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Hormone therapy provides an excellent survival rate after cancer but has many side effects, including joint pain in one out of two women. This leads about 13 % of women to stop their treatment within the first 6 months, impacting on its effectiveness, survival and the risk of recurrence. In order to better manage pain and quality of life, physical activity is highly recommended. In this context, the present review proposes a state of the art on the effects of adapted physical activity, based on the works referenced in PubMed. These studies show that physical activity has proved its worth in the primary prevention of cancer and is being evaluated in secondary prevention, particularly in the reduction of adverse effects. Overall, there is a reduction in joint pain, an improvement in quality of life and fatigue. Physical activity also plays a role in tertiary prevention. Paradoxically, oncologists and educators often note a reduction in the practice of physical activity due to fear of the onset of pain. It seems necessary to reinforce communication with patients and health professionals and to recommend the practice of physical activity in an appropriate setting.

Resume La maladie de Whipple est une infection rare causee par Trophyrema whipplei dont l’issue peut etre fatale en l’absence de traitement adapte. Dans la presentation clinique, deux formes s’opposent : la maladie de Whipple classique et les infections localisees a un organe (cœur, systeme nerveux central). La forme classique de la maladie de Whipple associe une alteration de l’etat general avec perte de poids, des signes digestifs et des manifestations articulaires. Les arthrites liees a T. whipplei sont seronegatives, palindromiques et touchent le plus souvent les grosses articulations. La symptomatologie aspecifique et variee, l’absence de culture sur des milieux standard et sa faible incidence font de la maladie de Whipple une infection particulierement difficile a diagnostiquer, avec un delai diagnostique de plusieurs annees dans la majorite des cas. Le diagnostic repose sur la biologie moleculaire (PCR quantitative T. whipplei) dans differents fluides de l’organisme (selles, salive, urines et sang) et l’examen histologique, notamment duodenales dans la forme classique de maladie de Whipple. Tout cas confirme d’infection a T. whipplei doit faire realiser une ponction lombaire a la recherche d’une atteinte neurologique associee. A ce jour, il n’existe pas de recommandation internationale pour le traitement des infections a T. whipplei. Le traitement propose repose sur l’administration de cephalosporines de 3e generation en traitement d’attaque, relaye par la suite par un traitement per os par sulfamethoxazole/trimethoprime en premiere intention (alternative, doxycycline + hydroxychloroquine), pour une duree minimale d’au moins un an. Les rechutes et la survenue de syndrome de reconstitution immunitaire sont les principales complications qui surviennent, essentiellement en cas d’atteinte neurologique.

National audience; Whipple disease is a rare chronic infection due to Trophyrema whipplei, potentially lethal in the absence of appropriate anti-infective treatment. The clinical presentation is either of classical Whipple disease or of localized infection. Symptoms of classic Whipple disease include weight loss, diarrhea and arthralgia. Arthropathy is usually migratory, seronegative and non-destructive joint disease affecting preferentially large peripheral joints. Polymorphous and non-specific symptoms and signs, combined with its low incidence and the failure to grow on standard culture media make Whipple disease a hard-to-diagnose infection, with a diagnosis delay of several years after symptoms onset in most cases. The diagnosis of classical Whipple's disease is based on PCR using sample fluids (stool, saliva, urine and blood) and has to be confirmed by duodenal biopsies. To date, there are no guidelines available for the treatment of T. whipplei infections. Current anti-infective treatment is based on third generation cephalosporins on initial course, and then be followed by oral doxycyclin (or sulfamethoxazole-trimethoprim) for at least twelve months. Relapses and immune reconstitution inflammatory syndrome are the main complications.

