[Fibromyalgia]. / La fibromyalgie.

PURPOSE: We review the current knowledge about fibromyalgia, adding to the clinical aspects, the nosology, epidemiology and pathogenesis. The therapeutic and social management of these suffering patients are discussed. KEY POINTS: The limitations of the American College of Rheumatology classification criteria used as diagnostic criteria are discussed. Fibromyalgia is not a simple psychiatric disorder, even if psychiatric symptoms are constantly found. Based on functional brain imaging, there is some evidence pointing to an abnormal function of the supra-spinal centres for pain regulation. CONCLUSION: Fibromyalgia is a clinical autonomous entity. Physiopathology knowledge is improving, but must be confirmed by new research. Patients will take profit of multimodal individualized treatment programs, including explanations about the diagnosis. In most cases, fibromyalgia is compatible with the maintenance of a professional activity, possibly adapted to the patient. Recognized disability requiring compensation is infrequent.

Microfilarial polyarthritis in a massive Loa loa infestation. A case report.

A Cameroonian affected with massive Loa loa infection developed febrile arthritis with involvement of both knees and the left ankle. Although the patient was first seen by us after one month of treatment with Indomethacin, at this time the joints were still inflamed and microfilariae of Loa loa were found in the synovial fluid. No other etiological mechanism was identified. Following the articular puncture and treatment with Ketoprofen, the arthritis subsisted within a week. This is the first case to be studied in which arthritis during loasis has been explicitly documented by the presence of intra-articular microfilariae.

[Acute polyarthritis associated with Sweet's syndrome]. / Polyarthrite aiguë accompagnant un syndrome de Sweet.

A 43-year old man presents with acute febrile neutrophilic dermatosis (Sweet's syndrome) associated with acute seronegative polyarthritis. Although no definite diagnosis of viral infection could be made, the patient had raised serum antibodies against cytomegalovirus (1/1280; 1/2560). Histological examination showed typical lesions of Sweet's syndrome as well as the presence of extra- and intracellular unidentified particles in histiocytes.

[Enthesopathies in ankylosing spondylitis and seronegative inflammatory rheumatism. 28 cases]. / Les enthésopathies dans la spondylarthrite ankylosante et les rhumatismes inflammatoires séronégatifs. 28 observations.

A few demonstrative cases of severe and disabling enthesopathy in patients with ankylosing spondylitis (AS) and related syndromes, psoriatic arthritis (PA) or Reiter's disease (RD) have prompted the authors to investigate the incidence of enthesopathy in such patients. A retrospective clinical and radiological study was conducted in 48 patients (mean age: 34.8 years) 27 of whom had AS, 9 RD and 12 PA. The overall incidence of enthesopathy was 58.3%. Beside the classical calcaneal lesions (50%), extracalcaneal manifestations of the disease involving the knees and shoulders were found in 39% of the patients. The HLA B27 antigen was detected in 87% of patients with enthesopathy, while 82% had clinical inflammation of the spine. The mean duration of clinical symptoms due to enthesopathy was 2-6 weeks in 36% and 6 months to 1 year in 45%. One striking feature of enthesopathy in this series was the lack of response to steroidal and non-steroidal anti-inflammatory drugs contrasting with the response of the associated arthritis. Since enthesopathies appear to be of diagnostic significance in the group of arthropathies of the spine, their incidence in other articular diseases should be the object of systematic comparative evaluations. A diffuse exacerbation of enthesopathy may constitute the initial manifestation of seronegative HLA B27 positive arthropathy, which is not without therapeutic implications.

[Polymyalgia rheumatica and temporal arteritis. Observations on prognosis and treatment]. / Pseudopolyarthrite rhizomélique et maladie de Horton: considérations pronostiques et thérapeutiques.

1. There is still controversy about polymyalgia rheumatica (PMR) and temporal arteritis (TA), either expressions of a single disease or two different conditions with overlapping. Nearly 50% of TA present with a PMR syndrome and 5% of PMR have a positive temporal artery biopsy. 2. Biopsy is useful for diagnostic purposes but does not seem to have any prognostic value in the management of PMR and TA. 3. The best symptomatic treatment is represented by prednisone. Prednisone has to be continued over a large period of time creating adverse effects in elderly people unless minimal doses are used. 4. TA visual or neurological complications are often observed in the first weeks of the disease thus leading many authors to recommend high doses (0.5 mg to 1 mg/kg/day) to patients with TA and even with PMR. To us starting high doses are to be used in severe clinical conditions of TA, particularly those presenting visual symptoms (nevertheless lower doses may be successful as well). Concerning other patients with TA and with PMR a starting dose of 10 to 30 mg depending on the clinical picture then a follow up dosage of 10 and even less, is suggested.