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.     

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.     

Évaluation de la reproductibilité et de la validité de construit d’une forme modifiée de l’indice algofonctionnel de Lequesne dans l’arthrose du genouAssessment of the test-retest reliability and construct validity of a modified Lequesne index in knee osteo-arthritis

Objectives. – To assess the test-retest reliability and the construct validity of a modified version of the Lequesne index.Methods. – Patients with symptomatic knee osteo-arthritis fulfilling the revised criteria of the american college of rheumatology completed the Lequesne index twice at a 3 h interval. Impairment outcome measures and patients’ perceived discomfort in walking and handicap were recorded. An item by item analysis was performed. Items having insufficient psychometric properties were excluded. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using Spearman rank correlation coefficient and a factor analysis was performed.Results. – Eighty-eight patients were included. One question assessing pain (question IE) had a weak reliability (Kappa = 0.39) and was excluded. The test-retest reliability of the modified questionnaire was excellent (ICC = 0.95). Expected convergent and divergent correlations were achieved excepted for Vas pain and Vas handicap (0.46 and 0.40 respectively), and the “a priori” double stratification was confirmed by factor analysis, explaining 48.7% of the variance.Conclusion. – The modified form of the Lequesne index has sufficient psychometric properties to be used to assess pain and function in knee osteo-arthritis in a french population.     

Retentissement osseux de l’anorexie mentale

The objective of this study was to evaluate the epidemiology, diagnosis, pathophysiology, and treatment of bone loss related to anorexia nervosa. Earlier onset and longer duration of anorexia nervosa are associated with more severe bone loss. Osteoporosis develops in 38 to 50% of cases. Bone mineral density measurement by dual-energy X-ray absorptiometry is useful for assessing bone mass, and bone marker assays provide information on bone turnover. Bone loss in anorexia nervosa is probably multifactoriel. Estrogen deficiency was long felt to be the major factor. However, in contrast to postmenopausal osteoporosis, bone loss associated with anorexia nervosa is related mainly to inadequate bone formation, with only a slight increase in bone resorption. This suggests a role for nutritional factors, such as disturbances in the growth hormone-somatomedin C axis (GH/IGF-I) related to malnutrition. The best treatment strategy for correcting bone mass in patients with anorexia nervosa is not agreed on. Resumption of menstrual cycles and weight gain seem necessary but not always sufficient. Studies found no benefits with estrogen therapy, but this was usually given as estrogen–progestin contraceptives. No vast studies evaluating hormone replacement therapy have been reported. Bone formation enhancers such as IGF-I seem to provide the best results, most notably when used in combination with estrogens. This suggests that complex treatment strategies combining bone formation enhancers and bone resorption inhibitors may deserve evaluation.     

Épaule aiguë hyperalgique atypique : intérêt de l’échographie

A patient presented with an atypical pattern of acute severe shoulder pain. Sonography elucidated the mechanism of the pain and allowed effective treatment. The patient was unable not only to move her shoulder but also to flex and to extend her elbow. Sonography showed a calcific deposit in the subscapularis tendon with local edema displacing the long head of the biceps tendon out of the bicipital groove. Local injection of a glucocorticoid under ultrasonographic control was followed within seven days by subsidence of the subscapularis tendon edema and by a return of the long head of the biceps tendon to its normal position in the bicipital groove.