[The risk/benefit ratio of low-dose cyclosporin in the treatment of severe rheumatoid arthritis]. / Etude du rapport efficacité/tolérance de la ciclosporine à faibles doses dans le traitement de la polyarthrite rhumatoide sévère.

Although the efficacy of cyclosporine therapy in rheumatoid arthritis has been established, there have been no long term studies of the risk/benefit ratio of cyclosporine A in severe rheumatoid arthritis. A prospective, open-label one-year study included 106 patients (83 women and 23 men; mean age 53 years; mean disease duration, 11 years) with rheumatoid arthritis. Mean number of previous second-line treatments was four and 69% of patients had failed methotrexate therapy. The initial dosage of cyclosporine was 3 mg/kg/d and was increased if needed up to 5 mg/kg/d. The dosage was reduced in the event of serum creatinine elevation (by more than 30% versus baseline) or diastolic blood pressure elevation (above 95 mmHg). The statistical analysis was performed on an intention-to-treat basis. In the 45 patients who completed the one-year study period, the mean dosage was 3.6 +/- 1 mg after six months and 3.3 +/- 1 mg/kg/d after one year. Significant improvements were seen in all the clinical efficacy parameters. The mean reduction in corticosteroid dosage was 0.5 mg/d. The study drug was discontinued prematurely in 61 patients (36 because of adverse events and 21 because of inefficacy). Twelve of the 56 patients with serum creatinine level elevation on at least one occasion and seven of the 35 patients with diastolic blood pressure elevation were taken off the study drug.

[Polyarthritis revealing hairy cell leukemia]. / Polyarthrite révélatrice d'une leucémie à tricholeucocytes.

A female patient simultaneously developed hematologic evidence of hairy cell leukemia and marked but short-lived inflammatory involvement of a number of joints. Both these groups of symptoms resolved simultaneously and rapidly under alpha-2 interferon therapy. This course suggests that the arthritis was a rheumatologic manifestation of the hematologic disease. The concomitant occurrence in this patient of arthritis, splenomegaly and leukopenia was suggestive of Felty syndrome: these two conditions need to be differentiated.

Automated percutaneous nucleotomy in the treatment of cervicobrachial neuralgia due to disc herniation.

Forty-five patients suffering from cervicobrachial neuralgia resistant to medical treatment were treated by automated percutaneous nucleotomy according to the technique used by Onik et al. in the lumbar segment of the spine. Good results were obtained with this technique in 85% of the patients. This figure is similar to that reported for nucleorthesis without the risk of calcification mentioned in the literature.

[Percutaneous automated lumbar nucleotomy]. / Nucléotomie lombaire percutanée automatisée.

The results of percutaneous automated lumbar nucleotomy in the treatment of lumbar disc herniation were assessed in a series of 39 patients. The technique consists of mechanical decompression of the herniated intervertebral disc without total excision. Only one-space discs were treated by this method. Sciatica was the predominant clinical symptom in 30 cases, and lumbar pain in 9 cases. Good to very good results were obtained in 70% of patients with sciatica and in 55% of patients with lumbar pain. After 4 cases of nucleotomy performed after failure of nucleolysis were excluded, the proportion of very good results rose to 77% in sciatica. Conversely, it seems that a number of failed nucleotomies can be treated by nucleolysis. Nucleotomy is very well tolerated and deserves to be used as first-line treatment of single and radiologically well documented lumbar disc herniations.

[Congestive outbreaks of osteo-arthrosis]. / Les poussées congestives de l'arthrose.

Osteo-arthritis is often interspersed with congestive episodes due to inflammation of the synovial membranes, the vascular component of which is more important than the cellular component. This explains why the clinical signs of inflammation are moderate and characterized mainly by a mechanical-type formula. The mechanism of these episodes involves several factors, and osteo-cartilaginous fragments, microcrystals and perhaps immune complexes have been blamed for their occurrence. The influence of inflammation on cartilage degradation has been proved experimentally, and this is supported by some clinical findings. Treatment consists of non-steroidal anti-inflammatory agents, intra-articular corticosteroid injections and relief of articular overload.

