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Objective Antibiotic treatment and arthroscopic or open drainage is the gold standard for septic arthritis. Full recovery takes time after surgery and hospital stay is longer than for arthrocentesis at the bedside. We aimed to evaluate the effectiveness of arthrocentesis (medical approach) versus a surgical approach. Method We retrospectively included 97 cases of native joint arthritis (hip and knee) between 2010 and 2017. The primary outcome was treatment failure of medical and surgical approaches (defined as surgical intervention within 7 days following diagnosis). Risk factors of failure were identified by univariable and multivariable logistic regression. Results We included 72 cases of knee arthritis, of which 43 and 29 were treated medically and surgically, respectively; 25 cases of hip arthritis, of which 8 and 17 were treated medically and surgically, respectively. Failure was observed in 39.2% of cases in the medical group and in 30.4% in the surgical group (P = 0.2) (37.5% vs. 52.9% and 39.5% vs. 17.2% for hip and knee, respectively). The univariate analysis identified age and male sex as risk factors for failure (P = 0.048 and P = 0.02, respectively), but only age was independently associated with failure (P = 0.04). Hospital length of stay was 12 days shorter in the medical group (21 vs. 33 days, P = 0.02), sequelae were less frequent and less important in the medical group (31.7% vs. 60%). Conclusion The medical treatment seems to be as effective as the surgical treatment for native joint septic arthritis with a shorter hospital stay and better functional outcome. Further prospective studies are warranted.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ., Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Summary Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.

Background: Janus kinase inhibitors (JAKis) represent a new alternative to treat rheumatoid arthritis (RA). The objective of this study was to evaluate the effectiveness, tolerance profile, and maintenance of these treatments (tofacitinib and baricitinib) in real life. Methods: All patients in the rheumatology department of Amiens University Hospital treated by JAKis for RA were included from 1 October 2017 to 20 May 2020. Clinical and biological data were provided retrospectively in this observational and single-center study. We aimed to study the JAKi maintenance rate at 12 months and their clinical and biological safety profiles. Results: Fifty-five patients were included. Drug maintenance at 12 months was 67.6%. Factors associated with poorer maintenance were a higher Charlson comorbidity index (HR 1.311 (1.089&ndash, 1.579), p = 0.0042), a higher age (HR 1.055 (1.015&ndash, 1.096), p = 0.0067), and corticosteroids therapy at initiation (HR 2.722 (1.006&ndash, 7.365), p = 0.0487). The clinical and biological safety profile was generally good. Conclusions: Our study found that a higher Charlson index, age, and corticosteroids appeared to be associated with the earlier discontinuation of treatment. JAKis had a response and tolerance profile in real life at least equivalent to that of biological disease-modifying antirheumatic drugs (bDMARDs).

Objectif : identifier les facteurs predictifs de nouvelles fractures vertebrales (FV) dans une cohorte de patients ayant beneficie de vertebroplastie pour le traitement de fractures osteoporotiques. Patients et methodes : il s’agissait d’une etude ambispective, observationnelle, monocentrique realisee au CHU d’Amiens. Les patients ayant ete hospitalises pour la realisation de vertebroplastie pour des FV osteoporotiques entre janvier 2012 et mars 2015 ont ete selectionnes a partir des donnees du DIM. L’ensemble des patients a ete contacte afin de beneficier d’une consultation en 2017/2018 avec realisation d’une radiographie du rachis et d’une osteodensitometrie. Resultats : 51 patients ont ete inclus. Parmi ces patients, 15 (29.4%) ont presente au moins une nouvelle FV. Les facteurs predictifs de nouvelle FV retrouves etaient le faible poids (p=0.02), l’IMC (p=0.04), avoir plus de 2 FV initiales (p=0.01), le T-score au col femoral (p=0.03) et le grade total de Genant (p=0.03). En analyse multivariee, ces resultats etaient confirmes pour ceux qui presentaient initialement plus de 2 FV avec un RR 2.9 (IC: 1.09-7.81) et pour l’IMC. Nous n’avons pas constate d’augmentation du risque de FV adjacente a la vertebroplastie. Conclusion : aucun facteur predictif de nouvelle FV apres une vertebroplastie n’est lie directement a la vertebroplastie (fuite de ciment intra discal, nombre de vertebre traite par vertebroplastie). Les facteurs predictifs de nouvelle FV apres une vertebroplastie sont la maigreur et la severite de l’osteoporose. Les seuls facteurs predictifs de nouvelle FV qui sont modifiables sont la maigreur et le T-score.

Objectives To study the characteristics of B-cell non-Hodgkin’s lymphoma (NHL) or Hodgkin lymphoma complicating rheumatoid arthritis (RA) and to identify RA-related factors associated with their occurrence. Methods A multicentre case–control study was performed in France. Cases were patients with RA fulfilling ACR-EULAR 2010 criteria in whom B-cell NHL or Hodgkin lymphoma developed after the diagnosis of RA. For each case, 2 controls were assigned at random from the ESPOIR cohort and were matched on age at lymphoma diagnosis (cases)/age at the 10-year follow-up visit in the cohort (controls). Case and control characteristics were compared to identify parameters associated with the occurrence of lymphoma. Results 54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphoma (DLBCL, n=27, 50.0%). On immunochemistry, 4 of 27 (14.8%) lymphoma cases were positive for Epstein-Barr virus. On univariate analysis, factors associated with the occurrence of lymphoma were male sex (OR 3.3, 95% CI 1.7 to 6.7), positivity for ACPA (OR 5.1, 95% CI 2.0 to 15.7) and rheumatoid factor (OR 3.9, 95% CI 1.6 to 12.2), and erosions on radiographs (OR 3.8, 95% CI 1.7 to 8.3) and DAS28 (OR 2.0, 95% CI 1.5 to 2.7), both at the time of matching. Methotrexate, TNF blockers and a number of previous biologics were not associated with the occurrence of lymphoma. On multivariable analysis, erosions and DAS28 remained significantly associated with increased risk of lymphoma. Conclusion Lymphomas complicating RA are mostly DLBCL. Risk of lymphoma in patients with RA was increased with markers of disease activity and severity, which supports the paradigm of a continuum between autoimmunity and lymphomagenesis in RA.