When acute arthralgia is associated with focal osteoporosis and reversible epiphyseal edema, all three spontaneously resolving without sequelae in a few months, it is then called transient focal osteoporosis. Well known at the hip, this pathology may be expressed at other joints and have a migratory character. In this case report, the patient presented himself with migrating transient focal osteoporosis that successively undertook, over one year, various anatomical zones within the same knee and then reached the contralateral knee. The evolution was characterized by a healing without sequelae after discharge and analgesic treatment.Lorsqu’une arthralgie aiguë est associée à une ostéoporose focale et à un oedème épiphysaire réversible, tout trois spontanément résolutifs sur le plan clinique et iconographique sans séquelles en quelques mois, la pathologie est alors nommée ostéoporose régionale transitoire. Bien connue à hauteur de la hanche, elle peut s’exprimer au niveau d’autres articulations, préférentiellement portantes des membres inférieurs et posséder un caractère migratoire. Dans ce rapport de cas, le patient a présenté une ostéoporose focale transitoire migrante touchant successivement, sur une année, diverses zones anatomiques au sein d’un même genou pour atteindre ensuite le genou controlatéral. L’évolution s’est caractérisée par une guérison sans séquelles après décharge et traitement antalgique.

The aim of this systematic review was to understand which procedure – total or partial wrist denervation – provides better results in terms of pain relief and function. This review was registered on PROSPERO (CRD42018088856). We searched the Medline (PubMed), Web of Science and Scopus databases. Twenty-one studies were included in this review. We assessed the quality of the studies using the Coleman Methodological Score. Data on demographics, surgical indications, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to work, and outcome measures were recorded. A total of 1065 patients were included in this review; the mean quality of the studies included was considered poor. The outcomes could not be analyzed because none of the studies had reliable outcome data reported, but both procedures were effective in terms of pain relief and range of motion. Partial wrist denervation has an average subsequent procedure rate of 19%. Total wrist denervation had an average subsequent procedure rate of 4.7%. No complications were reported in any patient who underwent partial wrist denervation versus 20 patients who underwent total wrist denervation. Both partial and total wrist denervation are safe and reliable procedures that can provide good pain relief and preserve wrist range of motion. Total wrist denervation offers better long-term outcomes in term of pain relief, with fewer subsequent procedures being needed compared to partial denervation, and with a low complication rate. Level of Evidence: Level III, Systematic review, Therapeutic.

New anti-cancer therapeutics have been developed in the recent years and dramatically change prognosis and patient management. Either used alone or in combination, immune checkpoint inhibitors (ICI), such as anti-CTLA-4 and anti-PD1/PD-(L)1, act by removing T-cell inhibition to enhance their antitumor response. This change in therapeutic targets leads to a break in immune-tolerance and a unique toxicity profile resulting in immune complications. These side effects, called Immune-Related Adverse Events (IrAEs), can affect all organs, with a wide range of clinical and biological presentations and severity. Various rheumatic and musculoskeletal manifestations have been reported in the literature, ranging from mild arthralgia, polymyalgia rheumatica, to genuine serodefined rheumatoid arthritis and myositis. Tolerance studies suggest some correlations between IrAEs occurrence and tumor response. Assessment of patient musculoskeletal status prior to the start of the ICI is warranted. Management of rheumatic IrAEs does not usually request ICI discontinuation, exception for myositis or very severe forms where it should be discussed. Treatment relies on non-steroidal anti-inflammatory drugs (NSAIDs) or low dose glucocortioids (20mg per day). Dose should be adjusted according to severity. The use of disease modifying anti-rheumatic drugs (DMARDs), either conventional and/or biological should be very cautious and result from a shared decision between oncologist and rheumatologist to best manage dysimmunitary complications without hampering the antitumor efficacy of ICI.

Still's disease is a rare multifactorial disease associated with systemic inflammation. Systemic-onset juvenile idiopathic arthritis and adult-onset Still's disease are both pediatric and respectively adult forms of the disease with a cut-off age of 16 years. The disease is characterized by the following features : hectic fever39° C, arthralgia or arthritis, rash, neutrophilia and systemic inflammation. The prognosis of the disease is functional and vital. The evolution over time is variable : regression, evolution by relapses with regression at term and chronic joint evolution. This focus describes the two forms of the disease, their complications and the therapeutic options.La maladie de Still est une maladie rare multifactorielle et associée à une inflammation systémique. L’arthrite juvénile idiopathique systémique et la maladie de Still de l’adulte sont les deux formes respectivement pédiatrique et adulte de la maladie, avec un âge seuil de 16 ans. Elle est caractérisée par les quatre éléments suivants : fièvre hectique39° C, arthralgies ou arthrites, éruption cutanée, neutrophilie et inflammation systémique. Le pronostic de la maladie est fonctionnel et vital. L’évolution au cours du temps est variable : régression, évolution par poussées avec régression à terme et évolution articulaire chronique. Cette mise au point décrit les deux formes de la maladie, leurs complications et les principes de leur prise en charge thérapeutique.

