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Objectives Osteoarthritis is a painful joint disease responsible for walking impairment. Its quantitative assessment by gait analysis in mice may be a relevant and noninvasive strategy to assess the disease severity. In this study, we aimed to determine the severity of osteoarthritis at the tissular and gait levels in unilateral and bilateral posttraumatic murine osteoarthritis. Methods Twenty-four C57BL/6 male mice were randomly assigned to 3 groups ( n = 8/group): controls, unilateral surgery, and bilateral surgery. Posttraumatic osteoarthritis was induced unilaterally or bilaterally by destabilization of the medial meniscus. Gait analysis was performed weekly with the CatWalkTM XT system until the 16th week after surgery. After animal sacrifices, histological and micro–computed tomographic assessment was performed. Results Operated knees showed a significant increase in the histological score compared with controls ( P < 0.001). Calcified anterior medial meniscal bone volume was higher on the ipsilateral side after unilateral destabilization of the medial meniscus ( P < 0.001) and on both sides after bilateral intervention ( P < 0.01). One week after surgery, the mice mean speed decreased significantly in both operated groups ( P < 0.001 and P < 0.05). In the unilateral group, a significant increase in the contralateral hind print area appeared from week 4 to week 16. Conclusions While bilateral destabilization of the medial meniscus induced no detectable gait modification except 1 week after surgery, unilateral model was responsible for a gait disturbance on the contralateral side. Further studies are needed to better define the place of the CatWalkTM in the evaluation of mouse models of osteoarthritis.

Musculoskeletal corticosteroid injections are widely performed, although the exact practice varies greatly due to advances in knowledge and techniques. This justifies updating and drawing up good practice recommendations. Using a consensus model formalized by the French National Authority for Health (HAS) and based on a literature review that resulted in a "white book‿, 13 recommendations were developed by a group of experts. These recommendations were then sent online to 48 specialists for evaluation, 27 of whom were rheumatologists and 15 of whom were general practitioners. These recommendations were also presented at the 34th annual meeting of the French Society for Rheumatology (SFR) (Paris, December 2021) at a symposium attended by a hundred or so rheumatologists, who voted on these recommendations in person. The results are presented as an overall score out of 10, a median out of 10 and as tertiles. The agreement was excellent for 10 of these 13 recommendations, with mean values of 8.5 to 9.1 out of 10, median values of 9 or 10 out of 10 and agreement of 91.7% to 97.9%, which corresponds to a consensus. The 3 other recommendations were broadly supported but were the subject of more debate. One relates to patient information (mean 7.3/10, median 8/10, upper tertile 72.9%) with discussion about the waiting period. Another related to the summary report (mean 8.4/10, median 9, upper tertile 91.7%) with discussions about its content and the need to specify the lot number of the injected product. The last one related to periprosthetic injections and the need to consult and get approval from a specialist (mean 8.0/10, median 8, upper tertile 83.3%) with mostly the general practitioners having reservations. In all, there is a very strong consensus among the musculoskeletal corticosteroid injection experts and specialists consulted, which justifies them being taken into consideration to improve our daily practice.

Resume Objectifs La plupart des etudes retrouvent une majoration du risque de fractures vertebrales chez les patients acromegales, malgre une densite minerale osseuse normale. Nous avons etudie la prevalence des fractures vertebrales chez les patients acromegales de moins de 80 ans suivis au CHU de Nantes. Methode Etude transversale monocentrique realisee au CHU de Nantes de 1988 a 2018. Cinquante patients (18 femmes, 32 hommes) d’un âge median de 52,3 ans (27 -78 ans) ont ete inclus. Les fractures vertebrales etaient evaluees sur des radiographies conventionnelles des rachis lombaire et thoracique de face et de profil, selon la methode semi-quantitative de Genant. Nous avons egalement etudie les deformations vertebrales autres que les fractures, en utilisant 3 criteres : presence d’osteophytes, presence de pincement discal et aspect cuneiforme des vertebres. Nous avons analyse la densite minerale osseuse par absorptiometrie bi-photonique et le statut hormonal. Resultats Trois patients (6 %) presentaient une fracture vertebrale : une fracture de grade 1 et 2 fractures de grade 2 selon la classification de Genant, chez deux patients osteoporotiques et un patient osteopenique. Leurs deficits ante-hypophysaires etaient substitues. En considerant les deformations franches (osteophyte ou pincement discal ≥ grade 2 ou aspect cuneiforme), le rachis dorsal etait deforme chez 22 patients (44 %) et le rachis lombaire chez 21 patients (42 %). Conclusions Les patients acromegales presentaient une faible prevalence de fractures vertebrales, mais un nombre important de deformations vertebrales. Nous supposons que cette forte prevalence de deformations franches pourrait expliquer la forte prevalence de fractures vertebrales rapportee precedemment.

