Ines Mahmoud

[Assessment of depression in rheumatoid arthritis: a cross sectional study on 60 patients].

OBJECTIVE To assess the prevalence of depression in a series of Tunisian patients with rheumatoid arthritis (RA) and to identify factors associated with its occurrence. METHODS We performed a cross sectional study on 60 patients with RA. The evaluation of depression was performed using the Montgomery and Asberg depression rating scale. RESULTS Our study revealed a high prevalence of depression in RA patients (45%). The main predictor factors of its occurrence were female gender, absence of professional activity, absence of social support, high activity of RA, impaired quality of life and existence of structural damage. PERSPECTIVES Our results highlight the importance of a good management of RA in order to prevent the occurrence of depression. They also underline the interest of screening for depression in RA patients to avoid its adverse effects on the course of RA.

Prévalence et facteurs prédictifs de la dépression au cours de la polyarthrite rhumatoïde

OBJECTIVE To assess the prevalence of depression in a series of Tunisian patients with rheumatoid arthritis (RA) and to identify factors associated with its occurrence. METHODS We performed a cross sectional study on 60 patients with RA. The evaluation of depression was performed using the Montgomery and Asberg depression rating scale. RESULTS Our study revealed a high prevalence of depression in RA patients (45%). The main predictor factors of its occurrence were female gender, absence of professional activity, absence of social support, high activity of RA, impaired quality of life and existence of structural damage. PERSPECTIVES Our results highlight the importance of a good management of RA in order to prevent the occurrence of depression. They also underline the interest of screening for depression in RA patients to avoid its adverse effects on the course of RA.

Pulmonary nodules in a patient with rheumatoid arthritis: Which diagnostic approach is the most appropiate?

Background: Pulmonary nodular excavation should firstly evoke tuberculosis or necrosis broncho-pulmonary tumor, particularly: epidermoid carcinoma. The case discussed here illustrated these difficulties in patients with rheumatoid arthritis (RA). Case Presentation: A 63-year-old woman was presented with a-three-year history of RA and a recent discovery of an excavated pulmonary nodule. Initial investigations focused on a rheumatoid origin. The evolution of the disease was worrisome and surgical exploration was deemed mandatory. The result was the discovery of a nodule of a malignant nature. Conclusion: In this paper, we discussed the excavation of the pulmonary nodule, its diagnoses and management of the difficulties we encountered.

Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients

BACKGROUND Knee osteoarthritis is a common pathology, characterized by a prevalence that increases with age. Absence of anatomo-clinical correlation is a complex management, particularly in a geriatric setting where it is not well studied. OBJECTIVE The aim of the present study is to investigate the epidemio-clinical profile, functional impairment and radiographic features of knee osteoarthritis in the old patients versus younger patients (<65 years). METHODS Cross-sectional study includes patients who were monitored for 6 months at a rheumatology department for knee osteoarthritis. Epidemio-clinical, anthropometric and radiographic data were gathered. A comparison was made of these various characteristics between patients of over 65 years of age (group1; n=56) and those under 65 (group2; n=56). RESULTS The mean age of the group 1 patients was 71±5 with a clear feminine predominance. Comorbidity was observed in two thirds of cases. More than half of them were overweight. Gonalgia had been evolving for approximately 8.4±9.2 years and was bilateral in 82.6% of the cases and of mechanical type in 94.6% of the cases. The patients experienced an average pain scale of 65.2mm. Pain had an anterior site in major of cases. An axial deviation of the lower limbs were observed in 60.7% of the cases and a limited mobility of the knees in 48.2% of the cases. The mean value of Lequesne index was 11.02±4.8. The walking distance was not limited in 37.5% of the cases. Radiographically, knee osteoarthritis was bilateral in all cases and stage 4 was observed in 50% of the cases. Comparative study showed that elderly patients had a smaller waist size (p=0.003), a longer course of gonalgia (p<0.0001), a widespread site of pain (p=0.004), and a more frequent limitation of walking distance (p<0.0001) as well as more axial deviation (p<0.0001) and joint mobility limitation (p=0.005). Gonalgia manifesting during rest was more frequent in elderly patients (p=0.001). In addition, impaired functioning (p=0.001) and the stage of radiographic damage (p=0.02) were more advanced in elderly patients. CONCLUSION The present study shows that knee osteoarthritis is more severe in the elderly patients in terms of clinical presentation and functional impairment.

Sacroiliac Joint Involvement in von Recklinghausen Neurofibromatosis

Neurofibromatosis (NF) type I is a genetic disorder caused by a mutation of the NF type I gene. This disease is associated with a variety of skeletal manifestations. In this article, we report a 33-year-old female patient with a known history of von Recklinghausens disease and inflammatory right buttock pain. Diagnostic imaging pointed out unilateral sacroiliitis possibly of a septic origin. Sacroiliac biopsy showed histological patterns consistent with NF. This case report summarizes an exceptional localization of NF mimicking the imaging of infectious sacroiliitis.

Osteonecrosis of the metatarsal head with exuberant periostitis.

Idiopathic necrosis of the metatarsal head is unusual in adulthood. We report five cases of an atypical necrosis of the metatarsal head with a solid periosteal reaction in adults. Different imaging features are reported and diagnosis difficulties are highlighted.

Article originalPrévalence et facteurs prédictifs de la dépression au cours de la polyarthrite rhumatoïdeAssessment of depression in rheumatoid arthritis: A cross sectional study on 60 patients

OBJECTIVE To assess the prevalence of depression in a series of Tunisian patients with rheumatoid arthritis (RA) and to identify factors associated with its occurrence. METHODS We performed a cross sectional study on 60 patients with RA. The evaluation of depression was performed using the Montgomery and Asberg depression rating scale. RESULTS Our study revealed a high prevalence of depression in RA patients (45%). The main predictor factors of its occurrence were female gender, absence of professional activity, absence of social support, high activity of RA, impaired quality of life and existence of structural damage. PERSPECTIVES Our results highlight the importance of a good management of RA in order to prevent the occurrence of depression. They also underline the interest of screening for depression in RA patients to avoid its adverse effects on the course of RA.

Original Etiology of Acute and Febrile Neck Pain: Cervical Calcification of Ligamentum Flavum

Calcification of Ligamentum Flavum (CLF) is an uncommon disorder. We present a 56-year-old patient with an acute inflammatory, febrile neck pain and higher value of ESR mimicking spine infection. The imaging investigations conclude for the diagnosis of calcification of the ligamentum flavum. Our observation illustrate the difficulties to differentiate, clinically, infection and calcium pyrophosphate dihydrate deposition in the spine and emphasize the importance of the imaging step in the diagnosis approach. Finally, we draw attention to the efficacy of medical treatment in our case and we discuss the different therapies proposed in the literature.