Superoxide dismutases in polymorphonuclear leukocytes from patients with ankylosing spondylitis or rheumatoid arthritis.

The activity of cyanide-sensitive and cyanide-insensitive superoxide dismutase (CNs- and CNi-SOD) was measured in polymorphonuclear neutrophils isolated from the blood of patients with ankylosing spondylitis (A.S.) or adults with rheumatoid arthritis (R.A.). Our purpose was to detect alterations in the protecting activity of these enzymes that might cause rheumatic lesions secondary to superoxide anion generation in the inflammatory loci. There was no difference in total SOD activity (CNs + CNi) in either A.S. or R.A. when compared to the control group. In contrast, CNi-SOD activity decreased in R.A. and A.S. and CNs-SOD activity rose significantly in A.S. only. None of the changes observed in SOD activity correlated with patient's age, erythrocyte sedimentation rate, clinical evolution of the disease or the drug doses administered. It is concluded that the reduced activity of CNi-SOD might be partly responsible for the reduced protection of the joints against oxygen-free radicals in patients with A.S. or R.A. Other factors however appear to have greater effects on the clinical evolution of these diseases.

[Antinuclear antibodies: analysis of images and classification of immunofluorescence aspects on nuclei isolated from rat hepatocytes]. / Anticorps anti-noyaux: analyse d'images et classification des aspects d'immunofluorescence, sur noyaux isolés d'hépatocytes de rat.

Image analysis and Fourier transformation of the various nuclear immunofluorescence patterns observed while detecting antinuclear antibodies allow an objective and quantitative definition of the fluorescence. They also point out various IF types hidden by the main pattern, without having to dilute the test serum. They make obvious the difference between speckled and reticular patterns, and reveal the existence of intermediate states. The usual nuclear IF patterns (homogeneous, ring, nucleolar, reticulated, speckled and diffuse) may be grouped, according to their photo emission, into nuclear and subnuclear patterns. The first group includes homogeneous, annular and passive nucleolar IF. The second group is composed of speckled, reticulated, mixed, and active nucleolar IF. Alternatively, these aspects may be grouped into three types: homogeneous nuclear IF (homogeneous and ring), heterogeneous nuclear IF (speckled, reticulated and mixed) and nucleolar IF (active or passive). Diffusion can affect or not these aspects and does not apply to a special type or pattern. Image analysis and the study of the image spatial spectrum lead to automated recognition of the IF types, and later on, to the discrimination of antinuclear antibodies.

Erythrocyte sedimentation rate of healthy subjects--chronological aspects.

Thanks to an elaborated mathematical approach, based on statistics and signal processing, the chronological changes of the Erythrocyte Sedimentation Rate (ESR) of young healthy subjects, considered from a collective point of view, have been discriminated into genuine and well-defined rhythms. These rhythms are tied up either to natural (year, season) or 'social' (month, week, holidays) cycles, or to some other causes, still unknown and possibly intrinsic (such is probably the case of a 26.5-day strongly marked period). The solar induced time variation strictly obeys a frequency modulation law, the relative amplitude of which is 10 per cent. Two axes of symmetry are found, centered on 8 August and 8 February. The rhythm is roughly in accordance with seasons. The modulation frequency is maximum at summer time. Oscillations of the ESR are observed during the week and the month. Fridays and the last fortnight of each month appear to be low ESR time.

[Chronic osteitis and arthritis of palmoplantar pustulosis. A familial form of B-27 negative spondylarthropathy]. / Les ostéites et arthrites chroniques de la pustulose palmo-plantaire. Une forme familiale de spondylarthropathie B27 négative.

A 35-year old woman presented with pustulosis palmaris et plantaris evolving in acute episodes parallel to those of a rheumatic disease consisting of bilateral sacro-iliac arthritis, manubriosternal fusion and sterno-clavicular arthritis. Her brother had spondylitis compatible with the diagnosis of pustular osteo-arthritis though without pustulosis. He presented with bilateral sacro-iliac arthritis, manubriosternal fusion, sterno-clavicular arthritis and an ossified fragment detached from the antero-inferior angle of C6. The two patients had the same HLA phenotype: A1, A9, B5, B41, CW4, DR2, DR4, absence of B27. In a specimen from the sacro-iliac joint the authors found active bone remodelling and inflammatory osteitis with fibrosis and infiltrates rich in mononucleate cells. An electron microscopic study--to the authors' knowledge, the first to be performed in such cases--demonstrated intracytoplasmic filamentous inclusions in two macrophages of the synovial fringe. Only one other case of the familial form has been published so far. Like the rheumatism of acne conglobata, the spondylitis of pustulosis palmaris et plantaris is one of the causes of sterno-costo-clavicular hyperostosis.