Some patients with moderate haemophilia (PWMH) report joint damage potentially responsible for gait disorders. Three-dimensional gait analysis (3DGA) is a relevant tool for the identification of complex musculoskeletal impairment. We performed an evaluation with 3DGA of 24 PWMH aged 44.3 ± 16.1 according to their joint status [Haemophilia Joint Health Score (HJHS) < 10 or HJHS ≥ 10] and assessed the correlation with the radiological and clinical parameters. Sixteen had HJHS < 10 (group 1) and eight had HJHS ≥ 10 (group 2). They were compared to 30 healthy subjects of a normative dataset. Both knee and ankle gait variable scores were increased in group 2 compared to the controls (p = 0.02 and p = 0.04, respectively). The PWMH of group 2 had a significant increase in their stance phase, double support duration, and stride width compared to the controls and group 1 (p < 0.01). Very low correlations were found for the ankle gait variable score with the ankle Pettersson sub-score (r2 = 0.250; p = 0.004) and ankle HJHS sub-score (r2 = 0.150; p = 0.04). For the knee, very low correlation was also found between the knee gait variable score and its HJHS sub-score (r2 = 0.290; p < 0.0001). Patients with moderate haemophilia presented a gait alteration in the case of poor lower limb joint status.

Objectives Patients with acromegaly appear to be at increased risk of vertebral fractures despite normal bone mineral density. We investigated the prevalence of vertebral fractures in a cohort of acromegalic patients under 80 years of age. Methods Monocentric cross-sectional study performed at Nantes University Hospital from 1988 to 2018. Fifty patients (18 females, 32 males) with a median age of 52.3 years (range: 27–78) were included. Radiological vertebral fractures were evaluated on conventional lumbar and thoracic spine radiographs using Genant's semiquantitative fracture assessment. We studied qualitative abnormalities of the spine using three criteria: osteophytes, disc-space narrowing and wedge-shaped vertebrae. We analysed bone mineral density and endocrine status. Results Three patients (6%) had a vertebral fracture: one grade 1 and two grade 2 according to Genant's assessment, with two osteoporotic and one osteopenic patients. They had no unsubstituted pituitary deficiency. Considering the frank deformations (osteophyte or disc narrowing ≥ grade 2 or wedge-shaped), the thoracic spine was deformed in 22 patients (44%) and the lumbar spine in 21 patients (42%). Conclusion Acromegalic patients had a low prevalence of vertebral fractures but had a significant amount of vertebral deformations. We speculate that this high prevalence of frank deformations could explain the previously reported high prevalence of vertebral fractures.

Resume La rhumatologie interventionnelle est en plein essor. Elle comporte des aspects de plus en plus a la fois ethiques et medico-legaux, et techniques avec des gestes de plus en plus guides, notamment grâce a l’echographie. Les aspects ethiques font debat, et si la grande positivite de la balance benefices/risques des gestes interventionnels en rhumatologie ne fait guere de doute, il y a quand meme un mouvement pour, d’une part, etre de plus en plus efficace, avec des etudes d’etablissement de preuves d’efficacite de plus en plus nombreuses, et une precision du geste apportees par le guidage, et d’autre part, de diminuer encore les risques, avec la encore le guidage, mais egalement avec des mesures adaptees en fonction de la gravite et de la frequence de ces risques. Les aspects medico-legaux ont fait l’objet d’une loi en 2002 qui satisfait la plupart des medecins et des patients, en distinguant bien ce qui est de l’ordre de la faute medicale de ce qui est de l’ordre de l’alea therapeutique, avec un fonds special dedie pour ces derniers patients lorsque le taux d’incapacite permanente est de plus de 25 %. L’environnement necessaire a la pratique de l’interventionnel ne fait pas encore l’objet de reglementation en France, mais des reunions sont en cours pour pallier ce manque. Pour la tres grande majorite des gestes courants en rhumatologie interventionnelle, il n’y aura a priori pas de mesures autres que d’adapter une salle de consultation a la bonne pratique des gestes interventionnels, possibles en externe. Enfin, l’asepsie a fait l’objet de recommandations consensuelles de la section SIRIS de la Societe francaise de rhumatologie, qui insiste surtout sur la necessite de procedures et de protocoles d’asepsie bien etablis, qui permettent de garder ce risque infectieux a des taux extremement bas, de l’ordre de 1/38 000, malgre la technicite du guidage. Meme a l’epoque des biotherapies, que ce soit pour les pathologies inflammatoires, mais egalement pour les pathologies mecaniques, la place de la rhumatologie interventionnelle reste et restera tres importante, avec plus de 2 millions de gestes realises par an en France, et plus de 90 % de patients satisfaits.