International audience; BACKGROUND:Paraneoplastic syndromes (PNS) are autoimmune disorders specifically associated with cancer. There are few data on anti-PD-1 or anti-PD-L1 immunotherapy in patients with a PNS. Our objective was to describe the outcome for patients with a pre-existing or newly diagnosed PNS following the initiation of anti-PD-1 or anti-PD-L1 immunotherapy.METHODS:We included all adult patients (aged ≥18) treated with anti-PD-1 or anti-PD-L1 immunotherapy for a solid tumor, diagnosed with a PNS, and registered in French pharmacovigilance databases. Patients were allocated to cohorts 1 and 2 if the PNS had been diagnosed before vs. after the initiation of immunotherapy, respectively.FINDINGS:Of the 1304 adult patients screened between June 27th, 2014, and January 2nd, 2019, 32 (2.45%) had a PNS and were allocated to either cohort 1 (n = 16) or cohort 2 (n = 16). The median (range) age was 64 (45-88). The tumor types were non-small-cell lung cancer (n = 15, 47%), melanoma (n = 6, 19%), renal carcinoma (n = 3, 9%), and other malignancies (n = 8, 25%). Eleven (34%) patients presented with a neurologic PNS, nine (28%) had a rheumatologic PNS, eight (25%) had a connective tissue PNS, and four (13%) had other types of PNS. The highest severity grade for the PNS was 1-2 in 10 patients (31%) and ≥ 3 in 22 patients (69%). Four patients (13%) died as a result of the progression of a neurologic PNS (encephalitis in three cases, and Lambert-Eaton syndrome in one case). Following the initiation of immunotherapy, the PNS symptoms worsened in eight (50%) of the 16 patients in cohort 1.INTERPRETATION:Our results show that PNSs tend to be worsened or revealed by anti-PD-1 or anti-PD-L1 immunotherapy. Cases of paraneoplastic encephalitis are of notable concern, in view of their severity. When initiating immunotherapy, physicians should carefully monitor patients with a pre-existing PNS.

Introduction Les inhibiteurs de Janus Kinases (anti-JAK) sont une nouvelle alternative therapeutique dans le traitement de la polyarthrite rhumatoide. L’objectif de cette etude est d’evaluer le profil d’efficacite et de tolerance de deux de ces molecules (tofacitinib et baricitinib) en vie reelle notamment a travers leur taux de maintenance. Patients et methodes L’ensemble des patients du service de rhumatologie du CHU d’Amiens traites par anti-JAK ont ete inclus dans cette etude du 01/10/2017 au 30/05/2020. Les donnees cliniques et biologiques ont ete recueillies de maniere retrospective dans cette etude observationnelle et monocentrique. Nous avons recherche le taux de maintenance a 12 mois ainsi que les profils de tolerance et efficacite clinique et biologique. Resultats Cinquante-cinq patients ont ete inclus dont 48 traites par baricitinib et 7 par tofacitinib. Le taux de maintenance therapeutique a 12 mois etait de 67,6 % [52,47–78,85]. Le seul facteur associe a une moins bonne maintenance etait le score de Charlson plus eleve (hazard ratio 1,311 [1,089–1,579] ; p = 0,0042). Aucune difference de maintien therapeutique n’a ete retrouvee, que les patients aient deja beneficie d’un inhibiteur d’interleukine 6 ou non, et quel que soit le nombre de biotherapies recues anterieurement. Les motifs d’arret du traitement etaient l’inefficacite primaire (30,4 %), l’intolerance digestive (26,1 %), l’echappement secondaire (17,4 %), les effets indesirables infectieux (17,4 %), les evenements cardiovasculaires (13 %), les anomalies biologiques (8,7 %) et le desir de grossesse pour une patiente (4,3 %). Il a ete recense dans notre population une embolie pulmonaire sur thrombose veineuse profonde, un infarctus du myocarde et un ulcere antral. La surveillance biologique a mis en evidence une tendance a la diminution de l’hemoglobine (difference moyenne de −0,5 g/dL a 6 mois) mais une correction de l’anemie pre-therapeutique presente chez 9,1 % de patients. Il a egalement ete note une tendance a la majoration des plaquettes (difference moyenne de + 41 032/mm3 a 6 mois) et a la diminution des leucocytes (difference moyenne de −396,5/mm3 a 6 mois) avec une predominance sur les polynucleaires neutrophiles (difference moyenne de −383,4/mm3 a 6 mois). Deux patients ont presente une cytolyse hepatique necessitant une suspension de traitement mais aucune alteration de la fonction renale n’a ete mise en evidence. Il existait un manque de donnees important concernant le bilan lipidique sans qu’une majoration de ce dernier n’ait ete notable. Concernant l’efficacite des anti-JAK, la proportion de repondeurs moderes et bons, selon les criteres de reponse EULAR, etait sur le DAS-28 VS et CRP respectivement de 44,4 % et 48,1 % a 3 mois, 71 % et 68,8 % a 6 mois, 78,9 % et 76,2 % a 12 mois, 81,3 % et 68,8 % a 18 mois et 100 % a 24 mois. Conclusion Notre etude a montre qu’un score de Charlson plus eleve semblait etre associe a un arret plus precoce du traitement. Les anti-JAK avaient un taux de persistance acceptable dans la vie reelle, comme decrit dans la litterature. Le profil de tolerance clinique et biologique etait globalement bon.

OBJECTIVE To assess the impact of weekly text messages on adherence in patients taking methotrexate (MTX) for rheumatoid arthritis (RA). METHODS This prospective, randomized pilot, single-site study included patients with RA stabilized using MTX alone or combined with biologics. Participants were randomized to 3 interventions: a standard consultation (controls), a 15-minute pharmacist-led counseling session, or the receipt of text message reminders. The change over time in the Compliance Questionnaire Rheumatology (CQR-19) score between baseline and 6 months was defined as the primary outcome for adherence. Multivariable analyses and final adherence (as a composite outcome of the CQR-19 score, the Girerd score, and the medication possession ratio) were probed in sensitivity tests. Rheumatologic scales, inflammation, and patient satisfaction were also analyzed. RESULTS A total of 96 patients (mean ± SD Disease Activity Score in 28 joints 2.42 ± 1.03) were monitored. The change over time in the CQR-19 score was significantly higher in the text message group (mean ± SD 3.32 ± 5.66; P = 0.02) than in the control group (mean ± SD 0.22 ± 6.56) and the pharmacist-led counseling group (mean ± SD -0.14 ± 7.56). Multivariable logistic regression showed that text messages remained associated with an increase in the CQR-19 score, independently of the baseline CQR-19 score (odds ratio 3.63 [95% confidence interval 1.26-10.49]; P = 0.017). In the text message group, the increase in the CQR-19 score was correlated with the Health Assessment Questionnaire score (r = -0.405, P = 0.021), and patient satisfaction was significantly higher (P < 0.01) than in the control group. CONCLUSION Our results showed evidence of a positive impact of text messages on adherence to MTX treatment for RA. The clinical benefit and the ideal target patient remain to be determined.

