Introduction Des formes graves de COVID-19 ont été observées chez des enfants atteints de leucémie aigüe (LA). De plus, l'apparition de l'infection pendant le traitement peut retarder la chimiothérapie, exposant potentiellement les patients à un risque plus élevé de rechute. La vaccination semble donc une stratégie préventive intéressante à considérer chez ces patients. Matériels et méthodes Au moment où le vaccin BNT162b2 n'avait pas encore l'autorisation de mise sur le marché chez l'enfant de moins de 12 ans, nous avons mené un essai de phase I-II (NCT04969601) pour évaluer l'immunogénicité et la tolérance de deux doses de vaccin à 21 jours d'intervalle chez des enfants atteints de LA âgés de 2 à 15 ans et leurs frères et soeurs. Une étude de dose (10, 20 ou 30 µg) a été réalisée chez les patients âgés de moins de 12 ans. Les critères de jugements principaux étaient la tolérance, évaluée par la toxicité dose limitante (TDL) dans les 7 jours suivant la vaccination, et l'immunogénicité, définie par l'obtention d'un titre d'IgG anti-Spike ≥ 260 BAU/ml 2 mois après la première injection. Si ce seuil n'était pas atteint, une troisième dose de vaccin était administrée. La recherche d'anticorps neutralisants et l'étude de la réponse cellulaire par Elispot ont également été réalisées 2 mois après la première injection. Les enfants ont été suivis pendant 12 mois. Résultats Soixante-seize enfants (61 patients et 15 frères et soeurs) ont été inclus dans l'étude. Aucun effet indésirable grave n'a été rapporté durant la phase d'escalade de dose ni pendant l'étude, la plupart des enfants a donc reçu une dose de vaccin de 30μg. Deux mois après la première injection, 52% des patients (32/61) versus 100% (15/15) des frères et soeurs avaient un titre d'IgG anti-Spike ≥ 260 BAU/ml et 48% (25/52) des patients versus 100% (11/11) les frères et soeurs avaient des anticorps neutralisants (p<0,001). De manière intéressante, 80% (44/55) des patients versus 100% (15/15) des frères et soeurs avaient un Elispot positif (P=0,1). La présence d'une lymphopénie, d'une hypogammaglobulinémie ou le fait d'être en phase intensive de traitement étaient associés à une moins bonne réponse. La réalisation d'une troisième injection a permis une séroconversion significative chez 50% (12/24) des patients. Vingt-cinq infections documentées sont survenues au cours de l'étude : 20 chez les patients et 5 chez les frères et soeurs (p=1). Aucune infection grave n'a été rapportée. Chez les patients, 15 infections ont entraîné un retard de la chimiothérapie allant de 5 à 14 jours. Conclusion Le vaccin BNT162b2 à la dose de 30μg (versus 10μg recommandé actuellement chez les moins de 12 ans) est bien toléré et permet d'obtenir une réponse humorale mais surtout cellulaire significative chez les enfants atteints de LA après la période de chimiothérapie intensive. Ces données d'immunoréactivité montrent que l'utilisation de vaccins à ARNm à visée anti-tumorale pourrait être explorée chez ces patients.Aucun lien d'intérêt

Le retour au travail durable des travailleurs diagnostiqués d’une maladie chronique représente un enjeu majeur de la pratique en médecine du travail. En tant que processus multifactoriel, le retour au travail dépend, entre autres, de facteurs psychologiques dont le sentiment d’efficacité personnelle à retourner au travail. Il s’agit d’un mécanisme cognitif traduisant les croyances d’un individu à pouvoir réaliser les actions nécessaires pour pouvoir retourner au travail, qui est à différencier de la notion de capacité de travail. Réalisée à partir d’une succession de revues de la littérature, cette mise au point vise à : (i) définir les spécificités du sentiment d’efficacité personnelle à retourner au travail ; (ii) introduire les connaissances en lien avec le retour au travail des patients diagnostiqués d’une maladie chronique ; (iii) présenter les outils favorisant son évaluation ; et (iv) présenter les stratégies d’intervention disponibles au sein de la littérature scientifique. Ainsi nous y discutons l’intérêt d’employer des mesures spécifiques du sentiment d’efficacité personnelle à retourner au travail, tant d’un point de vue conceptuel que clinique. Différents questionnaires sont présentés afin que les praticiens et/ou chercheurs en santé au travail puissent s’en saisir et les inclure au sein de leurs pratiques clinique et/ou scientifique.