Resume La radioprotection a fait l’objet d’une reevaluation par l’autorite de surete nucleaire (ASN) suite a une enquete de pratiques sur le terrain montrant d’importantes insuffisances de precautions, et pour se mettre en accord avec les nouvelles directives europeennes. Les rhumatologues sont de moins en moins impliques avec le choix de la nouvelle generation de jeunes rhumatologues de privilegier l’approche echographique, tant a visee diagnostique qu’interventionnelle. Cependant, les rayonnements X resteront de mise pour visualiser le tissu osseux et pratiquer des gestes interventionnels a ce niveau, et l’absorptiometrie, bien qu’extremement peu irradiante, est egalement concernee, tout comme la pratique de synoviortheses isotopiques. Enfin, les rhumatologues restent des prescripteurs d’examens ou d’actes interventionnels realises sous controle visuel grâce aux rayonnements X. Ceux qui seront exposes aux rayonnements ionisants devront respecter les nouvelles reglementations, acquerir un materiel adequat, respecter des procedures preetablies, et valider une formation de radioprotection vis-a-vis des patients d’une journee tous les 7 ans en France.

In medicine, the positive Hawthorne effect is defined as decreased symptom expression due to being observed. This effect occurs in addition to the decrease in symptom experience due to the placebo effect. Symptom overexpression, in contrast, whether related to conscious or to unconscious factors, defines the negative Hawthorne effect, which should be distinguished from the nocebo effect, defined as an increase in symptom experience. For instance, the negative Hawthorne effect can result in patients who seem fully relaxed evaluating their pain intensity at 11 on a 10-point Scale. The negative Hawthorne effect stems from multiple factors including a wish to receive greater consideration or priority management status; concern about failing to meet criteria for receiving a new treatment or being included in a therapeutic trial; conformism related to cultural factors or to circumstance (e.g., avoiding the canceling of a surgical procedure in the event of a last-minute improvement); disease mongering; a desire to be taken seriously by family and friends; a quest for secondary benefits; use of the evaluation to express frustration about being ill or bitterness at receiving a lower level of support; a gap between the expectation of complete relief and the true effectiveness of treatments; and pain exacerbation, with loss of reliability of pain intensity measurements, due to anxiety, guilt, depression, nervosity, catastrophizing, kinesiophobia, or repeated evaluations using methods that involve negative suggestions such as considering the worst pain imaginable. A sequence of a strong negative Hawthorne effect before treatment prescription followed by a strong positive Hawthorne effect after treatment initiation may make a greater contribution than the placebo effect to the improvements produced by treatments for pain.

ObjectiveSteroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL.MethodsThis was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0–100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up.ResultsThe estimated mean difference in the first week’s maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups.ConclusionNon-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption.Trial registration numberNTC02403856.

Resume En medecine, l’effet Hawthorne positif correspond a la moindre expression d’un symptome en presence d’un evaluateur. Il s’additionne au moindre ressenti que procure l’effet placebo. Quand le symptome est au contraire surexprime, consciemment ou inconsciemment, il s’agit d’un effet Hawthorne negatif, a distinguer des effets nocebo, durant lesquels le symptome est reellement plus ressenti. Un exemple d’effet Hawthorne negatif est celui des patients evaluant calmement leurs douleurs a onze sur dix. Les motifs d’effets Hawthorne negatifs sont nombreux : souhait d’etre davantage considere(e), ou pris(e) en charge prioritairement ; crainte de ne pas valider les criteres d’obtention d’un nouveau traitement ou d’integration dans un essai therapeutique ; conformisme culturel ou de circonstance, comme de ne pas annuler une intervention chirurgicale lorsqu’une amelioration survient in extremis ; disease mongering ou strategie de Knock ; desir d’etre pris au serieux par son entourage ; recherche de benefices secondaires ; utilisation de l’evaluation pour exprimer sa frustration d’etre malade, ou son depit de ne plus etre choye ; decalage entre les attentes d’un soulagement complet et l’efficience reelle des traitements ; majoration des douleurs, a l’origine de la demonetisation de leur chiffrage, par anxiete, culpabilite, depression, nervosisme, catastrophisme, kinesiophobie, ou du fait d’evaluations repetees avec des procedes comportant des suggestions negatives, comme l’evocation de la pire douleur imaginable. La succession de forts effets Hawthorne negatifs avant prescription, puis de forts effets Hawthorne positifs apres introduction des therapeutiques, pourrait, plus que l’effet placebo, expliquer une bonne part des ameliorations observees dans le traitement des douleurs.