Resume Objectifs L’etude observationnelle europeenne Forsteo a evalue l’incidence des fractures, des douleurs rachidiennes, de la qualite de vie (QV) et de la persistance du traitement chez les femmes menopausees traitees par du teriparatide en soins courants dans 8 pays europeens. Nous presentons les resultats pour la France, ou les criteres de remboursement du teriparatide par l’assurance-maladie sont reserves aux femmes ayant une maladie severe et avec traitement limite a 18 mois. Methodes Un echantillon representatif de femmes debutant un traitement par du teriparatide en France a ete suivi en soins courants pendant 36 mois. Nous avons pris en compte les caracteristiques des patientes a l’inclusion, la persistance au traitement par teriparatide (Kaplan-Meier analyse), l’incidence des fractures, douleurs rachidiennes, et la qualite de vie (EQ-5D) a l’inclusion, puis apres 18 et 36 mois de suivi (derniere observation rapportee (DOR) et modele mixte de mesures repetees (MMMR)). Resultats Cent seize rhumatologues ont inclus 309 patients, dont 290 (93,9 %) ont eu au moins une visite de suivi. L’âge moyen des femmes (ecart-type) etait de 74,5 (7,4) ans et 296 (95,8 %) avaient eu au moins 2 fractures vertebrales avant traitement par teriparatide. L’incidence des fractures cliniques, principalement vertebrales, diminuait six mois environ apres le debut du traitement par teriparatide, de facon durable jusqu’a 36 mois ( p = 0,013) quand la plupart des patients etaient traites par antiresorptifs. Les douleurs rachidiennes et les mesures EQ-5D etaient ameliorees de facon significative a 18 et 36 mois ( p Conclusion Les femmes francaises debutant un traitement par teriparatide en soins courants avaient une osteoporose severe et il existait une bonne observance du traitement, en accord avec les criteres de remboursement de l’assurance en France. L’amelioration du risque de fracture et des douleurs rachidiennes commencait peu apres le traitement et etait maintenue apres 36 mois de suivi.

Resume Rationnel Pour le diagnostic de fracture vertebrale (FV) chez l’homme, la concordance entre les medecins est faible. Objectifs Evaluer la concordance entre experts pour le diagnostic de FV, chez l’homme, sur radiographie standard. Evaluer cette concordance apres une reunion de consensus et etablissement d’un algorithme. Methodes La concordance de 13 rhumatologues, experimentes, a ete calculee chez 30 hommes osteoporotiques. Une reunion de consensus a ete mise en place ; ont ete analyses 28 autres dossiers d’hommes osteoporotiques avec suivi radiologique et FV incidente confirmee. Les experts ont defini puis hierarchise 18 criteres semiologiques radiologiques et etabli un algorithme de diagnostic de FV. Onze experts ont relu le premier set. La comparaison des deux lectures, sans et avec algorithme, a ete etudiee. Resultats Apres consensus et usage de l’algorithme les resultats sont : nombre de patients fractures (presentant au moins une FV) de 13 a 26 sur 30 (13 a 28 a la 1ere lecture), moyenne de la concordance a l’echelle du patient : 75 % (70 % a la 1ere lecture) ; nombre de FV detectees sur 390 vertebres evaluees : 18 a 59 (18 a 98 a la 1ere lecture) ; moyenne du pourcentage de concordance entre les experts a l’echelle de la vertebre 92 % (89 % a la 1ere lecture). L’algorithme a permis une bonne amelioration de la concordance, surtout pour 8 des 11 lecteurs. Conclusion Il existe des discordances entre les experts pour le diagnostic de FV. L’algorithme a permis d’ameliorer la concordance.

The agreement for vertebral fracture (VF) diagnosis in men, between doctors is poor. Objectives To assess the agreement for VF diagnosis, in men, on standard radiographs, between experts, before and after consensual workshop and establishing an algorithm. Methods The agreement between thirteen experimented rheumatologists has been calculated in thirty osteoporotic men. Then, the group discussed in a workshop and 28 other radiograph sets of osteoporotic men with follow-up radiographs and incident confirmed VF, have been reviewed. The experts identified and hierarchised 18 pathological features of vertebral deformation and established an algorithm of VF diagnosis. Eleven experts have realized a second reading of the first set of radiographs. We compared the agreement between the 2 readings without and with the algorithm. Results After consensus and the use of the algorithm the results are: number of fractured patients (with at least 1 VF) according to the experts varies from 13 to 26 patients out of 30 (13 to 28 during the first reading). The agreement between the experts at the patient level is 75% (70% at the first reading). Among the 390 vertebrae analyzed by the experts, the number of VF detected varies from 18 to 59 (18 to 98 at the first reading). The agreement between the experts at the vertebral level is 92% (89% at the first reading). The algorithm allows a good improvement of the agreement, especially for 8 of the 11 experts. Discrepancies for the VF diagnosis between experts exist. The algorithm improves the agreement.