Background: In France, budgetary constraints on the healthcare system have led to difficulties in access to care. Objectives: To evaluate whether difficulties in access to general practitioners (GP) or physiotherapists (PT) is associated with higher prevalence of chronic musculoskeletal pain Methods: This is a cross-sectional study nested in the Constances prospective cohort. The Constances cohort included people aged 18 to 69 with a selection representative for age, gender and socioeconomic status of the French adult population. All patients had to fill self-administered questionnaires at inclusion, with information related to demographics, medical symptoms, habitus, social and professional parameters. After excluding cancer, people who suffered from low back, neck, shoulder and knee pain lasting more than 30 days in the last 12 months were selected. Access to GP and PT at the local level was calculated via a proxy estimated based on nearby available medical resources (GP and PT density in the county) and the expected population health needs calculated by the percentage of older people people. The proxy resulted in 3 levels of access (LoA) - severe shortage area (SSA), moderate shortage area (MSA) and adequately served area (ASA) – for access to GP and PT, separately. The number of consultations (or months of care for PTs) was established via claims registered in the national health insurance database. Distribution difference between LoA groups were tested by Kruskal-Wallis test. Factors associated with the observed differences were identified by uni-then multivariate analysisafter adjustment on sex, age, comorbidities, BMI, depression, leisure and occupational physical activity, consumption of alcohol, tobacco or cannabis, diploma, socio-economic category and household income. Results: Overall, 193,436 participants were included. The distribution of LoA groups for GPs was: 5% for SSA, 32% for MSA and 62% for ASA. The distribution of groups of accessibility for PTs was: 5% for SSA, 28% for MSA and 65% for ASA. The number of consultations in the last 12 months was significantly different in the three groups (3.32, 3.65 and 3.69 respectively for GPs, p<0.001, and 0.59, 0.73 and 0.83 respectively for PTs, p<0.001). Prevalence of low back pain was significantly different between SSA, MSA and ASA for GP (27.5%, 25.9% and 23.0% in the three groups respectively). After adjusting for confounding factors, only MSA remained significantly associated (OR =1.03 [1.00-1.06]) to GPs access. Prevalence of low back pain was also significantly associated to PTs access (29.1%, 26.4% and 22.8% respectively), and remained significantly associated after adjusting for cofounding factors (OR=1.06 [1.03-1.09] for MSA and 1.13 [1.07-1.20] for SSA). Concerning neck, shoulder, hand or elbow but not knee, access to PTs was associated to reduced prevalence of chronic MSK pain after adjustment of confounding factors (Table 1).Table 1. Association between pain prevalence and access to GPs of PTs after adjusting of cofounding factors. Results are odds ratio with 95% confident interval. Significant odds ratio are in bold. Conclusion: Access to PTs rather than to GPs was associated with lower prevalence of chronic musculoskeletal pain in this cross-sectional study REFERENCES: NIL. Acknowledgements: We would like to thank all the participants of the CONSTANCES cohort, who made this study possible. This work was funded by a grant from the French Society of Rheumatology. Disclosure of Interests: None declared.