The concept of fibromyalgia has progressed to achieve a certain consensus regarding the definition of the condition. We summarize what is known in 2020, be it in terms of diagnosis, with the criteria that have changed over the years, or at the level of the psychological profile, via the notions of “catastrophizing” and “coping” and post-traumatic syndrome. The importance of fatigue and sleep disorders is underlined, with the chronological sequence of post-traumatic syndrome, chronic fatigue, and then amplification of the pain and the onset of multiple associated symptoms. The etiopathogenic debate has been enriched thanks to neuro-imaging data to discover the start of the central neurological signature. The many associated symptoms are reanalyzed in the context of so-called sister conditions which form sometimes more or less separate entities, such as chronic fatigue syndrome or restless legs syndrome for example. What these conditions have in common is hypersensitivity, not just to pain, but also to all exteroceptive stimuli, from deep sensitivity in the neuro-vegetative system, the sense organs and certain functions of the central nervous system, to the psychological aspects and sleep control. In summary, it is possible to define fibromyalgia as a cognitive disorder of cortical integration of chronic pain, with amplification of painful and sensory nociception, decrease in the threshold for the perception of pain, and persistence of a stimulus that maintains the process in chronicity. Fibromyalgia is part of a group of chronic hypersensitivity syndromes of central origin, with a very wide range of means of expression.

Objective: To assess the cross-sectional association between serum levels of Coll2-1 and Coll2-1NO2, two cartilage degradation biomarkers; the burden of magnetic resonance imaging (MRI) features and clinical outcomes; and to evaluate the predictive value of these biomarkers on progression. Design: A total of 121 subjects with knee osteoarthritis (OA) were followed during 1 year with pain, function, and MRI assessment (PRODIGE study). Type II collagen-specific biomarker Coll2-1 and its nitrated form Coll2-1NO2 were directly measured in serum using immunoassays at baseline and after 3-, 6-, and 12-month follow-up. Results: Serum Coll2-1 and Coll2-1NO2 were correlated with several baseline knee features quantified with Whole-Organ Magnetic Resonance Imaging Score (WORMS). Coll2-1 was significantly correlated with periarticular cysts/bursitis (ρ = 0.29, P < 0.01), subarticular bone attrition (ρ = 0.25, P = 0.01), subarticular cysts (ρ = 0.24, P = 0.02), and articular cartilage integrity (ρ = 0.23, P = 0.03) WORMS subscores for the whole joint as well as with the medial femorotibial joint sum score (ρ = 0.26, P = 0.01) and medial femorotibial joint cartilage (ρ = 0.23, P = 0.02). Coll2-1NO2 correlated with WORMS total score (ρ = 0.23, P = 0.02), WORMS scores in the patellofemoral (ρ = 0.23, P = 0.02) and medial femorotibial compartments (ρ = 0.21, P = 0.03), with osteophytes scores (ρ = 0.27, P < 0.01), subarticular cysts (ρ = 0.24, P = 0.019), and intraarticular loose bodies (ρ = 0.27, P = 0.007). Baseline Coll2-1NO2 was higher in subjects with a pain worsening (426.4 pg/mL [278.04-566.95]) as compared to non-progressors (306.84 pg/mL [200.37-427.84]) over 1 year (AUC = 0.655, P = 0.015). Conclusion: Serum cartilage biomarkers Coll2-1 and Coll2-1NO2 are associated with several knee OA features quantified with WORMS. Our study also shows that the baseline value of Coll2-1NO2 is positively associated with pain worsening.

