[Bone mineral density and bone metabolism in spondylarthropathies]. / Densité minérale et métabolisme osseux des spondylarthropathies.

AIMS: To study the prevalence of osteoporosis in a group of patients with spondyloarthropathy and to investigate bone turnover markers and correlation between bone mineral density and the age at the beginning of the disease. PATIENTS AND METHOD: Patients with spondyloarthropathy as defined by New York and ESSG criteria. Bone mineral density was measured at the lumbar spine and hip with Hologic QDR 1000. Serum levels of osteocalcin, deoxypyridinoline, 25 vitamin D, creatinine and parathyroid hormone were measured. RESULTS: 50 patients were included in the study: 37 men, mean age 40,2+/-13,8 years. Vertebral osteopenia was observed in 34% while femoral osteopenia occurred in 40% of patients. Serum vitamin D was low in 70% of patients without parathyroid hormone or kidney function modification. Markers of bone turn over were increased in 29% of patients. There was no correlation between these biological markers and the bone mineral density. We observed a significative correlation (P=0,02) between the age at the beginning of the disease and the bone mineral density. CONCLUSION: Osteopenia is present in patients with spondyloarthropathy without any correlation with the bone turnover biological markers. We observed a significative correlation between the age at the beginning of the disease and bone mineral density.

Spontaneous bilateral humeral head fractures occurring simultaneously in a woman with rheumatoid arthritis.

A 67-year-old woman with a 15-year history of seropositive rheumatoid arthritis developed acute night pain in both shoulders. Examination revealed bilateral swelling and joint mobility impairment. Ultrasonography disclosed joint effusions which were hemorrhagic on aspiration. Radiographs showed the presence of a four-part fracture of both humeral heads. Bilateral humeral head fractures can occur spontaneously in patients with rheumatoid arthritis and osteoporosis. Repeated use of crutches could be a predisposing factor.

Cholesterol crystal embolization simulating focal myositis.

Cholesterol crystal embolization usually produces characteristic skin lesions. We report a case responsible for myositis of the calf without suggestive skin lesions. The outcome in this 58-year-old patient was spontaneously favorable. Cholesterol crystal embolization can produce a range of clinical symptoms, with the skin, kidneys, and eyes being the most common targets. Generalized forms can result in systemic disease. The diagnosis rests on histological findings, and the treatment is symptomatic. Anticoagulants have been shown to worsen the manifestations, whereas antiplatelet therapy may be useful.

[Recurrent shoulder pain indicative of a tuberculous cervical spondylodiscitis]. / Une douleur scapulo-humérale chronique révélatrice d'une spondylodiscite cervicale tuberculeuse.

Shoulder pain is usually related to local osteoarticular or periarticular diseases of mechanical or inflammatory origin. Occasionally, it can be secondary to a discoradicular compression in the cervical spine. We report the case of a 67-year-old woman who was hospitalized for degradation of her general state, inflammation and painful shoulders. General and ear-nose-throat examinations were normal. Pain was elicited by palpation of the shoulders and the cervical spine. The mobility of shoulders and the neck was complete and painless. Laboratory tests showed inflammation with marked eosinophilia. Plain radiographs of the shoulders were normal. A 99mTc total bone scintigraphy showed an increased uptake ranging from D3 to D12. The thoraco-abdominal CT scan was normal. The evolution after seven months was marked by a occurrence of a sudden tetraparesy. The neck CT scan and magnetic resonance imagery showed a C6-C7 spondylodiscitis. The patient was operated and the symptoms disappeared. The Löwensten's culture of the removed discal tissue was positive and confirmed the presence of a Pott's disease. The evolution was favorable with a specific quadri-therapy for nine months. A negative scintigraphy and the presence of an eosinophilia were misleading in the present case. For shoulder pain without a clear etiology, cervical exploration should be adviced. Cervical tuberculosis can begin with isolated shoulder pain.

[Delayed discovery of vertebral sarcoidosis]. / Sarcoïdose vertébrale de découverte tardive.

Vertebral bone sarcoidosis is rare and may be difficult to diagnose. Clinical manifestations are often poor and the discovery can be fortuitous. We report a case of a 64 year old woman whose vertebral sarcoidosis diagnosis was established 20 years after the primary discovery of a cured thoracic sarcoidosis.

[Bilateral knee osteoarthritis associated with supracondylar chondromas and popliteal osteochondromas]. / Arthrose bilatérale du genou associée à des chondromes supracondyliens et à des ostéochondromes poplités.

The knee is a complicated joint where various diseases can coexist. We present a case of a woman with bilateral knee osteoarthritis who's radiographic follow up allowed a 15 year watch of a bilateral medial supracondylar chondroma and of a popliteal osteochondroma of the both knees. This observation emphasizes the usefulness of repeated radiographs, not only in order to survey the evolution of the knee osteoarthritis but also to disclose the appearance and/or disappearance of other lesions in the neighborhood.