Arthropathies

Arthrose

• Caractéristiques radiologiques:
  1. Pincement articulaire
  2. Sclérose sous-chondrale
  3. Ostéophytes
  4. Géodes
• Traitement: AINS, chirurgical (remplacement prothétique).
  • Arthrose du genou: duloxétine. Injection intra-articulaire de glucocorticoïdes ou d'acide hyaluronique dans l'arthrose du genou et de la hanche. Pas de bénéfice du paracétamol dans l'arthrose de la hanche et du genou.

Arthrites microcristallines

Chondrocalcinose

• Synonyme: pseudogoutte

Déposition de cristaux de pyrophosphate de calcium

Goutte

• Traitement de la crise de goutte:
  • Colchicine The simplest is colchicine, 1.2 mg at the first symptoms of a gout attack, followed 1 hour later by a 0.6-mg dose. Colchicine is most effective when used early in attacks (<24 hours after onset) and is less useful when the attack is well established.
  • AINS High-dose NSAID therapy for 5 to 7 days is effective
  • Glucocorticoïdes in any form—intra-articular injection, intramuscular depot injection (for example, depo-methylprednisolone, 40-80 mg), or an oral “burst” of prednisone (for example, 0.5 mg/kg/d, for 5 days).
  • For patients with severe and refractory attacks, or with contraindications to other treatments, off-label use of IL-1 inhibitors (anakinra or canakinumab) can be considered.
• Traitement hypo-uricémiant: Contrary to prior practice, urate-lowering therapy can be initiated during an acute attack if adequate anti-inflammatory therapy is concurrently started; doing so may improve compliance in some patients.
  • Xanthine oxidase inhibitors → reduce urate production: allopurinol, fébuxostat (Adénuric)
  • Uricosuric agents → decrease renal urate resorption: probénécide (Santuril)
  • Pegloticase (a uricase).

Source: https://ard.bmj.com/content/76/1/29

Polyarthrite rhumatoïde (PAR)

• Facteur rhumatoïde (FR) positif, anticorps anti-peptide cyclique citrulliné (anti-CCP) positif
• https://www.revmed.ch/RMS/2014/RMS-N-421/Traitement-de-fond-de-la-polyarthrite-rhumatoide