[Cross-sectional imaging of peripheral involvement in psoriatic arthritis]. / Nouvelle imagerie des atteintes périphériques du rhumatisme psoriasique.

The purpose of this article is to: 1) describe the main plain film, ultrasound and MR imaging features of peripheral involvement in psoriatic arthritis, 2) describe the advantages of ultrasound and MRI at the early stages of the disease; 3) describe how to use MRI and ultrasound in order to assess response to tumor necrosis factor-alpha blocker therapy.

Increased exposure to statins in patients developing chronic muscle diseases: a 2-year retrospective study.

OBJECTIVE: Case reports have suggested that lipid-lowering drugs (LLDs), especially statins, could induce or reveal chronic muscle diseases. We conducted a study to evaluate the association between chronic muscle diseases and prior exposure to LLDs. METHOD: This was a retrospective study of chronic primary muscle disease cases newly diagnosed at the Toulouse University Hospitals between January 2003 and December 2004 among patients living in the Midi-Pyrénées area, France. All patients remained symptomatic for more than 1 year after drug withdrawal, or required drugs for inflammatory myopathy. Data on the patient's exposure to LLDs and to other drugs were compared with that of matched controls (5/1) selected through the Midi-Pyrénées Health Insurance System database. RESULTS: A total of 37 patients were included in the study. Of those, 21 (56.8%) suffered from dermatomyositis (DM) or polymyositis (PM), 12 (32.4%) from genetic myopathy, and 4 (10.8%) from an unclassified disease. The prevalence of exposure to statins was 40.5% in patients and 20% in controls (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.21-6.14; p<0.01). There was a significant positive interaction between statins and proton pump inhibitors exposure (weighted OR 3.3, 95% CI 1.37-7.54; p = 0.02). Statin exposure rate was 47.6% among patients with DM/PM (OR 3.86, 95% CI 1.30-11.57; p<0.01). There was no difference between patients and controls for exposure to fibrates. CONCLUSION: Patients who developed chronic muscle diseases after the age of 50, including DM/PM, had a higher than expected frequency of prior exposure to statins. Further studies are needed to confirm this association and the role of proton pump inhibitors.

Blood concentrations of hydroxychloroquine and its desethyl derivative correlate negatively with the percentage of CD45RO+ cells among CD4+ lymphocytes in hydroxychloroquine-treated lupus patients.

The objective of the study was to investigate the influence of the blood concentrations of hydroxychloroquine ([HCQ]) and its derivative desethylhydroxychloroquine ([DHCQ]) on lymphocyte activation or differentiation in HCQ-treated lupus patients. We studied the correlations between [HCQ], [DHCQ], and the frequency of various lymphocyte subsets in 58 HCQ-treated lupus patients (mean HCQ dose: 4.93 +/- 1.58 mg/kg/day; mean duration of the disease: 122 +/- 64 months). [HCQ] and [DHCQ] were determined by high-performance liquid chromatography (HPLC). Lymphocyte markers were studied by flow cytometry using monoclonal anti-CD3, -CD4, -CD8, -CD25, -DR, -CD45RA, -CD45RO, -CD19, -CD38, and -CD86 antibodies. sIL2-R serum concentrations were measured by enzyme-linked immunosorbent assay (ELISA). [HCQ] and [DHCQ] were 599.9 ng/mL (median: 529.5; range: 55-1935) and 353.43 (median: 286 ng/mL; range: 118-1090). In a multiple regression analysis, [HCQ] and [DHCQ] were associated with the HCQ prescribed dose in mg/kg/day (P = 0.0002 and P = 0.03) and with compliance to the treatment (P = 0.004 and P = 0.03). We found a negative correlation between [HCQ], [DHCQ], and the CD45RO+ cell frequency among CD3+CD4+ cells (P = 0.03 and P = 0.007, respectively). Other lymphocyte subset markers (LSMs) and sIL2-R concentrations were not significantly associated with [HCQ] or [DHCQ]. In the multiple regression analysis, CD45RO+ expression was negatively influenced by [HCQ] (P = 0.005), and positively influenced by smoking habits (P = 0.005) and age (P = 0.005). Similar results were found in the multivariate model including [DHCQ]. Disease activity and taking more than 10 mg/day of corticosteroids or an immunosuppressive drug did not influence CD45RO+ expression. Lupus patients had less CD3+CD4+CD45RO+ cells than controls (P = 0.03). In lupus patients, HCQ and DHCQ may alter the generation or the blood circulation of CD4+CD45RO+ lymphocytes in a concentration-dependent pattern.