Objectives: Cutaneous tuberculosis (CTB) may be over-diagnosed due to imprecise diagnostic criteria or overlooked where mycobacterial investigations are negative. We evaluated the distinction between multibacillary and paucibacillary forms of CTB, as well as drug resistance and cure rates according to the results of mycobacterial investigations. Methods: We included retrospectively all patients diagnosed with CTB from 1995 to 2018 in two hospitals in Paris. Clinical forms were classified according to dermatological descriptions, into multibacillary (e.g. gumma, scrofuloderma, orificial TB) and paucibacillary forms (lupus vulgaris, verrucous tuberculosis, papulonecrotic tuberculids, nodular panniculitis). A distinction was made between microbiologically confirmed CTB and presumed CTB forms, which were treated presumptively. Cure was defined as the complete resolution of CTB in patients who completed anti-tuberculosis treatment. Results: Among the 124 patients with CTB, the most common forms were nodular panniculitis (30.6%), scrofuloderma (22.6%), gumma (18.6%), and lupus vulgaris (12.1%). Tuberculosis was confirmed in 78 patients (62.9%), among whom 13 (16.7%) exhibited resistance to anti-tuberculous drugs, and 46 were presumptively treated. Mycobacterial investigations were significantly more frequently positive for multibacillary (88.2%) than for paucibacillary CTB (39.3%) (p < 10-6). Patients with mycobacterial evidence of CTB exhibited significantly better cure rates than patients without (96.7% vs. 66.7%, p < 10-4), particularly among those with nodular panniculitis (100% vs. 63.0%, p < 10-3). Conclusion: The distinction between paucibacillary and multibacillary CTB is relevant. Resistant strains may be isolated. Antituberculosis drugs should be prescribed with caution in cases of panniculitis in the absence of evidence of mycobacterial infection. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Kimura disease (KD) is a rare, chronic angiolymphoproliferative inflammatory disease appearing to be mostly restricted to the skin and soft tissue. Cutaneous involvement of KD includes head and/or neck nodules showing suggestive histological features, frequently associated with an atopic dermatitis-like or prurigo-like presentation. KD is challenging to treat, with high rate of recurrence using current therapeutic strategies. Evidence for involvement of a T-helper type 2 (Th2) immune response in KD pathogenesis has been found in previous studies. Consequently, this study aimed to determine the efficacy and safety of dupilumab, a human monoclonal antibody that inhibits signalling of key Th2 cytokines, interleukin (IL)-4 and IL-13, within a single-centre cohort of patients with cutaneous KD. Two adults with a diagnosis of refractory (failure of at least one treatment line) cutaneous-restricted KD based on clinical, biological, histological, molecular and imaging findings received dupilumab for KD, and showed dramatic response with a good safety profile. Kimura disease (KD) is a rare, chronic lymphoproliferative inflammatory disease appearing to be mostly restricted to the skin and soft tissue. KD is challenging to treat, with a high rate of recurrence using current therapeutic strategies. Evidence for involvement of a T-helper type 2 (Th2) immune response in KD pathogenesis has been found in previous studies. Two adults with a diagnosis of refractory (failure of at least one treatment line) cutaneous-restricted KD based on clinical biological, histological, molecular and imaging findings received dupilumab (a Th2 cytokine blocker) for KD and showed dramatic response with a good safety profile.

The sustainable return to work of workers diagnosed with a chronic disease is a major issue in occupational medicine practice. As a multifactorial process, return to work depends, among other things, on psychological factors, including the self-efficacy to return to work. This is a cognitive mechanism reflecting an individual's belief that he or she can carry out the actions required to return to work; to be distinguished from the notion of work ability. Based on a series of literature reviews, this paper aims to: (i) define the specific features of the self efficacy to return to work; (ii) introduce the knowledge related to the return to work of patients diagnosed with a chronic disease; (iii) present the questionnaires promoting its evaluation; and (iv) present the intervention strategies available within the scientific literature. We discuss the value of using specific measures of self-efficacy to return to work, from both a conceptual and clinical point of view. Various questionnaires are presented so that occupational health practitioners and/or researchers can take them up and include them in their clinical and/or scientific practices.

Introduction Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs. Methods We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation. Results Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3–14) after stopping treatment. Conclusion MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence.