ResumeObjectifs L’etude observationnelle europeenne Forsteo a evalue l’incidence des fractures, des maux de dos, de la qualite de vie (QV) et de la persistance du traitement chez les femmes post-menopausees traitees par du teriparatide en routine dans 8 pays europeens. Nous presentons les resultats pour la France, ou les criteres de remboursement du teriparatide par l’assurance maladie sont reserves aux femmes ayant une maladie severe et avec traitement limite a 18 mois. Methodes Un echantillon representatif de femmes debutant un traitement par du teriparatide en France a ete suivi en routine pendant 36 mois. Nous avons pris en compte les caracteristiques des patientes a l’inclusion, la prise en continu de teriparatide (Kaplan-Meier analyse), l’incidence des fractures, des maux de dos, et la qualite de vie (EQ-5D) a l’inclusion, puis apres 18 et 36 mois de suivi (derniere observation reportee). Resultats Cent seize rhumatologues ont inclus 309 patients, dont 290 (93,9 %) ont eu au moins une visite de suivi. L’âge moyen des femmes (ecart-type) etait de 74,5 (7,4) ans et 296 (95,8 %) avaient eu au moins 2 fractures vertebrales avant traitement par teriparatide. L’incidence des fractures cliniques, principalement vertebrales, diminuait 6 mois environ apres le debut du traitement par teriparatide, et duraient jusqu’a 36 mois (p = 0,013). La plupart des patients etaient traites par antiresorptifs. Les maux de dos et les mesures EQ-5D etaient ameliores de facon significative a 18 et 36 mois (p

Background: The efficacy and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) are well demonstrated. Doses of 4 and 8 mg/kg are used intravenously. The objective of our study was to report the efficacy and safety for a set of patients who had an 8 mg/kg doze of TCZ and for another set who had this treatment first at a dose of 8 followed by 4 mg/kg. Methods: All RA patients treated with TCZ in a University Hospital Centre Department of Rheumatology between January 2010 and December 2014 were included. Sixty-three patients received TCZ at a dose of 8 mg/kg and 19 patients received this treatment first receiving a dose of 8 mg/kg decreased to 4 mg/kg. The demographic characteristics, the clinical response and adverse events were reported. Results: At the end of follow-up, 48% of patients were in clinical remission defined by disease activity score based on 28 joints with an erythrocyte sedimentation rate Conclusion: Our study reported the efficacy and safety of the TCZ in patients with RA in ‘real life' with the dose of 8 mg/kg or 8 then 4 mg/kg.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 2 juin 2017

Objective To assess the immediate and long-term efficacy and safety of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of refractory pain resulting from osteoporotic vertebral fractures. Methods A retrospective, open study of percutaneous vertebroplasty (PV) was conducted with long-term follow-up. PV with PMMA was carried out between 1990 and 1996 in 40 patients with symptomatic osteoporotic vertebral fracture(s) that had not responded to maximum medical therapy. In 1997, each patient was asked to come back to our institution for a physical and spinal X-ray examination. Efficacy was assessed by changes over time in pain on Huskisson's visual analogue scale (VAS). Results Thirty-four vertebrae treated by PV in 25 patients were evaluated with long-term follow-up. The mean duration of follow-up was 48 months (range 12–84 months). Pain assessed by the VAS significantly ( P Conclusion PV appears to be a safe and useful procedure for the treatment of focal back pain secondary to osteoporotic vertebral fracture when conservative treatment has failed.

Resume Introduction La presence sur les radiographies d’un pincement discal associe a un phenomene du vide discal est habituellement consideree comme des signes fiables de discopathie degenerative. Nous rapportons une observation ou la presence d’images de gaz intradiscal etait associee a une spondylodiscite a Clostridium perfringens . Methodes Nous rapportons une observation d’une femme âgee de 79 ans hospitalisee pour lombalgies d’horaire inflammatoire depuis deux mois d’intensite croissante. Elle est apyretique, la VS est a 61 mm/h, la CRP a 13 mg/l, les hemocultures sont negatives. Les radiographies, le scanner et l’IRM sont en faveur d’une spondylodiscite L4–L5. Il existe sur les radiographies et le scanner des images de gaz au sein du disque L4–L5. La ponction biopsie discale permet d’isoler un C. perfringens . La recherche d’une porte d’entree n’a retrouve qu’une diverticulose colique. L’evolution fut favorable sous amoxicilline en monotherapie. Discussion Les spondylodiscites a C. perfringens sont rares : seulement sept cas ont ete publies chez des humains. Une porte d’entree digestive est retrouvee dans 70 % des spondylodiscites a C. perfringens . Des images de gaz intradiscal sont visualisees sur les radiographies ou le scanner dans 80 % des cas. Les hemocultures sont positives dans 75 %. L’evolution est favorable sous antibiotique, meme en monotherapie. Les autres caracteristiques des spondylodiscites a C. perfringens ne different pas des spondylodiscites bacteriennes habituelles. Conclusion La presence d’images de gaz intradiscal ne permet pas d’eliminer formellement une spondylodiscite infectieuse mais peut etre associee a une spondylodiscite a C. perfringens .

Resume Objectifs Definir la meilleure strategie d'identification de la bacterie responsable et de demande d'examens d'imagerie ; rediger des conseils utilisables en pratique quotidienne sur le traitement medicamenteux et non medicamenteux des spondylodiscites bacteriennes non tuberculeuses de l'adulte. Methodes Ces propositions ont ete redigees par un rhumatologue et un infectiologue a partir de leur experience et de l'analyse de la litterature, puis confrontees a l'avis de quatre experts. La recherche d'articles publies en anglais ou en francais s'est faite sur medline de 1975 a mai 2006 en utilisant les mots cles : infectious spondylodiscitis, infectious spondylitis, spondylodiscitis, discitis, vertebral osteomyelitis, spine infection, bone and joint infections. Resultats Quatre-vingt-cinq articles ont ete selectionnes pour etre lus dans leur integralite. Il n'y a aucune etude prospective randomisee controlee publiee a ce jour sur ce sujet. Sauf situation exceptionnelle (neutropenie ou sepsis mal tolere), le traitement antibiotique n'est debute que lorsque l'on a la certitude d'avoir isole la bacterie responsable par des hemocultures ou une ponction biopsie discale. Le traitement d'attaque necessite une association bactericide de deux antibiotiques synergiques a posologie elevee. La duree totale du traitement antibiotique doit etre au moins de 12 semaines. Le bilan initial comprend systematiquement des radiographies du rachis et du thorax, une IRM du rachis. Dans les spondylodiscites par voie hematogene a streptocoque et a staphylocoque, l'echographie cardiaque peut etre demandee systematiquement. Des radiographies centrees sur le disque infecte sont systematiquement demandees a un et trois mois apres le debut des antibiotiques et a trois mois apres la fin des antibiotiques. Une IRM de controle est le plus souvent inutile si l'evolution clinique et biologique est favorable. S'il y avait initialement un abces collecte, ou si l'evolution est defavorable, une IRM de controle peut etre demandee apres un mois de traitement. Une surveillance clinique et biologique pendant la totalite du traitement antibiotique et dans les six mois qui suivent son arret est indispensable. Conclusions Des propositions a partir d'etudes descriptives et d'avis d'experts ont pu etre redigees. Elles devraient permettre d'optimiser et d'uniformiser le traitement des spondylodiscites. Des etudes complementaires avec notamment des etudes prospectives randomisees multicentriques comparant un traitement intraveineux a un traitement per os d'emblee ou des durees de traitement differentes sont necessaires pour ameliorer la valeur scientifique de ces propositions.

