des douleurs rachidiennes. La prevalence etait de 59,6 % dans le groupe MP et 23 % dans le groupe temoins (p Conclusions. – Les douleurs chroniques rachidiennes sont assez frequentes au cours de la MP. Les consequences fonctionnelles sont notoires et une attention plus particuliere doit leur etre portee pour diminuer le handicap fonctionnel chez de tels patients.

Cross-sectional survey.To estimate the extent of back pain in Parkinson's disease (PD).PD is a common and disabling condition during the course of which back pain may develop. In contrast, the literature on the epidemiology of back pain in PD is poor.Patients with PD, seen consecutively in a neurology clinic over a period of 4 months, were inquired about back pain through a self-questionnaire and compared to an age- and sex-matched control group of chronically ill patients.The study involved 104 parkinsonians (mean age: 67.3 years) who had had PD for an average of 11.6 years, and 100 controls (mean age: 65.8 years) who had chronic heart disease or diabetes for an average of 14.2 years. Sixty-two parkinsonians and 23 controls reported back pain. The prevalence was 59.6% in the parkinsonian group and 23.0% in the control group (P0.0001). Pain severity was evaluated with a visual analogic scale and averaged 54 +/- 23 mm in parkinsonians and 41 +/- 19 mm in control (P0.0001).Chronic back pain is quite common in PD. It is responsible for a substantial functional impact and needs more attention to reduce disability of such patients.

Resume L’inflammation de la membrane arachnoidienne peut produire un exsudat fibrineux autour des racines nerveuses et entrainer des adherences entre celles-ci et le fourreau dural. Nous rapportons l’observation d’un homme âge de 23 ans souffrant d’une sciatique aigue tronquee et inflammatoire. Le diagnostic etiologique d’arachnoidite a ete porte devant l’association de signes typiques au myeloscanner et a l’IRM. La seule cause retrouvee a cette arachnoidite etait une ponction lombaire a l’âge de six ans, qui avait ete effectue pour suspicion de meningite. Les sequelles d’arachnoidite sont de diagnostic difficile. Quand l’IRM ou la saccoradiculographie est evocatrice de ce diagnostic, un interrogatoire precis et cible est necessaire pour rechercher un antecedent, parfois ancien, de pathologie ou de geste local invasif sur le rachis et/ou les meninges.

Objectifs Evaluer la concordance entre evaluation clinique (C) et echographie (ultrason–US) de la synovite (modes B, D et B + D) dans la polyarthrite rhumatoide (PR) active avant et apres traitement par anti-TNF, puis etudier les facteurs associes a une bonne concordance. Methodes Soixante-seize patients (necessitant une therapie anti-TNF) avec PR active (criteres ACR 1987) ont ete inclus dans une cohorte prospective, multicentrique avec 2 ans de suivi. Pour chaque patient, 38 articulations ont ete evaluees (2 poignets, 2 coudes, 2 epaules, 2 genoux, 10 MCP, 10 IPP, 10 MTP). Le grade de la synovite etait collecte a M0 en utilisant une variable semi-quantitative pour evaluation C (de 0 = pas de synovite de facon certaine a 3 = presence de synovite de facon importante), US mode B (de 0 = pas d’epaississement synovial a 3 = hypertrophie synoviale severe) et mode D (de 0 = aucun flux dans la synoviale a 3 = signaux de vaisseaux dans plus de la moitie de l’aire de la synoviale). Le coefficient kappa a ete determine pour evaluer la fiabilite des variables categorielles (synovite si grade ≥ 1). Les facteurs associes a une bonne concordance ont ete evalues par des analyses uni- et multivariees (tous les facteurs statistiquement significatifs et non correles dans le modele univarie ont ete inclus dans l’analyse multivariee). Resultats La concordance avant traitement anti-TNF entre evaluation C et US (kappa -0,08 a 0,51) ainsi que la concordance entre modes B et D (0,30 a 0,67) etaient variables en fonction du type d’articulation evaluee. La concordance entre C et US etait particulierement faible pour les articulations MTP et les epaules (kappa – mode B : faible DAS28, EVA clinique elevee et positivite des facteurs rhumatoides (FR) ; – mode D : pas d’evolution semi-recente de la PR (2–5 ans), activite moderee de la PR (DAS 3,2–5,1), âge entre 40 et 50 ans, etre une femme. Apres anti-TNF ces facteurs etaient : – mode B : site articulaire (genoux, coudes, MCP 4 et 5, IPP 2 a 5), etre un homme, faible IMC, pas d’evolution semi-recente de la PR (2–5 ans), incapacite moderee sur l’echelle HAQ et faible DAS28 ; – mode D : site articulaire (genoux, coudes, MCP 4 et 5, IPP 1 a 5), faible IMC, evolution recente de la PR, incapacite moderee sur l’echelle HAQ, faible DAS28, evaluation clinique faible et positivite des facteurs rhumatoides (FR). Conclusions La concordance entre les evaluations C et US depend du site articulaire. L’evaluation C sous-estime particulierement la synovite MTP et epaule. Les facteurs associes a une bonne concordance sur les autres sites articulaires sont nombreux et varient en fonction des modes US (les facteurs associes a une bonne concordance C-US modes B et D sont differents) et du traitement (site articulaire, HAQ, IMC faible sont associes a une bonne concordance C-US mais pas avant therapie TNF).

