Bien que les relations entre traumatisme et rhumatisme inflammatoire chronique prêtent à discussion depuis de nombreuses années, il existe quelques observations bien documentées qui confirment la possibilité de cette association. Nous rapportons l’observation d’un homme de 45 ans, porteur d’un psoriasis cutané, qui présentait une arthrite de l’avant–pied droit après un traumatisme. Le diagnostic de rhumatisme psoriasique posttraumatique était retenu car les critères d’imputabilité du traumatisme ainsi que ceux de rhumatisme psoriasique étaient parfaitement respectés.

El estudio diagnóstico de un dolor de pie o de tobillo (global o localizado: talalgia, metatarsalgia, dolor en el medio o en el retropié) se basa en el sencillo análisis clínico de sus circunstancias de aparición (práctica de un deporte y fracturas por fatiga o tendinopatías; condiciones climáticas particulares, como el frío intenso y las congelaciones, etc.) o en la presencia de grandes cuadros clínicos que lo acompañan: aspecto clínico inflamatorio, con un síndrome inflamatorio revelado por los exámenes de laboratorio (lesiones cutáneas inflamatorias o infecciosas, artritis) o sin él (algodistrofia, enfermedad ósea de Paget, artropatías neuropáticas); presencia de trastornos tegumentarios sospechosos (psoriasis y artritis, vasculitis y enfermedades sistémicas, nódulos incrustados de un sarcoma de Kaposi, etc.); aparición de signos vasculares arteriales (arteriopatías) o venosos; existencia de signos neurológicos centrales o periféricos (síndromes de canal medular, afecciones neurológicas espontáneas o familiares); pie congénitamente malformado o deformado (trastorno estático: pie cavo, eventualmente familiar y/o relacionado con una enfermedad neurológica subyacente; pie plano, en ocasiones secundario a una artropatía; hallux valgus o rigidus, etc.). Todas estas situaciones deben sustentarse mediante un examen físico, ayudado por exploraciones complementarias simples y habituales. La ausencia de diagnóstico etiológico de certeza obliga a basarse en procedimientos más sofisticados y costosos antes de concluir en una posible, pero inusual, causa de tipo psicológico (síndrome de conversión).

Introduction. - Half of the patients with genetic hemochromatosis will have arthritis. Two of these articular involvements are well-known: the arthropathy involving the phalangeal and the metacarpophalangeal joints of the hand, useful for diagnosis, and hip arthropathy. Iron deposits seem to be involved in articular cartilage destruction.Exegesis. - We report five cases of patients with hemochromatosis hip involvement. Hip arthropathy revealed hemochromatosis in one case and appeared despite efficient phlebotomies in another case. Three of these patients required hip arthroplasty.Conclusion. - Hip arthropathy remains a frequent but unknown event in genetic hemochromatosis (12,5%) and it involves the functional prognosis. (C) 2002 Editions scientifiques et medicales Elsevier SAS.

INTRODUCTION:Half of the patients with genetic hemochromatosis will have arthritis. Two of these articular involvements are well-known: the arthropathy involving the phalangeal and the metacarpophalangeal joints of the hand, useful for diagnosis, and hip arthropathy. Iron deposits seem to be involved in articular cartilage destruction. EXEGESIS:We report five cases of patients with hemochromatosis hip involvement. Hip arthropathy revealed hemochromatosis in one case and appeared despite efficient phlebotomies in another case. Three of these patients required hip arthroplasty. CONCLUSION:Hip arthropathy remains a frequent but unknown event in genetic hemochromatosis (12.5%) and it involves the functional prognosis.

A partir de 140 spondylarthropathies (138 hommes) evoluant depuis sept ans (0,1-40 ans) chez des malades âges de 39 ans (18-65 ans) et repondant aux criteres d'Amor, il est precise la place des deux criteres lies a l'atteinte du pied dans le diagnostic de certitude. Ainsi, 66 spondylarthropathies comportent talalgie et/ou orteil en saucisse contre 74 qui ne la presentent pas: 13 de ces 66 cas (neuf spondylarthropathies inclassees, quatre avec psoriasis) n'auraient pas ete diagnostiquees si elles n'avaient comporte talalgie et/ou orteil en saucisse. La talalgie est presente 56 fois, un orteil en saucisse est retrouve 26 fois, les deux ensemble 16 fois. Les differents tests statistiques reconnaissent a l'orteil en saucisse un lien etroit avec les signes inflammatoires cliniques et biologiques, lien qui tient en realite a la synovite par oligoarthrite.