This review lists current evidences for a contribution of gut mycobiota to the pathogenesis of SpA and related conditions. Gut mycobiota has a small size as compared to bacterial microbiota, but an even greater inter- and intra-individual variability. Although most fungi (brought by food or air) are only transitory present, a core mycobiota of gut resident fungi exists, and interplays with bacteria in a complex manner. A dysbiosis of this gut mycobiota has been observed in Crohn's disease and sclerosing cholangitis, with decreased proportion of Saccharomyces cerevisiae and outgrowth of more pathogenic gut fungi. Fungal-induced lower number of commensal gut bacteria can promote translocation of some bacterial/fungal antigens through mucosae, and live fungi can also cross the epithelial border in Crohn's disease. This dysbiosis also lower the ability of bacteria to metabolize tryptophan into regulatory metabolites, consequently enhancing tryptophan metabolism within human cells, which might contribute to fatigue. Translocation of mycobiotal antigens like curdlan (beta-glucan), which plays a major role in the pathogenesis of SpA in the SGK mice, has been observed in humans. This translocation of fungal antigens in human SpA might account for the anti-Saccharomyces antibodies found in this setting. Contribution of fungal antigens to psoriasis and hidradenitis suppurativa would fit with the preferential homing of fungi in the skin area most involved in those conditions. Fungal antigens also possess autoimmune uveitis-promoting function. As genes associated with SpA (CARD9 and IL23R) strongly regulate the innate immune response against fungi, further studies on fungi contribution to SpA are needed.

International audience; Introduction: Knee joint bleedings are responsible for quadriceps atrophy and strength deficit in patients with severe haemophilia. Little is known about patients with moderate haemophilia (PWMH).Aim: To evaluate isokinetic quadriceps and hamstrings strength in PWMH and to assess correlation with radiological and clinical parameter.Methods: 18 PWMH aged 37.1 ± 11.4 and 18 healthy age-, weight- and height-matched controls performed a knee isokinetic test at 180°/s to assess quadriceps and hamstrings strength. In the PWMH group, knee Pettersson's score was pursued and Haemophilia Joint Health Score 2.1 (HJHS) was performed to determine unaffected knees (knee HJHS = 0) and affected ones (knee HJHS >0).Results: Affected knees had a decrease of quadriceps strength compared to controls, 1.26 ± 0.47 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.60 ± 0.29 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). Unaffected knees also had a decrease of quadriceps strength compared to controls, 1.36 ± 0.31 vs 1.64 ± 0.27 Nm/kg and a decrease of hamstring strength, 0.69 ± 0.18 vs 1.03 ± 0.21 Nm/kg, (P < 0.001). The conventional hamstring-to-quadriceps ratio was significantly decreased in affected knees compared to controls, 0.46 ± 0.15 vs 0.64 ± 0.13 (P < 0.001) but also in unaffected knees, 0.53 ± 0.16 vs 0.64 ± 0.13 (P = 0.02).No correlation was found between strength and HJHS or Pettersson's score.Conclusion: PWMH have a significant knee strength deficit, both on the quadriceps and the hamstrings, which is responsible for an important muscle imbalance.

Clinical history and physical examination are usually not sufficient to diagnose leg chronic exertional compartment syndrome (CECS). Two predictive clinical models have been proposed. The first model by De Bruijn et al. is displayed as a nomogram that predicts the probability of CECS according to a risk score. The second model by Fouasson-Chailloux et al. combines two signs (post-effort muscle hardness on palpation or hernia). To evaluate those models, we performed a prospective study on patients who were referred for possible CECS. 201 patients underwent intra-compartmental pressure at 1-min post-exercise (CECS if ≥ 30 mmHg) – 115 had CECS. For the De Bruijn et al. model, the risk score was 7.5±2.2 in the CECS group and 4.6±1.7 in the non-CECS group (p

Resume L’interrogatoire et l’examen neurologique ne suffisent souvent pas au diagnostic de sciatique radiculaire, sur lequel repose surtout la reproduction de la douleur par la mise en tension des racines. Celle-ci est realisee d’ordinaire seulement par la manœuvre de Lasegue, dont le premier temps, jambe tendue, est denomme straight-leg-raising (SLR). Le test de Lasegue n’est toutefois pas parfait, ni toujours bien realise et interprete. La dorsiflexion de la cheville en fin de test (test de Braggard) peut etre plus sensible. Toutefois, ces deux tests peuvent etre parfois faussement negatifs, si bien que d’autres tests de mise en tension radiculaire peuvent aider a poser le diagnostic positif d’une souffrance sciatique en presence de douleurs atypiques d’un membre inferieur. Il s’agit premierement du signe de Christodoulides, qui correspond a la reproduction d’une douleur de topographie L5 lors de la realisation d’un test de Leri (femoral stretch test) ; deuxiemement, du signe de Slump, qui consiste sur un patient assis, a etendre la jambe douloureuse a l’horizontale puis a flechir passivement le cou (ou l’inverse) ; et troisiemement, du signe de la corde de l’arc, qui consiste lors de la manœuvre de Lasegue, une fois le genou un peu flechi apres avoir atteint le degre maximal d’elevation passive du membre douloureux, a appuyer sur le trajet des nerfs peroniers et tibiaux dans le creux poplite pour reproduire ou non la douleur connue du patient. La combinaison de tous ces tests pourrait beaucoup ameliorer tant la sensibilite que la specificite de l’examen clinique des sciatiques.

