[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.

[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.

[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.

[A case of congenital insensitivity to pain with destructive arthropathies of the limbs and spine. Discussion on nosology and physiopathology of the disease]. / Etude d'un cas d'insensibilité congénitale à la douleur avec arthropathies destructrices des membres et du rachis. Discussion à ce propos de la nosologie et de la physiopathologie de l'affection.

A seventeen year old boy presented with destructive arthropathy of the lower limbs and discovertebral spaces. Past history yielded recurrent episodes of indolent fractures and progressive knee and ankle deterioration. The patient denied any pain sensation in the past and at examination. Other neurological tests were normal. Beta-endorphin level was elevated in the CSF. Response to the cold pressor test was modified after injection of Naloxone. The nosology and physiopathology of congenital insensitivity to pain are discussed.

[Enthesopathy in inflammatory spondyloarthropathy. Incidence, clinical, radiological and anatomical descriptions. Current status of the question. Apropos of 37 cases]. / Les enthésopathies des spondyloarthropathies inflammatoires. Fréquence, description clinique, radiologique et anatomique. Etat actuel de la question. A propos de 37 observations.

Based on a series of 37 personal patients and data from the literature, a number of characteristics of enthesopathies can be observed in the course of inflammatory spondyloarthropathies. Our series is based on 20 cases of ankylosing spondylitis (ASP), 8 cases of Fiessinger-Leroy-Reiter syndrome, 8 cases of psoriatic rheumatism (Pso Rh) and one combined form (psoriasis + Reiter + ASP). As well as the frequent involvement of the calcaneus (29 patients), we found more unusual extra-calcaneal localisations in 23 patients. The clinical symptomatology consisted of pain on activity and on weight-bearing at the sites of insertion of the tendons, which were sometimes swollen. The disease was occasionally very incapacitating. The radiological signs consist of lesions of erosion (initially) and reconstruction (subsequently). The histological signs consist of zones of osseous reorganisation and osteo-tendinous inflammatory infiltration. The mechanism of these enthesopathic lesions is still unclear. Our observations are similar to those reported in the literature, which are essentially paediatric studies. Enthesopathy appears to be a diagnostic and lesional element in common with inflammatory spondyloarthropathies (which include ASP, Reiter's Pso Rh, enteropathic rheumatisms and Behçet's disease) and, at least partially, with juvenile rheumatisms. In the latter case, the precocity of the tendinoperiosteal signs seems to be a very important element in the orientation of the diagnosis at the pre-spondylitic stage.