[Polymyalgia rheumatica and giant cell arteritis: recent data and current situation]. / Polymyalgia rheumatica et artérite giganto-cellttulaire: données actuellttes.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are two frequently linked inflammatory diseases of the elderly. The diagnosis of GCA is based on temporal artery biopsy, but results must not delay steroid therapy because of the potential sudden ocular and neurologic ischemic complications. PET-scan and MRI angiography can be helpful in difficult cases. The diagnosis of PMR is essentially clinical, centred on subacute onset of morning aching and stiffness in the shoulder and hip girdles. The treatment of both entities is still based on glucocorticoids (10-20 mg/j of prednisone for PMR, and 40-60 for GCA). Methotrexate, though, now appears a sometimes-useful corticosteroid-sparing agent, both in PMR and GCA. There also appears to be a role for low dose aspirin to decrease ischemic events in GCA.

[Diagnosis and treatment of calcium pyrophosphate crystal-induced arthropathy]. / Diagnose und Therapie der Kalziumpyrophosphatkristall-induzierten Arthropathie.

Calcium pyrophosphate dihydrate deposition (CPPDD) disease is the term used to describe a group of common and potentially severe metabolic arthropathies. In these, CPPD crystals form and are deposited in the cartilage matrix (chondrocalcinosis) and induce inflammatory and/or destructive mechanisms. Most cases are idiopathic, but hyperparathyroidism, hemochromatosis, hypomagnesemia and hypophosphatemia can promote or cause chondrocalcinosis. Early disease (with onset before the age of 60 years) thus requires that the patient be examined for these metabolic conditions, particularly hemochromatosis. The prevalence of CPPDD disease in the general population increases with age, being 10-15% in the age group 65-75 years and more than 40% in the over-80s. Although frequently asymptomatic, chondrocalcinosis can involve severe acute attacks of inflammatory arthritis (pseudogout) and also various types of chronic arthropathy including pseudorheumatoid arthritis, pseudo-osteoarthritis, and pseudoneuropathic joint disease. CPPD crystals can also be deposited in the bursae, ligaments, and tendons and generate inflammation and/or ruptures. The diagnosis is based on synovial fluid analysis (positively birefringent CPPD crystals visualized by compensated polarized light microscopy) and X-rays (punctate and linear radiodense areas in fibrocartilage and hyaline cartilage). Treatment is primarily symptomatic, since there is no known drug that can prevent progression of the joint destruction). Nonsteroid anti-inflammatory drugs (NSAIDs) and intra-articular or systemic glucocorticoids (amounts must be only small if use is prolonged) are the most useful treatments. Colchicine can be effective in recurring pseudogout, and magnesium can be used prophylactically. In a small uncontrolled series methotrexate was effective and aroused interest; it can be used when other treatments fail.

[Calcium pyrophosphate dihydrate crystal induced arthropathy]. / Arthropathies à cristaux de pyrophosphate de calcium.

CPPD deposition disease is a common and potentially severe arthropathy. Hyperparathyroidism, hemochromatosis and hypomagnesaemia can favour chondrocalcinosis and must be looked for in early disease (< or =60 years). Chondrocalcinosis can cause severe attacks of inflammatory arthritis (pseudogout) as well as various forms of chronic arthropathies including pseudo RA, pseudo OA and pseudo neuropathic joint disease. Diagnosis is based on synovial fluid analysis, (positively birefringent CPPD crystals) and X-rays (punctuated and linear radio densities in cartilage). NSAIDs and i.a. or systemic glucocorticoids are the most useful treatments. Colchicine can be effective in recurring pseudogout, and magnesium for attacks' prevention. Methotrexate proved effective in a small uncontrolled series, and can be used when other treatments fail.