Previous studies showed that the control of inflammation by biological therapies has a positive effect on bone in inflammatory diseases. The objective of this study was to assess the effects on bone mineral density (BMD) and bone remodeling of an anti-IL-6 monoclonal antibody (tocilizumab (TCZ)) in patients with rheumatoid arthritis (RA). Methods One hundred and three patients (75% women, 52 ± 12 years) with active RA were treated with TCZ 8 mg/kg + methotrexate (MTX) every 4 weeks during 48 weeks. Hip and lumbar spine BMDs were measured at baseline and after 48 weeks by dual energy X-ray absorptiometry (DXA). Pro-collagen serum type I N-terminal propeptide (PINP), serum C-terminal cross-linked telopeptide of type I collagen (CTX-I), and serum levels of total Dickkopf-1 (Dkk-1) and sclerostin were assessed at baseline, 12 and 48 weeks. Results BMD was available for 76 patients at baseline and at the end of the study. There was no change in lumbar spine and hip BMD over 48 weeks. Serum PINP increased from baseline by 22% ( P ≤ 0.001) and 19% ( P ≤ 0.001) at week 12 and week 48, whereas serum CTX-I remained stable. Serum DKK-1 significantly decreased from baseline by −31% ( P ≤ 0.001) and −25% ( P = 0.025) at week 12 and 48. Similar results were observed in the patients receiving low doses of oral corticosteroids. Conclusion In this 1-year prospective open study, patients with active RA receiving TCZ and MTX had no change in BMD, a decrease in serum DKK-1 and an increase in bone formation marker.

The inflammation of the arachnoid mater may produce a fibrinous exudate around the roots that causes them to adhere to the dural sheath. We report the case of a man aged 23 years who suffered from acute inflammatory truncated sciatica. The diagnosis of adhesive arachnoiditis was made in front of clinical arguments associated to typical signs on Myelo CT Scan and MRI. The only explanation ever found was a traumatic lumbar puncture at the age of 6 years for suspected meningitis. Sequelae of arachnoiditis are difficult to diagnosis. When MRI or myelography suggests it as a possibility, precise directed questioning is necessary to seek a history, albeit distant, of spinal or meningeal events.

Objectives To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Methods Patients with RA. Study design Prospective, 2-year follow-up. Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p, SCOPUS: ar.j, info:eu-repo/semantics/published

Objective.Clinical joint examination (CJE) is less time-consuming than ultrasound (US) in rheumatoid arthritis (RA). Low concordance between CJE and US would indicate that the 2 tests provide different types of information. Knowledge of factors associated with CJE/US concordance would help to select patients and joints for US. Our objective was to identify factors associated with CJE/US concordance.Methods.Seventy-six patients with RA requiring tumor necrosis factor-α (TNF-α) antagonist therapy were included in a prospective, multicenter cohort. In each patient, 38 joints were evaluated. Synovitis was scored using CJE, B-mode US (B-US), and power Doppler US (PDUS). Joints whose kappa coefficient (κ) for agreement CJE/US was < 0.1 were considered discordant. Multivariate analysis was performed to identify factors independently associated with CJE/US concordance, defined as factors yielding p < 0.05 and OR > 2.Results.Concordance before TNF-α antagonist therapy varied across joints for CJE/US (κ = −0.08 to 0.51) and B-US/PDUS (κ = 0.30 to 0.67). CJE/US concordance was low at the metatarsophalangeal joints and shoulders (κ < 0.1). Before TNF-α antagonist therapy, a low 28-joint Disease Activity Score (DAS28) was associated with good CJE/B-US concordance, and no factors were associated with CJE/PDUS concordance. After TNF-α antagonist therapy, only the joint site was associated with CJE/B-US concordance; joint site and short disease duration were associated with CJE/PDUS concordance.Conclusion.Concordance between CJE and US is poor overall. US adds information to CJE, most notably at the metatarsophalangeal joints and shoulders. Usefulness is decreased for B-US when DAS28 is low and for PDUS when disease duration is short.