Un homme de 63 ans presente une spondylarthrite ankylosante depuis 28 ans a forme axiale pure et depuis 7 ans une polyarthrite rhumatoide seronegative, avec syndrome de Felty et a forme macrogeodique. Les geodes interessent les mains et les pieds, les poignets, un coude, les epaules, les hanches, un genou et ne s'accompagnent d'aucune demineralisation juxta-articulaire, ni de pincement 1 ni d'erosions 1 ni de destruction articulaire. Elles contiennent un pannus rhumatoide, en particulier celles de la hanche ou a ete ecartee la possibilite d'une coxite macrogeodique de la spondylarthite ankylosante. Le typage HLA revele les haplotypes B27 et DR4 et l'HLA B27 jouerait peut-etre un role dans l'aggravation de la coxite rhumatoide.

OBJECTIVES:Determine the characteristic features of sacroiliac lesions observed in patients with Paget's disease.PATIENTS AND METHODS:A retrospective analysis of the hospital files of 87 patients cared for over a period of 12 years was performed. Six patients, 4 women and 2 men, mean age 79 years, were retained for study. In 4 patients one or both sacroiliac joints were involved with complete fusion of the sacral and iliac bones, confirmed by CT-scan in 3. In the 2 other patients, only one border was involved. Scintigraphy showed polyostotic Paget's disease in 3 cases with pelvic localization in the 3 others. Ankylosing spondylarthritis (B27+) was associated in 1 case and in 2 joint chondrocalcinosis without a calcium rim was visualized at the sacroiliac joint. Sacroiliac fusion was related either to new bone forming a bridge in front of the articular space or destruction of the joint cartilage with pagetic fusion.CONCLUSION:Sacroiliac involvement in Paget's disease leads to joint fusion by cartilaginous destruction and should suggest possible ankylosing spondylarthritis, ankylosing vertebral hyperostosis, or joint chondrocalcinosis.

A 63-year-old man with strictly axial ankylosing spondylitis since the age of 28 years had a seven-year history of cystic seronegative rheumatoid arthritis with Felty's syndrome. Cysts were present in the hands, feet, wrists, shoulders, hips, one elbow, and one knee. There was no evidence of juxtaarticular demineralization, joint space loss, erosions, or joint destruction. Rheumatoid pannus was demonstrated within the cysts, particularly at the hip, ruling out cystic hip disease due to ankylosing spondylitis. HLA typing demonstrated the B27 and DR4 haplotypes. HLA B27 may be associated with a worse prognosis of rheumatoid hip involvement.

OBJECTIVES: Determine the characteristic features of sacroiliac lesions observed in patients with Paget's disease. PATIENTS AND METHODS: A retrospective analysis of the hospital files of 87 patients cared for over a period of 12 years was performed. Six patients, 4 women and 2 men, mean age 79 years, were retained for study. In 4 patients one or both sacroiliac joints were involved with complete fusion of the sacral and iliac bones, confirmed by CT-scan in 3. In the 2 other patients, only one border was involved. Scintigraphy showed polyostotic Paget's disease in 3 cases with pelvic localization in the 3 others. Ankylosing spondylarthritis (B27+) was associated in 1 case and in 2 joint chondrocalcinosis without a calcium rim was visualized at the sacroiliac joint. Sacroiliac fusion was related either to new bone forming a bridge in front of the articular space or destruction of the joint cartilage with pagetic fusion. CONCLUSION: Sacroiliac involvement in Paget's disease leads to joint fusion by cartilaginous destruction and should suggest possible ankylosing spondylarthritis, ankylosing vertebral hyperostosis, or joint chondrocalcinosis.

While radiographic lesions of the sacroiliac joint (SIJ) are common in patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, they are rarely accompanied by clinical symptoms. We report the case of a 69-year-old woman who presented with an acute sacoiliitis and a linear calcification in the right SIJ on CT scan. The patient recovered well after intra-articular steroid injections.

BACKGROUND: The iliac bone is an uncommon localization for bone insufficiency fractures. We report a new type.CASE REPORT: A 51-year-old woman with postmenopause osteoporosis was seen fora fracture of the ischiopubic branch of the iliac bone. X-ray also revealed an unknown fracture situated above the anterior superior iliac spine continuing cranially and medially towards the iliac crestDISCUSSION: Three types of iliac fractures due to bone deficiency have been described. Type 1, (oblique iliac), the fracture is oblique beginning in the greater sciatic notch and extending a more or less into the iliac wing. Type 2 (superior medial iliac) involves the most medial part of the iliac wing, approximately parallel to the sacroiliac joint In type 3 (supra-acetabular), the fracture is in a supra-acetabular localization. Our case suggests a fourth type should be individualized.

The case of a patient who had both Paget's disease and axial ankylosing spondylitis is reported. Sacroiliac joint lesions can be caused by either or both conditions. It follows that the diagnosis of axial ankylosing spondylitis in a patient with Paget's disease should rest on strict criteria that do not take into account radiological evidence of sacroiliitis (criteria developed by Baudouin, and Landureau) or on Amor's criteria.