Percutaneous automated lumbar nucleotomy.

The results of percutaneous automated lumbar nucleotomy in the treatment of lumbar disc herniation were assessed in a series of 39 patients. The technique consists of mechanical decompression of the herniated intervertebral disc without total excision. Only one-space discs were treated by this method. Sciatica was the predominant clinical symptom in 30 cases, and lumbar pain in 9 cases. Good to very good results were obtained in 70% of patients with sciatica and in 55% of patients with lumbar pain. After 4 cases of nucleotomy performed after failure of nucleolysis were excluded, the proportion of very good results rose to 77% in sciatica. Conversely, it seems that a number of failed nucleotomies can be treated by nucleolysis. Nucleotomy is very well tolerated and deserves to be used as first-line treatment of single and radiologically well documented lumbar disc herniations.

[A congestive bout of arthrosis: is it an inflammatory outbreak?]. / La poussée congestive de l'arthrose est-elle une poussée inflammatoire?

The arthrotic disease is frequently dotted with "bouts" characterized by a new outbreak of pain which may lead to inflammation and sometimes, for superficial joints, characterized by increased local heat and, mostly, hydarthrosis. But, the inflammatory component usually remains moderate and many clinicians prefer the term of congestive bout which, in addition, respects the classical opposition arthrosis-arthritis. Actually, this opposition is not so clear-cut, and it appears more and more clearly that arthrosis is a multi-factorial disease where, in addition to mechanical, genetic or metabolic factors, the synovial inflammation plays a major role in the degeneration of the cartilage. The findings of arthroscopy and pathology let to believe that congestive bouts are actually inflammatory bouts.

Percutaneous angioplasty of atherosclerotic and postsurgical stenosis of carotid arteries.

A technique for safe angioplasty of atherosclerotic stenosis of internal and common carotid arteries is described in which temporary balloon occlusion of the internal carotid artery is used to prevent cerebral embolization during manifestation of ulcerated plaques. Its successful use in six atherosclerotic stenosis is described. Five angioplasties of postsurgical stenoses are also reported in which the technique of temporary occlusion was not used. The future of carotid artery angioplasty is discussed.

[Fasciitis and Shulman's syndrome. A nosologic discussion]. / Fasciites et syndrome de Shulman. Un débat nosologique.

Eosinophilic fasciitis or Shulman's syndrome is linked to scleroderma, systemic sclerodermia as various types of localized sclerodermia, by a nosological relationship analyzed by the authors. But, excluding the one concerning eosinophilic fasciitis and deep morphea, the authors seem to believe that the current differences are still justified, since the clinical picture and the levels of the histological lesions vary from one entity to the other. The nosological debate concerning eosinophilic fasciitis demonstrates also that a histologically recognized fasciitis has no complete specificity. By far, it goes beyond sclerodermia. Inflammation of the fascia is possible in the course of disseminated lupus erythematosus and other connective tissue inflammations. It is also described beyond connective tissue inflammations during rhizomelic pseudo-polyarthritis, and mostly in the course of three diseases: Texier's disease, drepanocytosis, and the spanish toxic syndrome, where it may be associated to a hypereosinophilia.

[Spinal biphotonic absorptiometry]. / L'absorptiométrie biphotonique rachidienne.

Spinal biphotonic absorptiometry allows a quantitative investigation of bone mineralisation. The study of a control and an osteoporotic population allowed the definition of the fracture threshold independent of age and the curve of the variation in the mineral content with aging. A good correlation was observed with computed tomography. The criteria of definition of a population at risk for the purposes of a longitudinal study are proposed. Biphotonic absorptiometry is an excellent examination for the detection of demineralisation and for the monitoring of treated subjects.