Expression clinique des rhumatismes inflammatoires et microcristallins dans les suites d’un accident vasculaire cérébral ischémique ou hémorragique

Abstract : Background: a connexion between neuro-immunological diseases, pain and the clinical expression of rheumatic diseases has been suspected with great interest for many years, as illustrated by recent publications. We propose to describe prospectively the clinical expression of gout and pseudo-gout, right after an ischemic or hemorrhagic stroke, and retrospectively the clinical expression of rheumatic diseases (RD) (rheumatoid arthritis, spondylo-arthritis, systemic scleroderma) after an ischemic or hemorrhagic stroke. Methods: from January 2016 to April 2017, we realized a prospective observational multicentric study. Patients were included with joint attacks after an ischemic or hemorrhagic stroke, during their hospitalization in neurology units. The observational retrospective monocentric study was realized from 2008 to March, 2016, using the databases of the University Hospital of Bordeaux’s rheumatology and neurology units. We recorded demographic, neurologic and eumatologic characteristics in acute setting, during the joint attack (neurology hospitalization) and during the follow-up consultation in rheumatology for RD, far away from stroke. We calculated median and average value with standard-deviation. We used a Chi-square test with adjustment to compare the clinical expression of gout and pseudo gout between unaffected and paretic side. Results: we included 37 gout and pseudo-gout patients and finally studied 33 patients. We included 104 RD and in the end studied 18 RD. Gout and pseudo-gout occur in 82% of cases on the paretic side: 77.7 % of cases in gout ( p=0,09), and 83% of cases in pseudo-gout (p=0,001), right after an ischemic or hemorrhagic stroke. Gout and seudo-gout were a rare event, occurring in 0.5 à 1.1% of cases during the neurologic hospitalization for stroke. The average delay of gout and pseudo-gout attack after stroke was 5.5 days. RD occurred preferentially, on the unaffected side, as radiographical lesions. Calcinosis of systemic sclerosis’ patients occurred preferentially on the paretic side, without decisive conclusion for rheumatoid nodules. Conclusion: gout and pseudo-gout occur mainly on the paretic side of patients right after ischemic or hemorrhagic stroke, whereas rheumatic diseases, diagnosed before stroke or “de novo” after stroke, occur preferentially on the unaffected side. Further investigations are necessary to understand these immuno-neurological mechanisms.
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Master Thesis
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Fanny Busquet. Expression clinique des rhumatismes inflammatoires et microcristallins dans les suites d’un accident vasculaire cérébral ischémique ou hémorragique. Médecine humaine et pathologie. 2017. ⟨dumas-01624841⟩

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