Utilisation de l'imagerie par résonance magnétique pour l'évaluation quantitative des synovites des mains chez les patients atteints de polyarthrite rhumatoïde traités par infliximab

Aim. – To investigate the clinical response and to evaluate by magnetic resonance imaging the inflammatory tissue changes in refractory rheumatoid arthritis patients treated with infliximab.Methods. – Sixteen refractory rheumatoid arthritis patients who were treated with intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every eight weeks thereafter, were examined with magnetic resonance imaging of the dominant affected wrist and hand before treatment and one year after therapy. The volume of the enhancing inflammatory tissue was evaluated in fat suppressed contrast enhanced T1–weighted images by using the Analyse 4.0 software. Disease activity was evaluated by assessing the disease activity score for 28 joint indices. The clinical improvement was evaluated according to the American College of Rheumatology 20% response criteria.Results. – There were 13 females and three males with mean age 49.5 (17.0) years and mean disease duration 10.5 (8.0) years. Ten patients had positive IgM rheumatoid factor. One year after treatment, a significant reduction of the erythrocyte sedimentation rate, the C-reactive protein, the disease activity scores for 28 joint indices and the volume of the enhancing inflammatory tissue were observed. All but two of the rheumatoid arthritis patients achieved the American College of Rheumatology 20% response criteria, while nine (56.25%) and five (31.25%) patients achieved the 50 and 70% American College of Rheumatology response criteria respectively. A positive correlation between the volume of the enhancing inflammatory tissue, swollen joint count, tender joint count, as well as disease activity score for 28 joint indices (R = 0.66, R = 0.79, R = 0.57 respectively) was found before treatment.Conclusions. – In refractory rheumatoid arthritis patients, the addition of infliximab therapy may result in clinical, laboratory and magnetic resonance imaging improvement. Magnetic Resonance Imaging assessment of the volume of the enhancing inflammatory tissue may represent an additional tool for the investigation of joint disease activity and responsiveness to treatment.     

La douleur dans la gonarthose. Apport de l’arthroscopie et de l’imagerie par résonance magnétiqueContribution of arthroscopy and magnetic resonance imaging to the evaluation of knee osteoarthritis.

In knee osteoarthritis, arthroscopy provides valuable information that suggests an original approach to the disease. In combination with recent imaging study data, this information can be used to develop a novel concept of the evaluation of knee osteoarthritis. The main mechanisms responsible for flares of the disease seem to be synovitis, degenerative meniscal disease, and subchondral bone lesions. Treatments targeted at each of these mechanisms can be used as appropriate. Determination of the exact nature of the lesions can be difficult and relies at present on sophisticated investigations not readily available in everyday practice. Further work is needed to determine how a finer analysis of symptoms and signs in combination with simple investigations can differentiate between the various pathological patterns of knee osteoarthritis.     

Conception et évaluation de la qualité d’une information écrite sur le scanner et l’imagerie par résonance magnétique en neuropédiatrie

Introduction

We designed written information concerning two medical imaging techniques: the computed tomography scanner and the magnetic resonance imaging (MRI), and we evaluated the quality of the information in particular its readability.

Methods

Written information concerning scanner and MRI were elaborate starting from a reference frame based on a lexicon of the good practices. The written information sheets were initially reviewed by eight doctors, 45 nurses and by 26 couples of parents of hospitalized children, and finally by the communication and juridical services of our hospital. They were asked to improve the lexico-syntactic readability in order to increase the comprehension of the written information. Seventy-two couples of parents of hospitalized children who had not taken part of the protocol before evaluated the final version of the documents. The quality of the documents was evaluated using the scores of readability of Flesch and the Flesch-Kincaid, and a questionnaire of comprehension, managed before and after the delivery of written information.

Results

A total of 144 persons participated in the study. The number of right answers after reading written information increased by 38 % and by 35 % for the scanner and MRI information's respectively. Flesch and Flesch-Kincaid scores were not improved in the revised version of the written information compared to the first version.

Conclusion

Although readability scores for information sheets were low, our results suggest that they brought information, which contributed to a better understanding of these two medical imaging techniques by parents.     

Comparaison de deux échelles de qualité de vie, l’une générique et l’autre spécifique, dans l’évaluation de l’efficacité d’un traitement thermal global dans l’arthrose du genou

Objectifs. – Notre étude a eu pour buts d’étudier l’efficacité à court terme du traitement thermal sur la qualité de vie des patients atteints d’arthrose du genou et d’analyser les différences et les corrélations entre les résultats obtenues avec deux échelles de qualité de vie, l’une générique et l’autre spécifique des affections rhumatismales.Patients et méthodes. – Nous avons sélectionné par randomisation 50 patients atteints de gonarthrose, qui ont bénéficié d’un programme de traitement thermal de type global et polyvalent pendant une durée de 21 jours. Les résultats chez les 46 patients ayant terminé l’étude ont été évalués avec les échelles de qualité de vie SF-36 (générique) et AIMS2 (spécifique).Résultats. – Une amélioration statistiquement significative a été observée dans tous les domaines du SF-36. Tous les domaines de l’AIMS2 se sont aussi améliorés, mais cette amélioration n’était significative que pour la moitié d’entre eux. Il existait une corrélation significative des domaines correspondants entre les deux échelles, à l’exception des domaines d’activité physique.Conclusion. – Un traitement thermal global, polyvalent, semble améliorer, à court terme, la qualité de vie des patients atteints d’une gonarthrose.Objectives. – To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis.Patients and Methods. – Fifty patients with knee osteoarthritis were randomly recruited. They underwent a comprehensive spa therapy program for 21 days. Forty-six patients completed the study. The results were evaluated with SF-36 and AIMS2.Results. – Statistically significant improvement was observed in all subscales of SF-36. All subscales of AIMS2 improved too, but only half of them were significant. Correlation between matching subscales of each test was also significant, except physical activity.Conclusion. – Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term.     

