Joint, bone, spine : revue du rhumatisme
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Ankylosing spondylitis (AS) in its established and early forms accounts for more than 5% of all cases of chronic low back pain. Attention has focused recently on decreasing the time from symptom onset to the diagnosis of AS, which currently ranges from five to 10 years. An earlier diagnosis would lead to improved management, in particular thanks to the recent introduction and continuing development of biotherapies, such as TNFalpha antagonists, and new imaging techniques, including Doppler ultrasonography and magnetic resonance imaging have proved capable of detecting early signs of AS. ⋯ Several groups have been working on means of improving the early diagnosis of AS. An algorithm for the early diagnosis of axial AS developed by Rudwaleit et al. needs to be confirmed by prospective studies. The Assessment of SpondyloArthritis international Society (ASAS) has just issued new diagnostic criteria for AS that performed well in a large cohort of patients with recent-onset low back pain.
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Peripheral nerves disorders are common in the rheumatologic practice and can mimic a variety of musculoskeletal diseases. Clinical evaluation remains the mainstay for diagnosing nerve disorders of the extremities. A careful history and an accurate physical examination lead in most patients to a high diagnostic suspicion. ⋯ Well recognized advantages of this technique in this field are: the possibility of realizing a dynamic examination and assessing long nerves segments in a short time; it is non-invasive and low cost. In addition US is better accepted by the patients. In this article we present a brief description of the normal and US anatomy of the peripheral nerves followed by a description of the US appearance of the most frequent disorders: entrapment neuropathies (EN), tumor and cystic lesions.
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In patients with symptoms caused by intervertebral disk displacement, studies of epidural corticosteroid injections have produced compelling evidence of a short-term analgesic effect (lasting about 3 weeks), despite a number of discrepancies. In contrast, no reductions were noted in the time off work or need for surgery. Strong evidence supports a short-term symptomatic effect of guided transforaminal corticosteroid injections, and there is also some evidence of a long-term effect. ⋯ Intradural injections should not be performed, as they may induce adverse effects and have not been proved effective. Interspinous injections and iliolumbar ligament injections can be considered in selected patients. Although published data have led to controversy about the effectiveness of local corticosteroid injections, a short-term analgesic effect is usually obtained, making this modality useful for the second-line treatment of patients with disk-related sciatica, as well as in selected patients with chronic low back pain.
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Fibromyalgia, a syndrome characterized by widespread pain and diffuse tenderness, is considered a multifactorial disorder. Central nervous system sensitization is a major pathophysiological aspect of fibromyalgia, while various external stimuli such as infection, trauma and stress may contribute to development of the syndrome. In addition, current evidence points towards the existence of a genetic basis for fibromyalgia and information has been accumulated regarding the role of a number of candidate genes in fibromyalgia pathogenesis. In the present review, we have summarized the clinical manifestations of fibromyalgia, as well as the necessary laboratory workup; subsequently we have attempted to cover various aspects of pathogenesis with special emphasis on the genetic aspects currently uncovered.
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Hereditary recurrent fevers are rare genetic diseases characterized by apparently spontaneous attacks of inflammation. They include familial Mediterranean fever (FMF); tumor necrosis factor (TNF) receptor periodic syndrome (TRAPS); hyperimmunoglobulinemia D syndrome (HIDS); and hereditary periodic fevers related to mutations in the CIAS1 (cold induced autoinflammatory syndrome 1) gene, such as Muckle-Wells syndrome, familial cold urticaria, and CINCA/NOMID (chronic infantile neurological cutaneous and articular/neonatal-onset multisystemic inflammatory disease). Musculoskeletal manifestations are common. ⋯ Among differential diagnoses, infection should be considered routinely. The treatment of the inflammatory attacks is nonspecific. New pathophysiological insights have led to the development of promising maintenance treatments designed to reduce the number and severity of the inflammatory attacks and to diminish the risk of secondary amyloidosis.