[Ultrasound features of entesopathy in patients with psoriatic dactylitis]. / Signes échographiques d'enthésopathies au cours des dactylites psoriasiques.

PURPOSE: To describe the sonographic features of entesopathy in patients with psoriatic dactylitis. Materials and methods. Clinical, radiographic and sonographic evaluation of 120 hand joints with clinical abnormality including 20 fingers in 17 patients with rheumatoid arthritis (RA) and 20 fingers in 17 patients with psoriatic arthritis (PA). RESULTS: Forty cases of dactylitis. In patients with RA: 29 cases of synovitis, 15 cases of tenosynovitis, and 2 cases of tendinitis; in patients with PA: 21 cases of synovitis and 3 cases of tenosynovitis. Bone erosions were present in RA patients whereas erosions with bone production were present in PA patients. A total of 60% of RA and PA patients showed erosions on conventional radiographs. Features suggesting entesopathy were present in PA patients only: specific changes of P3, capsular hyperostosis and periarticular periostitis. CONCLUSION: Based on evaluation of PA patients, it seems that sonographic features suggesting entesopathy in patients with dactylitis may be present.

Maintenance treatment with recombinant alpha interferon after autologous bone marrow transplantation for aggressive myeloma in first remission after conventional induction chemotherapy.

Twenty patients (median age 57 years) with high tumor mass myeloma in first remission after conventional chemotherapy received a two-phase treatment: autologous bone marrow transplantation (ABMT) using a preparative regimen of high dose melphalan plus total body irradiation followed by maintenance treatment with recombinant alpha interferon. Before ABMT all patients were in partial remission, while after ABMT 10 (50%) achieved complete remission, and 10 remained in partial remission (with a 90% decrease in measurable paraprotein in 7/10). With a median follow-up of 19.8 months (12.2-33.5) after diagnosis and 13 months (4-25) after ABMT, the Kaplan-Meier 2-year post-ABMT probability of progression-free survival was 85% (95% CI = 58.7-95.8%). None of the 10 patients in complete remission has relapsed. No toxic death occurred. Alpha interferon was introduced early after ABMT (2.7 months) and was well tolerated. This strategy may represent an advance in the management of aggressive myeloma.

Harpagophytum procumbens in the treatment of knee and hip osteoarthritis. Four-month results of a prospective, multicenter, double-blind trial versus diacerhein.

OBJECTIVE: To evaluate the efficacy and safety of Harpagophytum in the treatment of hip and knee osteoarthritis comparatively with the slow-acting drug for osteoarthritis, diacerhein. PATIENTS AND METHODS: A multicenter, randomized, double-blind, parallel-group study was conducted in 122 patients with hip and/or knee osteoarthritis. Treatment duration was four months and the primary evaluation criterion was the pain score on a visual analog scale. Harpagophytum 2,610 mg per day was compared with diacerhein 100 mg per day. RESULTS: After four months, considerable improvements in osteoarthritis symptoms were seen in both groups, with no significant differences for pain, functional disability, or the Lequesne score. However, use of analgesic (acetaminophen-caffeine) and nonsteroidal anti-inflammatory (diclofenac) medications was significantly reduced in the Harpagophytum group, which also had a significantly lower rate of adverse events. CONCLUSION: In this study, Harpagophytum was at least as effective as a reference drug (diacerhein) in the treatment of knee or hip osteoarthritis and reduced the need for analgesic and nonsteroidal anti-inflammatory therapy.

Does vascular endothelial growth factor in the rheumatoid synovium predict joint destruction? A clinical, radiological, and pathological study in 12 patients monitored for 10 years.