Acute lymphoblastic leukaemia's (ALL) prognosis has improved with increased treatment intensity and haematopoietic stem cell transplantation (allo-HSCT). Despite this progress, 2%–3% treatment failed in children after induction.1 Furthermore, usual treatments such as chemotherapy are associated with high morbidity and mortality: death-related toxicity is similar to death due to relapse.2 New therapeutics have been developed to improve prognosis without increasing morbidity.3 Blinatumomab has first been validated in adult patients with relapse/refractory ALL and with minimum residual disease (MRD) + B-ALL.4 Paediatric patients treated with blinatumomab versus chemotherapy as consolidation pre-alloHSCT resulted in improved event-free survival and MRD despite the previous MRD status.5, 6 Recently, a retrospective study has evaluated blinatumomab in case of overwhelming toxicity contraindicating conventional protocols using chemotherapy.7 All patients could finally be treated with chemotherapy after toxicity resolution. The aim of our study was to evaluate blinatumomab's effectiveness in paediatric patients with complete remission (CR) 1 or CR2 B-ALL presenting temporary contraindication to chemotherapy, in order to start chemotherapy again after toxicity resolution. We retrospectively retrieved information from the medical chart of paediatric patients treated with blinatumomab between 2015 and 2022. Patients were diagnosed with a B-ALL with a temporary contraindication chemotherapy because of an acute complication or according to their medical history. Nine centres, among the 22 treating B-ALL in children in France, participated in the study. All 23 patients' characteristics, diagnostic pathways, treatments and outcomes were extracted from medical charts and are presented in Table 1 and Table S1. The median age was 5 years. Only one patient had >5% medullary blasts, 15 patients (65%) had negative MRD and 7 (30%) patients had detectable MRD. The median delay between toxicity and blinatumomab initiation was 30 days (range: 13–156). The median number of cycles was 2 (range: 1–12). In total, 18 patients had infectious complications: pulmonary fungal infection (8/23; 35%), bacterial sepsis (9/23; 39%), cutaneous infection (3/23; 13%) and pertussis (1/23; 4%) (Table S1). Six patients presented neurological toxicity including PRES syndrome (3/23; 13%) and meningeal infection (2/23; 8.6%). Six patients presented metabolic complications: hyperammonemia in a patient with portocaval shunt, pancreatitis (4/23; 17%) and hyperbilirubinemia (1/23; 4%). Three patients had digestive complications including two with severe haemorrhages. Most patients presented combined complications before blinatumomab introduction. Only one patient died from disease during the follow-up (4%) and three patients relapsed including the deceased one (13%). Two of them were already treated with blinatumomab after one first relapse. Overall, 20 patients had a prolonged controlled disease after blinatumomab (87%). None relapsed or had a progressive disease during treatment with blinatumomab. The patient with >5% blasts had stable disease with persistent blasts after treatment with blinatumomab. Only one other patient had blast after treatment with blinatumomab, but this patient did not have myelogram before treatment with blinatumomab and had a prolonged interruption of treatment. All the other patients with detectable MRD before treatment with blinatumomab had undetectable MRD after treatment. In total, 15 patients were on first remission (65%), 6 were on second remission (26%) and 2 were not on remission yet. The median follow-up was 749 days (range: 236–2720). The median follow-up after blinatumomab introduction was 581 days (range: 84–1506). After blinatumomab treatment, most patients received conventional chemotherapy (22/23; 96%); only five patients had allo-HSCT (22%). In total, 12 patients presented toxicity during blinatumomab treatment (52%) (Table 2): grade 3–4 neutropenia (n = 3), grade 1–3 cholestasis (n = 3), renal alteration (n = 1), neurological complications (n = 5) and grade 3 digestive infection (n = 1) (Table S1). Two patients had complications during two cycles. Among the five patients with neurological impairment, three of them presented grade 4 seizures on the first cycle. Two of them required a definitive treatment interruption, one after 16 h and the other after 12 days including a break of 4 days. The last one tolerated blinatumomab well at 5 μg/m2/day. None of them had a second cycle or presented relapse