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Resume Objectifs Des etudes ont releve une frequence moins elevee de la polyarthrite rhumatoide (PR) dans la population africaine. Il n’existe cependant aucune donnee precise concernant la population d’origine afro-caribeenne. Le projet EPPPRA est une etude epidemiologique prospective visant a definir la prevalence et les caracteristiques cliniques de la PR aux Antilles francaises (Martinique, Guadeloupe, Guyane francaise). Methodes EPPPRA regroupe l’ensemble des rhumatologues exercant aux Antilles francaises auxquels il a ete propose d’inclure pendant une periode d’un an tous les patients ayant un diagnostic clinique de PR. Nous rapportons ici les resultats obtenus en Martinique. Resultats D’apres les resultats de l’EPPPRA, la prevalence globale de la PR standardisee selon l’âge (population mondiale de reference) est estimee a 0,10 % [IC 95 % : 0,09 % a 0,11 %] en Martinique avec une nette predominance feminine (88,1 %) et 93,1 % des patients auto-declares d’origine ethnique afro-caribeenne. L’âge moyen au moment du diagnostic etait de 49,6 ± 16,0 ans. Dans la majorite des cas, les sujets remplissaient au moins 4 criteres (94,4 %) de la classification 1987 de l’American College of Rheumatology (ACR) et obtenaient un minimum de 6 points (78,2 %) selon la classification 2010 de l’ACR/European League Against Rheumatism (EULAR). Un taux eleve de seropositivite a ete retrouve (84,2 %). Malgre le retentissement fonctionnel observe chez 40,5 % des patients, la maladie etait faiblement active chez 71,4 % d’entre eux. Le traitement le plus courant etait le Methotrexate (73 %), suivi des biotherapies (24,4 %). De nombreux patients (68,6 %) ont egalement beneficie d’une corticotherapie. Les facteurs de risque cardiovasculaire tres frequents contrastaient avec une consommation de tabac particulierement basse (8,7 %). Conclusion Ce travail met en evidence la faible prevalence standardisee de la PR observee dans une population francaise d’origine afro-caribeenne et en souligne les caracteristiques specifiques (forte predominance feminine, taux de seropositivite eleve, faible consommation de tabac). Malgre la facilite d’acces aux soins de sante et aux biotherapies, la PR est d’evolution destructrice au retentissement fonctionnel invalidant dans environ la moitie des cas de cette etude.

Objectives Studies suggest that rheumatoid arthritis (RA) is less frequent in African populations. However, no recent precise data exists for Afro-Caribbeans. The EPPPRA project is a prospective epidemiological survey to describe prevalence and clinical aspects of RA in the French West Indies (Martinique, Guadeloupe, French Guiana). Methods EPPPRA involved all rheumatologists from the French West Indies who included all patients with a known clinical diagnosis of RA, during a one-year period. We outline here results for Martinique. Results EPPPRA estimated an overall world age-standardized prevalence of RA at 0.10% [95% CI 0.09% to 0.11%] in Martinique, with a high female predominance (88.1%) and 93.1% of self-reported Afro-Caribbeans. Mean age at diagnosis was 49.6 ± 16.0 years. A majority of subjects presented at least 4 criteria points from the 1987 American College of Rheumatology (ACR) classification (94.4%) and at least 6 points (78.2%) from the 2010 ACR/European League Against Rheumatism (EULAR) classification. A high immune seropositivity rate was highlighted (84.2%). Despite functional impact observed in 40.5% of patients, 71.4% presented a low disease activity level. Methotrexate was the most common ongoing treatment (73%), followed by biotherapies (24.4%). Numerous patients (68.6%) received a steroid regimen. Cardiovascular risk factors were very frequent, contrasting with a very low tobacco use (8.7%), Conclusion This work outlines low standardized prevalence of RA in a French Afro-Caribbean population with specific characteristics (high female predominance, high immune seropositivity, low tobacco use). Despite easy access to care and biotherapies, approximately half of RA patients still present destructive disease with functional impact.

Objective To describe chronic chikungunya manifestations seen during the outbreak in the Caribbean from December 2013 to January 2015. Methods Patients were seen at our center, the only rheumatology department in Martinique Island, and were examined by a senior rheumatologist using a standard care report form. Chikungunya was diagnosed collectively based on consensus among all clinicians. The median time from onset of acute chikungunya to the first rheumatology consultation was calculated, severity was evaluated based on clinical scales and the degree of joint destruction, and each patient's treatment was recorded. Results For the 147 patients analyzed, the median time between onset of acute chikungunya and the first rheumatology consultation was 8 months. After review of each patient's medical record, 19 (12.9%) were diagnosed as having epidemic-influenced chikungunya. Four distinct rheumatologic patterns were observed in the remaining patients (those with compatible history and positive serologic findings): 47 patients (32%) had reactivation of painful chronic mechanical manifestations, 9 patients (6.1%) had fibromyalgia, 45 patients (30.6%) met criteria for spondyloarthritis (as evaluated before the chikungunya virus infection in all patients) and experienced a flare, and 27 patients (18.4%), with no history of joint disease, developed de novo bilateral symmetric chronic inflammatory joint disease in response to chikungunya virus infection. For inflammatory arthritis, most patients were treated with methotrexate (up to 25 mg/week), with good response and tolerance. Thirteen patients were treated with conventional doses of anti–tumor necrosis factor agents, with good tolerance and efficacy as expected. Conclusion The term “chronic chikungunya syndrome” covers multiple etiologies. Compliance with the French Society of Rheumatology recommendations, careful recording of patient histories, and serologic verification help prevent errors inherent to the epidemic context and ensure early therapeutic intervention for these patients. To avoid late initiation of treatment, patients should receive rheumatologic consultation as early as possible.

This study aimed to describe the prevalence of overweight (excluding obesity) and obesity, and distribution of waist circumference, in children and adults in four French Overseas Territories (Guadeloupe, Martinique, French Guiana in the Caribbean and French Polynesia in the Pacific Ocean).The survey was designed to provide a sample representative of the population in each of the four territories. The protocol aimed to evaluate 600 adults (aged ≥ 15 years) and 300 children (aged: 5-14 years) in each territory.In children, the differences were small among the territories in the prevalence of overweight (excluding obesity), as defined by the International Obesity Task Force (IOTF): Guadeloupe, 15.4%; Martinique, 17.0%; French Guiana, 13.2%; and French Polynesia, 17.2% (P = 0.49). Larger, significant, differences were observed for obesity, with prevalences of 7.2%, 7.7%, 5.4% and 15.9%, respectively (P0.002). In adults, the prevalence of obesity also differed significantly among the territories: 22.9%, 22.0%, 17.9% and 33.1% in Guadeloupe, Martinique, French Guiana and French Polynesia, respectively (P0.001, adjusted for age and gender). However, overweight (excluding obesity) was again more homogeneously distributed, with prevalences of 31.7%, 33.6%, 30.3% and 34.4%, respectively (P = 0.43, adjusted for age and gender). Waist circumference was larger in French Polynesia than in the other territories in both genders, and in both children and adults.While the distribution of overweight was relatively homogeneous, the prevalence of obesity differed considerably across the four territories. It was especially high in French Polynesia, and in children and women. Appropriate programmes are urgently needed in these populations, especially in children, to avoid the morbidity associated with obesity.