[Radioguided puncture-infiltration in the treatment of refractory calcifying periarthritis of shoulders]. / Ponction-infiltration radio-guidée dans le traitement des périarthrites calcifiantes rebelles d'épaules.

Trituration-aspiration-infiltration of calcifications of the shoulder region is a method applied for treatment of intractable calcifying periarthritis. A television screen is used to guide the needle until it is in contact with the calcifications provoking the symptoms. Trituration and aspiration of the calcified lesions is followed by saturation with prolonged released corticoids of 41 shoulders treated, recovery or improvement was noted in 70% after one month, results being rated as excellent in 19 patients followed up for 3 months.

[Oligo-arthritis associated with type IV hyperlipoproteinemia]. / Oligo-arthrite associée à une hyperlipoprotéinémie de type IV.

A case of chronic, corticosteroid-responsive arthritis affecting particularly one ankle in a patient with type IV hyperlipoproteinaemia is reported. After gout or inflammatory rheumatism of another nature had been excluded, and following synovial fluid examination and synovial membrane biopsy, a diagnosis of type IV hyperlipoproteinaemia rheumatism was made. At electron microscopy, the synovial membrane showed numerous large spumous cells and a peculiar appearance of the capillary vessels.

[Osteoarthritis of rare etiology]. / Arthroses d'étiologie rare.

Although osteoarthritis is characterized by a uniform pattern of clinical and radiological manifestations, it is a syndrome that can be produced by a variety of causative factors. Rare causes of osteoarthritis can be categorized as follows: 1) systemic metabolic disorders due to known biochemical and/or genetic abnormalities, such as hemochromatosis, ochronosis, Wilson's disease, Ehlers-Danlos syndrome (and probably the "idiopathic" joint hypermobility syndrome), sickle cell anemia, and thalassemia; 2) endocrine disorders, such as acromegaly, whose joint manifestations are now well-known, and hypothyroidism; 3) Paget's disease of bone, osteopetrosis (which induces changes in bone elasticity), and other systemic bone diseases; 4) dysplasias, which form a vast group including familial polyepiphyseal dysplasia, spondyloepiphyseal dysplasia congenita (especially its milder forms), Stickler's syndrome, osteo-onychodysplasia, Kniest's dysplasia, trichorhinopharyngeal syndrome, and a group of diseases that affect the epiphyses; 5) endemic forms of osteoarthritis, e.g., Mselini disease, Kashin-Beck disease, and Malnad disease, which are unknown in western Europe but have been reported to affect thousands of individuals in endemic areas. All these disorders are usually responsible for premature osteoarthritis, whose presentation sometimes bears the imprint of the causative abnormality but can be identical to that of common osteoarthritis. The effects of toxic substances (Kashin-Beck disease) or genetically-determined collagen II abnormalities (epiphyseal dysplasias) may explain the occurrence of these rare forms of premature osteoarthritis.

[Treatment of rheumatoid polyarthritis with methotrexate]. / Traitement de la polyarthrite rhumatoïde par le méthotrexate.

This retrospective study involved 60 patients (7 men, 53 women) with rheumatoid arthritis (RA) and given methotrexate between 1985 and 1990. The mean time that RA had been present was 12 years and more than half of the patients had received more than 3 types of general treatment in the past. The mean total duration of MTX was 17.3 months, with a total dose of 790 mg. The efficacy of MTX was confirmed by a significant improvement in clinical and laboratory parameters. Treatment was withdrawn permanently in 21 cases (35% of patients). Adverse reactions, responsible for two thirds of treatment withdrawals (14/21) occurred in most instances during the first year of treatment. Hepatic toxicity was commonest. Two cases of aplasia were reported as well as 3 cases of pneumonitis, one fatal. These involved two cases of secondary infection and one of pneumonitis directly imputable to MTX. Withdrawals for inefficacy were rare, occurring in less than 10 p. cent of patients. Treatment continuation rates were 77 p. cent at 1 year, 66 p. cent at 18 months, 55 p. cent at 2 years, 42 p. cent at 3 years and 32 p. cent at 4 years. MTX is effective treatment for RA but is not free of adverse reactions, sometimes potentially fatal. Prolonged monitoring is necessary because of the sometimes delayed onset of adverse reactions.