or death. Another patient presented grade 2 seizures on cycle 4 that did not require intensive care. All the five patients had first received blinatumomab at 15 μg/m2/day. The four patients with seizures did not present clinical similarities: age from 2 to 14 years, various central nervous system status, and different initial toxicities: colitis, bacterial sepsis associated with pancreatitis and digestive haemorrhage, and PRES syndrome with seizures. Another patient had an interruption of the treatment with blinatumomab because of hyperammonemia on the second cycle, but this patient had a portocaval shunt. The patient with epilepsy did not present any neurological complication with a treatment initiated at 5 μg/m2/day. Among the six patients treated with 5 μg/m2/day, none of them presented neurological toxicity, but three of them had other toxicities, such as hepatic or renal impairment. Five of them had an increased dosage at 15 μg/m2/day without other impairments. Our results are consistent with a previous study on 11 paediatric patients treated with blinatumomab because of overwhelming toxicity, but no patient had severe adverse events during treatment with blinatumomab.7 This therapeutic strategy allowed us to reduce time without treatment against B-ALL. Retrospective studies established a link between treatment delay and disease-free survival.8 In adult studies, less adverse effects are reported under blinatumomab than under conventional chemotherapy, with similar neurological adverse events in both groups but less other adverse effects.9 Blinatumomab appears to be safe even though neurological events and cytokine release syndrome (CRS) might occur.10, 11 In phase I/II paediatric studies, the most frequent reported adverse events are cytopenia, CRS (4/49 patients) and seizures (2/49 patients).12 Adverse events are more frequent in our study than in those last ones, but indications are different: inflammatory and infectious situations might induce higher complications. In one centre, it was decided to initiate treatment with blinatumomab at a lower dosage of 5 μg/m2/day, without neurological events in these patients. Furthermore, phase I study monitored toxicity with 5, 15 and 30 μg/m2/day with higher dose every 7 days, and adverse events were more frequent with higher dose; thus, recommended dosage has been determined at 5 and then increased to 15 μg/m2/day.12 Initiation of blinatumomab at 5 μg/m2/day in case of complication such as the infectious one should be preconized. In adult studies, neurotoxicity is not associated with dosage but age, other treatments and previous neurotoxicity.13 This could help to determine risk groups and to adjust the therapeutic strategy for specific patients. In this retrospective multicentric study of 23 patients treated with blinatumomab because of temporary contraindication to chemotherapy, this strategy was associated with disease control as a bridge to chemotherapy after toxicity resolution. Adverse events induced by blinatumomab are relatively frequent in our paediatric study and might require to adjust the initial dosage in this particular indication. Drs Collignon and Brethon conceptualized the study, found resources and acquisitions and wrote this paper. Drs Domenech, Ducassou, Pluchart, Bruno, Pasquet, Simon, Petit and Rialland-Battisti reviewed and edited the paper. This study was supported by Assistance Publique des Hôpitaux de Paris. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Table S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Al decir que un paciente es «negro», se le supone una ascendencia africana subsahariana o que tiene una piel muy oscura. En ambos casos, el médico que ha recibido una formación centrada en pacientes de piel clara de ascendencia europea puede tener algunas dificultades diagnósticas o terapéuticas. Los principales ámbitos en cuestión son las diferencias en la semiología de las lesiones cutáneas, su percepción por parte del paciente y los riesgos de secuelas discrómicas, en relación con una actividad melanocítica intensa; algunas particularidades epidemiológicas debidas a factores genéticos o ambientales, y singularmente, una incidencia muy baja de los cánceres cutáneos fotoinducidos; determinadas afecciones capilares relacionadas con las especificidades del cabello afrotexturizado; una frecuencia y gravedad más elevadas de enfermedad queloide, verdadera «necesidad médica no satisfecha»; necesidades o hábitos cosméticos específicos, y las complicaciones derivadas del uso de productos despigmentantes.