Introduction Chez les patients d’origine africaine, la nephropathie lupique (NL) est de moins bon pronostic que dans la population caucasienne. Cependant, les donnees sur le devenir a long terme de ces patients sont rares dans les pays ou l’acces aux soins est gratuit. C’est ici ce que nous decrivons. Patients et methodes Il s’agit d’une etude retrospective. Entre 2002 et 2015, en Martinique, tous les patients qui avaient une NL prouvee par biopsie et suivis au moins 24 mois, etaient inclus. Resultats Quatre-vingt-neuf patients ont ete inclus. Le suivi median etait de 106 mois (2,5 a 317 mois). Aucun patient n’etait perdu de vue. L’âge median au diagnostic de NL etait 30 ans. La proteinurie mediane au diagnostic etait de 2,31 g/24 h (0,6 a 27), la creatininemie mediane a 88 μmol/L (26 a 500). En cumulatif, les NL proliferatives etait retrouvees chez 68/89 patients (76,4 %) au diagnostic. Les 21 patients restants presentaient une classe V, I ou II chez respectivement 17, 3 et 1 patients. Concernant les NL proliferatives, le traitement d’induction etait le cyclophosphamide (CYC), mycophenolate mofetil (MMF) ou l’azathioprine (AZA) chez respectivement 66,1 %, 24,9 % et 4,4 % des patients. En entretien, le MMF, le CYC et l’AZA etaient utilises chez respectivement 75 %, 5,9 % et 5,9 % des patients. Tous recevaient un traitement par corticoide oral et 91 % par hydroxychloroquine. A 1 an, sur 89 patients, 14,6 % entraient en remission partielle (RP) et 43,8 % en remission complete (RC). Au cours du suivi, 13 classes V sur 17 (76,5 %) se transformaient en NL proliferative. Apres un suivi moyen de 118,4 mois, 43,8 % des patients (39/89) etaient toujours en RC, 7,9 % (n = 7) en RP, 39,3 % (n = 35) etaient insuffisant renaux chronique dont 15,7 % (n = 14) d’hemodialyses chronique et 9 % (n = 8) etaient decedes. A 10 ans, sur 89 patients la mortalite etait de 8,7 %. Discussion Chez les caucasiens la survie a 10 ans est egalement de 90 %. Le biais socioeconomique, limitant l’acces aux soins, pourrait expliquer le pronostic defavorable classiquement decrit de la population afro-caribeenne. Conclusion Le pronostic vital dans la population afro-caribeenne est comparable aux populations caucasiennes, probablement lies a l’acces gratuit aux soins.

Resume Introduction L’infarctus musculaire diabetique est une complication exceptionnelle du diabete sucre. Elle concerne les patients ayant une maladie mal controlee et deja compliquee. Elle se manifeste par des douleurs musculaires avec gonflement touchant surtout les muscles de la cuisse, associees parfois a la fievre et une alteration de l’etat general. Observations Nous rapportons cinq cas d’infarctus musculaire diabetique survenant chez trois patientes originaires des Antilles presentant une forme atypique. Le diagnostic a donc ete pose sur la biopsie musculaire, permettant d’eliminer un diagnostic frequent en milieu tropical (contrairement aux zones temperees) et de pronostic redoutable, la pyomyosite. Conclusion L’existence d’infarctus musculaire diabetique chez trois patientes, complication pourtant consideree comme exceptionnelle dans la litterature au sein d’une population de petite taille, nous semble plus liee a la frequence du diabete aux Antilles qu’a un caractere proprement ethnique.

La survenue d’une polyarthrite chez un sujet âge est un probleme diagnostique auquel le medecin est de plus en plus confronte. Le diagnostic d’une polyarthrite recente est souvent difficile chez un sujet jeune. Chez le sujet âge, cette difficulte est accrue par l’existence frequente de pathologies associees, l’aspect souvent trompeur des rhumatismes a debut tardif et l’existence de pathologies articulaires propres aux sujets âges. Pourtant ce diagnostic est important a faire dans les meilleurs delais. Cette polyarthrite peut en effet reveler une affection mettant en jeu rapidement le pronostic vital, pathologie infectieuse ou neoplasique, et elle survient souvent chez un sujet fragilise par l’âge, les pathologies viscerales associees et les traitements qui les accompagnent.

Introduction La maladie de Horton (MH) est une vascularite touchant les gros vaisseaux du sujet âge, en particulier l’aorte et ses branches crâniennes. Elle plus frequemment decrite chez les caucasiens mais plus rare dans les populations d’origine africaine et asiatique. Actuellement, non seulement il existe tres peu de series de patients d’origine africaine dans la litterature, mais on n’a pas de donnees sur l’incidence de cette maladie dans ces populations. L’objectif de notre etude est de decrire les caracteristiques de cette maladie dans notre population et d’en calculer l’incidence. Patients et methodes Etude retrospective, monocentrique, descriptive des patients atteints d’une maladie de Horton suivie en Martinique. Le recueil des donnees a ete fait par recoupement des sources : 2 seuls laboratoires d’anatomie pathologique de l’ile, services de medecine interne et rhumatologie. Les criteres d’inclusions etaient : une biopsie de l’artere temporale (BAT) compatible avec une maladie de Horton chez un patient vivant en Martinique. Les criteres d’exclusion etaient l’absence de BAT ou une BAT negative. Resultats Trente-huit patients atteints de MH confirmee par une BAT ont ete retrouves de 1991 a 2016 dont 2 d’origine caucasienne et les 36 autres d’origine afro-caribeenne. Il y avait 29 femmes et 9 hommes avec un sex-ratio (F/H) de 3,2 avec un âge moyen de 75,8 ans ± 7,24 au diagnostic. Les caracteristiques cliniques etaient : 12,1 % (4/33) de fievre, 75 % (25/33) un amaigrissement, 71,4 % (25/35) des cephalees, 35,4 % (11/31) une claudication de la mâchoire, 36,3 % (12/33) une hyperesthesie du cuir chevelu, 37,1 % (13/35) une atteinte ophtalmologique dont 12 avaient une nevrite optique ischemique anterieure (NOIA) et un avait une baisse d’acuite visuelle non precisee. On mettait en evidence chez 38,2 % (13/34) une pseudopolyarthrite rhizomelique associee et 8,8 % (3/34) des arthralgies inflammatoires. Des complications ischemiques non ophtalmiques etaient retrouvees chez 4 patients (11,7 %) : une arterite des membres inferieurs (n = 2), un infarctus cerebral (n = 2). Dix patients (41 %) presentaient d’autres atteintes moins frequentes : douleurs de mâchoire amenant a une avulsion dentaire (n = 5), carotidodynies (n = 2), signes digestifs (n = 2), et une toux seche (n = 2). Un syndrome inflammatoire biologique etait present dans plus 90 % des cas avec une CRP > 10 mg/L dans 93,7 % (30/32) des cas avec une moyenne de 93,7 mg/L ± 69,9 et la VS > 50 mm dans 90,4 % (19/21). Quatorze patients ont eu un scanner thoraco-abdominal retrouvant une seule aortite. La totalite des patients ont ete traitees par corticotherapie de 0,7 a 1 mg/kg associe a des bolus chez 3 patients (pour une NOIA). La moitie des patients (17/34) recevaient un traitement adjuvant par antiagregant plaquettaire. La duree moyenne de suivi etait de 43,2 mois. Il y avait 7 (18,4 %) perdus de vue ( Conclusion Nous decrivons ici la premiere serie composee (95 %) d’une population Afro-caribeenne et la premiere etude epidemiologique de la MH dans une population originaire d’Afrique noire. Nos donnees confirment bien la moins grande frequence de la MH dans ces populations comparativement aux Europeens. Si la majorite des caracteristiques cliniques de nos patients sont similaires aux autres cohortes de la litterature, les complications ischemiques semblent moins frequentes dans notre population. Mais le manque de certaines donnees peut avoir joue un role dans cette difference.

