[Clinical diagnosis of Lyme borreliosis in case of joint and muscular presentations]. / Le diagnostic clinique des manifestations articulaires et musculaires de la borréliose de Lyme.

The diagnosis of Lyme borreliosis in case of joint and muscular presentations is generally suggested by epidemiological factors. However, as a rule, laboratory testing is required to confirm the diagnosis. When considering the epidemiology of Lyme borreliosis in France, the only areas free of ticks infected by Borrelia burgdorgeri sl, are those close to the Mediterranean sea or at high altitude. The risk is greatest in the Alsace region. Exposure is particularly high among forest workers and people who use the countryside for their leisure activities. The likelihood of infection following a tick bite is difficult to assess; indeed, the bite site may remain unnoticed. A medical history of erythema migrans, if untreated, is a major diagnostic clue, although the association appears to be less consistent in France than in the US. Lyme arthritis generally arises apparently spontaneously. It is characteristically mono- or oligo-articular, asymmetrical, predominantly affects the knee, and has an intermittent course. Synovial cysts and enthesitis are common. Myositis is rare, polymorphic, and has been linked to other symptoms in the same localizations. Minor arthralgia and myalgia frequently occur, principally early in the course of the infection. It was suggested that sequels of the disease include so-called fibromyalgic syndromes. The principal differential diagnosis as far as arthritis is concerned, is made on spondylarthropathy and chronic juvenile arthritis. Rheumatoid arthritis is another pathology, although Lyme arthritis does sometimes evolve to chronicity.

Segregation analysis and variance components analysis of bone mineral density in healthy families.

Bone mineral density (BMD) was measured in 1992-93 in 129 nuclear families, including 258 parents and 183 children, and was analyzed for familial resemblance factors. BMD measurements were adjusted on weight and age. Segregation analysis rejected the monogenic hypothesis and exhibited a strong polygenic component. Variance components analysis was then used to estimate the parameters of a multivariate normal model including an additive polygenic component, a common environment factor, and a residual specific to each individual. The genetic component was independent of sex and age. The common environmental factor was not significant. The variance of the residual specific factor appeared to be a quadratic function of age, reaching its minimum value at 26.4 years. Consequently, the maximum value for heritability (ratio of genetic variance to total variance) is observed at this age (h2 = 0.84). According to this model, the correlation between two relatives is a function of the ages of each individual in the pair.

Quality of life in ankylosing spondylitis: validation of the ankylosing spondylitis Arthritis Impact Measurement Scales 2, a modified Arthritis Impact Measurement Scales Questionnaire.

OBJECTIVE: To develop a questionnaire measuring quality of life in ankylosing spondylitis (AS). METHODS: A focus group technique contributed to the generation of an AS-specific questionnaire using the Arthritis Impact Measurement Scales 2 (AIMS2) (12 dimensions), supplemented with items from the Health Assessment Questionnaire for the Spondylar-thropathies, as well as original new items. Patients from a self-help group provided data to assess the validity (n = 146) and reproducibility (n = 43) of the AS-AIMS2. RESULTS: The focus group generated a thirteenth dimension including 6 items labeled "spine mobility." Principal component analyses on AS-AIMS2 showed satisfactory dimensionality (74.1% of variance explained), high internal consistency (Cronbach's alpha = 0.78-0.91), significant convergent validity of the new dimension with spine pain and mobility, and good reproducibility in the 13 dimensions and 5 components (intraclass correlation coefficient = 0.7-0.9). The scores in each component of the AS-AIMS2 showed a marked deterioration of quality of life in these young patients. CONCLUSIONS: The disease-specific AS-AIMS2 questionnaire should help improve care management in AS.

Influence of sulfasalazine on established collagen arthritis in rats.

Collagen induced arthritis (CIA) in rats is an experimental model that is characterized by an erosive synovitis associated with periostitis and both peripheral and axial ossifying enthesopathy. The influence of long-term therapy with sulfasalazine (80 mg/day on weekdays) on established CIA in Wistar Furth rats was investigated. Clinical and X-ray examination showed a significant improvement in the joint lesions of the uninjected paws in the treated rats as compared to controls. This effect was, however, delayed. On the other hand, periosteal new bone formation and caudal enthesopathy (spondylodiscitis) were not altered by the treatment.

Is quality of life affected by season and weather conditions in ankylosing spondylitis?

OBJECTIVE: To examine the links between the quality of life (QOL) and season and weather conditions in ankylosing spondylitis (AS) patients. METHODS: A cohort of 146 AS patients (67% males), with a mean age of 47.3 years and a mean disease duration of 12.8 years, answered a self-administered questionnaire, the AS-AIMS2 validated for AS, 4 times over a period of one year in a postal survey. Clinical measures were assessed in a subsample of the cohort. Meterological data including daily temperature, hygrometry, wind speed and atmospheric pressure were collected over the same period. RESULTS: In this cohort, 106 patients completed the follow-up. A higher lumbar spine flexibility (Schober index) was associated with a higher climatic temperature and lower wind speed. Physical QOL improved in the summer, as did Social Interaction in the summer and fall, while Role QOL decreased in winter. A lower perceived QOL was significantly associated with a higher temperature and wind speed over the past 4 weeks, and with a higher hygrometry and atmospheric pressure over the past 2 days prior to completion of the questionnaire. CONCLUSION: This study provides some support to the popular belief and frequent patient complaints of a link between health status and perceived quality of life, as assessed by a specific questionnaire, with season and weather conditions.