L’editeur a le regret de vous informer que cet article ayant deja ete publie dans: REVUE DU RHUMATISME, TOME 82/2 (2015) 137–138, http://dx.doi.org/10.1016/j.rhum.2014.08.006 , cette seconde publication faite par erreur a ete retiree.

Resume Les complications osteoarticulaires du traitement par le BCG sont rares mais doivent etre connues en raison de son utilisation tres large. La vaccination par le BCG peut se compliquer exceptionnellement d'infections osteoarticulaires. La BCG-therapie intravesicale utilisee dans le traitement des cancers superficiels de vessie peut se compliquer d'arthralgies, d'arthrites reactionnelles, ou d'infections osteoarticulaires. La BCG-therapie intradermique utilisee dans le traitement de certains cancers peut induire des polyarthrites bilaterales et symetriques touchant preferentiellement les doigts et les poignets ou des infections osteoarticulaires. En pratique, devant une arthrite survenue apres BCG-therapie intravesicale, la presence de fievre ne permet pas de distinguer les arthrites reactionnelles des arthrites infectieuses. L'atteinte oligo- ou polyarticulaire, la survenue quelques semaines (et non plusieurs mois) apres la derniere instillation est en faveur d'une arthrite reactionnelle mais il convient de toute facon d'eliminer une arthrite septique par l'examen du liquide articulaire. Les arthrites reactionnelles au BCG repondent bien habituellement aux anti-inflammatoires non steroidiens. Les infections osteoarticulaires secondaires au BCG doivent etre traitees par une association rifampicine, isoniazide et ethambutol pendant deux mois suivie par rifampicine et isoniazide pendant dix mois.

We report three new cases of longitudinal femoral shaft fracture due to bone insufficiency and review the eight cases reported in the literature. The typical patient is a woman older than 65 years of age who present with mechanical pain in the thigh and/or groin. Palpation of the thigh may reproduce the pain. The diagnosis is often made late because the radiographs are normal initially. However, an early and consistent finding is increased radionuclide uptake along the femoral shaft. The fracture line is readily evidenced by computed tomography but may be difficult to see on magnetic resonance imaging. Use of crutches for 6 weeks to protect the bone from weight bearing ensures healing of the fracture.

Resume A partir de l’analyse de 3 nouvelles observations et des 8 cas rapportes dans la litterature, nous precisons les principales caracteristiques des fractures longitudinales de la diaphyse femorale par insuffisance osseuse. Elles surviennent essentiellement chez des femmes âgees de plus de 65 ans. Elles sont responsables de douleur d’horaire mecanique de la cuisse et/ou du pli de l’aine. Parfois, la douleur est reveillee par la palpation de la cuisse. Le diagnostic est souvent porte tardivement en raison du delai d’apparition des signes radiologiques. La scintigraphie montre precocement et constamment une hyperfixation longitudinale de la diaphyse femorale. Le trait de fracture est facilement mis en evidence par la tomodensitometrie osseuse, alors qu’il n’est pas toujours bien visible en IRM. L’evolution est generalement favorable apres mise en decharge a l’aide de cannes anglaises pendant 6 semaines.

The aim of this study was to determine whether early changes in bone markers could predict long-term response in bone mineral density (BMD) after calcium (500 mg) and vitamin D (400 IU) supplementation twice daily in ambulatory elderly women with vitamin D insufficiency (25-hydroxyvitamin D

Experimentally, leptin has a positive effect on bone mass when infused intravenously, but a negative one after intracerebroventricular administration. Renal failure increases its serum level above the concentration beyond which its transport to the brain may be saturated. Thus, we tested, in a chronic haemodialysis population, the hypothesis of a positive relationship between serum leptin and bone mineral density (BMD) when serum levels are above this threshold.Serum leptin (using a two-site RIA), and BMD at the femoral neck, midshaft, and ultradistal radius, as measured by DEXA, were assessed in 17 female and 16 male chronic dialysis patients, with comparable calcium and phosphate metabolism, age and dialysis duration.Polynomial regression analysis showed a U-shaped correlation between BMD Z-score, with an inflexion point, which may correspond to the concentration threshold at which leptin blood-brain carrier is saturated. Linear regression analysis showed no correlation between BMD and serum leptin levels below these points but a significant positive correlation between BMD at the two radius sites and leptin levels above these points. The correlation remained significant after adjustment for BMI, serum PTH and duration of dialysis. Leptin levels were twice as high in female patients and associated with higher BMD Z-scores close to zero.This study suggests a bone-sparing effect of serum leptin in haemodialysis patients only when the serum levels of leptin were higher than the presumed threshold of blood-brain transport saturation. Higher leptin levels in post-menopausal female haemodialysis patients than in male patients may account for their slower bone loss with ageing.