Introduction Chez les patients d’origine africaine, la nephropathie lupique (NL) est de moins bon pronostic que dans la population caucasienne. Des donnees sur le devenir a long terme des patients d’origine africaine atteints de NL sont rares dans les pays ou l’acces aux soins est gratuit. Dans cette etude, nous decrivons le pronostic a long terme dans cette population. Materiels et methodes Il s’agit d’une etude retrospective, 1 140 biopsies renales ont ete interpretees par le service d’anatomopathologie du CHU de Fort-de-France en Martinique (France) entre 2002 et 2015. Tous les patients qui avaient une NL prouvee par biopsie (classification ISN/RPS) et dont le suivi etait d’au moins 24 mois (dont 12 mois minimum de suivi en Martinique) ont ete inclus. La remission etait definie par l’absence de diminution du DFG > 10 %, l’absence de leucocyturie ou d’hematurie ( 1 g/24 h de la proteinurie si RC > 2 g/24 h si RP, ou une augmentation > 25 % de la creatinemie persistante 2 mois consecutifs. Resultats Sur 1 140 biopsies renales, 155 cherchaient une NL concernant 126 patients. Quatre-vingt-neuf patients ont etes inclus (93,3 % de femmes) et 37 exclus. Il s’agissait de la premiere biopsie renale pour 77/89 patients (86,5 %). Le temps de suivi median etait de 106 mois (2,5–317). Aucun patient n’etait perdu de vue. L’âge median de diagnostic du LES etait de 27 ans et 30 ans pour la NL. La proteinurie mediane au diagnostic etait de 2,31 g/24 h (0,6 a 27), la creatininemie mediane a 88 μmol/L (26 a 500). Dix-huit pour cent ( n = 16) des patients presentaient un syndrome des antiphospholipides au diagnostic. En cumulatif, les NL proliferatives etait retrouvees chez 68/89 patients (76,4 %) au diagnostic : 17 presentaient une classe III (19,1 %), 22 une classe IV (24,7 %), 18 une classe III + V (20,2 %), 11 une classe IV + V (12,4 %). Le reste des 21 patients presentaient une classe V ( n = 17 ; 19,1 %), une classe I ( n = 3 ; 3,4 %) ou une classe II ( n = 1 ; 1,1 %). Concernant les NL proliferatives, le traitement d’induction etait le cyclophosphamide (CYC), le mycophenolate mofetil (MMF) ou l’azathioprine (AZA) chez respectivement 66,1 % (45/68), 17 (24,9 %) et 3 (4,4 %) patients. Le MMF etait utilise comme traitement d’entretien chez 51 patients (75 %), CYC et AZA chacun dans 5,9 % des cas. Trois et 9 patients n’ont respectivement jamais recu de traitement d’entretien et d’induction. Tous les patients ont recus un traitement par corticoide oral et 91 % par hydroxychloroquine. Apres le diagnostic de NL, sur 89 patients, 23 entraient en RP (25,7 %), 41 en RC (46 %) et 25 n’entraient jamais en remission (28,3 %). Concernant les NL proliferatives ( n = 68), 47 % ( n = 32) entraient en RC et 25 % ( n = 17) en RP. Au cours du suivi, 68 nouvelles biopsies renales etaient pratiquees : 13 classes V sur 17 (76,5 %) se transformaient en NL proliferative (III + V, n = 3 : 17,6 % ; IV + V, n = 10 : 58,8 %) apres une duree mediane de 95 mois (20,1 a 158,5). A la fin du suivi, 23 patients avaient presente un episode de rechute (26,1 %), 8 deux episodes (9,1 %) et 1 trois episodes (1,1 %). Apres un suivi moyen de 118,4 mois, chez les 89 patients, 43,8 % (39/89) etaient toujours en RC, 7,9 % ( n = 7) en RP, 39,3 % ( n = 35) insuffisants renaux chronique dont 15,7 % ( n = 14) d’hemodialyses chroniques et 9 % ( n = 8) etaient decedes. La mortalite pour l’ensemble des 89 patients etait 3,4 % a 1 an, 5,7 % a 5 ans, 8,7 % a 10 ans, 12,5 % a 15 ans, et pour les NL proliferatives respectivement 4,4 %, 7,5 %, 12,9 %, 17,4 %. Des resultats loin de ceux retrouves dans les iles voisines avec une mortalite rapportee a 5 ans entre 59 % [1] et 68 % [2] . Conclusion Dans la population afrocaribeenne atteinte de NL, la RC est atteinte dans 47 % des cas, RP dans 25 % et la mortalite a 10 ans est de 12,9 %. Ces resultats sont probablement en partie lies a l’acces gratuit aux soins qui permet de s’affranchir du biais socioeconomique.

