[Lyme arthritis]. / L'arthrite de Lyme.

Infection by spirochete Borrelia burgdorferi is mainly observed in the United States where it has taken the name of Lyme's disease, and in Europe. Its evolution may be very extended, in several phases. A few weeks after a tick-bite, the primary lesion appears, which is a chronic migrating erythema. In the following weeks or months, in the secondary phase, nerve lesions may appear, quite similar in Europe and in the United States, and cardiac lesions, mostly seen in the United States. In the following weeks, months, or years, during the tertiary phase, articular lesions may appear, frequent in the United States, much more unusual in Europe. Several years later, chronic lesions of the central nervous system may appear, described in the United States, and chronic skin lesions such as chronic atrophying acrodermatitis sometimes associated with destructive lesions of the joints underlying the skin lesion, which are only recognized in Europe. The discovery of the spirochete in a small number of these lesions, including the latest in the evolution, permits to think that, throughout this evolution, this disease is secondary to the persistence of the germ within the body; this explains the efficacy of the penicillin treatment, including in the oldest forms of the disease. Serology is quite reliable; but it becomes positive only 2 to 4 weeks after the onset of the chronic migrating erythema: needless to say the importance of this single cutaneous lesion which enables to make the diagnosis and requires the use of a tetracycline or penicillin treatment.

[Joint manifestations of Yersinia enterocolitica infections]. / Les manifestations articulaires des infections a Yersinia enterocolitica

Different recent studies, notably Scandinavian studies, have described a "rheumatism" caused by Yersinia enterocolitica infection. The picture usually seen is that of a subacute, febrile oligoarthritis predominantly in the lower limbs, associated with diarrhoea and hyperleucocytosis, polynucleosis, and a marked increase in the sedimentation rate. Benign carditis may also be associated. The diagnosis rests on the discovery of the organism by coproculture and on serodiagnosis. Evolution is favourable within several weeks or several months. Treatment includes antibiotics and antinflammatory preparations.

[Bone and muscular lesions in sarcoidosis]. / Les lésions osseuses et les lésions musculaires de la sarcoïdose.

Bone lesions are observed in 10 to 15 p. 100 of cases of sarcoidosis. They occur in women in 2 out of 3 cases; the age of onset is slightly later than that of the sarcoidosis; the lesions involve mainly the fingers and toes but any part of the skeleton may be affected. The lesions are nearly always lytic, sometimes associated with chronic cutaneous, ocular or nasal sarcoid lesions; progression is slow and improvement is usually observed with steroid therapy: mortality is higher in patients with sarcoidosis and bone lesions than when there are none. Muscle involvement is present in about 50 p. 100 of cases of sarcoidosis but is usually clinically latent. Symptoms are sometimes observed related either to intramuscular nodules or to pseudomyopathy . These clinical presentations may be the only clinical sign of sarcoidosis for some time. It is important to recognise the true underlying cause with the aid of histology as steroid treatment is effective.

[Polyarthritis in the elderly]. / Die Alterspolyarthritis.

Ten to thirty-three per cent of all cases of rheumatoid arthritis (RA) develop after sixty years of age. Late-onset RA patients are more likely to be male, to have faster onset of symptoms, to experience shoulder and hip disease initially, and to have higher erythrocyte sedimentation rates; they are less likely to develop rheumatoid nodules, extraarticular manifestations, positive serologic tests, or unfavorable outcomes. There are roughly three patterns of late-onset RA: a classical form which resembles typical adult-onset RA; a limited, fairly mild form in which Gougerot-Sjögren syndrome often coexists; and a form in which the shoulders and hips are involved first. The latter form, whose early stage closely resembles polymyalgia rheumatica (PMR), accounts for approximately 25% of cases, is very specific of elderly patients, and is difficult to differentiate from PMR. RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a different entity from RA.

[Definition of and diagnostic criteria for osteoarthritis. Application of anti-osteoarthritis agents to clinical experimentation]. / Définition et critères diagnostiques de l'arthrose. Application à l'expérimentation clinique des anti-arthrosiques.

The best definition of osteoarthritis is anatomical, but to be rigorous must include the biochemical characteristics of osteoarthritis cartilage. The most appropriate diagnostic criteria for clinical trials are those of Lequesne. However, radiological criteria assume that osteoarthritis had already developed and should be modified in order to permit the inclusion of early stages of osteoarthritis. The ACR classification criteria are less appropriate to the needs of clinical trials because of their lack of specificity. They are, nevertheless, of interest to the clinician in diagnosis and to the epidemiologist because of their simplicity. Diagnostic criteria of early-stage osteoarthritis proposed by Amor are of great interest to the clinician. However, their application to clinical trials still suggests certain difficulties. One can hope that such difficulties will be resolved with the development of M.R.I. and/or the discovery of novel biologic markers.

[Inoculation spondylodiskitis]. / Spondylodiscites d'inoculation.