Objectives. – Calcium and vitamin D deficiency is common in older individuals, particularly those who live in nursing homes, and increases the risk of osteoporosis and fractures. Methods. – We conducted a randomized double-blind placebo-controlled study of combined supplementation with 500 mg of elemental calcium, as carbonate, and 400 IU of vitamin D bid for 12 months in women older than 65 years of age with vitamin D deficiency, defined as serum 25(OH)D concentrations ≤12 ng/ml. Results. – Mean patient age was 75 ± 7 years, and median daily dietary intakes of calcium and vitamin D were 697 mg and 66.8 IU in the supplemented group (n = 95) and 671 mg and 61.8 IU in the placebo group (n = 97). The median serum 25(OH)D level was 7.0 ng/ml in both groups, and the medial intact parathyroid hormone (PTHi) levels were 49 and 48 pg/ml in the supplemented and placebo groups, respectively. The median increase in serum 25(OH)D was 22.0 ng/ml in the supplemented group and 4 ng/ml in the placebo group (P < 0.0001), and the median PTHi decrease was 17 and 5 pg/ml, respectively (P < 0.0001). The median bone mineral density increase was significantly greater in the supplemented group than in the placebo group: +2.98% vs. –0.21% at L2-L4 (P = 0.0009), +1.19% and –0.83% at the femoral neck (P = 0.015), +0.86% and –0.56% at the trochanter (P = 0.015), and +0.99% and +0.11% for the whole body (P = 0.01). Similarly, the median decrease in the main bone markers was significantly greater in the treated group than in the placebo group: –1.35 μg/l vs. +0.50 μg/l for bone alkaline phosphatase (P = 0.008), –16.6 nmol/mmol creatinine vs. –2.3 nmol/mmol creatinine for urinary type I amino-terminal telopeptide (P = 0.001), and –896 pmol/l vs. –201 pmol/l for serum type I carboxy-terminal telopeptide (P = 0.003). We found no significant differences between the two groups for serum calcium, although urinary calcium excretion changed more in the supplemented group than in the placebo group. In conclusion, bone mass in older women with vitamin D deficiency increases significantly at the lumbar spine, femur, trochanter, and whole body after calcium and vitamin D supplementation for 1 year, and concomitantly bone markers improved as vitamin D levels returned to normal.

Resume Objectifs. – L’insuffisance en vitamine D et en calcium est frequente chez les sujets âges, notamment institutionnalises et represente un facteur de risque d’osteoporose et donc de fractures. Methodes. – Nous avons evalue, a partir d’une etude randomisee en double aveugle contre placebo, les effets de l’administration d’une association de 500 mg de calcium elementaire, sous la forme de carbonate et de 400 UI de vitamine D3, deux fois par jour pendant 12 mois chez des femmes âgees de plus de 65 ans et presentant une insuffisance en vitamine D definie par des concentrations seriques en 25(OH)D ≤ 12 ng/ml. Resultats. – Les patientes incluses etaient âgees en moyenne de 75 ± 7 ans, leurs rations alimentaires journalieres medianes en calcium et en vitamine D dans les groupes placebo (n = 97) et supplementes (n = 95) etaient respectivement de 671 mg et 61,8 UI et de 697 mg et 66,8 UI. Les concentrations medianes de 25(OH)D etaient de 7,0 ng/ml dans les deux groupes, celles de la PTHi etaient respectivement de 48 et 49 pg/ml. L’augmentation mediane de la 25(OH)D est de 22,0 ng/ml vs 4 ng/ml (p

Resume La vertebroplastie acrylique (VP) est utilisee de plus en plus frequemment, pour traiter les tassements vertebraux osteoporotiques. Il n’y a cependant pas d’etude controlee dans la litterature qui permettrait de confirmer l’interet de cette therapeutique, qui reste discutee dans l’osteoporose. Ce traitement local s’adresse en effet a une maladie generale (l’osteoporose), et la plupart des tassements devient indolore en quelques jours ou quelques semaines. Les donnees actuelles de la litterature plaident pour une diminution des douleurs, dans 90 a 100 % des cas selon les etudes, avec une diminution en moyenne de moitie de la douleur. La tolerance est habituellement bonne, mais des complications neurologiques graves, bien qu’exceptionnelles sont possibles. L’incident le plus frequent est la survenue de radiculalgies, generalement par fuite foraminale du ciment. Un doute persiste quant a l’augmentation du risque de tassement des vertebres adjacentes. Dans l’avenir il est possible que l’injection de ciments resorbables represente un progres par rapport au ciment acrylique actuellement utilise. Dans l’immediat la VP ne doit etre envisagee pour le traitement de tassements osteoporotiques que dans des cas particuliers et dans le cadre d’une discussion pluridisciplinaire comportant la presence d’un rhumatologue.

Acrylic cement vertebroplasty is being increasingly used to treat osteoporotic vertebral compression fractures (VCFs), although no controlled studies supporting this trend have been published. Vertebroplasty remains controversial as a treatment for osteoporotic fractures because it is a local response to a systemic disease and because the pain caused by osteoporotic fractures usually subsides within a few days or weeks. Current data suggest that pain severity may decrease by half, on average, in 90–100% of patients. Although vertebroplasty is usually well tolerated, serious neurological complications have been reported in a few patients. The most common adverse event is nerve root pain, usually caused by leakage of the cement into the intervertebral foramen. Whether vertebroplasty is followed by an increased risk of osteoporotic fractures in the adjacent vertebras remains unclear. Resorbable cements are being developed and may provide better results than the acrylic cements used today. At present, acrylic cement vertebroplasty to treat osteoporotic VCFs is appropriate in only a minority of patients selected carefully by a multidisciplinary team including a rheumatologist.

Resume Introduction D’apres les ouvrages de references, les spondylodiscites par voie hematogene de l’adulte debuteraient a la partie anterieure des corps vertebraux a proximite des plateaux vertebraux. Observation Nous rapportons une observation de spondylodiscite L1-L2 a Staphylococcus aureus par voie hematogene chez une femme âgee de 81 ans. L’IRM initiale realisee quatre jours apres le debut des symptomes n’a mis en evidence qu’un hypersignal du disque en sequence ponderee T2 et une prise de gadolinium des parties molles en avant du disque L1-L2, associees a une epidurite sans aucune atteinte des plateaux ni des corps vertebraux. L’IRM de controle a mis en evidence des signes typiques de spondylodiscite infectieuse. Discussion L’analyse de la litterature n’a retrouve qu’une seule observation similaire. Il s’agit donc d’une situation rare, mais a laquelle nous risquons d’etre confronte plus frequemment en raison de la realisation plus precoce de l’IRM en cas de suspicion clinique de spondylodiscites infectieuses. Conclusion Certaines spondylodiscites infectieuses de l’adulte par voie hematogene pourraient debuter soit directement au niveau du disque soit en avant du disque ou dans l’espace epidural. Cette presentation inhabituelle de discite infectieuse de l’adulte sur l’IRM initiale realisee tres precocement merite d’etre connue pour eviter un retard diagnostique et therapeutique. Elle incite a ne pas hesiter en cas de contexte clinique evocateur et d’image atypique sur une IRM realisee precocement a redemander une IRM de controle une semaine plus tard pour confirmer le diagnostic de spondylodiscite infectieuse.