Charcot-Marie-Tooth disease (CMT) is classified into hereditary motor and sensory neuropathy and can induce severe neuro-orthopaedics deformities, disabling at an early age. Hip dysplasia is present in 6% of CMT patients affecting preferentially CMT1 patients and can appear from the age of 8 years. The pathophysiological is paradoxical because we are confronted with proximal osteoarthritis deformations but genetics research brings use new trail. The main functional complaint is a hip joint pain during walking. Four orthopaedics abnormalities can be revealed by physical and radiological exam: acetabular dysplasia, femoral dysplasia, high femoral antetorsion and excentric head of femur. The natural evolution, in the absence of treatment, is an early secondary osteoarthritis. The therapeutic management should be as early as possible with preventive measures and joint health. During the symptomatic phase, the only treatment is a surgical correction. A systematic clinical examination of the hip all CMT children and a radiograph of the pelvis at the slightest clinical suspicion is recommended.

Nous rapportons le cas d’un homme de 35 ans, ayant présenté tout d’abord des douleurs musculaires diffuses puis des douleurs articulaires, surtout au niveau lombaire et au niveau du genou droit. Le diagnostic de gonococcémie est effectué grâce aux hémocultures positives en absence de signes génitaux [Polyarthralgias in a young patient, what should we think about ?] We report the case of a 35 year old man, who first presented diffuse muscle pain and then joint pain, especially in the lumbar and right knee level. The diagnosis of gonococcal septicemia is done through positive blood cultures in the absence of genital signs.

Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by combined pustular skin eruption and arthralgia. It may be associated with inflammatory bowel disease or bowel bypass surgery. We report a case of BADAS in a patient with ulcerative colitis.A 39-year-old woman was being treated for a severe flare-up of ulcerative colitis present over the preceding 2 months and treated with prednisone, azathioprine and cyclosporine. She was also presenting a cutaneous eruption and arthralgia that had begun three days earlier. Dermatological examination revealed profuse vesicular and pustular lesions. Biopsy specimens showed mature neutrophilic infiltrate within the dermis. A diagnosis of BADAS was made and the same treatment was maintained. Systemic symptoms were resolved but the vesicular lesions were superseded by hypertrophic scars.Bowel-associated dermatosis-arthritis syndrome consists of a vesiculopustular eruption associated with arthralgia and/or arthritis and fever, as was the case in our patient. The histological picture is characterized by abundant neutrophilic infiltrate in the superficial dermis. The clinical and histological features and the course of BADAS allow this entity to be classified within the spectrum of neutrophilic dermatoses. Treatment chiefly involves systemic corticosteroids.

Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening dermatological conditions. Their most common cause is medication. However, in a small proportion of patients these dermatological conditions could be the first presentation of systemic lupus erythematosus. We now describe a 34-year-old patient who presented with manifestations of Stevens-Johnson as a first feature of systemic lupus erythematosus. Systemic lupus erythematosus reveled by Stevens-Johnson syndrome has been infrequently reviewed in the previous literature. This diagnosis should be considered when cutaneous adverse drug reactions occur without clear drug causality.

Vascular involvement in Behçet's disease is rare, but may be inaugural in many cases. We report a case of Behçet's disease revealed by two pre-rupture aneurysms - a subrenal abdominal aortic aneurysm and a femoral aneurysm. This patient had only one of the International Study Group for Behçet's disease diagnostic criteria: pseudofolliculitis. Behçet's disease must be considered as a possible diagnosis in patients with unexplained inflammatory arteriopathy.

