Résumé :
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Communication n° 396 Background: Macrophagic myofasciitis (MMF) is a recently described muscular pathological lesion assessing persistence of aluminium hydroxide at site of previous intramuscular (im) injections of aluminium hydroxide-containing vaccines. MMF is detected mainly in adults presenting with chronic arthromyalgias and fatigue. The low detection rate of MMF among vaccine receivers undergoing deltoid muscle biopsy prompted us to identify predictive factors for MMF in myalgic vaccinees. Patients & Methods: A retrospective case-control study was conducted in a series of 130 consecutive vaccinated patients with chronic myalgias referred to the Créteil Neuromuscular Reference Centre from 2002 to 2004. All patients underwent deltoid muscle biopsy and were classified as "MMF" or "non-MMF" according to histopathological findings. In all patients, evaluation included 156 clinical and laboratory parameters. After univariate analysis, most discriminating parameters were used to set up bioclinical scores. For each score, positive and negative predictive values were calculated and performance evaluated by using Receiver Operating Characteristic Curves method. Results: MMF was detected in 42/130 patients (32%). MMF patients had lower tender point count than non-MMF patients (p=0.04), only 2/42 MMF patients fulfilling ACR criteria for fibromyalgia. Parameters used for scores were: (1) tender point count < 11; (2) arthralgias; (3) spinal pain; (4) dorsal spinal pain; (5) vaccine history; (6) documented previous administration of aluminium hydroxide-containing vaccine; and (7) anti-HBs antibodies serum level. Four scores were set up including various combination of 3 to 7 parameters, 1 point being ascribed to each present parameter. Sensibility ranged from 50.0 to 88.1% and negative predictive value from 76.1 to 87.5%. The most reliable score included parameters # 1, 2 and 4. Its sensibility and negative predictive value were respectively 78.6% and 82.4%. Conclusion: (1) MMF was detected in 32% of vaccinees with chronic myalgias; (2) Most MMF patients did not fulfil criteria for fibromyalgia; (3) Our approach could allow us to set up non-histological criteria for MMF.
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