Resume Objectif. Evaluer la prevalence en France de la maladie osseuse de Paget de la femme âgee. Patients et methodes. La prevalence de la maladie de Paget et de l'hemangiome localises au rachis dorsal et lombaire a ete evaluee chez 770 femmes tirees au sort parmi celles participant a l'etude Epidos. Epidos est une etude prospective d'evaluation des facteurs de risque de fracture de l'extremite superieure du femur a laquelle ont participe 7 598 femmes volontaires âgees de plus de 75 ans, vivant a domicile, recrutees par cinq centres (Amiens, Lyon, Paris, Montpellier, Toulouse). Les radiographies du rachis dorsal et lombaire face et profil ont ete lues par deux rhumatologues et classees en quatres groupes : absence de maladie de Paget et absence d'hemangiome, maladie de Paget ou hemangiome possible, maladie de Paget certaine, hemangiome certain. Les radiographies des trois derniers groupes ont ete relues de facon independante par un professeur de rhumatologie et un professeur de radiologie. Resultats. Les resultats ont ete etablis sur 745 radiographies, apres en avoir exclu 25 qui n'etaient pas completes ou etaient de mauvaise qualite. Le diagnostic d'hemangiome vertebral a ete porte chez quatre femmes (0,54 %, IC 95 % = 0,01–1,1 %). Une maladie de Paget vertebrale a ete diagnostiquee chez quatre femmes (0,54 %, IC 95 % = 0,01–1,1 %). Toutes les vertebres pagetiques etaient lombaires. La maladie de Paget n'etait pas connue avant l'inclusion dans l'etude pour trois des quatre cas. Comme il a ete suggere que l'atteinte du rachis dorsal ou lombaire represente 30 a 50 % des localisations pagetiques, la prevalence globale de la maladie de Paget de la femme francaise de plus de 75 ans peut etre estimee entre 1,1 % et 1,8 %. Conclusion. La prevalence de la maladie osseuse de Paget chez la femme francaise âgee est similaire a celle recemment rapportee en Angleterre.

Introduction A combination of disk space narrowing and vacuum phenomenon on radiographs of the spine is usually considered a reliable indicator of degenerative disk disease. We report a case in which vacuum phenomenon was related to Clostridium perfringens discitis. Methods A 79-year-old woman was admitted for inflammatory low back pain that had worsened steadily over the last 2 months. Her body temperature was normal, laboratory tests showed inflammation (erythrocyte sedimentation rate, 61 mm/h; and C-reactive protein, 13 mg/L), and blood cultures were negative. Imaging studies (radiographs, computed tomography [CT], and magnetic resonance imaging) indicated L4–L5 discitis. Vacuum phenomenon within the L4–L5 disk was seen on radiographs and CT scans. C. perfringens was recovered by fine-needle biopsy of the disk. Diverticular disease of the colon was the only identifiable portal of entry. Amoxicillin therapy ensured a full recovery. Discussion C. perfringens discitis is rare, with only 7 published cases in humans. A gastrointestinal portal of entry was identified in 70% of cases. Radiographs or CT scans visualized vacuum phenomenon in 80% of cases. Positive blood cultures were noted in 75% of cases. The outcome was favorable with antibiotic therapy, even when a single-drug was used. The other characteristics of C. perfringens discitis were indistinguishable from those of discitis caused by the usual organisms. Conclusion Presence of gas within the disk does not rule out infectious discitis and may indicate C. perfringens discitis.

Revue du rhumatisme - In Press.Proof corrected by the author Available online since jeudi 29 janvier 2015

a b s t r a c t Objectives: The European Forsteo Observational Study assessed the clinical fracture incidence, back pain, quality of life (QoL), and treatment persistence amongst post-menopausal women, who were prescribed teriparatide in routine care in eight European countries. We present the results for France, with health- insurance reimbursement criteria channel teriparatide to women with severe disease and limit treatment to 18 months. Methods: A representative sample of women initiating teriparatide in France was followed in routine care for 36 months. We described patients' characteristics at baseline and persistence to teri- paratide (Kaplan-Meier analysis), fracture incidence, back pain, and QoL (EQ-5D) at baseline, 18 and 36 months follow-up (last-observation-carried-forward (LOCF) and mixed-models-for-repeated- measures (MMRM). Results: One hundred and sixteen rheumatologists included 309 patients, of whom 290 (93.9%) had at least one follow-up visit. Women's mean age (standard deviation) was 74.5 years (7.4) and 296 (95.8%) had greater or equal to two vertebral fractures prior to teriparatide initiation. Clinical fracture incidence, mainly vertebral fractures, decreased around 6 months after teriparatide initiation, and was sustained at 36 months (P = 0.013) when most patients were treated by anti-resorptives. Back pain and EQ-5D meas- ures improved significantly at 18 and 36 months (P < 0.0001) in the LOCF analyses but did not improve in the EQ-5D VAS measure after covariate adjustment in the MMRM model. Median treatment duration was 17.4 months. Conclusion: French women initiating teriparatide in routine care had severe osteoporosis and showed good treatment persistence, consistent with France's insurance reimbursement criteria. Improvements in fracture risk and back pain began soon after treatment and was maintained at 36 months follow-up.

SummaryWe present the first case of human spondylodiscitis due to Shewanella algae. Our patient did not have any predisposing factors. The portal of entry was probably a cutaneous lesion on the leg, exposed to seawater. Bacteria were isolated in pure culture from a needle biopsy specimen of the vertebral disk. Automated identification systems identified the organism as Shewanella putrefaciens. However, molecular biology identified it as S. algae. Treatment with ceftriaxone and amikacin, then ciprofloxacin successfully addressed the infection. We also review four published cases of human osteoarticular infections caused by Shewanella spp: two cases of arthritis and two cases of osteomyelitis. Two patients had predisposing factors, and contact with water was found in two cases. The clinical, radiological and biological characteristics of S. algae spondylodiscitis are indistinguishable from those of spondylodiscitis of other causes. A cutaneous lesion with exposure to water is a potential portal of entry. Molecular typing is necessary to obtain a precise bacteriological identification.