Resume Les biofilms sont un mode de persistance, notamment a la surface des muqueuses, de 99,99 % des bacteries et levures, dans un etat metaboliquement peu actif. Elles y partagent au mieux les substrats, mais s’y controlent les unes les autres, via la secretion de peptides anti-microbiens. Elles y mutualisent aussi leur defense contre les menaces exterieures par la synthese d’un abri commun, traverse de fins canaux, fait d’un melange de glycoproteines (variables selon les especes de bacteries/levures), d’ADN extracellulaires bacteriens ou fongiques, et de molecules d’attachement, dont des molecules amyloides. Cette gangue et/ou l’etat dormant induit de certaines de ces bacteries/levures peut induire des faux negatifs des methodes de detection usuelle des agents infectieux, y compris PCR. Des bacteries peuvent aussi persister sous forme de biofilms intracellulaires au sein des macrophages et utiliser ces chevaux de Troie pour migrer des muqueuses aux articulations, dans lesquelles des biofilms extracellulaires peuvent se reformer grâce a la presence facilitante du liquide synovial. Certains biofilms peuvent induire un etat de phagocytose frustree des macrophages, source d’inflammation chronique, et/ou provoquer des phenomenes de NETose inefficace des polynucleaires. S’en suit une liberation d’ADN humain et de molecules citrullinees associees a des molecules amyloides bacteriennes, pouvant aboutir a une auto-immunisation a l’encontre de ces antigenes, cibles des auto-anticorps des rhumatismes inflammatoires. Les sels d’or, qui pouvaient induire des remissions tres durables des polyarthrites rhumatoides, sont ex vivo plus efficaces sur les biofilms que les antibiotiques. Des biofilms pourraient donc participer a l’initiation et/ou aux poussees des rhumatismes inflammatoires chroniques.

Osteoarthritis affects hundreds of millions of people worldwide, and its prevalence is constantly increasing. While there is no effective treatment to date, new promising therapeutic strategies and targets are being investigated. Innovative cell therapies are reaching clinical trials, and the most recent progress in our understanding of the pathology is opening new routes for gene therapy. In the long term, the development of new biofabrication tools such as 3D bioprinting might pave the way for the use of personalized mini-joint models that would allow clinicians to screen drugs and personalize treatments. This review offers an overview of the most promising therapeutic approaches in the field of osteoarthritis, from coming treatments to those that are yet to be discovered., L’arthrose affecte des centaines de millions de personnes à travers le monde et sa prévalence ne fait qu’augmenter. Si aucun traitement ne permet de stopper le développement de l’arthrose à ce jour, de nouvelles stratégies et cibles thérapeutiques sont à l’étude. Ainsi, alors que des thérapies cellulaires de nouvelle génération font d’ores et déjà l’objet d’études cliniques, l’amélioration de la compréhension de cette pathologie ouvre la voie à de possibles thérapies géniques. À plus long terme, le développement d’outils de biofabrication tels que la bio-impression 3D permettent d’entrevoir l’utilisation de modèles personnalisés de mini-articulations pour le criblage de principes actifs et l’application de traitements sur mesure. Cette revue propose un tour d’horizon des approches thérapeutiques les plus prometteuses pour traiter l’arthrose, des traitements à venir à ceux qu’il reste à découvrir.

Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasegue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasegue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2 minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasegue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.

International audience; Haemophilia is characterized by a congenital deficiency of clotting factor VIII or IX. One of the consequences of haemophilia is joint bleedings. Repetitive haemathroses induce cartilage damage and chronic synovitis leading to joint deterioration, and to definitive haemophilic arthropathy which is source of walking disability. Three-dimension gait analysis (3DGA) appears particularly relevant in the case of haemophilia because it allows an evaluation of several joints in weight-bearing situations. The purpose of this study was to review the interest and the contribution of 3DGA in the management of patients with haemophilia. The greatest interest of gait analysis would be to detect early walking changes with a non-invasive and well-tolerated examination, especially in paediatric population. In adulthood, this technic may be also useful to help detect walking worsening in patients known to have already arthropathy. However, it takes time to realize and needs expensive equipment, which limits its possibility of routine use. Although generalizations of these results remain difficult,especially to compare patients with haemophilia to normal population. Indeed, in the studies, patient groups are small and usually heterogeneous in terms of age and target joints. It certainly results of the rarity of the disease. So, it could be interesting to perform a study with a larger cohort in order to allow subgroup analysis, helping to define clearly the place of 3DGA in the strategy of haemophilia evaluation.