Introduction Il n’y a pas de donnees dans la litterature sur les interactions entre chikungunya (chik) et lupus erythemateux dissemine (LED). Beaucoup d’infections sont susceptibles de provoquer des poussees de LED, mais ceci a peu ete etudie dans la litterature. La Martinique a connu pour la premiere fois une epidemie de chik au cours de l’annee 2014 qui a ete l’occasion d’etudier la relation entre le LED et cette infection virale. Patients et methodes L’objectif principal etait de decrire chez des patients lupiques l’evolution d’une infection par le chik. Nous avons egalement cherche a savoir : – si le chik pouvait modifier l’activite du LED ; – le role des traitements du LED, en particulier les medicaments immunosuppresseurs, sur l’evolution du chik. Nous avons realise une etude principalement prospective mais incluant aussi quelques patients retrospectivement, monocentrique, evaluant de facon systematique tous les patients atteints de LED (repondants aux criteres de l’ACR de 1997), vus dans l’unite de medecine interne et de rhumatologie du centre hospitalier universitaire, entre janvier 2014 et septembre 2015, relevant de : – l’activite du LED ; – la presence de signes compatibles avec un episode de chik. Une serologie virale systematique a ete prescrite pour tous les patients lors de leur suivi biologique habituel. Un chik grave etait considere en presence d’une encephalopathie, d’une myocardite ou d’une defaillance multiviscerale. Resultats Deux cent cinquante-deux patients etaient preleves pour la realisation d’une serologie chik, avec 140 resultats recueillis en septembre 2015. Soixante-huit etaient inclus avec une serologie positive pour le chik (femmes : 65 ; hommes : 3). Leurs caracteristiques etaient : âge au moment de la serologie (48,0 ans, extremes : 23–81), l’anciennete du diagnostic de LED au diagnostic de chik (12,3 ans ; n = 65), une atteinte renale (47,0 % ; n = 68), le traitement par des medicaments immunosuppresseurs (31,8 % ; n = 66), de l’hydroxychloroquine ou de la chloroquine (83,3 % ; n = 66), de la prednisone (63,6 %, 2 manquants), ou du rituximab (n = 3). Des signes cliniques compatibles avec un episode de chik etaient retrouves chez 82,7 % (16 manquants) des patients ayant une serologie positive. Quatre patients presentaient des signes graves de chik (5,9 %), tous ayant moins de 55 ans. Ils avaient une encephalopathie (n = 4), des lesions cutanees bulleuses (n = 3), une atteinte renale (n = 2) et un seul etait sous immunosuppresseur (mycophenolate). Une de ces 4 patientes, dialysee sous faible dose de corticoides, decedait dans un contexte de syndrome de fuite capillaire systemique et d’une defaillance multiviscerale. Sur 52 patients ayant fait un chik (11,5 %) six ont decrit une poussee de lupus, tous apres un episode de chik symptomatique : 5/6 etaient sous prednisone, 5/6 sous hydroxychloroquine et 3/6 sous traitement immunosuppresseur. Conclusion Le LED devrait etre considere comme un facteur de risque de chik grave, au meme titre que les nourrissons ou les personnes âgees. Le chik peut provoquer une poussee du LED chez un patient sur 10. Les immunosuppresseurs ne semblent pas influencer le tableau clinique de chik et ne doivent a notre sens pas etre arretes lors d’un episode.

Resume Les auteurs rapportent 2 observations d'arthrite reactionnelles a anguillule (Strongyloides stercoralis), parasite dont la prevalence reste elevee aux Antilles. Ils soulignent quelques particularites cliniques, biologiques et therapeutiques de ces arthrites : affection rare, se presentant volontiers comme une spondylarthropathie, absence d'HLA B27, resistance aux AINS, contre-indication des corticoides, efficacite spectaculaire des anti-parasitaires specifiques. Le cadre nosologique et les criteres diagnostiques des rhumatismes parasitaires sont brievement discutes.

A methodology for evaluating range image segmentation algorithms is proposed. This methodology involves (1) a common set of 40 laser range finder images and 40 structured light scanner images that have manually specified ground truth and (2) a set of defined performance metrics for instances of correctly segmented, missed, and noise regions, over- and under-segmentation, and accuracy of the recovered geometry. A tool is used to objectively compare a machine generated segmentation against the specified ground truth. Four research groups have contributed to evaluate their own algorithm for segmenting a range image into planar patches.

Resume Nous rapportons le resultat d'une etude prospective ouverte visant a apprecier l'efficacite d'un traitement par le methotrexate a la dose de 7,5 mg par semaine dans une population de 16 lupus erythemateux systemiques corticodependants qui necessitaient des doses quotidiennes de prednisone superieures a 15 mg. Une efficacite precoce du methotrexate a ete objectivee sur notre population des la fin du troisieme mois sur les quatre parametres evolutifs etudies: index d'activite sur echelle visuelle analogique ; dose quotidienne de prednisone ; nombre d'articulations douloureuses, et indice fonctionnel de Lee. Une amelioration a ete effective chez 13 patients, qui presentaient surtout des manifestations articulaires et cutanees du lupus erythemateux systemique, ce qui a permis une reduction de leur corticotherapie en dessous de 10 mg par jour. Un echappement secondaire est survenu dans quatre cas et n'a pas ete sensible a l'augmentation de la posologie du methotrexate a 10 mg par semaine. Seuls quatre cas d'intolerance mineure au traitement ont ete notes. Cette etude suggere un effet benefique du traitement par le methotrexate a faibles doses dans les manifestations articulaires et cutanees du lupus corticodependant et souligne son role d'epargne cortisonique.

Introduction Les infections sont une des principales causes de mortalite et de morbidite au cours du lupus systemique (LS). Le chikungunya (CHIK) est une arbovirose transmise par les moustiques qui se caracterise par une polyarthrite aigue febrile, souvent persistante et invalidante, volontiers accompagnee d’une eruption cutanee. Des formes graves avec atteintes neurologiques, cardiaques ou hepatiques sont decrites, avec un groupe tres a risque que sont les nouveau-nes. Les Antilles francaises etant une region de forte prevalence du LS et, depuis 2013, une zone emergente de CHIK, nous rapportons le tableau initial de 15 patients ayant contracte le virus chikungunya. Aucune donnee n’existe dans la litterature sur ce sujet. Patients et methodes Une etude retrospective a ete menee de janvier a aout 2014 au CHU de Martinique. Les patients inclus presentaient un LS selon les criteres ACR 1997 et ont ete vus avec un CHIK symptomatique et une confirmation biologique (detection initiale de l’ARN viral du CHIK par PCR-RT ou presence d’anticorps de type IgM ou IgG specifiques anti-CHIK par methode Elisa). Nous avons recueilli le tableau clinique et biologique a la consultation precedente et au moment du CHIK. Resultats Quinze patients dont 12 femmes, avec un âge moyen de 50 ans (± 10,9 ans) ont ete inclus. Vingt pour cent ( n = 3) avaient une PCR CHIK positive et 80 % ( n = 12) une serologie CHIK positive. Au diagnostic, tous les patients presentaient de la fievre et des arthralgies dont 33 % ( n = 5) d’arthrites, principalement au niveau des poignets et des chevilles. Une eruption cutanee etait presente % ( n = 8), de type eruption morbilliforme (33 %, n = 5), dermatose bulleuse (20 %, n = 3) et œdemes des extremites (26 %, n = 4). La CRP initiale etait en moyenne > 150 mg/L. On observait une thrombopenie et une leucopenie dans 26 % des cas ( n = 4). Le score moyen de SLEDAI avant infection etait de 2,1 et au moment de l’infection de 4,5. Deux biopsies renales realisees devant un syndrome nephrotique de novo montraient une nephropathie lupique de classe III, des lesions de necrose tubulaire aigue et une hyalinose segmentaire et focale. Dans les 6 mois precedant le CHIK, 73 % ( n = 11) recevaient plus de 5 mg de prednisone, 60 % ( n = 9) etaient sous immunosuppresseur, tous recevaient de l’hydroxychloroquine. Des signes de gravite survenaient chez 3 patients (20 %) sans traitement immunosuppresseur, avec 1 syndrome d’activation macrophagique (PCR CHIK + dans la moelle a 18 jours), 1 encephalite avec purpura bulleux et 1 tableau de defaillance multiviscerale avec hypotension severe, troubles de conscience, thrombopenie grave et syndrome de fuite capillaire avec eruption cutanee de type erytheme necrolytique toxique (PCR Chik + dans le liquide de bulles a 2 semaines), aboutissant au deces. Discussion L’infection CHIK et le LS presentent des manifestations communes avec fievre, atteintes articulaires, leucopenie et thrombopenie rendant difficile le diagnostic differentiel. De plus, une poussee de lupus systemique peut etre declenchee par le CHIK. Quelques aspects du CHIK permettent toutefois de tenter de lui attribuer certaines manifestations : œdemes et douleurs acraux majeurs, localisation, forme et extension des lesions cutanees, douleurs articulaires d’horaire inflammatoire mais avec une raideur de duree courte. Conclusion En conclusion, les quelques tableaux tres graves de CHIK que nous rapportons, proches de ce qu’on voit chez le nouveau-ne, font du LS un facteur de risque important.