Neisseria meningitidis is a Gram-negative bacteria that can be highly pathogenic in humans and responsible for life-threatening and acute diseases. In a few cases, it can lead to an atypical form of sepsis-acute, subacute, or chronic-which, even if progression is slower, may carry the same risks for patients as conventional acute forms.Case 1 presented with recurrent fever, polyarthralgia, and generalized macular rash. Case 2 had fever for the previous 10days with neck pain and macular rash. Blood cultures were positive for group B meningococcus in both cases. Polymerase chain reaction (PCR) analysis for the same pathogen was also positive in the cerebrospinal fluid (CSF) of Case 2. Following intravenous antibiotic treatment, the progression was favorable in both cases.Chronic meningococcemia is characterized by a triad of clinical features, including a fever lasting for at least 1week, arthralgia, and a cutaneous rash. This condition evolves positively without any sequelae if treated properly. PCR and blood culture are two complimentary tools that support the diagnosis.Meningococcal infection can manifest in a variety of ways. Chronic meningococcemia diagnosis should be considered in a triad of prolonged fever, rash, and arthralgia. Better access to state-of-the-art techniques such as PCR is recommended in the future so as to provide optimal care of patients suffering from this condition.

Idiopathic granulomatous mastitis (IGM) is a benign, aseptic inflammatory disease of unknown origin, which must be distinguished from tumoral and infectious processes that affect the breast, including tuberculosis. IGM is a rare cause of erythema nodosum, but it is useful for dermatologists to be aware of this association.A 32-year-old nulliparous woman presented with erythema nodosum, arthralgia and fever. On examination, she had a firm and painful mass of 5cm in the right breast with retraction and axillary adenopathy. The breast lump developed gradually over the preceding 4 months. Although two biopsies showed no evidence of atypical cells, inflammatory areas and a granulomatous process were seen. Culture of breast tissue for mycobacteria was negative. A diagnostic of idiopathic granulomatous mastitis was made. Systemic corticosteroids led to a reduction in size of the mass, but relapse occurred in the contralateral breast on dose-reduction of the corticosteroids.IGM is a rare disease of unknown aetiology. Diagnosis is based on characteristic histological features and exclusion of other granulomatous diseases. Extra-mammary signs are rare and include erythema nodosum, arthralgia and episcleritis. Management is poorly codified.

Gonalgia is a frequent reason for consultation of a primary care physician. The road leading to diagnosis is mainly clinical. A detailed medical history and physical examination are capital for establishing diagnostic hypotheses and choosing the most appropriate imaging test. Initially, a simple X-ray of the knee joint is the most common exam, even though it is not always needed, especially after a minor trauma. MRI and CT-scan allow a more detailed examination of the structures; however, they should only be ordered to answer a specific question. Most of the time, echography is reserved to extra-articular pathologies and for guiding an articular tap.

Herein we report a case of cat scratch disease on account of its atypical presentation.A 21-year-old woman presented erythema nodosum associated with painful bilateral inguinal adenopathy, odynophagia, joint pain and evening urticaria in a setting of impaired general condition. Initial serological testing for Bartonella henselae was negative. PCR for Bartonella henselae performed on an adenectomy fragment was positive. A favourable outcome was achieved with azithromycin.This case shows an atypical and severe presentation of cat scratch disease and raises the problem of sensitivity of serotyping.

Bullous lupus is a subepidermal autoimmune bullous dermatosis, a rare entity that forms one of the cutaneous signs of systemic lupus erythematosus. We report on the clinical, immunopathological and progressive features of bullous lupus in three patients.Our patients consisted of two women and one man aged 34, 22 and 30 years respectively. A diagnosis of bullous lupus erythematosus was evoked by blisters or vesicular blisters and confirmed, in addition to criteria for the diagnosis of systemic lupus erythematosus, by the presence of subepidermal blistering with infiltrate containing neutrophils and eosinophils as revealed by histological analysis, and of deposits of IgG and IgM (two cases) or of IgA (one case) at the dermo-epidermal junction observed under direct immunofluorescence. Indirect immunofluorescence showed anti-collagen VII antibodies. Lupus nephritis was present in two cases. Our patients were treated with corticosteroids and immunosuppressants.Bullous lupus erythematosus may be the first sign of systemic lupus erythematosus with severe visceral involvement, especially renal involvement, suggesting that it may be a marker of activity and prognosis.