Objective The primary objective of this study was to compare the efficacy of local injection of a local anesthetic with a glucocorticoid versus a local anesthetic with saline to treat low back pain due to lumbosacral transitional vertebras (LSTV) with a pseudoarticulation. Methods A randomized placebo-controlled double-blind study was conducted in patients with unilateral low back pain ascribed clinically to LSTV. Patients were randomized to lidocaine plus saline (LS group) or lidocaine plus cortivazol (LC group) injected locally under computed tomography guidance. The primary outcome measure was the 24-hour mean visual analog scale (VAS) score for low back pain 4 weeks after the injection. Results Of 16 randomized patients, 15 were included in the analysis, 8 in the LS group and 7 in the LC group. The mean VAS pain score at week 4 was not significantly different between the two groups. In the two groups pooled, the mean VAS pain score decreased significantly from baseline to week 4, from 5.52 ± 0.99 to 3.86 ± 2.55 (P ≤ 0.05). The difference remained significant at week 12. Significant improvements occurred in the EIFEL disability index and items of the Dallas Pain Questionnaire. No adverse events were recorded. Conclusion In patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear.

Resume Objectif L’objectif principal de cette etude etait de comparer l’efficacite des infiltrations anesthesie locale et corticoides versus anesthesie locale et serum physiologique dans le traitement des anomalies transitionnelles de la charniere lombosacree (ATLS). Methodes Les patients presentant une lombalgie unilaterale cliniquement liee a une ATLS ont ete randomises pour infiltration en double insu lidocaine et serum physiologique (LSP) versus lidocaine et cortivazole (LC) sous scanner. Le critere principal etudie etait l’evolution de l’EVA moyenne des 24 dernieres heures a 4 semaines. Resultats Seuls 16 patients ont ete randomises et 15 etudies (8 LSP et 7 LC). Il n’existait pas de difference significative entre les 2 groupes sur l’EVA moyenne a S4. Par contre si on regardait l’evolution de l’ensemble des patients, on notait une amelioration significative de l’EVA a S4 par rapport au baseline : EVA 5,52 ± 0,99 a S0 et 3,86 ± 2,55 a S4 ( p = Conclusion Dans les douleurs chroniques evoquant une origine ATLS avec neoarticulation de type II ou IV de la classification de Castellvi une infiltration peut etre proposee car elle peut ameliorer la douleur et la fonction durablement sans prejuger du mecanisme de l’amelioration.

Purpose To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy. Methods Review of relevant articles on this topic available in the PubMed database. Results An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasegue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels. Conclusions As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression.

International audience; Osteoarthritis affects hundreds of millions of people worldwide, and its prevalence is constantly increasing. While there is currently no treatment that can alter the course of the disease, promising therapeutic strategies and novel targets are being investigated. Innovative cell therapies are already reaching clinical trials, and recent progress in our understanding of the disease is opening new routes for gene therapy. In the long term, the development of new biofabrication tools, such as 3D bioprinting, may pave the way for personalized mini-joint models that could be used to screen drugs and to personalize treatments. This review provides an overview of the most promising therapeutic approaches in the field of osteoarthritis, from upcoming treatments to those that are yet to be discovered.

