OBJECTIVES: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and fatigue. Its prevalence is estimated to be at 3.4% in women and 0.5% in men. It is a major cause of morbidity. Our objective was to evaluate, using a self-questionnaire sent by mail, the level of knowledge of French physicians, general practitioners, and rheumatologists on fibromyalgia and to analyse their therapeutic approach. METHODS: The demographic characteristics of a sample of general practitioners and rheumatologists were compared to those of the overall data available. This comparison demonstrated the good representativeness of our sample. RESULTS: Fibromyalgia was considered as a disease by 23% of rheumatologists and 33% of general practitioners. While on average, each rheumatologist followed 30 fibromyalgia patients, each general practitioner followed 6.1 patients (i.e., 2 to 5% of their practice's patient base). Among rheumatologists, 6.4% made no distinction between this disease and depression vs. 13.1% of general practitioners. The diagnosis of fibromyalgia was made based on tenderness that occurs in precise, localized areas of the body (trigger points) by 94% of rheumatologists and 79.1% of general practitioners. Of general practitioners and rheumatologists, 93.7% and 73.7% respectively, have not received any medical school training on fibromyalgia or chronic fatigue syndrome. CONCLUSION: Given the lack of medical school training and continuing professional education concerning fibromyalgia (rare use of pain rating scales, confusion in the classification of rheumatic diseases), there is an urgent need to initiate an explicit teaching effort on chronic pain, and on fibromyalgia in particular.

Clinical Competence↗

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Pubic post-fracture osteolysis simulating a malignancy.

The authors report one case of pubic post-fracture osteolysis, an uncommon and as yet not well understood pathology. It corresponds to an unusual healing of an insufficiency fracture in osteoporotic patients. Its pathogenesis is unclear, but the biomechanical theory seems to be the most convincing.

Biomechanical Phenomena↗

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[Dual-photon absorptiometry of the calcaneum in osteoporosis. Preliminary results].

Anteroposterior views of the lumbar spine are commonly used for the measurement of bone mineral density (BMD) by diphoton absorptiometry (DPA). Values in lumbar vertebral BMD can be increased by the existence of a compression fracture, osteoarthrosis, scoliosis or aortic calcifications. Evaluation of bone loss at a peripheral site, such as the calcaneum (essentially trabecular site), could compensate for the principal causes of error associated with vertebral measurement. Calcaneal BMD in 195 control women was used to establish reference values closely correlated with lumbar BMD (p less than 0.001). The same study was undertaken in osteoporotic women. Preliminary results based upon 38 cases are reported here. Measurement of BMD of the calcaneum was correlated with vertebral trabecular bone density measured by double energy CT scan, indicating that this peripheral site offers a good reflection of what is happening at vertebral trabecular level. In contrast, calcaneal BMD was not correlated with spinal BMD, except if patients with osteoarthrosis and/or scoliosis were eliminated. Measurement of the BMD of the calcaneum by DPA is thus a simple, rapid and reproducible method for evaluation of a trabecular bone site which could be complementary to the measurement of lumbar BMD when the latter is falsified by artefacts.

Absorptiometry, Photon↗

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[Is fibrositis an immuno-rheumatologic disease?].

An attempt was made to test the hypothesis that immunological dysfunction occurs in primary polyenthesopathy (PP) by studying skin immunofluorescence, capillary microscopy, photoplethysmography and the lymphocyte populations in PP patients defined according to the usual criteria of Yunus. Skin immunofluorescence in 15 PP patients (14 women, 1 man, average age 50.9 years) failed to reveal any deposit of IgG, A, M, Clq, or C3c either at the dermoepidermal junction or in the vessels. 26 patients (24 women, 2 men, average age 50.5 years) were studied using capillary microscopy and 12 using digital photoplethysmography. The microvascularization abnormalities observed were mild and non specific. A study of the lymphocyte populations using Coulter flux cytometry in 35 PP patients (32 women, 3 men, average age 46 years) did not show any modification in the number of CD4 and CD8 lymphocytes by comparison with the controls. These results do not agree with the data given in the literature and this is probably due to the heterogeneity of the patients studied, with some studies showing a low concentration of antinuclear factors and an abnormal frequency of dry symptoms which, in the opinion of the authors, is considered as an exclusion criterion in the diagnosis of PP. In the author's view, polyenthesopathy is not an immune disease.

Adult↗

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Orbital pseudo-tumor in temporal arteritis revealed by computerized tomography.

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Aged↗

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Tophaceous gout of the patella with primary hyperparathyroidism.

The case of an 81-year-old woman with persistent post-traumatic pain of the knee linked to tophaceous gout of the patella is presented. This gout was associated with adenomatous primary hyperparathyroidism. The relationship between hyperuricemia, hyperparathyroidism and chronic renal failure is discussed.

Adenoma↗

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[Cauda equina syndrome disclosing adenocarcinoma of the ethmoid].

Cauda equina metastases have been exceptionally described in sinusal neoplasms. MRI with gadolinium injection show up the primitive lesion and its neurologic extension. We report a case of cauda equina syndrome in which, only MRI, had show up intradural metastases and localised the ethmoïd sinus carcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Cytomegalovirus-induced pneumonia in a rheumatoid arthritis patient treated with low dose methotrexate.

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Antirheumatic Agents↗

PubMedDate not supplied

Inhospital management of common lumbosciatic syndrome. An opinion survey among French rheumatologists.

To determine which treatments are most commonly offered to patients younger than 70 years of age admitted for uncomplicated lumbosciatica suggestive of disk herniation, we sent a 43-item questionnaire to 106 rheumatology departments in France. The questionnaire collected information on hospital stay duration, modalities of rest, drug treatments, local glucocorticoid injections, physical treatments, sick leave duration and advice given to the patients. The response rate was 77% (84 questionnaires). Substantial variations were found across departments. Hospital stay duration ranged from five to 20 days and nonsteroidal antiinflammatory drug treatment duration from five to 30 days. Local glucocorticoid therapy was given as one to four injections at intervals of two to seven days. Spinal traction was used in 38% and a corset in 50% of study centers. Neither was there any consensus regarding immediate or delayed physiotherapy. Most respondents recommended bedrest for no longer than 15 days, a nonsteroidal antiinflammatory drug, a level I or II analgesic, local glucocorticoid injections and, in the event of persistent pain at the end of the hospital stay, a lumbar corset.

Aged↗