This survey has been realized in order to show the diagnostic interest of the standard radiography in the non traumatic knee's pain.The main objectives of this work were to describe the elementary lesions, the etiological aspects of the non traumatic knee's pain and to list the met pathologies.It was about a prospective survey of six months (december 2007-may 2008) track in the departments of radiology of the Teaching Hospitals of Lomé and on a population of 187 patients enduring a non traumatic knee's pain.The frequency was of 2.5%. The average of age was of 48.55 years (extreme: 18 and 92 years). The feminine sex (63.10%) was the most represented. The housewives were the most represented (36.36%). of The bodily mass indication was consisted between 09 and 42 Kg/m2s with an average of 25.65 Kg/m2s. The osteophyte (26.67%) was the most observed elementary radiographic lesion. The arthrosic knee (47.71%) was the dominant pathology and the chondrocalcinose (02.74%) least represented. A predominance of the tricompartimentale arthrosic knee (38.46%) was cleared itself. The malformatives abnormalities were in 58.62% of the osteoarthritis cases seat.This survey reveals the importance diagnostic of the x-ray and the wealth of the pathology of the knee in Africa particularly in Togo.

International audience; Primary Sjögren syndrome (pSS) is a progressive autoimmune disease characterized by sicca and systemic manifestations. In this Review, we summarize the available data on topical and systemic medications, according to clinical signs and disease activity, and we describe the ongoing studies using biologic drugs in the treatment of pSS. Expanding knowledge about the epidemiology, classification criteria, systemic activity scoring (ESSDAI) and patient-reported outcomes (ESSPRI) is driving active research. Treatment decisions are based on the evaluation of symptoms and extraglandular manifestations. Symptomatic treatment is usually appropriate, whereas systemic treatment is reserved for systemic manifestations. Sicca is managed by education, environment modification, elimination of contingent offending drugs, artificial tears, secretagogues and treatments for complications. Mild systemic signs such as fatigue are treated by exercise. Pain can require short-term moderate-dose glucocorticoid therapy and, in some cases, disease-modifying drugs. Severe and acute systemic manifestations indicate treatment with glucocorticoids and/or immunosuppressant drugs. The role for biologic agents is promising, but no double-blind randomized controlled trials (RCTs) proving the efficacy of these drugs are available. Targets for new treatments directed against the immunopathological mechanisms of pSS include epithelial cells, T cells, B-cell overactivity, the interferon signature, proinflammatory cytokines, ectopic germinal centre formation, chemokines involved in lymphoid cell homing, and epigenetic modifications.

Intravesical BCG immuno-therapy with maintenance therapy is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. In practice, adverse events (AEs) of BCG therapy could restrict its prescription by urologists. The aim of this article was to present a review of these AEs and of their management.A bibliographic research in French and English using Medline(®) and Embase(®) with the keywords "BCG", "bladder", "complication", "toxicity", "adverse reaction", "prevention" and "treatment" was performed.The main mechanism of AEs of BCG are infectious (cystitis, fever), immuno-allergic (granulomatous prostatitis, epididymo-orchitis, and granulomatous reactions) and auto-immune (arthralgies, rash). Management of AEs is based on their pathophysiological mechanisms. Classifications of BCG therapy AEs based on clinical features allow to adapt their treatments.The combination of antibiotics directed against BCG, steroid or non-steroidal anti-inflammatory medication and symptomatic treatment is currently the triad on which is set up the appropriate treatment of severe AEs. Reductions of BCG doses and ofloxacin medication after instillation decrease the frequency and severity of minor and moderate AEs. Severe or more than 7 days long infectious AEs, immuno-allergic AEs or auto-immune during more than 7 days impose cessation of BCG immuno-therapy.