[Multicentric reticulohistiocytosis. A case with unusual clinical, radiologic and ultrastructural aspects]. / Réticulo-histiocytose multicentrique. Un cas avec aspects cliniques, radiologiques et ultrastructuraux inhabituels.

We are reporting a case of multicentric reticulo-histiocytosis which is exceptional because of its gravity and the diversity of the clinical lesions: huge subcutaneous nodules, bone destruction in the spine responsible for spondylolisthesis, pulmonary fibrosis, acute pericarditis, laryngeal compression requiring a permanent tracheostomy. From ultrastructural observations, various hypotheses to explain the intra-macrophagic accumulation of membrane granules and lipids are discussed.

[Chronic polyarthrosynovitis in the goat: histological and physicochemical study of an animal model of apatite crystallopathic rheumatism]. / Polyarthro-synovite chronique chez la chèvre : étude histologique et physico-chimique d'un modèle animal de rhumatisme cristallopathique à apatite.

The aim of this paper is to describe clinical pattern and pathogenesis of spontaneous chronic polyarthritis observed in Swiss goats. Roentgenograms, histologic findings, ultrastructural study and microprobe analysis of synovium samples show apatite microcrystal deposit ion. Thus this spontaneous goat disease may be related to apatite microcrystal deposit ion disease in man, so called crystallopathic-hydroxyapatite rheumatism.

[Ultrastructural and microanalytic study of gold depots in the synovial membrane of man and animals during treatment with sodium aurothiopropanol sulfonate]. / Etude ultrastructurale et microanalyse des dépôts d'or dans la membrane synoviale chez l'homme et chez l'animal au cours des traitements par l'aurothiopropanol-sulfonate de sodium.

In inflammatory rheumatism treated by gold therapy synoviocytes A are stuffed with gold salt deposits leading to a therapeutic thesaurismosis. These deposits are localized in lysosomes, then called aurosomes. However they may be rarely near collagen fibers or free, particularly in ankylosing spondylitis synovitis. Their structural morphological aspect is the same in several human rheumatic diseases and in rabbit experimental arthritis whatever the gold salt used. In such deposits, microprobe analysis shows gold and sulphur. This latter is probably given by the cell. Therapeutic effect of gold salts may imply the effect of the thiol moiety and the gold metal one.

[Rheumatism caused by lipid thesaurismosis. Articular involvement in hyperlipoproteinemia type II : presence of microcrystals in the mitochondria of synoviocytes]. / Le rhumatisme des thésaurismoses à lipides. Atteinte articulaire au cours de l'hyperdyslipidémie de type II : présence de microcristaux dans les mitochondries des synoviocytes.

For 13 years polyarthritis with specific synovial involvement was observed in a case of type II hyperlipoproteinemia. Microcrystals similar to those described in Gaucher's and Fabry's disease were seen in synovial cytoplasm and mitochondria. These data suggest a microcrystalline pathogenesis for type II hyperlipoproteinemia arthritis as in gout and chondrocalcinosis.

[Lipid thesaurismosis rheumatism. Joint manifestation during glucocerebrosidase deficiency (Gaucher's disease). Ultrastructural study of the synovial membrane]. / Le rhumatisme des thésaurismoses à lipides. Atteinte articulaire au cours de la carence en glucocérébrosidase (maladie de Gaucher. Etude ultrastructurale de la synoviale.

Articular inflammatory involvement may be the first sign of gluocecerebrosidase deficiency (Gaucher's disease). Electron microscope study shows specific synovial storage lesions which explain arthritic manifestations. Furthermore presence of mitochondrial microcrystals, (apatite?), suggest microcrystal pathogenesis of Gaucher's arthritis.

[Hydroxyapatite microcrystals in synovial mitochondria in human and experimental rheumatism]. / Microcristaux d'hydroxyapatite dans les mitochondries des synoviocytes au cours de divers rhumatismes humains et expérimentaux.

This paper deals with mitochondria microcrystal deposition in some human inflammatory rheumatism and in experimental arthritis. Hydroxyapatite microcrystals were observed in Ankylosing Spondylitis (AS) and Reiter Syndrome (RS) but never in rheumatoid synovitis nor in chondrocalcinosis synovitis. In Rat and Rabbit experimental arthritis, they were always seen in mitochondria as in AS and RS and never in lysosomes. This fact suggests mitochondrial abnormalities in calcium metabolism, which may be a consequence of synovial inflammation in a susceptible host.