Lymphocyte subpopulations in an experimental model of axial and peripheral enthesiopathies.

We report a study of lymphocyte subsets in experimental arthritis induced in Wistar Furth rats by native human type II collagen and muramyl dipeptide. This experimental arthritis shares similarities with both the spondyloarthropathies and rheumatoid arthritis. Peripheral blood T lymphocytes, primarily the CD4+ cells (p = 0.01), were lower in arthritic rats than in the controls, although the difference in the CD4/CD8 ratio was not statistically significant. Splenic CD4 cells were significantly (p = 0.03) more numerous in arthritic rats, while the numbers of MHC class II positive cells (p = 0.002) and kappa-bearing B-cells (p = 0.0004) were significantly lower. Determination of peripheral blood and spleen lymphocytes subsets could therefore be used for the assessment of arthritis and for the evaluation of therapeutic agents. Thymic T-cell differentiation does not appear to be impaired in this model. These results differ from the peripheral blood disturbances described in the active stages of human rheumatoid arthritis and are more similar to those reported in ankylosing spondylitis patients. However, the absence of alterations in the Peyer's patches suggests that pathogeneic mechanisms involving mucosal areas and exogenous intestinal antigens are not reproduced in this model.

Longitudinal study of rheumatoid arthritis patients discloses sustained elevated serum levels of soluble CD106 (V-CAM).

OBJECTIVE: To appreciate the evolution of serum angiogenic and/or adhesion molecules levels during a long term follow-up of rheumatoid arthritis (RA) patients. METHODS: Serum levels of 5 soluble adhesion/angiogenesis glycoproteins (VEGF, CD31, CD54, CD62E, CD106) were measured in Elisa in samples collected over 6 years in a cohort of 43 RA patients with monitored clinical parameters of disease activity and severity. RESULTS: RA patients had significantly higher levels (p < 0.0001) of sCD106 (VCAM-1) than control subjects. Conversely, the levels of soluble VEGF, CD31, CD54 and CD62E were normal or lower than normal. No statistically significant time effect was noted. No effect either was noted as related to the therapeutic agents taken by the patients. CONCLUSION: The sustained elevated serum levels of sCD106 observed here imply that this molecule might be related to the chronicity and progression of RA.

Magnetic resonance imaging may be an asset to diagnose and classify fluoroquinolone-associated Achilles tendinitis.

The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone-associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2*-weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture.

Clinical pharmacokinetics of nonsteroidal anti-inflammatory drugs in the cerebrospinal fluid.

The pharmacokinetics of nonsteroidal anti-inflammatory drugs (NSAIDs) in the cerebrospinal fluid (CSF) is of clinical interest as it may be related to some of their properties and side-effects. Two types of NSAIDs can be described with respect to their concentration and time course in CSF: in the first type, the transfer across the blood-brain barrier seems to be controlled by simple physico-chemical factors. These drugs (oxyphenbutazone, indomethacin, ketoprofen) are characterized by a high lipophilicity. At steady state, their free plasma concentrations correspond to their CSF concentrations. The second group consists of more hydrophilic compounds (salicylates); there is no correlation between plasma concentrations and CSF concentration. Further investigation needs to be carried out on CNS side-effects and the antialgesic activity of salicylates in relation on their CSF distribution.

Validity and discriminant ability of the HAQ Functional Index in early rheumatoid arthritis.

A sensitive and valid instrument is needed in the earliest stages of rheumatoid arthritis (RA) for the measurement of functional disability. A French version of the Health Assessment Questionnaire Functional Disability Index (HAQ) has been developed, validated in an early RA sample (i.e. with disease duration less than 5 yr; n = 50), and compared with longstanding RA (n = 32) and control subjects (n = 59). Five factors provided by principal components analysis accounted for 75% of the variability of the HAQ score (construct validity). It appeared to be significantly correlated with clinical and radiological variables and to be reproducible (r intraclass = 0.964). It proved to be discriminant in groups with various levels of disability (HAQ score = 1.332 in early RA, 1.745 in longstanding RA, and 0.152 in controls; p less than 10(-5). Finally, the validity of the original scoring method of the HAQ, as compared with other scoring methods, was confirmed.

Radionuclide imaging in hip abnormalities.

The uptake of Tc-99m-diphosphonate was studied topographically and quantitatively on 258 diseased hips. For many diseased hips, bone scintigraphy provides items of information that complement the clinical, radiological, and biological data, with which it should always be compared. The localization, extent, and intensity of the uptake differ greatly according to the hip disorder studied, and depend not only on the cause of the lesion but also on its stage of evolution. Bone scintigraphy can shed light on the etiologic diagnosis of a painful hip at the beginning of its evolution, before definite roentgenographic signs appear, thanks to some very precise characteristics of the uptake, this is the case for transient osteoporosis of the hip, aseptic osteonecrosis, Legg-Perthes disease, early arthritis of the hip joint, and stress fractures of the femoral neck or of the pubic rami.