La panniculite associée au déficit en alpha1-antitrypsine est principalement associée au variant ZZ, variant le plus sévère caractérisé par un faible taux sérique d'alpha1-antitrypsine. Cependant, des cas exceptionnels ont été décrits avec le variant MS le moins déficitaire. Nous décrivons ici un cas de panniculite associée à un variant MS et soulignons l'importance du phénotypage et du génotypage de l'alpha1-antitrypsine dans le diagnostic de ces formes rares de panniculite à taux sérique normal. Il s'agissait d'une femme de 46 ans, sans antécédent, qui présentait depuis six mois des nodules sous-cutanés douloureux et inflammatoires des membres supérieurs sans guérison spontanée. Le bilan de panniculite (anticorps antinucléaires, lipasémie, amylasémie, explorations microbiologiques) était négatif, y compris le taux sérique d'alpha1-antitrypsine (1,17 g/L, N > 1 g/L). L'examen histologique montrait une panniculite lobulaire granulomateuse et neutrophilique polymorphe et lipophagique. Le génotypage de l'alpha1-antitrypsine a révélé une hétérozygotie du gène SERPINA1 avec une mutation de l'exon 3 (c.863 A>T ; p.Glu288Val) correspondant à l'allèle déficitaire S et donc à un phénotype MS. La patiente a été traitée avec succès par corticostéroïdes et méthotrexate puis avec un relais par dapsone sans récidive des lésions pendant un an. Le déficit en alpha1-antitrypsine est une maladie autosomique dominante rare avec une prévalence de panniculite estimée entre 0,1 % et 0,9 % des cas. Entre 1970 et 2020, 117 cas de panniculite associées à ce déficit ont été rapportés dans la littérature. Il s'agit d'une panniculite lobulaire avec classiquement un infiltrat riche en polynucléaires neutrophiles et macrophages. L'alpha1-antitrypsine est une protéine codée par le gène SERPINA1 qui protège les tissus de l'action de l'élastase neutrophilique. Environ 90 % de la population générale présente un génotype de type sauvage (variant MM). Les mutations du gène SERPINA1 conduisent à des variants déficitaires tels que MS, SS, MZ, SZ et ZZ, ZZ étant le variant le plus rare et le plus sévère. Soixante-dix pour cent des panniculites associées à ce déficit s'observent chez les variants ZZ. Le variant MS, concernant 5 % de la population, induit le plus souvent un taux suffisant d'alpha1-antitrypsine, sans symptôme associé. Moins de 10 cas de panniculites neutrophiliques avec variant MS ont été rapportés. La panniculite associée au déficit en alpha1-antitrypsine est une entité rare et le plus souvent décrite dans les variants ZZ. De rares cas existent avec d'autres variants y compris le variant le moins déficitaire MS. En cas de forte suspicion anatomoclinique, il semble nécessaire de réaliser un phénotypage et/ou un génotypage systématique de l'alpha1-antitrypsine en cas d'absence de déficit pondéral.

La durée et le contenu des programmes de réentraînement à l’effort (RAE) à destination des patients lombalgiques chroniques restent controversés. En effet, les programmes intensifs restent coûteux, chronophages et ne peuvent donc être proposés qu’à une minorité des patients les plus lourdement invalidés. Or des prises en charge alternatives ont montré des résultats encourageants et la pandémie Covid a permis le développement de la télérééducation. L’objectif de cette étude était de comparer un programme de RAE à mi-temps, contenant des séances de télérééducation à un programme de RAE à temps plein. Étude rétrospective, monocentrique, menée au Centre de médecine physique et réadaptation d’Angers chez 151 travailleurs lombalgiques chroniques ayant bénéficié d’un programme de RAE temps plein de 5 semaines (RAE-tp) [avant septembre 2020] ou d’un programme de RAE de contenu similaire (kinésithérapie, activité physique adaptée (APA), ergothérapie, psychomotricité, soutien psychologie, conseils diététiques, accompagnement social), de 5 semaines à mi-temps en Centre complété par des séances de télérééducation dispensées par un professeur d’APA et un kinésithérapeute (RAE-tr) à partir de la 3e semaine du programme [après septembre 2020]. Les résultats obtenus en fin de programme et l’évolution des paramètres physiques et psychosociaux au cours des deux programmes ont été comparés. Soixante-seize patients ont bénéficié du programme RAE-tp (53,9 % de femmes, 44,5 ± 8,6 ans) et 75 patients du programme RAE-tr (50,8 % d’hommes, 44,3 ± 9,2 ans). Les caractéristiques médicales et sociodémographiques des deux groupes étaient similaires à l’inclusion. On observait une amélioration significative (p < 0,001) de l’ensemble des paramètres physiques et psychosociaux en fin du programme dans les deux groupes. En fin de programme, seuls les scores obtenus aux tests d’endurance de Sorensen (p < 0,001) et d’Ito-Shirado (p = 0,011) étaient significativement plus élevés dans le groupe RAE-tp avec également un gain significativement plus important au cours du programme (p < 0,001 et p = 0,004 respectivement) dans le groupe RAE-tp. Cependant, il n’y avait pas de différence significative entre les deux groupes pour les autres tests physiques et psychosociaux (EVA, distance doigt-sol, port de charges, Dallas, FABQ, HAD). Le RAE mixte, associant des séances en présentiel et de télérééducation semble être une alternative pertinente pour la prise en charge de la lombalgie chronique. Le développement de tels programmes pourrait permettre la prise en charge d’un plus grand nombre de patients à un coût moindre.