Œdème intermittent, asymétrique et prenant le godet au cours du lupus érythémateux disséminé : deux cas étudiés par imagerie par résonance magnétique nucléaireRemitting asymmetrical pitting oedema in systemic lupus erythematosus: two cases studied with magnetic resonance imaging.

To our knowledge, only three cases of remitting symmetrical pitting oedema in systemic lupus erythematosus have been reported so far. This is the first report of two patients with asymmetrical pitting oedema and systemic lupus erythematosus. The first patient presented two consecutive episodes of unilateral oedema. The first episode involved the distal part of the right lower extremity and remitted spontaneously while the second involved the volar region of the left wrist and distal half of the forearm and promptly responded to steroids. Magnetic resonance imaging of the left wrist and forearm showed tenosynovitis of the flexor tendons and subcutaneous oedema. The second patient instead developed a single episode of pitting oedema of the distal part of the right lower extremity that resolved spontaneously. Magnetic resonance imaging of the right ankle and foot showed subcutaneous oedema without involvement of the tendon sheaths or osteoarticular and ligamental structures. These two cases suggest that pitting oedema in systemic lupus erythematosus may occasionally be asymmetric and associated or not with tenosynovitis.     

Une complication exceptionnelle de l’Angio-Behçet : l’érosion vertébrale. À propos d’un cas et revue de la littérature

La maladie de Behçet est une maladie systémique fréquente au Japon et dans les pays du pourtour méditerranéen. Elle est caractérisée par une vascularite de cause inconnue. Nous présentons ici l’observation d’un homme âgé de 47 ans, atteint d’une maladie de Behçet évoluant depuis 28 ans, qui a présenté une lombalgie aiguë d’apparence banale et chez lequel a été découverte une atteinte destructrice de la troisième vertèbre lombaire, secondaire à un pseudo-anévrisme géant de l’artère iliaque primitive droite. Nous discutons cette observation rare et nous présentons une brève revue de la littérature sur le sujet, en étudiant trois cas similaires rapportés précédemment.Behçet’s Disease is a multisystem disorder commonly seen in Japan and in Mediterranean countries characterized by a vasculitis of unknown origin. In this work we describe a case of a 47-years-old man with Behçet’s disease of 28 years evolution who presented with a common lumbago and revealed to have a rare case of destruction of the third lumbar vertebra due to a giant pseudoaneurysm of the right iliac artery. In the discussion, we make a brief review of the literature on the subject and analyse the existence of three similar cases.     

Analgésie contrôlée par le patient : étude de la demande en fentanyl chez le brûlé à la phase aiguë

This study assessed over the first post-burn week the patients' demands for opiates delivered with a PCA device, changes in opioid delivery along the day, especially during painful events and the incidence of side effects. Twenty-two patients (8 women, 14 men), mean age 33 years (± 12 SD), mean BSA 21 % (± 13 SD), mean deep dermal burn 12 % (± 11 SD) were included. Fentanyl was delivered by i.v. route using a PCA device during the first 6 days post burn. Bolus dose was fixed at 1 μg · kg⁻¹, lock-out time at 30 min and the 4 h limit dose at 7 μg · kg⁻¹. The following data were collected every day : satisfied and non-satisfied demands, total daily dose, demands during and after dressing change period (4 h), during afternoon (10 h) and overnight periods (10 h). Heart rate (HR), respiratory rate (RR), blood pressure (BP), Paco₂ and Spo₂ were also monitored. The mean total daily demands were similar from D1 to D6 (28 ± 7). Around 7 demands/day were not satisfied. The mean total daily satisfied demands were also the same : 21 ± 5. Individual demands were over a wide range (minimum : 15, maximum : 41 demands/day for total demands and 13 and 34 respectively for the satisfied ones). Mean fentanyl delivery was 1,7 ± 0,1 μg · kg⁻¹ · h⁻¹ during dressing period, 0,9 ± 0,3 μg · kg⁻¹ · h⁻¹ during afternoon period (10 h) and 0,5 ± 0,2 during overnight period (10 h). No-satisfied demands were around 4 boluses during dressing change period, 2 boluses during afternoon period, and one bolus during overnight period. Neither HR nor BP were modified for more than 20 % of control values ; RR never decreased under 12 c · min⁻¹ and Paco₂ remained unchanged. This study showed that the provision of analgesia in burn injury requires large doses of opioids. Individual demands are scattered over a wide range. The need for analgesics remains unchanged for several days. A PCA device is an efficient and safe tool for administration of opioids. Analgesia is appropriate, except during the dressing period.