[Abnormalities of the muscular bioenergetics in Steinert's disease]. / Anomalies de la bioénergétique musculaire dans une maladie de Steinert.

The thenar muscles and gastrocnemius of a patient with myotonic dystrophy were investigated, at rest, by phosphorus nuclear magnetic resonance spectroscopy. A decrease in phosphocreatine level and an increase in inorganic phosphate and phosphodiester levels were found in the gastrocnemius, which was clinically spared, whilst the thenar muscles, which were wasted and affected by myotonia, exhibited only an increased inorganic phosphate level and an elevated pH. These findings were comparable with those found in other muscular disorders, such as Duchenne's and Becker's dystrophies, as well as in limb girdle dystrophy. They suggested that the abnormalities observed were unrelated to myotonia or wasting, and the possibility of a secondary mitochondrial disorder in myotonic dystrophy, is to be considered.

Decrease of in vitro serum protein binding of salicylate in rheumatoid arthritis.

Free and bound fractions of salicylates were separated by equilibrium dialysis and measured by spectrofluorimetry in 27 patients with rheumatoid arthritis and in 16 controls. The results showed that in patients with rheumatoid arthritis, the binding of salicylate to proteins decreased in an overproportional manner with the decrease of serum albumin concentrations. This phenomenon was linked with the severity of the inflammatory syndrome. The saturation binding capacity per unit of protein concentration was lower in the patients suffering from active forms of the condition, a finding which suggests that the changes observed are not due only to quantitative changes in the serum albumins. This study confirms the importance of determining free salicylate concentrations in the treatment of patients with inflammatory diseases.

[Fractures caused by bone insufficiency of the proximal femoral epiphysis. Contribution of MRI]. / Les fractures par insuffisance osseuse de l'épiphyse fémorale supérieure. Apport de l'IRM.

The fractures by bony insufficiency are particularly well seen on MRI. On T1 weighted images they are detected as a very hypointense line surrounded by a hypointense area. On T2 weighted images, the hypointense line is also recognized and represents the fracture surrounded by a hyperintense area due to oedema or hemorrhage. Five cases of bony insufficiency fracture of the femoral head are reported. The features of the superior subchondral locations of these fractures and some primary and limited epiphyseal osteonecrosis are similar and consistent with a common pathogeny.

[Determination of the best diagnostic criteria of sacroiliitis with MRI]. / Détermination des meilleurs critères diagnostiques des sacro-iliites en IRM.

AIM: To determine which signs are the most accurate in the diagnosis of sacroiliitis with MRI. MATERIAL AND METHODS: 40 consecutive patients with inflammatory low back pain underwent MRI at 1.5 T with FSE T2 and SE T1 weighted-images before and after Gadolinium-DOTA injection. 22 patients were suffering from spondylarthropathy while the other 18 patients constituted the control group. Each examination was interpreted by two independent observers who analysed 11 different signs. RESULTS: Intra and inter observer reproducibility were high (respectively 76% and 70%). Inter observer reproducibility was excellent for bone marrow edema (89%) but low for bone productions (38%). Three lesions displayed a high positive predictive value: ligamentous contrast enhancement (86%), bone marrow edema (80%) and bone erosions (70%). Intra articular enhancement of the sacro-iliac joint was a less sensitive sign than bone marrow edema. CONCLUSION: This study confirms the excellent positive predictive value of MRI for an early diagnosis of active sacroiliitis. Bone marrow edema seems to be a more pertinent sign than intra articular enhancement.

[Familial articular chondrocalcinosis]. / Les chondrocalcinoses articulaires familiales.

Articular chondrocalcinosis is a well-defined radiological entity with or without clinical manifestations. A familial form was described by Sitaj and Zitnan in 1957. Attention has mostly been paid to chondrocalcinosis associated with metabolic diseases and to "sporadic" chondrocalcinosis, usually due to ageing of the joint. Familial chondrocalcinosis, of which more and more cases are reported, is increasingly under study and is used as a model for pathogenic research. It already appears that familial chondrocalcinosis, of dominant autosomal transmission, is a new metabolic disease.

[Familial articular chondrocalcinosis: study of an Alsatian family]. / Les chondrocalcinoses articulaires familiales: étude d'une famille alsacienne.

Familial articular chondrocalcinosis is a chronic articular disease characterized by acute intermittent attacks of arthritis, presence of calcium pyrophosphate dihydrate crystal in synovial fluid, cartilage and periarticular soft tissue and by x rays calcium deposition in articular cartilage. A family originating from Alsace, with an autosomal dominant transmission has been studied. As in English and Argentinean families, a linkage to the short arm of chromosome 5p has been found. These results suggest that a defective gene at this location may be related to the chondrocalcinosis in these families.