Objective.To date, early diagnosis of stress fractures depends on magnetic resonance imaging (MRI) or bone scan scintigraphy, as radiographs are usually normal at onset of symptoms. These examinations are expensive or invasive, time-consuming, and poorly accessible. A recent report has shown the ability of ultrasonography (US) to detect early stress fractures. Our objective was to evaluate sensitivity and specificity of US versus dedicated MRI (0.2 Tesla), taken as the gold standard, in early diagnosis of metatarsal bone stress fractures.Methods.A case-control study from November 2006 to December 2007 was performed. All consecutive patients with mechanical pain and swelling of the metatarsal region for less than 3 months and with normal radiographs were included. US and dedicated MRI examinations of the metatarsal bones were performed the same day by experienced rheumatologists with expertise in US and MRI. Reading was undertaken blind to the clinical assessment and MRI/US results.Results.Forty-one feet were analyzed on US and dedicated MRI from 37 patients (28 women, 9 men, mean age 52.7 ± 14.1 yrs). MRI detected 13 fractures in 12 patients. Sensitivity of US was 83%, specificity 76%, positive predictive value 59%, and negative predictive value 92%. Positive likehood ratio was 3.45, negative likehood ratio 0.22.Conclusion.In cases of normal radiographs, US is indicated in the diagnosis of metatarsal bone stress fractures, as it is a low cost, noninvasive, rapid, and easy technique with good sensitivity and specificity. From these data, we propose a new imaging algorithm including US.

Objective To evaluate the inter- and intra-observer agreement of ultrasonographic metacarpophalangeal joint static images in patients with rheumatoid arthritis by two investigators with different ultrasonographic experience. Methods Ultrasonography was performed by the senior on 386 metacarpophalangeal joints respectively in B-mode and 408 in power Doppler of 17 patients with active rheumatoid arthritis. A first interpretation was done and images were stored at examination time. Static images were then read twice by two independent investigators of different experiment (4-year and 1-year experience in musculoskeletal ultrasonography respectively for the senior and the junior). Results For the intra-investigator reproducibility kappa or weighted kappa coefficient ranged from 0.74 to 0.99 for the junior and the senior for B and power Doppler mode. For inter-investigator reproducibility kappa or weighted kappa coefficient ranged from 0.61 and 0.98 for qualitative B and power Doppler modes and semi-quantitative power Doppler. The inter-investigator weighted kappa was 0.49 for semi-quantitative B-mode. The agreement between the dynamic exam and the static exam; results were very good for both readers in power Doppler Mode (0.89). In B-Mode, they didn't reach statistical significance. The reliability for measuring synovial thickness was excellent – rho = 0.7609 ( p = 0.00001). Conclusion An experienced rheumatologist and a junior achieved high inter- and intra-observer agreement rates for the identification of synovitis and power Doppler activity for static images of ultrasonography. Trainees could use that method as a first step in US learning.

Background: Camptocormia is defined as an abnormal flexion of the trunk that appears when standing or walking and disappears in the supine position. The origin of the disorder is unknown, but it is usually attributed either to a primary or a secondary paravertebral muscle myopathy or a motor neurone disorder. Camptocormia is also observed in a minority of patients with parkinsonism. Objective: To characterise the clinical and electrophysiological features of camptocormia and parkinsonian symptoms in patients with Parkinson’s disease and camptocormia compared with patients with Parkinson’s disease without camptocormia. Methods: Patients with parkinsonism and camptocormia (excluding patients with multiple system atrophy) prospectively underwent a multidisciplinary clinical (neurological, neuropsychological, psychological, rheumatological) and neurophysiological (electromyogram, ocular movement recording) examination and were compared with age-matched patients with Parkinson’s disease without camptocormia. Results: The camptocormia developed after 8.5 (SD 5.3) years of parkinsonism, responded poorly to levodopa treatment (20%) and displayed features consistent with axial dystonia. Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm. Conclusion: We suggest that (1) the salient features of parkinsonism observed in patients with camptocormia are likely to represent a specific form of Parkinson’s disease and camptocormia is an axial dystonia and (2) both camptocormia and parkinsonism in these patients might result from additional, non-dopaminergic neuronal dysfunction in the basal ganglia.

To the Editor: We thank Drs. Leininger and Fields for their interest in our article1. First, we would like to make clear that “cortical thickening” is synonymous with “cortical disruption.” Second, it is right that, … Address correspondence to Dr. Fautrel; E-mail: bruno.fautrel{at}psl.aphp.fr