Revue du Rhumatisme Monographies最新文献

Rheumatologists and internists may need to establish the etiological diagnosis and handle the therapeutic management of adults with uveitis. A prospective study named ULISSE (Uveitis: clinical and medicoeconomic evaluation of a standardized strategy for etiological diagnosis) has shown that a standardized strategy for the etiological diagnosis of uveitis was neither inferior nor superior to an open strategy. Subsequent analysis showed that only a few diagnostic tests were useful for the etiological assessment of uveitis. These tests were often inexpensive, simple, usually guided by clinical findings, and allowed an etiological diagnosis to be made for many patients. Three systemic diseases are particularly prevalent in patients referred to internists or rheumatologists: HLA-B27- and spondyloarthritis-associated uveitis, Behçet's disease, and sarcoidosis. Uveitis associated with spondyloarthritis follows a « rule of 90 »: around 90 of cases are unilateral, anterior, and acute. Among patients with uveitis and spondyloarthritis, about two thirds are diagnosed with joint disease during a uveitis assessment. Patients with inflammatory or noninflammatory low back pain should be routinely evaluated for spondyloarthritis, which is the leading cause of uveitis in western countries. The risk of blindness is extremely low, and the main complication is recurrent uveitis, seen in 50 to 60 % of cases. Sulfasalazine decreases the frequency, duration, and severity of uveitis and can be used prophylactically. Sarcoidosis is an underestimated cause of uveitis, which occurs in 15 % of cases, with a predilection for middle-aged women. The treatment of sarcoid uveitis largely follows the general principles of idiopathic uveitis. Behçet's disease uveitis affects young people of both sexes and of all origins and usually presents as panuveitis and retinal vasculitis. The treatment of Behçet's uveitis aims at a complete disappearance of the ocular inflammation. The prognosis of the severe and refractory forms has been dramatically changed by the introduction of TNF-α antagonists.

Contact loss between the articular disc and the TMJ mandibular condyle, and the excessive stress on lateral pterygoid muscles can lead to temporo-mandibular dysfunction (TMD) in roughly 5% of people (twice more often in females). The TMD syndrome is a mix of pain and cliking arising from temporo-mandibular joint, sometimes associated with otalgia or tinnitus, and regional hypersensitivity, with myo-fascial pain of neighbouring muscles (masseter, temporalis, and sometimes sternocleidomastoid, scalenus, trapezus). Main symptoms are TM pain, often combined with cervicalgia and temporal and occipital headaches. Tinnitus and otalgia can also be found and are suggestive of the diagnosis when they occur during mouth opening. Pain in the throat and the face can also be noticed. A tenderness of the temporo-mandibular joint, an audible “click”, and an asymmetrical opening of the mouth, reduced to less than three fingers, are main findings. Several underlying disorders must be searched for: (1) malocclusion, sometimes induced by orthodontics treatments; (2) inappropriate dental prosthesis; (3) maxillo-mandibular dysmorphosis; (4) abnormal deglutition with tongue interposition during the 2500 oral stages of swallowing, so that speech therapist advice can be welcome; (5) cervical scoliosis and asymmetrical hearing or sight can worsen myofascial syndromes; (6) stress and fibromyalgia can coexist but are not the main source of TMD. Occlusal treatment, physiotherapy, cognitive-behavorial treatment seem the most useful treatments of this frustrating disorder, soft occlusal splint therapy being little effective.

The upper cervical spine (occiput-atlas-axis) is an osteo-ligamentary system that may be subject to specific lesions in chronic inflammatory diseases of the spine. Rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, and articular chondrocalcinosis can lead to destruction or calcification of the osteo-ligamentary elements and result in situations of biomechanical instability and/or compression of the neuraxis. The purpose of this article is to summarize the current indications and to present the most recent considerations regarding surgical management. It should be noted that the indications for inflammatory diseases of the upper cervical spine tend to decrease. The surgical principles of decompression/stabilization remain broadly classical, adapted to the anatomical situation. For decompression, a technical innovation is the anterior approach by nasal endoscopy, but it is not very widespread. For stabilization, the most recent work favors the shortest fixtures and shows the interest for the concept of sagittal spinal balance at the cervical level.