Dengue fever (DF) is an epidemic viral mosquito-borne infection limited to tropical and subtropical countries. Biological therapies have been frequently used for the last 15 years in the treatment of inflammatory rheumatic conditions like rheumatoid arthritis. However, no data is available regarding the characteristics of this infection in patients on biological therapy. Yet, numerous patients on biotherapy have holidays in countries where DF exists. Moreover, the mosquitoes Aedes albopictus , vector of this viral disease, is now found in some developed countries such as southern Europe and the USA, allowing the possibility of a DF outbreak. We conducted a survey of individuals on biotherapy and described a case series of the patients experiencing DF. Our 8 patients on biotherapy (anti-TNF, n =6; rituximab, n =2) for a rheumatic condition did not experience severe DF.

Diabetic muscular infarction is an exceptional complication of diabetes mellitus. Patients with macro- and microvascular manifestations are mostly concerned. Muscular pain with swelling of the thigh is the main manifestation, sometimes associated with fever.We report here five cases of diabetic muscular infarction in three Afro-carribean patients with atypical clinical features. The surgical biopsy procedure allowed the diagnosis and ruled out pyomyositis, a more common bacterial disease on tropical condition.This report of three cases of this exceptional disease in a small population seems more related to the high prevalence of diabetes mellitus in the French West Indies than to their ethnic origin.

Introduction Les nephropathies lupiques proliferatives (NLP) sont plus graves et de moins bon pronostic chez les patients originaires d’Afrique noire que chez les Caucasiens. Le mycophenolate est le medicament plutot recommande en cas de NLP dans ces populations bien que l’analyse du sous-groupe afro-americain de l’etude Aspreva Lupus Management n’ait pas permis de montrer de superiorite du mycophenolate sur le cyclophosphamide. Les strategies de baisse de corticoides sont tres importantes dans les populations noires du fait de la frequence du diabete, de l’hypertension et de leurs complications cardiovasculaires. Il n’y a pas de donnees sur l’utilisation du protocole EUROLUPUS avec de faibles doses de corticoides en traitement des NLP dans les populations originaires d’Afrique subsaharienne. Nous apportons notre experience sur une cohorte de 34 patients martiniquais. Patients et methodes Tous les patients ayant un lupus systemique (selon les criteres ACR 1997) traites dans le service de medecine interne et rhumatologie depuis 2008 pour une NLP prouvee par une biopsie renale (classes III et IV ISN-RPS) se voyaient proposer un traitement d’attaque par mycophenolate ou cyclophosphamide (CYC) selon deux modalites (EUROLUPUS et NIH). Ceux choisissant 6 doses intraveineuses de CYC a 500 mg tous les 15 jours recevaient une dose initiale de 0,5 mg/kg/j de prednisone per os et pas de bolus de prednisolone, quand il n’y avait pas d’indication imperative (principalement glomerulonephrite rapidement progressive, cytopenie auto-immune, myocardite, atteinte cerebrale). Trente-six patients consecutifs allaient choisir ce regime et etre retrospectivement evalues en consultation dans la vraie vie a 3, 6, 12, 24 et 36 mois pour l’apparition d’une remission complete (RC : proteinurie 24 h Resultats Trente-quatre patients consecutifs (32 femmes, 2 hommes) recevaient 34 protocoles EUROLUPUS entre 2008 et 2015. Aucun patient n’etait perdu de vue. Moins de 10 % des patients recevaient des bolus de methylprednisolone. Le taux de remission global (complete + partielle) etait respectivement a 3 mois de 23,5 % (RC seulement), a 6 mois de 47,1 % (RC 41,2 % ; RP 5,9 %), a 1 an de 67,6 % (RC 55,9 % ; RP 11,7 %), a 2 ans et 3 ans de 76,5 % (RC 64,7 % ; RP 11,7 %). Le taux d’echec etait de 14,7 % a 3 mois et de 23,5 % a 6 mois. Plus aucun n’etait en situation d’echec au-dela de 6 mois. Parmi les patients en echec, 75 % etaient incompliants. La necessite d’une epuration extrarenale etait de 14,7 %, survenant pour toutes dans la premiere annee, une incompliance etant retrouvee dans 80 % des cas. Conclusion Dans des conditions differentes des etudes prospectives (aucune selection, en condition de vraie vie, etude retrospective), le protocole EUROLUPUS dans notre population d’ascendance subsaharienne semble avoir des resultats tres proches des etudes prospectives disponibles. Cela suggere que le mycophenolate n’est pas la seule molecule de choix dans les NLP dans les populations noires. Cela souligne aussi que les echecs sont tres volontiers lies a des problemes de compliance, imposant d’ameliorer celle-ci par des methodes comme l’education therapeutique.