Objectives To develop recommendations about identifying the causative organism, obtaining imaging studies, and selecting pharmacological and non-pharmacological treatments in adults with pyogenic discitis and vertebral osteomyelitis (PDVO). Methods A rheumatologist and an infectiologist drafted recommendations based on their personal experience and a review of studies in English or French retrieved on Medline using the following search terms: “infectious spondylodiscitis”, “infectious spondylitis”, “spondylodiscitis”, “discitis”, “vertebral osteomyelitis”, “spine infection”, and “bone and joint infections”. The recommendations were submitted to four experts for validation. Results 85 articles were selected for detailed review. No prospective randomized controlled trials were identified. Antimicrobial therapy should be initiated only after recovery of the causative organism in blood cultures or percutaneous disk biopsy specimens, except in patients with neutropenia or severe sepsis. The initial treatment rests on a combination of two bactericidal and synergistic antimicrobials in high dosages. The total duration of antimicrobial therapy should be 12 weeks at least. Radiographs of the spine and chest and magnetic resonance imaging (MRI) of the spine should be performed routinely during the initial evaluation. In PDVO due to hematogenous dissemination of a streptococcus or staphylococcus, routine echocardiography may be in order. Radiographs centered on the affected disk should be obtained 1 and 3 months into antimicrobial therapy and 3 months after treatment discontinuation. Follow-up MRI is usually unnecessary when the clinical and laboratory abnormalities respond to treatment. If not, or if the initial investigations show a collected abscess, a repeat MRI after 1 month of antimicrobial treatment may be useful. Clinical and laboratory follow-up is mandatory throughout antimicrobial therapy and during the first 6 months after treatment discontinuation. Conclusions Recommendations based on descriptive studies and expert opinion were developed. They can be expected to improve the quality and uniformity of PDVO management. Further studies are needed to improve the level of evidence that is available for developing recommendations. In particular, prospective randomized multicenter studies should be performed to compare the intravenous to the oral route for initial antimicrobials administration and to compare different treatment durations.

Objective: This article presents the results of an evaluationof the clinical and laboratory safety of a 1-year course of treatment with a combination calcium and vitamin D tablet in ambulatory women aged >65 years with vitamin D insufficiency. Methods: In a multicenter, randomized, double-blind, placebo-controlled study conducted in France, women with a 25-hydroxyvitamin D level ≤12 ng/mL were randomized to receive either a combination tablet containing calcium carbonate 500 mg and vitamin D3 400 IU taken twice daily or a matching placebo tablet for 1 year. A complete clinical examination was performed at baseline and at 3, 6, 9, and 12 months of treatment; blood and urine samples were collected for laboratory analyses at the same time points. Safety was monitored based on adverse events recorded during the treatment period and on the results of laboratory tests, including measurement of creatinine and uric acid levels. Results: The study included 192 women (mean [SD] age, 74.6 [6.9] years; mean weight, 64.0 [12.5] kg), 95 in the calcium + vitamin D group and 97 in the placebo group. Fifty women (21/95 [22.1%] calcium + vitamin D, 29/96 [30.2%] placebo) were prematurely withdrawn from the study for various reasons, with no difference in withdrawals between groups. Treatment-related adverse events were reported in 21 (22.1%) and 23 (24.0%) women in the respective treatment groups. These events consisted mainly of metabolic disorders (9 [9.5%] and 10 [10.4%], respectively), particularly hypercalcemia (6 [6.3%] and 8 [8.3%]) and gastrointestinal disorders (9 [9.5%] and 8 [8.3%]). No major complications directly related to calcium and vitamin D supplementation occurred during the course of treatment. Although renal function was not altered, the group who received calcium + vitamin D had significantly elevated concentrations of serum uric acid compared with those who received placebo (52.3% vs 37.2%; P = 0.046) but not urinary uric acid. Conclusions: In these ambulatory elderly women with vitamin D deficiency, supplementation with calcium + vitamin D appeared to be well tolerated over 1 year of treatment. No significant effects on creatinine clearance were observed. However, the proportion of women with elevated serum uric acid concentrations was significantly greater in those who received calcium + vitamin D compared with those who received placebo.

The aim of this study is to evaluate, in vivo, the trabecular bone structure of the calcaneus of healthy volunteers and osteoporotic patients by texture analysis of MR images. Automated methods of texture analysis cover a wide range of techniques enabling quantitative analysis of grey level intensity and distribution within a region of interest (ROI). Texture analysis is not used very frequently since the interpretation of the large number of calculated parameters is difficult. We here apply multiparametric data analyses such as Correspondence Factorial Analysis (CFA) and Hierarchical Ascending Classification (HAC) to determine the relevant parameters to differentiate between two sets of images (healthy young volunteers and osteoporotic older patients).

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 7 mai 2013

Revue du rhumatisme - In Press.Proof corrected by the author Available online since jeudi 25 avril 2013

Although osteoarticular side effects of the Bacillus Calmette-Guerin (BCG) are rare compared to the number of administrations, BCG vaccination and cancer therapy are so widely used that the absolute number of cases is not negligible. Osteoarticular infection is an exceedingly rare complication of vaccination with the BCG. Intravesical BCG instillations used to treat superficial bladder cancer may cause arthralgia, reactive arthritis or osteoarticular infections. Intradermal BCG therapy used to treat a number of malignancies can cause osteoarticular infections or bilateral symmetric polyarthritis predominating in the wrists and fingers. In practice, when intravesical BCG instillation is followed by arthritis, hyperthermia is unhelpful for distinguishing septic arthritis from reactive arthritis. Arguments pointing to reactive arthritis include oligo- or polyarticular involvement and onset a few weeks (as opposed to a few months) after the last instillation. Nevertheless, joint fluid examination is in order to rule out septic arthritis. BCG-induced reactive arthritis usually responds well to nonsteroidal anti-inflammatory drugs. Osteoarticular infections related to BCG therapy should be treated by rifampin, isoniazid and ethambutol for 2 months, followed by rifampin and isoniazid for 10 months.

We report three new cases of longitudinal femoral shaft fracture due to bone insufficiency and review the eight cases reported in the literature. The typical patient is a woman older than 65 years of age who present with mechanical pain in the thigh and/or groin. Palpation of the thigh may reproduce the pain. The diagnosis is often made late because the radiographs are normal initially. However, an early and consistent finding is increased radionuclide uptake along the femoral shaft. The fracture line is readily evidenced by computed tomography but may be difficult to see on magnetic resonance imaging. Use of crutches for 6 weeks to protect the bone from weight bearing ensures healing of the fracture.