Parotid enlargement can be of inflammatory (sialitis), metabolic or tumoral. Many systemic diseases, mainly Sjögren's syndrome and sarcoidosis, can lead to parotid hypertrophy. The differential diagnosis, which is sometimes difficult, despite radiological investigations) (ultrasound, MRI, cytological fine needle puncture) will be infectious, lithiasis or tumor.

Giant cell arteritis affects between 15 and 45 people out of 100,000 people over 50 in Northern Europe. The cranial form predominates and impacts the functional prognosis due to the ophthalmologic involvement and the risk of blindness. New recommendations have facilitated the diagnosis by favoring the use of ultrasound of supra-aortic and temporal arteries in the face of a high clinical probability.

Facial nevralgias are rare but debilitating paroxystic or chronic pains. Consensual diagnostic criteria can help to establish the diagnosis, but misleading presentations exist. Trijeminal neuralgia has a pic incidence in women in theirs 1950s. Patients complains of lightning pain in the territory of a branch of the trijeminal nerve. The nerve lesion is most often secondary to a microvascular compression. The pain is triggered by a light sensation on a small area of the face. Pain are severe and sometimes confused with a dental affection. Pharmacotherapy is primarily based on carbamazepine/oxcarbazepine. Microvascular decompression is offered to patients not sufficiently controlled medically. Cluster headache is more common in young men. The pain last 30 minutes to one hour is periorbital. Region and is accompanied by cranial autonomic symptoms. Cluster attacks have a circadian and circumannual rhythmicity. The pathyphysiology is nor fully understood. Intranasal/subcutaneous triptan or high concentration oxygen inhalation are the mainstay of acute treatment. Prevention of cluster recurrence is based on verapamil or lithium administration. Postherpetic neuralgia is defined of the persistence of pain 3 months after a herpes zoster rash. The prevalence of the disease increased with age. It presents as a chronic neuropathic pain that must be treated with appropriate medications. Other facial nevralgias have been described such as occipital or glossopharyngeal nevralgia. Due to their significant impact on quality of life, awareness of the entities is critical an early and to avoid misdiagnosis.

Giant cell arteritis is the most frequent vasculitis affecting the temporal artery. However, other types of vascular diseases, that are vasculitis or not, may affect the temporal artery. Among them, ANCA-associated vasculitis is probably the most common vasculitis. It typically affects peri-adventitial small vessel of the temporal artery and sometimes mimic signs of giant cell arteritis with other symptoms that are more specific of ANCA-associated vasculitis and lead to search for ANCA. IgG4-related disease can also cause temporal arteritis. Some infections can also affect the temporal artery. It essentially relies on varicella-zoster virus (VZV), a herpes virus that has an arterial tropism and whose the role in triggering giant cell arteritis has been suggested. Drugs, mainly checkpoint inhibitors that are used to treat cancer, can also trigger giant cell arteritis. The temporal artery can also be affected by diseases other than vasculitis such as atherosclerosis, calcyphilaxis, aneurysm or arteriovenous fistula. In this review, we describe these different diseases affecting the temporal artery.

The international therapeutic recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) associated with therapeutic education. Cognitive and behavioural therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a bio-psycho-social vision of rehabilitation. To allow for an optimal personalisation of the rehabilitation's therapeutic approach, the clinician can use simple and validated instruments for measuring physical performancethat will highlight levels of physical condition ranging from low to very low. Several systematic reviews and meta-analyses show strong evidence that supervised aerobic and resistance training programs reduce the pain's intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trial (RCT) studies among male FM subjects and adolescents.

The prescription of physical activity has been included in France in the Public Health Code since 2016. This practice aims to encourage and maintain regular and appropriate physical activity for patients with long-term disability. The prescribing doctor carries out a preliminary assessment to identify the patient's risks, particularly cardiovascular risks, as well as the need for physical activity. The doctor indicates on the prescription the recommended modalities of physical activity (aerobic, muscular strength, flexibility, etc.) as well as the elements of frequency, intensity, temporality and the type of activity recommended. The patient's fears and beliefs as well as the motivation are also indicated. Depending on the functional impairment, the patient can be referred to different health professionals. The development of the skills necessary for prescribing physical activity and interprofessional coordination will be two future challenges in the promotion of physical activity for patients.