An enquiry on French rheumatology units permitted the authors to collect 122 cases of inoculation spondylodiscitis from 1967 to 1979, whereas over the same period were observed on these units 793 cases of spontaneous non-tuberculous spondylodiscitis. There were also 10 cases of spondylodiscitis after discography. Discal curettage was the most frequent cause. The staphylococcus is the germ most commonly encountered. The course is on the whole favourable, without clinical sequelae and a radiological blockage only occurred in 25 cases.

[Contribution to the study of scapulo-humeral periarthritis: anatomical lesions of simple chronic painful shoulder]. / Contribution à l'étude des périarthrites scapulo-humérales: les lésions anatomiques de l'épaule douloureuse simple chronique.

The authors restate that simple pain of the shoulder, which is a form of scapulo-humeral periarthritis characterized by the existence of pain without limitation of movement, is almost always associated with lesions of the tendons of the short muscle teres of the shoulder. They term chronic simple pain of the shoulder the rare cases where, despite therapy that is reputed to be efficient, there is a gradual development lasting more than one year, either continuously or with relaps periods of less than three weeks. They show that these chronic shoulders are practically always associated with a rupture of the coat of the muscle teres or a calcification of the tendons of the teres coat. Ruptures are as much frequent in men as in women and calcifications definitely more frequent in women (60%). Before 30 years of age, the most frequent lesion is almost always a calcification, and after 65 rupture is more common. Between 30 to 65, the probability of a calcification in a chronic simple painful shoulder, goes from 100% to 0, while the probability of a rupture increases from 0 to 100%.

[Vasomotor polyarthralgia]. / Les polyarthralgies vasomotrices.

The authors report 11 observations of middle-age women seeking medical treatment for polyarthralgia most often involving the hands and often several articulations of legs and arms, with pain sometimes increasing during the night and frequently accompanied by a feeling of stiffness in the morning. The clinical, biological, and radiological studies did not disclose any organic disease except for vasomotor disorders of the Raynaud's disease type, acrocyanosis, acrorigor and clubbed fingers. Therapy with vasodilator isoxsuprine caused the disappearance or the diminution of the pain in 10 out of 11 cases. The authors suggest that these polyarthralgia are the consequence of arterioloconstriction which is a disturbance common to all the vasomotor disorders observed in their 11 patients.

Double-blind trial of ketoprofen compared with placebo in osteoarthrosis of the hip.

In this study, patients suffering from osteoarthrosis of the hip received two successive periods of treatment, A and B, each of two weeks, with either ketoprofen or a placebo. The daily dosage of ketoprofen was 150 mg in three divided doses of 50 mg. In each case the findings necessary for diagnosis and for assessment of progress during the treatment were recorded. At the end of the trial, the patient's preference for one or other of the two periods of treatment was used as the criterion. The results were analysed by the sequential method. The therapeutic effects assessed by the various criteria included in the protocol (patient's subjective assessment, pain at rest, duration of morning stiffness, distance walked without pain, range of movements, etc.) were also recorded. Nine cases were sufficient to provide a statistically significant result in favour of ketoprofen. In eight cases the preference was definitely in favour of ketoprofen. In a single case there was no preference for one or other of the two periods of treatment (failure of both ketoprofen and placebo). Tolerance to ketoprofen was excellent.

Double-blind study of ketoprofen against a placebo in osteoarthritis of the hip.

In this trial, the patients suffering from osteoarthritis of the hip received either ketoporfen or a placebo successively for 2 treatment periods, A and B, of 14 days each. The daily dosage of ketoprofen was 150 mg in 3 doses of 50 mg. In each case treated, the parameters necessary for the diagnosis and those necessary to assess progress under treatment are reported. At the end of the trial, results have been rated according to the preference of the patient for treatment period A or B. The results were analysed by the sequential method. The therapeutic results reported were obtained from various criteria stated in the protocol (subjective evaluation by the patient, pain when resting, duration of morning stiffness, distance of pain-free walking, amplitude of movements, etc.). Nine cases were sufficient to produce a significant statistical result in favour of ketoprofen. In eight observations a preference in favour of ketoprofen was apparent. In one case only, there was no preference for either one or the other of the two treatment periods (failure of ketoprofen and of the placebo). Ketoprofen was excellently tolerated.

[Etiological diagnosis of spondylitis. I. Clinical, biological and radiological aspects]. / Contribution au diagnostic étiologique des spondylodiscites . I.--Les éléments cliniques, biologiques et radiologiques

The authors compared the different elements of diagnosis contributed by the clinical examination, and by laboratory and radiological investigations in 33 cases of Pott's disease and 46 cases of non-tuberculous spondylodiscitis. They show that certain elements indicate the diagnosis of Pott's disease : associated visceral tuberculosis, and a radiogram showing in particular a centro-somatic notch, recent primary infection, absence of pain, minimum signs of medullary compression ; other elements on the other hand, indicate a diagnosis of non-tuberculous spondylodiscitis : a negative cutaneous tuberculin test, a positive haemoculture, humoral signs of melitococcosis or of typhoid fever, any indication of possible means of entry of infection in the two months before the disease, radiological signs of reconstruction in the first four months of evolution, location of the lesion in the anterior upper part of the vertebra, and to a lesser degree, the acute febrile nature of the clinical picture. The authors recall that the existence of a large abscess, of which there were no examples in the present series, is an indication in favour of tuberculosis.