Background Rheumatoid arthritis (RA) is a disabling chronic disease, regarded as the most frequent inflammatory rheumatism in adults, with a prevalence estimated between 0.3 and 1%, and a feminine ascendancy. In metropolitan France this prevalence is estimated from 0.3% to 0.5% of the general population. No precise data is available for French West Indies, and the prevalence of RA in this population of African ancestry is poorly evaluated. Objectives The objective of the study is to estimate RA prevalence in the FWI by a census forward-looking epidemiological survey in the hospital and liberal sectors for one year duration. Methods It is a unique tour with clinical examination, self-administered questionnaires and declaration. Secondary objectives are description of clinical and socio economical aspects of RA and cardiovascular comorbidities. We present the results for Martinique. Our survey was widely distributed (radio, press, patients9 associations…) to ensure a good completeness. Data were analysed using SAS 9.3 software (SAS Institute Inc., Cary, NC, USA). Throrough descriptive analysis of collected variables was conducted. Crude prevalence rates were adjusted to a standard population of Martinique (nationwide census in 2010). The 95% CIs were calculated using the Poisson distribution. Results Our completeness is good. 538 RA were collected, giving a prevalence in Martinique of 0.184% of the adult population (290 000), respectively 0.049 for men and 0.292 for women. 44% of these patients are treated in private practice and 56% in hospital. This cohort is composed of 88% women and 12% men; 92% were born in Caribbean and 7.7% elsewhere. Patients self declared of Afro Caribbean origin in 92.7%, Caribbean White in 1.7%, caucasian in 3% and other in 2.1%. Their mean disease duration was 9.7±10 years. RF and ACPA were positive in 82.2% (FR+ 392, ACPA+349, 35% low level, 65% high level): CCP+FR+ in 306, FR+CCP- in 77, FR-CCP+ in 41, FR-CCP- in 96. 17% had extra articular manifestations. ACR1987 and ACR2010 criteria were pos in 94.4% and 78%. HAQ was 1and 2 in 3%. DAS28 were respectively 5.1 in 3%. Less than 5% are ever smoker. Parodontopathy is infrequent. Cardiovascular risk factors were noticed in 89,4% with a mean of 2 CVRF beside RA. Conclusions This work clarifies the low prevalence of RA in this population of African origin. Some characteristics as: reduced prevalence, strong female representation, strong seropositivity, high levels of anti-CCP, no tobacco, differentiate our patients from other populations and evoke another etiology than tobacco. Disclosure of Interest None declared

Background Chick is an epidemic disease due to an arthropod-borne virus ( Alphavirus ) transmitted by Aedes mosquitoes. CHIKV causes an acute illness with a febrile phase, followed by a period of severe polyarthritis that can persist for long time. There is no specific treatment, the best prevention is mosquito control and avoidance of bites. Martinique (French West Indies) is currently experiencing an outbreak of CHIK with 170 000 reported cases (Dec 1st). Objectives No data is available regarding the prognosis of Chikungunya in patients under biologics. We have observed 22 patients with Chik infection while on biotherapy and DMARDS for rheumatic diseases, between January and May 2014. Methods Physicians prescribing biologics were asked to declare patients under biologics experiencing Chik. For each patient we collected diseases characteristics and course, current treatment (steroids, immunosuppressant, biologics…), changes in the treatment during infection, and outcome. 22 patients were included, all with a diagnosis confirmed by PCR (20/22) or serology. Results Among these patients were 19 women and 3 men, 3 Caucasians and 19 Afro-Caribbean9s. There were 5 spondyloarthritis (3 associated with Crohn), 1 psoriatic rheumatism, 2 systemic lupus, 1 antisynthetase syndrome and 13 RA. 17 had methotrexate (mean dose 21.6 mg), 3 Plaquenil, 2 Imuran, 1 cellcept, 2 cyclophosphamide. 11/22 were under steroids (mean dose of 8.6 mg/d). All experienced fever (mean duration 1.7 day), skin rash (15/22, mean duration 1.3 d), and acute disabling polyarthritis (mean pain VAS 8.4, mean SJC 9.6, mean TJC 6.8) for a mean 11.5 days duration. Nine had back pain and 4 tenosynovitis. None of them showed any organ failure, one single episode of transient thrombopenia was noted. None of them was hospitalized for Chik. Analgesic treatment (alone 4/22), associated with NSAIDs (17/22) or prednisone (1/22) and rest were sufficient to overcome the crisis. All but one patient maintained their previous treatment (DMARDS, Biologic, steroids…) without specific complication. All patients were able to differentiate between Chik related complains and those related to their preexisting condition. Mean clinical disease scores before and after Chik (DAS, BASDAI, SLEDAI) remained unchanged. Conclusions This is the first report of the occurrence of Chik in patients under biologics. Patients under biologics are at increased risk for serious infections either viral or bacterial, but no data has been published regarding Chik. This study was not conducted to discover all cases of Chik among patients under biologic. Chik does not seem to be deleterious in patients under biologics who do not exhibit more severe or prolonged disease than common forms. Chik does not seem to aggravate pre-existing disease. It does not seem necessary to modify the basic treatment of rheumatism in the announcement of a Chik as the clinical pictures observed in these patients are quite benign. NSAIDs and best rest are mostly effective. Chik does not seem harmful in patients receiving biological and this issue should be given to travellers. Disclosure of Interest None declared

Background Lumbar canal stenosis (LCS) is a clinicopathological and radiological disease first described in 1949, causing a neurovascular compression leading to back pain, radicular, sensory or motor deficit which treatment is difficult. Objectives The objectives of our study were appraisal of a protocolized treatment for 3 months and identification of predictive factors for failure of medical treatment. This is a prospective nonrandomized study with no control group. All patients satisfying inclusion criteria were included after clinical and radiological evaluation. Methods Clinical inclusion criteria were neurogenic claudication, radiculopathy at rest with or without back pain, mono or multirooted sensory, motor or reflex abnormalities of the lower limbs. Radiological inclusion criteria were: anteroposterior dural sac diameter 2 , reduction in the anteroposterior diameter of the spinal canal >25% on myelography in supine extended position. Results Included patients had at least one clinical and one radiological criteria. Treatment was 2 epidural injections of 125 mg hydrocortancyl 15 days apart, combined with NSAIDs or analgesic, associated with physiotherapy sessions over 2 months. 147 patients were included. Mean age was 62±13 years. F/M sex ratio is 1.3. Mean BMI was 27.5±4.3, overweight was present in 72.1%. At baseline, mean duration for back pain and radicular pain were 9.3±10.5 and 4.4±5.7years. Primary objective was evolution of the Oswestry [1] score (a low back pain disability questionnaire) at 3 months as compared to baseline. Secondary objective was the evolution of pain. At the end of treatment, the mean value for the Oswestry score decreased from 41.2 to 39.7 (p=0.17). Mean VAS for lumbar pain decreased from 53.6 to 42.1 (p BMI, duration of back and radicular pain, mean lumbar radicular VAS and mean Oswestry score at inclusion were not significantly different in improved and non improved patients. Predictors of good response to treatment were the initial presence of impulsivity cough and nocturnal pain. Conclusions In conclusion with this approach there was no significant decrease in Oswestry score, however there was a significant decrease in mean VAS lumbar and radicular pain. No predictor of poor response has been highlighted. Predictors of good response were the initial presence of impulsivity at cough and nocturnal pain. These results show the limits of medical treatment in the management of SCL. References Niskanen RO, The Oswestry Low Back Pain Disability Questionnaire. a two-year follow-up of spine surgery patients. Scand J Surg, 2002 91 (2):. P. 208-11. Disclosure of Interest None declared

