A case of destructive polyarthropathy in a 17-year-old youth following pefloxacin treatment.

Joint and muscle pain have been reported with quinolones; however, arthropathies induced by quinolones do not result in erosive changes in humans, although such changes have occurred in animal studies. We report an unusual case of destructive polyarthropathy in a 17-year-old boy after treatment with pefloxacin 800 mg/day for 3 months. Pefloxacin may have accentuated the cartilage damage in this case, even if an underlying joint disease could not be excluded.

Nerve root pain secondary to posterior articular cysts: a report of 6 cases and review of the literature.

The authors report 6 cases of posterior articular cysts responsible for nerve root pain, generally in the form of sciatica. Cysts of the posterior intervertebral joints are a rare cause of nerve root compression. Plain x-rays demonstrate posterior inter-apophyseal osteoarthritis. Demonstration of the posterior articular cyst requires the use of computed tomography with contrast injection and/or MRI. Arthrography of the posterior inter-apophyseal joint allows the cyst to be opacified and treated by infiltration of a corticosteroid.

Iatrogenically induced vertebral osteomyelitis due to Pseudomonas aeruginosa.

We report three cases of iatrogenically induced vertebral osteomyelitis due to Pseudomonas aeruginosa. One case was a post-nucleotomy and post-operative complication of herniated disk treatment, one was related to infection of an epidural catheter in a patient suffering from rheumatoid arthritis and the third followed urinary investigation in a patient with prostate cancer. Infection was cured in all patients with antibiotic treatment. These case reports shed light on the possibility of infections with pseudomonas aeruginosa, in addition to the more common infections such as by staphylococci, especially following iatrogenic maneuvers.

Elastase activity in cartilage extracts and synovial fluids from subjects with osteoarthritis or rheumatoid arthritis: the prominent role of metalloproteinases.

OBJECTIVE: Polymorphonuclear leukocyte (PMN) elastase is able to degrade the extra-cellular matrix components of cartilage. However, in vitro several proteinases can degrade elastin. The purpose of this study was to evaluate the role of the serine proteinases and metalloproteinases in the elastase activity measured in cartilage extracts from patients with osteoarthritis (OA), as well as in synovial fluid (SF) from patients with rheumatoid arthritis (RA) and OA. METHODS: Elastase activity was determined using synthetic low molecular weight substrates and radiolabelled insoluble elastin. Aminophenyl mercuric acetate was used to activate the prometalloproteinases. RESULTS: Elastase activity, measured using synthetic substrates, was higher in BA SF (0.76 + 0.03 microU/ml, n = 12) than in OA SF (0.14 + 0.04 microU/ml, n = 12) (p < 0.001). This activity was inhibited by metal chelating agents: 86% inhibition in OA and 75% inhibition in RA. However, in RA SF the inhibitor of serine proteinase (PMSF) also induced a 40% inhibition. Elastase activity, measured using radiolabelled elastin, in OA SF and RA SF samples and in OA cartilage extract was very low, but increased following activation by mercurial agents. Again this activity was inhibited by metal chelating agents. CONCLUSIONS: Taken together these results indicate that elastase activity (measured by standard methods) in OA and RA SF is mainly due to metalloenzymes.

Methotrexate serum binding in rheumatoid arthritis.

The serum binding of methotrexate was determined by equilibrium dialysis using radiolabelled methotrexate. Methotrexate was only albumin-bound in serum. The binding was 46% in controls versus 42% in rheumatoid arthritis and 44% in cancer. Serum binding was significantly decreased by salicylate and high concentration of naproxen. Hypoalbuminemia and concomitant administration of salicylate or naproxen may influence methotrexate toxicity.

Vestibular syndrome in multiple myeloma: role of magnetic resonance imaging.

The authors report a case of multiple myeloma involving the temporal bone and responsible for a vestibular syndrome associated with hypoacusis. The lesion was best visualised by magnetic resonance imaging.

Is hyperlipidaemia a contributing factor to algodystrophy (reflex sympathetic dystrophy)?

To appreciate hyperlipidaemia as a contributing factor to reflex sympathetic dystrophy (RSD), we have evaluated basal lipidic values (cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A1, B) and frequency of hypertriglyceridaemia (Turpin's diagnosis criteria) in 75 cases of RSD and in 75 paired controls. No difference exists in both groups with regard to frequency of hypertriglyceridaemia or basal lipidic values. These values seem independent of age, sex, duration of localization or etiology (traumatic or nontraumatic) of RSD. Hyperlipidaemia does not seem a contributing factor to RSD.

General diseases of the spine in rheumatoid arthritis.

The past year has contributed to a better understanding of the management of cervical spine instability in patients with rheumatoid arthritis. Neurologic recovery after surgery is better and the percentage of recurrence is lower in cases of isolated atlantoaxial subluxation (AAS) compared with cases of AAS associated with basilar invagination or with subaxial subluxation. This suggests that the sooner surgery is undertaken in limited AAS, the better the outcome. The atlantoaxial posterior interval seems to be the best predictor of neurologic recovery following posterior fusion for AAS. Osteoporosis is a major problem in patients with rheumatoid arthritis. Recent studies show that corticosteroids, even in a low dosage, contribute to spinal bone loss. This bone loss may be partially reversible after ceasing corticoid therapy. A new corticosteroid, deflazacort, which does not inhibit intestinal absorption of calcium, seems to limit bone loss.

Klebsiella pneumoniae septic arthritis of a lumbar facet joint.

Only 3 cases of isolated septic arthritis of a lumbar facet joint have been reported, all due to Staphylococcus aureus. We describe a case of Klebsiella pneumoniae septic arthritis of a lumbar facet joint in an HLA-B27 positive patient.

[The treatment of osteoporosis (author's transl)]. / Traitement de l'ostéoporose commune.

Treatment for osteoporosis cannot yet be prescribed in a perfectly rational manner, as the total picture of the pathogenesis of this disease remains uncertain. Furthermore, lack of significant criteria makes it difficult to evaluate the different therapeutic methods proposed, and none of them appears to be entirely satisfactory. By acting methodically, however, one can obtain good relief of pain, quiescent osteoporotic activity over long periods, and bone remineralization. At the present time, preference has to be given to standard medications such as calcium, phosphorus, and anabolic proteins which are nearly always given in association. Calcium inhibits osteolysis by slowing down parathyroid secretion. Phosphorus accelerates calcium fixation in bone and appears to stimulate the formation of osteoblasts. Anabolic compounds protect the bone-forming framework and assist the deposition of mineral salts in the bones. The prescription of vitamin D is of value when there is a deficiency. Among recent medications which have been tried, only calcitonin appears to be of some practical value, by assisting inhibition of certain flare-ups and lytic episodes of the osteoporosis when associated with standard therapy.

Pseudo-felty's syndrome. Report of a case with no symptoms for at least 15 years.

The prognosis of large granular lymphocyte proliferation with rheumatoid arthritis (pseudo-Felty's syndrome) remains uncertain. We report a case with a 15-year follow-up. To date, the patient has not developed lymphadenopathy, splenomegaly, abnormalities in erythrocyte or platelet counts, neutropenia or severe or unexplained infections. This favorable course is not ascribable to an unusual lymphocyte phenotype (CD3+, CD8+, CD57+). A beneficial effect of methotrexate therapy is possible.