Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.

OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. METHODS: Review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. Arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean C-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. Synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.

Two new cancer locations accompanied with palmar fasciitis and polyarthritis.

Only 35 cases of cancer with palmar fasciitis and polyarthritis have been published to date. We report two new cases, one with a transitional cell carcinoma of the renal pelvis and the other with an adenocarcinoma of the uterus. Neither of these locations has been reported in association with palmar fasciitis and polyarthritis. Palmar fasciitis with polyarthritis can occur in a wide range of cancers and warrants extensive investigations for a malignant tumor.

Prevalence and biological consequences of vitamin D deficiency in elderly institutionalized subjects.

The prevalence of vitamin D deficiency was evaluated in a population of elderly institutionalized subjects in seven long-term geriatric care facilities in France (Amiens, Francheville, Ivry, Lille, Montpellier, Oissel and Villejuif). Residents whose functional capability was relatively good were entered into the study. There were 126 patients (99 females and 27 males) with a mean age +/- SD of 84 +/- 6.6 years. All subjects had been institutionalized for over six months and were capable of walking at least as far as the dining room. None had received vitamin D or other compounds known to affect the metabolism of phosphorus and calcium within six months before the study. Vitamin D status was evaluated by determining serum 25 hydroxyvitamin D (25 OH D) levels using a radiocompetition assay after extraction and chromatographic separation. Mean serum 25 OH D was 3.17 +/- 2.52 ng/ml (median 2.5). Eighty-five per cent of subjects had serum 25 OH D values of less than 5 ng/ml and 98% had values under 10 ng/ml, which is the cutoff usually taken to define vitamin D deficiency. Mean serum levels of intact parathyroid hormone were increased approximately two-fold as compared with values in healthy adults (70 +/- 39 pg/ml versus 33 +/- 12 pg/ml). Biochemical markers for bone formation (alkaline phosphatase, osteocalcin) and bone resorption (TRAP, hydroxyproline, pyridinoline) were all increased, with mean values 1.4-fold to 3.4-fold those seen in healthy adults. Serum 25 OH D levels were negatively correlated with serum intact parathyroid hormone levels (r = 0.41; p < 0.0001). Serum intact parathyroid hormone levels were positively correlated with alkaline phosphatase activity (r = 0.30; p < 0.001) and serum osteocalcin levels (r = 0.36; p < 0.0001) and negatively correlated with corrected serum calcium levels (r = -0.20; p < 0.02). Conclusion. Our data demonstrate that severe vitamin D deficiency is present in virtually all elderly institutionalized subjects and is accompanied with secondary hyperparathyroidism responsible for increases in markers of bone remodeling. Routine vitamin D supplementation is warranted in elderly institutionalized subjects.

[Evaluation of the calcium content of diet by frequential self-questionnaire]. / Evaluation de la teneur en calcium du régime alimentaire par autoquestionnaire fréquentiel.

A frequential type self-questionnaire enabling evaluation of the calcium content of the diet of an individual as well as of a given population was designed on the basis of 20 different types of food (items) rich in calcium and/or frequently eaten in metropolitan France. Comparison with the weekly docket system, chosen as a reference method, validated the self-questionnaire. Similarity with the weekly docket method disappeared when the size of portions was left to one side, drinks were eliminated or only dairy products were taken into account. The self-questionnaire with its 20 items thus offers a simple and rapid method for estimation of the daily calcium intake of a given individual to within an accuracy of 20% and as result is a dietetic evaluation technique suitable for both clinical and epidemiological use.

[Fluoride bioavailability from sodium fluoride alone or in association with different calcium salts]. / Fluoride bioavailability from sodium fluoride alone or in association with different calcium salts.

Fluoride pharmacokinetics were studied in twelve healthy subjects after oral administration of one tablet of osteofluor-containing 25 mg of sodium fluoride alone or associated with different calcium salts (500 mg Ca element) given as microcrystalline hydroxyapatite compound or powdered tri-calcium phosphate. Fluoride was measured in plasma and urine with a specific electrode and fluoride bioavailability from the three drugs was compared. Calcium absorption after oral load was assessed by measuring variations from the fasting state of plasma calcium and parathyroid hormone and of the urinary calcium to creatinine ratio. The bioavailability of fluoride is significantly decreased by the association to sodium fluoride of hydroxyapatite but not of tri-calcium phosphate. Calcium absorption seems greater after administration of hydroxyapatite compound. The decrease of the fluoride bioavailability is probably dependent on the capacity of calcium absorption from the calcium salts. The association of calcium to fluoride is absolutely required for treatment of osteoporosis. The microcrystalline hydroxyapatite compound seems preferable in view of its greater calcium absorption and of its limited decrease in fluoride bioavailability.

[Paget's disease and metastatic epithelioma on the same bone. 11 new cases and review of the literature]. / Maladie de Paget et métastase d'épithéliomas sur le même os. Onze nouvelles observations et revue de la littérature.

The authors collected observations concerning 11 newly histologically proved cases of a combination of Paget's disease and carcinoma metastatic to bone on the same bone from members of the French Rheumatology Society. The most frequent locations can be specified from their analysis and an analysis of 26 detailed cases from the literature, i.e. pelvis, femur, rachis, tibia, humerus, and the cancers most frequently involved--prostate, bronchi, kidney, breast and intestine. The most usual histological appearance is osteolytic, except in the case of prostatic carcinoma. The metastasis reveals the presence of cancer in 2 cases out of 3, whereas Paget's disease is most often already diagnosed. A histological examination is necessary because of the risk of non recognition of such metastases or of confusion with sarcomatous degeneration. It does not appear to be exceptional to find Paget's disease in combination with a metastasis on the same bone. Although six of the cases concern metastases only located at sites of Paget's disease, an analysis of all the cases does not seem to indicate that Paget bone is more exposed to metastases than normal bone, since both diseases in fact locate preferentially at the same sites on the skeleton.

[Comparison of the fluoride bioavailability from two oral preparations of monofluorophosphate disodium in combination with various calcium salts]. / Comparaison de la biodisponibilité du fluor à partir de deux préparations orales de monofluorophosphate disodique en association avec différents sels de calcium.

We studied, in twelve healthy volunteers, the pharmacokinetics of inorganic fluoride and calcium variations in serum and urine, parathormone variations in serum after administration of two oral preparations containing 100 mg of disodium monofluorophosphate (13.2 mg F as element) with different calcium salts (500 mg Ca as element). Fluoride was estimated in serum and urine with an ion specific electrode. The fluoride bioavailability from two preparations is identical with an areas under the curve corresponding to 61.05 and 62.53 mumols.l-1 h (after deduction of physiological fluoride concentrations) and urinary fluoride excretion after 72 hours corresponding to 266.6 and 246.1 mumols. The plasma peak appearance is rapid (one hour) and similar. The significant increase of urinary Ca-Creat ratio (70 to 100%) is identical four hours after drug administration. In the same way, a significant and early decrease of intact PTH in serum, measured with chemiluminometric method, was observed from two drugs. From these observations we may conclude that the two preparations are biologically equivalent.