OBJECTIVE: Synovial angiogenesis is at the epicenter of rheumatoid pannus development and is largely dependent on vascular endothelial growth factor (VEGF). We sought to determine whether the VEGF level in rheumatoid synovial tissue is a marker for disease severity. PATIENTS AND METHODS: Twelve patients with rheumatoid arthritis (RA) underwent a clinical and radiological evaluation at the time of a synovial biopsy done during joint surgery required by RA progression (T1) and, on average, 10 years later (T2). Immunohistochemistry was used to detect and quantitate VEGF in the synovial biopsy taken at T1. RESULTS: VEGF labeling was seen on endothelial cells and macrophages in all 12 synovial biopsies. The amount of endothelial-cell VEGF labeling (assessed semi-quantitatively) was significantly correlated with Larsen score progression during the 10-year follow-up. The amounts of endothelial cell or macrophage VEGF labeling was not correlated with the joint count, radiological stage of the biopsied joint or progression of this stage, Larsen scores at T1 or T2, presence of rheumatoid factor, or presence of extra-articular manifestations. CONCLUSION: Our results suggest that the amount of VEGF in the rheumatoid synovium may be a marker for joint destruction in patients with RA.

[Renal microscopic hematuria in rheumatoid polyarthritis]. / Hématurie microscopique d'origine rénale au cours de la polyarthrite rhumatoïde.

In a retrospective study of 162 cases of rheumatoid arthritis we found that 24 patients (14.8%) had presented with microscopic haematuria with or without proteinuria. Renal biopsy had been performed in 15 of these 24 patients. Apart from the classical lesions of extramembranous glomerulonephritis, amyloidosis and interstitial nephritis, 60% of histological results showed lesions of mesangial glomerulonephritis. These lesions seemed to be independent of maintenance treatments, but they might have been facilitated by the chronic inflammation kept going by the rheumatoid disease itself.

[Pneumorenal syndrome induced by d-penicillamine: Goodpasture's syndrome or microscopic polyarteritis?]. / Syndrome pneumo-rénal induit par la d-pénicillamine: syndrome de Goodpasture ou polyartérite microscopique?

Diffuse alveolar haemorrhage associated with glomerulonephritis is a rare but serious complication of d-penicillamine therapy. A case is reported which illustrates the usefulness of bronchoalveolar lavage and kidney needle biopsy for the early diagnosis of this condition. A search for antiglomerular basement membrane antibodies in serum was negative, whereas antigranulocyte cytoplasmic antibodies were present. These immunological results differentiated the disease from Goodpasture's syndrome to which it is clinically related and placed it in the same category as microscopic polyarteritis. After treatment with corticosteroids, cytostatic drugs and plasmapheresis, the outcome was favourable in contrast with the usually poor prognosis.

[Capsular retraction of shoulder: prospective study of imaging benefits in 20 patients]. / Capsulites rétractiles de l'épaule: étude prospective de l'apport de l'imagerie chez 20 patients.

PURPOSE: To evaluate the contribution of principal imaging techniques in diagnosis and treatment in adhesive capsulitis of the shoulder. MATERIALS AND METHODS: In 20 patients presenting adhesive capsulitis of shoulder since mean of 6,7 months, the following examinations were performed: radiographies, angioscintigraphy, MRI as well as an opaque arthrography and a bursography associated with corticosteroid injection. Patients were followed during one year. RESULTS: The opaque arthrography was to affirm the adhesive capsulitis for the inclusion of the patients. Radiographies (patchy demineralization) and scintigraphy (hyperfixation) were often pathological. In MRI, T1 fat-saturated sequences after contrast injection almost always showed enhancement of the articular capsula, the synovia, the miscellaneous bone or the sub-acromial bursa. The latter was often modified and retracted at bursography. In 19 of 20 cases, a functional improvement was observed after the opacifications. CONCLUSION: Therapeutic effect of both arthrography and bursography is almost proved. Post contrast MRI confirms presence of vascular troubles in all the shoulder structures even at this advanced stage.