This paper describes a definition of the range image segmentation (of polyhedral scenes) problem, a data set to use in evaluation, a method for specifying ground truth, and a set of metrics to classify segmentation results against ground truths. >

To review epidemiological and clinical aspects of systemic lupus erythematosus (SLE) in Martinique, French West Indies.Cases of SLE were identified by attending physicians. Patients who presented with at least four of the criteria defined by the American College of Rheumatology were included. Determination of incidence and prevalence included the new cases arising during the 1990-1999 period and 1999 population census results. Probability of survival was based on the use of the Kaplan-Meier estimator.Two hundred and eighty-six patients were studied, including 265 females (92.7%). The average annual incidence was 4.7 cases per 100,000 inhabitants (95% confidence interval [CI]: 2.5-6.9). The prevalence for 1999 was 64.2 cases per 100,000 inhabitants (CI: 56.2-72.2). The mean age at onset was 30 years. Eleven percent of all patients had at least one parent with SLE. Renal disease was present in 139 patients (48.6%), and neurological disorders were diagnosed in 70 patients (24.5%). Patients tested positive for the following antibodies: anti-Sm (37.1%), anti-RNP (58.7%), anti-SSA (47.2%). Mean survival time was: 96.4% (CI: 94.1-98.7) at 5 years, 91.8% (CI: 87.9-95.7) at 10 years. Survival was significantly reduced in patients with end-stage renal disease (n = 40, chi 2 = 6.96, P0.01).The high incidence of SLE in Martinique and the immunological characteristics of patients were found to be similar to those described in other populations of African descent. The frequency of renal disease and survival rates were identical to those reported in Caucasians.

Resume Le virus HTLV-1 entraine un dereglement du systeme immunitaire difficile a evaluer. Nous rapportons l'observation d'une antillaise de 49 ans, atteinte d'une sarcoidose, revelee par des adenopathies hilaires bilaterales, une hypercalcemie, une uveite, des lesions histologiques de granulome sarcoidosique. Elle presentait des anticorps anti HTLV-1. Trois ans plus tard elle developpait une leucemie/lymphome T de l'adulte. Les relations eventuelles entre l'infection retrovirale HTLV-1, et les differentes pathologies observees sont discutees.

Background No study describes the frequency of Behcet’s disease (BD) in the populations of African origin and its characteristics. Objectives To retrospectively assess by retrieval of multiple sources, the epidemiology and characteristics of BD in the mainly African descent population of Martinique, a French Island in the Caribbean. Methods In 2011 we consulted 5 different sources. Patients were included if they lived in Martinique, were classified as certain if they fulfilled the international criteria for BD. The diagnosis was considered only as probable if they had recurrent oral ulcers with at least one other international criteria but no other possible diagnosis. The incidence during the 1997-2011 interval and prevalence at December 31, 2010 were calculated. Basic and BD-related characteristics were recorded. Results 48 patients were indicated as BD. Only 36 (female, n=22; male, n=14) fulfilled the criteria. Mean age at diagnosis was 38.5 years old (range: 8-64), 36.6 for women and 41.6 for men. Disease onset was over 50 years old for 7 patients. Mean time between first signs and diagnosis was 4.2 years (range: 0-22). Twenty eight began their disease between 1997 and 2011 allowing a total crude mean annual incidence estimation of 0.72 new cases/10 5 inhabitants (0.79/10 5 for female and 0.59/10 5 for males, 0.37/10 5 for certain cases and 0.35/10 5 for probable). In December 2010, 28 patients were alive, 5 lost to follow up and 3 deceased: the crude prevalence was estimated as 7.04/10 5 inhabitants (Female: 7.49; male: 6.51). Genital ulcers were found in 75.6%. Dermatological manifestations were: pseudofolliculitis (52%), erythema nodosum (13.5%). Pathergy test was done for 6 patients and positive for 4. Nine patients had ophthalmologic involvement: anterior uveitis (55.5%, n=5), panuveitis and posterior uveitis (11.1%, n=1 each), conjunctival ulceration (22.2%, n=2). Parenchymal brain involvement was more frequent than non-parenchymal (7 versus 3 patients) without any cerebral venous thrombosis. Rheumatic manifestations were occurred in 20 patients (55.6%) mainly females (60%): polyarthritis (38.9%), monoarthritis and spondylarthropathy (11.1% each). Deep vein thromboses were seen in 2 cases and superficial in 1, central retinal artery occlusion in 1 patient. The colon was involved in 6 cases and the ileo-cecal region in one. Conclusions In Martinique, BD seems to be a rare disease compared to Mediterranean and most Asian countries. The incidence is comparable to Spain and Switzerland. The prevalence is higher than in most European countries and USA. Black population seems to have particular manifestations of BD: older age at onset and rare uveitis. Disclosure of Interest None Declared

The authors report an open prospective study in a group of 16 patients who presented systemic lupus erythematosus with cutaneous and articular symptoms, and who required treatment with a minimum dose of 15 mg per day of prednisone. Methotrexate was given at a dose of 7.5 mg IM per week. Efficacy was demonstrated at the third month with a statistical analysis of four evolution parameters. Improvement was observed in 13 patients out of 16 and permitted the reduction of the amount of prednisone required. Secondary relapse occurred in four cases in spite of an increase in the dose of methotrexate (10 mg per week). Minor side effects were observed in four cases, and methotrexate was discontinued in only two cases. This study suggests that treatment by low doses of methotrexate is beneficial to patients with articular and cutaneous manifestations of corticodependent systemic lupus erythematosus and this therapy could be corticosteroid-sparing.

A retrospective study was conducted in Martinique to identify patients with polyarthritis and positive serologic tests for the human T-cell lymphotropic virus Type I (HTLV-1). Patients with metabolic or bacterial causes of polyarthritis were excluded. We found 17 cases of HTLV-1-positive polyarthritis (6.7% of the total of polyarthritis patients followed in our department); there were 14 females and three males, and all the patients were West-Indian blacks. Mean age at diagnosis was 50 years. Five patients also had tropical spastic paraparesis. The polyarthritis was the inaugural manifestation of T-cell leukemia in one patient. Four patients had received blood transfusions. Fever, myalgia, and/or skin lesions were present at onset of the polyarthritis in seven cases. All 17 patients had peripheral, bilateral, symmetric polyarthritis; the most commonly involved sites were the hands (17/17) and knees (14/17). Three patients had rheumatoid factor and five had antinuclear antibody. Ten patients met at least four American Rheumatism Association criteria for rheumatoid arthritis; they accounted for 6.7% (10/150) of all polyarthritis patients managed in the same hospital department during the same period. We compared these ten patients with 20 HTLV-1-negative rheumatoid arthritis patients matched on gender, ethnic origin, and disease duration. There were no significant differences between the two groups for any of the parameters studied.