[Villonodular synovitis of the knee]. / Contribution à l'étude de la synovite villonodulaire du genou.

The authors report the main results of a study of 12 cases of villous nodular synovitis of the knee. The distribution according to age and sex is in agreement with the data in the literature. The delay between the first sign and the first consultation was, on average, 1.5 years, varying from a few days to 12 years. This long history is due to the usual mildness of the symptoms. The delay between the first consultation and the diagnosis, less variable is, on average, 6 months; this is due to difficulty in diagnosis. More than the extent of the lesions, it seems that the macroscopic appearance dictates the symptoms: villous synovitis or sessile villonodular synovitis, whether diffuse or partial, manifests itself mainly by serous blood-stained effusions; pediculated nodular synovitis, diffuse or localised, is characterised by symptoms on movement. Straight X ray was negative in all the cases reported here. Arthrography gave the diagnosis in 6 of the 9 cases where it was carried out. Arthroscopy was the best examination; in all cases where it was carried out, the macroscopic appearance of the synovial membrane permitted the diagnosis which was confirmed by biopsy under direct vision. Synoviorthesis may give good results, especially radio-isotopic synoviorthesis.

[Etiological diagnosis of spondylitis. II. Vertebral puncture biopsy and surgical approach]. / Contribution au diagnostic étiologique des spondylodiscites. II.--La ponction biopsie vertébrale et l'abord chirurgical

The authors tried to determine the ways in which vertebral puncture biopsy and the direct surgical approach can helpin the etiological diagnosis of spondylodiscitis, when the clinical radiological, and laboratory examination leave the clinician in doubt. Out of 28 vertebral puncture biopsies, proof of tuberculosis was obtained in 4 cases, and proof of a non-tuberculous cause was obtained in 1 case as a result of isolating the responsible organism. Thirty-eight cases were submitted to the direct surgical approach. When the indication for surgery was solely in order to investigate the etiology, proof of tuberculosis was obtained in half of the cases, and only exceptionally was a non-tuberculous organism discovered. In almost half the cases, the histological characteristics were non-specific and no organisms were detected. Most of these latter cases were, in fact, non-tuberculous spondylodiscitis, although subsequently some of them exhibited evidence of a tuberculous character. In the present state of knowledge, it seems that, in cases of clearly non-tuberculous spondylodiscitis, the direct surgical approach is not justified if the objective is solely to isolate the organism, so that its sensitivity to antibiotics can be tested. The following reasons are given for this conclusion : the direct surgical approach only rarely leads to isolation of the causal organism; although treatment based on knowledge of antibiotic sensitivity may help to restrict evolution of the disease, it does not reduce significantly, or only rarely, the permanent partial incapacity. If the results published by Seignon and Gougeon are confirmed, early needle puncture of the diskovertebral centre of the disease should be practised more widely.

[Lumbosciatica and nerve root anomalies]. / Lombosciatique et anomalies radiculaires.

The authors report 3 cases of lumbar pain and sciatica where operation revealed the existence of abnormalities in the distribution of L5 and S1 roots. In one case, the L5 root was not recognised within fibrous tissue also surrounding S1 and S2 and histological examination of this "fibrosis" led to the identification of nerve structures. Development of postoperative L5 paralysis showed that the L5 root was contained within the tissue non-individualised, consisting of multiple rootlets. In the other two cases the L5 and S1 roots arose from a common trunk. There was an associated herniated disc in all three cases. A review of the literature revealed the rarity of such abnormalities, as well as the fact that they were not recognised before surgery. They are difficult to recognise, even at the time of operation. The prognosis is less good than in typical lumbar pain and sciatica, essentially because of surgical difficulties of the disc curettage.

[Bone density and biological markers in a population of 330 women]. / Densité osseuse et marqueurs biologiques dans une population de 330 femmes.

A population of 330 non-selected women underwent determination of bone density by means of Bi X absorptiometry of the lumbar spine and femur. The findings showed a negative correlation with the time since the menopause and a positive correlation with the duration of genitally active life and with substitutive hormonal treatment. The determination of the L1 density can replace that of the entire lumbar spine in cases in which osteoarthritis, atheroma or crushing make this determination unreliable. Conclusions cannot yet be based on measurements of the neck of femur. Changes in the biological markers in function of bone density values are difficult to interpret. The measurement of bone density and the assay of biological markers reflect two distinct phenomena, both of which must be taken into consideration in assessing osteoporotic risk.

[Acute leukaemias after treatment using cytotoxic agents for rheumatological purpose. 19 cases among 2006 patients(author's transl)]. / Leucémies aiguës après traitement par agents cytotoxiques en rhumatologie. 19 observations chez 2006 patients.

The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.