[Hip algodystrophy and pregnancy]. / Algodystrophie de hanche et grossesse.

We report two cases of algodystrophy of the hip in pregnancy. The principle characteristics of the condition are: the occurrence of the symptoms in the second or third trimester of the pregnancy; and these are more marked on the left than on the right hip and radiological decalcification. MRI is accurate, specific and non invasive and it has largely taken the place of scintigraphy and tomodensitometry in making the diagnosis and in the differential diagnosis of early aseptic necrosis of the femoral head. Recovery always occurs in less than a year without sequelae. The physiopathogenic mechanism still is to be discussed but it does seem that the mechanical factors play a very important role.

[Spontaneous pneumomediastinum in dermatomyositis: a pathophysiological approach using imaging]. / Pneumomédiastin spontané et dermatomyosite: approche physiopathologique par l'imagerie.

INTRODUCTION: Spontaneous pneumomediastinum is a rare complication of dermatomyositis. CASE REPORT: We report a case of pneumomediastinum with massive subcutaneous emphysema occurring in a female patient with dermatomyositis treated with cortico-steroids. CONCLUSIONS: Our case illustrates perfectly the mechanism of spread of air along the broncho-vascular structures and also explains the presence of pneumomediastinum in the absence of pneumothorax.

[Paget's disease: errors to be avoided]. / Maladie de Paget: erreurs à ne pas commettre.

Paget's disease of bone occurs in elderly people and resembles no other disease. The most frequent diagnostic errors are made when it is discovered in young adults, especially after an injury. Forms with osteolysis of the lower limbs are the most misleading, and it is better to avoid biopsies in such cases, as they may be followed by fractures. In geriatric pathology the failure to recognize that cerebral, spinal cord and cardiac manifestations are due to a specific vascular disorder of pagetic origin is a serious error as it deprives the patient of calcitonin which is the only effective therapy. Errors in the interpretation of laboratory results are easily avoided if a low hydroxyproline diet is prescribed during the week that precedes the tests. The biochemical activity should be correlated with the pagetic bone mass. Histology may wrongly suggest primary hyperparathyroidism, but patients with Paget's disease have no hypercalcaemia unless they are bedridden. Treatment relies on calcitonin and/or disodium etidronate (EHDP). Only 50% of the patients require this treatment the indications of which must carefully be weighed. EHDP may have adverse effects on bones, including fractures and pseudosarcomatous osteolysis, notably when it is given in high doses or for limited and/or osteolytic lesions. Pre and post-operative calcitonin therapy is recommended in patients undergoing surgery.

[Treatment of Horton disease. Value of synthetic antimalarials. Apropos of a retrospective study of 36 patients]. / Traitement de la maladie de Horton. Intérêt des antipaludéens de synthèse. A propos d'une série rétrospective de 36 patients.

Thirty-six patients with giant cells arteritis were studied retrospectively. Histological examination of the temporal artery or another artery was positive in 95% of cases. Mean follow-up was five years. A synthetic antimalarial was used in every case. Two groups were differentiated. One (Group I) was composed of 21 patients who were given the antimalarial drug as part of the first-line therapy, either with a corticosteroid in a mean dose of 36 mg/d (18 patients) or with a nonsteroidal antiinflammatory agent. The other group (Group II) included 15 patients in whom the antimalarial was used after a period of corticosteroid therapy, because of steroid-dependency (n = 5) or adverse effects (n = 9), or as part of a routinely used protocol (n = 1). Withdrawal of the corticosteroid was achieved in 81% of cases, after a mean interval of 15 months. Many patients discontinued the corticosteroid after less than one year. The 18 Group I patients who were given a corticosteroid were all able to discontinue this drug. The overall recovery rate was 58%; mean time to recovery was 33 months with a mean follow-up of 52 months. There were no recurrences at discontinuation of the treatment. Adverse effects of antimalarial therapy were recorded in 30.5% of patients and required discontinuation of the drug in 19%. The most often used regimen was hydroxychloroquine (40 mg/d) for at least two years and prednisone 20 to 30 mg/d for two months, in the absence of vascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Magnetic resonance imaging in osteoid osteoma]. / Imagerie par résonance magnétique des ostéomes ostéoïdes.