Objectif L’objectif de l’enquete transversale PODIUM (Prevalence de l’Obesite, de sa Diversite et de son Image Ultra-Marine) fut de mesurer la prevalence du surpoids, de l’obesite et de sa repartition au sein des adultes et des enfants de 5 ans et plus, residents des quatre territoires ultra-marins : Guadeloupe, Martinique, Guyane, Polynesie. Materiels et methodes De decembre 2007 a novembre 2008, 3 612 sujets, soit environ 600 adultes (15 ans et plus) et 300 enfants (5 a 14 ans) selectionnes aleatoirement et representatifs de la population de chaque territoire, ont ete inclus. Les parametres mesures au domicile des sujets par des enqueteurs formes furent entre autres : le poids (balance electronique), la taille (toise electronique), le pourcentage de masse grasse (impedancemetrie), le tour de taille (TT). Resultats Chez les enfants la prevalence de l’obesite etait de 8.9 % en Guadeloupe, 9.3 % en Martinique, 6.4 % en Guyane et 17.6 % en Polynesie, plus elevee chez les garcons, sauf en Polynesie. Chez les hommes en Guadeloupe la prevalence de l’obesite etait de 18 %, 16 % en Martinique, 13 % en Guyane, et 29 % en Polynesie, et plus elevee chez les femmes : 27 %, 27 %, 22 % et 37 % respectivement. La prevalence du surpoids etait d’environ 30 % dans les deux sexes et les quatre territoires. La Polynesie a egalement montre les moyennes de TT les plus elevees et les plus fortes prevalences d’obesite abdominale dans les 2 sexes sans reflet evident sur les pourcentages de masse grasse observes. Conclusion Outre des differences d’adiposite entre les territoires, par comparaison aux donnees anterieures de la litterature, l’aggravation est nette et reclame un programme de prevention particulierement a partir de la grossesse et de la petite enfance. Les enjeux de prise en charge sont majeurs puisque les prevalences du diabete de type 2, deja elevees dans ces territoires, risquent encore d’augmenter.

A retrospective study of 26 adults with acute T-cell leukemia showed that 14 patients (54%) had hypercalcemia at some point of the disease. Hypercalcemia was found at presentation in nine patients and revealed the disease in one. Eight patients had hypercalcemia at the time of death. Serum phosphorus and parathyroid hormone levels were normal. All patients with hypercalcemia tested positive for the HTLV-1 by Elisa and Western blot. Six patients had focalized or diffuse lytic roentgenographic bone lesions. Hypercalcemia in acute T-cell leukemia may involve production of interleukin-1-alpha and parathyroid hormone-related protein by HTLV-1-infected cells.

This article reports the results of a pathoepidemiological study of a cohort of black men who had prostatic surgery at Howard University Hospital between 1968 and 1989. The median age of patients at diagnosis of prostate cancer increased by 8 years during the study period, indicating either a delay in seeking medical care or a true delay in onset of the disease. The trends of prevalence of biopsies with cancer in various age groups suggested a sharp rise in the incidence of prostate cancer after the age of 70. The significant increase in popularity of needle biopsy during the period 1982 to 1989 after a 7-year plateau is an indication of increased perceived value of this procedure with experience and technical improvement. The prevalence of biopsies with cancer in all successive time periods of the study showed a bimodal distribution with an early hump in the 50- to 54-year-old age group. This hump is analogous to the break in the rising incidence of breast cancer between the ages of 47 and 52 (Clemmesen hook). This similarity could be explained on the basis of hormonal dependence of the two cancers.

The HTLV-1 virus causes a disturbance of the immune system, the evaluation of which is often difficult. We report a case of sarcoidosis in a 49 year old woman of Martinique as evidenced by bilateral hilar adenopathy, hypercalcaemia, uveitis and granulomatous lesions on histological examination. Serological was positive for HTLV-1 antibodies. Three years later she developed an adult T-cell leukemia/lymphoma. The relationships between the HTLV-1 retroviral infection and different pathologies observed are discussed.

The human retrovirus HTLV-1 (Human T-cell Lymphotrophic Virus) is responsible for malignant proliferations of mature T lymphocytes. It is also now implicated in neurological disorders dominated by spastic paraplegia. A study of 140 cases of lumbar and root pain enabled us to identify 8 of apparently idiopathic atypical lumbar and root pain which led to the discovery of a positive HTLV-1 serology performed routinely. These cases were remarkable in terms of the rarity and minimal extent of spinal cord signs and of Lasegue's sign, their duration of more than a year and the existence of neurological signs indicative of central involvement. In 2 patients there was secondary progression to a spastic paraparesis. It would appear that the neurotropism of HTLV-1 virus is not limited to the central nervous system but that it can also involve the peripheral nervous system as indicated by certain cases in the literature as well as those collected in Martinique, an endemic area for the virus. Rheumatologists should be aware of this possibility when confronted with such cases of atypical lumbar and root pain and should seek the existence of an HTLV-1 virus infection among other viral etiologies, in particular when the patient concerned comes from an endemic area.

Human T-lymphotropic virus type 1 (HTLV-1) proviral load is related to the development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and has also been shown to be elevated in the peripheral blood in HTLV-1-infected patients with uveitis or alveolitis. Increased proliferation of HTLV-1-infected cells in, or migration of such cells into, the central nervous system is also seen in HAM/TSP. In the present study, we evaluated the proviral load in a cohort of HTLV-1-infected patients with arthritic conditions. HTLV-1 proviral load in the peripheral blood from 12 patients with RA and 6 patients with connective tissue disease was significantly higher than that in matched asymptomatic HTLV-1 carriers, but similar to that in matched HAM/TSP controls. HAM/TSP was seen in one-third of the HTLV-1-infected patients with RA or connective tissue disease, but did not account for the higher proviral load compared to the asymptomatic carrier group. The proviral load was increased in the synovial fluid and tissue from an HTLV-1-infected patient with RA, the values suggesting that the majority of infiltrated cells were HTLV-1-infected. In the peripheral blood from HTLV-1-infected patients with RA or connective tissue disease, HTLV-1 proviral load correlated with the percentages of memory CD4+ T cells and activated T cells, and these percentages were shown to be markedly higher in the synovial fluid than in the peripheral blood in an HTLV-1-infected patient with RA. These biological findings are consistent with a role of the retrovirus in the development of arthritis in HTLV-1-infected patients. A high level of HTLV-1-infected lymphocytes in the peripheral blood and their accumulation in situ might play a central role in the pathogenesis of HTLV-1-associated inflammatory disorders. Alternatively, the autoimmune arthritis, its etiological factors or treatments might secondarily enhance HTLV-1 proviral load.