Resume Objectif Realiser une synthese d’articles abordant le role de l’etirement radiculaire dans la physiopathologie de la radiculopathie. Methodes Revue d’articles pertinents sur ce theme disponibles dans la base de donnees PubMed. Resultats Une etude microscopique peroperatoire de patients presentant une sciatique a revele dans tous les cas une adherence de la hernie a la dure-mere des racines nerveuses. Lors du test d’elevation de la jambe tendue ( Straight leg raising [SLR], manœuvre de Lasegue), l’adherence des tissus periradiculaires limite le deplacement de la racine nerveuse, et des modifications ischemiques transitoires dans la racine provoquees par l’etirement perturbent temporairement la conduction. Les racines rachidiennes sont plus fragiles que les nerfs peripheriques, et d’autres contraintes mecaniques que la compression radiculaire peuvent provoquer une radiculopathie, en particulier si elles alterent egalement le flux sanguin intraradiculaire ou la fonction des villosites arachnoidiennes, etroitement liees aux veines radiculaires. Ainsi, l’arachnoidite (disparition de la graisse peridurale autour du sac dural) et la fibrose epidurale postoperatoire peuvent favoriser une sciatique, notamment chez des patients dont le tronc sciatique adhere egalement au muscle piriforme ou obturateur interne. De fait, l’etirement radiculaire est fortement accru par une adherence a deux niveaux. Conclusions L’exces de traction des racines nerveuses n’etant pas visible a l’imagerie, nombre de medecins ont perdu l’habitude de prendre en consideration les changements microscopiques et physiologiques, alors que dans plus de 10 % des sciatiques, la compression des racines nerveuses n’apparait pas sur l’IRM lombaire. Rappelons que si la compression de la racine d’un nerf spinal implique un etirement radiculaire, l’inverse n’est pas vrai : il arrive que des racines soient etirees sans qu’aucune compression ne soit visible.

To describe the ultrasound abnormalities seen in septic arthritis and to assess their associations with clinical, biological, and radiological outcomes.We prospectively included 34 patients with septic arthritis of a native joint (knee, n=19; shoulder, n=6; hip, n=4; ankle, n=3; or wrist, n=2). Ultrasonography was performed to record synovial-membrane thickness and vascularity, joint effusion, and abnormalities of adjacent soft tissues, at baseline then 4days, 2weeks, and 3months later. Motion-range limitation of the affected joint was evaluated after 3months. Radiography was performed at inclusion and after 3months.Mean age was 63.7±17.6years. After 3months, 20 (58.8%) patients had motion-range limitation with worsening of the total radiological score (P0.001). The proportion of patients with synovitis was very high initially (96.4% at baseline, 96.3% after 4days, and 100% after 2weeks) then diminished to 77.8% after 3months (P=0.051). Synovial-membrane thickness was significantly higher after 4days and 2weeks compared to baseline (median, +17.3% and +20%, respectively; P=0.015) and was significantly lower after 3months compared to the earlier time points (median, -31.5%, P=0.015). A positive Doppler signal was common at baseline (n=18, 64.3%) then significantly less so after 3months (n=7, 25.9%; P=0.04). An unchanged or higher Doppler grade after 2weeks compared to baseline was associated with motion-range limitation at last follow-up (P=0.033).We report the first study on ultrasound evidence of synovitis, joint effusion, and soft tissue alterations at baseline and over time in patients with septic arthritis. Persistent synovitis and joint effusion 3months after starting antibiotic therapy was not associated with treatment failure. However, Doppler signal changes over the first 2weeks were associated with the 3-month functional outcome.

Resume La NETose suicidaire differe des autres morts cellulaires par l’expulsion d’ADN nucleaire melange a des proteines prealablement citrullinees par l’arginine deiminase 4 des neutrophiles. Ces « filets » (NETs) sont sertis de proteines des granules cytoplasmiques a activite bactericide. Lors de la NETose vitale, le neutrophile anuclee survit a cette expulsion et garde une capacite a migrer et a etre infecte par des bacteries vivantes. Lors des NEToses mitochondriales, seul les enzymes et de l’ADN mitochondrial oxydes sont ejectes. On retrouve au sein des NETs, les cibles de la plupart des auto-anticorps des polyarthrites rhumatoides (PR), lupus et vascularites. Les chevauchements cliniques et biologiques entre bronchectasies, PR, lupus et vascularites, designent la NETose comme un cofacteur inducteur probable de ces ruptures de tolerance. La NETose accroit la probabilite d’une association entre ces auto-antigenes et des antigenes infectieux au sein des biofilms, et d’une reaction auto-immune en cas de defaut de clairance de l’ensemble. La NETose aggrave le risque de lesions endotheliales et de thrombose. Cependant, la pathogenie des PR, lupus et vascularites ne se resume pas a ces auto-anticorps contre les NETs, et d’autres stimuli que les NETs pourraient aussi contribuer a leur induction, notamment d’autres circonstances d’hypercitrullination. La contribution d’infections intracellulaires a la rupture de tolerance aux NETs, pourrait etre plus etudiee, comme les infections « dormantes » qui favorisent aussi la citrullination pour entretenir leur dormance. La seule inhibition de la NETose pourrait en effet ne pas suffire a stopper les pathologies dysimmunitaires si des infections latentes persistent, dont au sein des neutrophiles.