Background Few studies include a sufficient number of people to be representative of a general population and to estimate the musculoskeletal pain prevalence. Objectives To estimate the prevalence of musculoskeletal and widespread pain in the French popualtion using a large and representative cohort. Methods The Constances cohort is composed of volunteers, aged 18 to 69 years at inclusion. Eligible subjects were selected at random by stratified sampling with unequal probabilities, over-representing individuals with a higher probability of not volunteering (according to their age, sex, socioprofessional category) with adjustment coefficients weight participation bias. Individuals diagnosed with a cancer were excluded. Musculoskeletal pain was assessed by the Nordic Questionnaire. Significant pain lasted at least 30 days during the last 12 months. Widespread pain concerned at least 4 of the 6 areas. Chronic moderate to severe pain reached a pain score ≥ 4/10 in the last 7 days. Data from the entire cohort were described and then the French population prevalence was estimated, based on people included in 2017 with adjustment coefficients. Results 193,436 people were included in the cohort. The French population prevalence of each pain location and widespread pain were estimated among the 25,472 people included in 2017. Conclusion The prevalence of musculoskeletal pain in the French population is high, particularly for chronic pain of moderate to severe intensity, which underlines the need to improve their detection, prevention and management. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.Pain prevalence in the cohort (%)Moderate to severe pain prevalence in the cohort (%)Pain prevalence estimation in the french population (% [SD])Moderate to severe pain prevalence estimation in the french population (% [SD])Back24.616.025.9 [25.4-26.5]17.9 [17.4-18.4]Neck16.610.417.1 [16.7-17.6]11.2 [10.8-11.6]Shoulder16.39.417.0 [16.5-17.5]10.5 [10.1-10.8]Knee18.911.119.8 [19.3-20.2]12.4 [12-12.8]Hand14.07.714.7 [14.2-15.1]8.5 [8.2-8.8]Elbow8.54.39.2 [8.2-9.6]4.9 [4.7-5.2]Widespread pain7.03.8.1 [7.8-8.5]4.2 [4-4.5]

En 1875, Gustave Bouchereau (1835–1900), Gustave Lolliot (1835–1882) et Valentin Magnan (1833–1916) ouvrent une maison de santé privée dit « le Château de Suresnes » dans cette dite commune (1875). Cet établissement accueillait des patients aliénés selon les termes de la loi de 1838. G. Lolliot en sera le premier médecin directeur. En 1882, Honoré Saury (1854–1924) lui succède. Il a pour médecin adjoint Léon Victor Revertégat (1860–1938), ancien interne des asiles de la Seine (1894), qui en devient le médecin-directeur en 1893–1894. Plus tard, il sera le fondateur d’une maison de santé à Sannois (Val d’Oise). Le peintre Maurice Utrillo (1883–1955) séjourna entre 1912 et 1914 dans cet établissement. Du temps où V. Magnan était encore en vie, d’autres médecins vont se succéder à la maison de santé de Suresnes : Gabriel Stanislas Jacques (1860–1914), Socrate Lalou (1875–1930), Jules-Albert Baronnet (1852–1936), Jean-Maurice Sardain (1876–1961) et Aimable-Clovis Crété (1875–1934). Tous y resteront peu de temps, hormis G. Jacques qui décède dans sa 50e année alors qu’il occupe les fonctions de médecin-directeur à la maison de santé de Suresnes. S. Lalou, plus orienté vers des recherches expérimentales que clinicien, est nommé professeur de pharmacologie dans son pays d’origine, la Roumanie. A.-C. Crété exerce à la maison de santé de Suresnes après avoir exercé à celle de Fontenay-sous-Bois. Il termine sa carrière au sanatorium de Guervenan (Finistère) qui complète les dispensaires d’hygiène sociale et antituberculeux. J.