The purpose of this study was to determine magnetic resonance imaging (MRI) features of osteoid osteomas and to evaluate the place of MRI in the diagnostic workup of suspected osteoid osteoma by comparing its diagnostic value with that of computed tomography (CT). Nine patients with radioclinical features highly suggestive of osteoid osteoma were investigated using bone scintigraphy, CT scan and MRI. MRI sequences were weighted for T1 (TR: 500 ms-TE: 34 ms), T2 (TR:2000 ms-TE:50-100 ms) and T1 after intravenous injection of gadolinium-DTPA contrast material. The appearance of the nidus and surrounding area were analyzed, as well as the accompanying inflammatory reaction involving the bone marrow, soft tissues or synovium. All patients had surgical treatment. Clinical recovery was achieved in every case. Histological studies confirmed the diagnosis of osteoid osteoma in 7 patients. In two cases, histological confirmation was not obtained and the exact nature of the lesion therefore remained in doubt, although clinical and scintigraphic findings as well as the subsequent course were consistent with the diagnosis of osteoid osteoma. In 5 cases, MRI proved inferior to CT scan for detecting the nidus. MRI disclosed edema of the bone marrow not seen on CT scan sections in 5 cases, edema of the soft tissues in three cases, and synovitis with joint effusion in one patient with an epiphyseal osteoid osteoma. At present, MRI plays only an ancillary role in the diagnosis of osteoid osteoma, which rests on the concomitant use of bone scintigraphy and CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rheumatologic aspects of toxocariasis (visceral Larva migrans). Apropos of 2 cases]. / Les formes rhumatologiques de la toxocarose (Larva Migrans viscérale). A propos de 2 cas.

Visceral Larva migrans is a human infection by the larvae of dog ascarids or, more rarely, ascarids of other animal species. It is endemic in France. Two cases which respectively manifested as acute oligoarthritis and inflammatory myalgia with increased muscle enzyme levels are reported. Manifestations of the minor forms of this infestation are reviewed.

Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI.

This pilot study aimed to evaluate the correlation between clinical symptoms and cartilage volume through MRI in patients with knee osteoarthritis after 48 weeks of treatment with Structum®. Multicenter, double-blind, placebo-controlled, parallel-group study. Symptomatic knee osteoarthritis patients aged 50-75 years received either Structum® (500 mg twice daily; N = 22) or placebo (N = 21) during 48 weeks. Inclusion criteria were global pain in the target knee ≥30 mm (VAS 0-100) and radiological Kellgren-Lawrence grade 2 or 3. Clinical assessments included Lequesne index and VAS for pain on motion, at baseline, 24 and 48 weeks, and MRI at baseline and at 24 and 48 weeks. Global and compartments cartilage volume, joint cartilage abnormalities, meniscal lesions, ligaments abnormalities, synovitis, synovial effusion, osteophytes, subchondral cysts, popliteal cysts and subchondral oedema were quantified. The quantitative and qualitative reproducibility of MRI was tested by the Spearman correlation coefficient and kappa coefficients, respectively. Treatments were compared by an analysis of covariance with baseline value as covariate. Groups were comparable at baseline for demographics, disease characteristics, and cartilage volumes. A significant inter-readers correlation was seen for the assessment of cartilage volumes, number of cysts, and osteophytes (correlation coefficients from 0.951 to 0.980 within investigator and from 0.714 to 0.957). After 48 weeks, symptoms improved in both groups. The total cartilage volume increased in the Structum® group (+180 mm(3) + SD) which opposed to a loss in the placebo (-46 mm(3) + SD; NS). No statistically significant differences between groups were observed for the other MRI parameters. No correlations were evidenced between key MRI parameters changes and symptoms. The difference in the evolution of cartilage volume between the two groups could reflect a structure modifying effect of Structum®. This pilot study confirms the usefulness of quantitative and qualitative MRI as a sensitive tool to assess a structure modifying drugs in knee osteoarthritis.