[The rheumatism in type IIa hypercholesterolemia]. / Le rhumatisme de l'hypercholestérolémie de type IIa.

The authors report three cases of type IIa hypercholesterolemia in which ultrastructural observation of the synovial fluid revealed the presence of frothy cells and microcrystals. A questionnaire-based retrospective investigation amongst a population of 201 patients followed-up for type IIa essential hypercholesterolemia revealed the presence of joint disorders in 92 cases (45.8%). The condition sometimes affected a single joint (17.4%), but was generally polyarticular (82.6%), affecting the large joints. Joint pain was reported in 38 cases (41.3% of the patients presenting joint disease and 18.9% of the group as a whole) and predominantly affected the arms. Acute arthritis (54 cases) occurred preferentially in the legs. In 35 cases (38% of the joint-disease cases and 17.4% of the population as a whole) this resulted in acute rheumatic fever. Nineteen of these cases were unspecified forms of arthritis (20.7% amongst the joint-disease sufferers and 9.5% of the population). This analysis, combined with ultrastructural studies of the synovial fluid from 3 patients, establishes the existence of hypercholesterolemic rheumatism amongst heterozygotes as well as amongst homozygotes.

Presence of paf-acether in rheumatic diseases.

Paf-acether (paf) is a naturally occurring phospholipid involved in inflammatory processes. The presence of paf, its precursor lyso paf, and lipo-paf has been determined in blood and synovial fluid from 13 patients with rheumatoid arthritis (RA), 11 with spondylarthropathies, eight with other inflammatory rheumatisms, 13 with chondrocalcinosis, 15 with osteoarthritis, and also in blood from nine healthy subjects. Paf and lipo-paf were measured by rabbit platelet aggregation after isolation by high performance liquid chromatography, whereas lyso paf was first chemically acetylated to give paf. Lipo-paf in blood was higher in patients than in controls; lipo-paf concentrations in blood and in synovial fluid were significantly higher in rheumatoid arthritis than in osteoarthritis and chondrocalcinosis. By contrast, paf and lyso paf reached their lower values in rheumatoid arthritis. The amounts of lipid mediators were not correlated with biological parameters of inflammation. Lipo-paf, which is considered as a storage form of paf, may be the important form of paf in active inflammatory rheumatism.

[Camptocormia in the elderly. A new entity by paravertebral muscle involvement?]. / Camptocormie du sujet âgé. Une nouvelle entité par atteinte des muscles paravertébraux?

"Camptocormism" in the elderly is an acquired kyphosis which increases during walking and is totally reducible in dorsal horizontal position in two thirds of cases. The authors report 16 cases of camptocormism in patients with a mean age of 76 (12 women, 4 men). Camptocormism was accompanied in 5 cases by an extrapyramidal syndrome, in 3 cases by articular chondrocalcinosis, in 1 case by giant cell arteritis and in 1 by rheumatoid arthritis. There was no inflammatory syndrome and muscle enzymes were raised in only 4 cases. Electromyogram of the paravertebral muscles was pathological in 5 cases, with neurogenic changes in 4 cases and a myogenic type tracing in one. CT scan or magnetic resonance imaging showed evidence in all cases of atrophy with fatty involution of the paravertebral muscles. Biopsies of the paravertebral muscles revealed moderate mononuclear cell infiltrates in 4 cases with similar abnormalities in peripheral muscles. Corticosteroids had a beneficial effect in 11 cases out of 13 and the most prolonged results were seen after bolus doses of methylprednisolone. These findings suggest that camptocormism in the elderly could be linked to inadequacy of the paravertebral muscles or, in certain cases, to interstitial myositis.

Substance P levels in the synovium and synovial fluid from patients with rheumatoid arthritis and osteoarthritis.

Experimental results suggest that substance P (SP) may play an important role in pain and inflammation in rheumatic diseases. Measurements of SP-like immunoreactivity (SPLI) were performed in synovial fluid (SF) and synovial tissue from 40 patients with rheumatoid arthritis (RA) or osteoarthritis (OA). High levels of SPLI were found in the SF of patients with RA compared with OA. Conversely, SPLI content in synovial tissue was higher in OA than in RA, suggesting that there is an active secretory process of SPLI into the SF in RA, thus depleting SPLI stores in the synovium. Our data support the involvement of SP in the perpetuation and exacerbation of inflammation in RA, and may also explain some clinical features of this disease.