-A. Baronnet, L.-V. Revertégat et J.-M. Sardain ont été des médecins qui n’ont pas parfaitement apprécié toutes les satisfactions que donne l’exercice de la psychiatrie, se réorientant vers l’odontologie probablement pour des questions financières. Parmi eux, L. Revertégat, G. Jacques et J.-M. Sardain ont été membres de la Société clinique de médecine mentale ; le premier en 1908 et les deux autres en 1910. Seul L. Revertégat a été membre de la Société Médico-Psychologique en 1906.In 1875, Gustave Bouchereau (1835–1900), Gustave Lolliot (1835–1882) and Valentin Magnan (1833–1916) opened a private nursing home for psychiatric patients (insane or not) in Suresnes, known as “le Château de Suresnes” (1875). This establishment took care of patients declared insane according to the terms of the law of 1838. G. Lolliot was the first medical director. In 1882, Honoré Saury (1854–1924) succeeded him. His physician assistant was Léon Victor Revertégat (1860–1938), a former intern of the Seine asylums (1894). This latter became in turn the medical director in 1893–94. Later, he was the founder of a private nursing home in Sannois (Val d’Oise). One of his patients was the painter Maurice Utrillo (1883–1955); he was hospitalized between 1912 and 1914 over there. L. Revertégat was a member of the Société Médico-Psychologique and of the Société clinique de médecine mentale respectively in 1906 and 1908. Afterwards, while V. Magnan was still alive, other doctors followed suite: Gabriel Stanislas Jacques (1860–1914), Socrate Lalou (1875–1930), Jules-Albert Baronnet (1852–1936), Jean-Maurice Sardain (1876–1961) and Aimable-Clovis Crété (1875–1934). Among them, G. Jacques and J.-M Sardain were members of the mental medicine society in 1910. G. Jacques died in his 50th year while he was medical director. S. Lalou was more interested in experimental research rather than clinical study; he returned to his native country (Romania) where he was appointed professor of pharmacology (Bucarest). After working in a private nursing home for the psychiatric ill in Fontenay-sous-Bois, A.-C. Crété. worked in that of Suresnes and finished his career in a sanatorium in Guervenan (Bretagne) which completed the social hygiene and anti-tuberculosis dispensaries. J.-A. Baronnet, L.-V. Revertégat et J.-M. Sardain were doctors who did not seem to particularly appreciate the satisfaction brought by the psychiatry specialty and later became dentists; most probably for financial reasons.

Angioimmunoblastic T-cell lymphoma (AITL) is a peripheral lymphoma with a follicular helper T-cell immunophenotype that may involve the skin [1, 2]. Maculopapular exanthema is the most common dermatological manifestation. Herein, we describe an atypical presentation with palpebral oedema and erythema. A 50-year-old woman with a history of type 1 diabetes presented with lymphadenopathy and annular patches on her trunk and legs which had been present for a few months. Skin biopsy showed a lymphoid infiltrate with folliculotropism, epidermotropism and dominant clonal T-cell receptor gene rearrangement. An initial diagnosis of folliculotropic mycosis fungoides was proposed. A lymph node biopsy revealed non-specific follicular hyperplasia with the same clonal rearrangement as in the skin. A second nodal biopsy showed preserved architecture, follicular hyperplasia, abundant dendritic cells, and mantle zones with an “onion-skin” appearance, suggestive of Castleman’s disease. Serological testing for HTLV1 was negative. Slight thrombocytopenia and lymphopenia were found. Topical corticosteroids resulted in complete remission of skin lesions.