Two cases of discitis due to Propionibacterium acnes.

We report two cases of discitis due to Propionibacterium acnes and review previously published cases of bone and joint infections in which this organism was recovered as a pure culture. P. acnes is an anaerobic organism usually considered a normal inhabitant of the skin but capable of producing a variety of infections including discitis, osteitis, arthritis, and chest wall osteitis. Most patients were immunocompetent. A few infections occurred spontaneously, whereas others were secondary to a break in the skin or to implantation of foreign material into the body for instance during internal fixation of a fracture or arthroplasty. Cases of P. acnes chest wall infection have been reported in patients with palmoplantar pustulosis or chronic or multifocal osteitis, supporting a role for P. acnes in SAPHO syndrome.

Hypophosphatemic osteomalacia with plantar neurilemoma. A review of the literature (100 cases).

A case of hypophosphatemic osteomalacia with recovery after removal of a plantar neurilemoma is reported. One hundred cases of osteomalacia with a connective tissue tumor were found in the medical literature. Both sexes and all age groups were affected. Patients often had severe osteomalacia with decreased serum 1,25 (OH)2 vitamin D and phosphate levels and renal phosphate wasting. These abnormalities resolved immediately after complete excision of the tumor, which was often a small lesion found after the diagnosis of osteomalacia. Of the 100 tumors, 87 were benign and half were vascular (e.g., hemangiopericytoma, hemangioma, angiofibroma). A large number of tumors could not be readily classified because they contained vascular structures, giant cells, spindle-shaped cells, and cartilage. Many other histologic variants were observed, including giant cell tumors, nonossifying fibromas, cartilaginous tumors, and osteosarcomas. The tumor was usually located in a limb, generally a lower limb, and was skeletal in nearly half the cases. The tumors produced one or more substances with a capacity for blocking intracellular phosphate transfer and inhibiting renal tube 1 alpha hydroxylase. The link between these two abnormalities remains unclear.

[Chronic sarcoidosis-polyarthritis with infantile onset. Persistent synovial granulomas under corticotherapy]. / Polyarthrite sarcoïdosique chronique à début infantile. Granulomes synoviaux persistant sous corticothérapie.

The case of a patient who developed sarcoidosis with chronic joint symptoms at the age of four and still has active disease twenty years later despite three years of corticosteroid therapy is reported. During the course of the disease, specific histologic features of sarcoidosis were evidenced twice in synovial specimens, twice in skin biopsy specimens, and once in bronchial tissue. Deformations and joint lesions developed in the hands and feet. The combination of arthritis, skin lesions, and uveitis occurs both in juvenile-onset sarcoidosis and in chronic juvenile joint diseases, raising significant diagnostic problems which can be solved by histologic studies of synovial or skin biopsy specimens.

[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.

[Acne-pustulosis-hyperostosis-osteitis syndrome. Results of a national survey. 85 cases]. / Le syndrome acné pustulose hyperostose ostéite (SAPHO). Résultats d'une enquête nationale. 85 observations.

The authors report the data collected by a national investigation organized by the French Society of Rheumatology, concerning the osteo-articular manifestations of severe acne, palmo-plantar pustulosis and primary thoracic and peripheral hyperostosis. This investigation collected 85 case-reports including 13 severe acne, 44 PPP and 28 hyperostosis without the dermatitis mentioned above. From this investigation, it appears that dermatological and osseous pictures described under various denominations, present common characteristics and transition forms justifying their common study under the acronym SAPHO (Syndrome Acne-Pustulosis-Hyperostosis-Osteitis). The bony involvement, especially anterior thoracic, but also vertebral and even peripheral seems to be the common denominator between these diseases. It realizes a true rheumatoid inflammatory osteitis, osseous counterpart of synovial and cartilagenous affections in inflammatory rheumatoid diseases. This group has rather loose connections with common psoriasis and slightly more definite relationships with primary ankylosing spondylarthritis. These clinical and immunogenetic connections occur also through bony involvement.

[Pyrithioxin and rheumatoid polyarthritis]. / Pyrithioxine et polyarthrite rhumatoïde.

After reviewing the literature, the authors demonstrate that pyrithioxine is active in rheumatoid arthritis. The effectiveness is marked by a 50 per cent reduction in the articular index in 59.7 per cent of cases, a reduction in the duration of morning stiffness in 49 per cent of cases, a decreased erythrocyte sedimentation rate in 52.4 per cent of cases and a statistically significant decrease in the mean of these parameters in relation to the mean value at the beginning of treatment. The good results were considered to be those cases in which two of the three criteria (articular index, morning stiffness and erythrocyte sedimentation rate) were decreased by at least 50 per cent. Secondary escapes from treatment (13 per cent) and suspension of treatment for intolerance were considered to represent treatment failures. A good result was obtained in 42.7 per cent of cases. Side effects were observed in 40.1 per cent of cases and were responsible for suspension of treatment in 22.8 per cent of cases. Half of the side effects consisted of muco-cutaneous reactions which generally appeared early and were benign. Haematological, renal and gastrointestinal effects and aguestia occurred more rarely. However, a number of patients died as a result of agranulocytosis, hepatitis or extramembranous glomerulonephritis.

[Thoracic hyperostoses. Description, nosology, etiology]. / Les hyperostoses thoraciques. Description, nosologie, étiologies.

Thoracic hyperostosis is a bone disease with an inflammatory appearance which results in hypertrophy and condensation of the bony elements of the anterior thorax, the sternum, the clavicle and the ribs. 14 cases of the primary form of this disease, Köhler's primary sterno-costo-clavicular hyperostosis, have been reported in the literature. This benign disease is associated with only one complication: subclavian vein thrombosis. The secondary forms of thoracic hyperostosis are associated with extrathoracic signs and occur in a context suggestive of spondyloarthropathy. A sub-group is distinguished on the basis of the presence of cutaneous signs: hyperostosis associated with osteoarthritis in the context of palmo-plantar pustulosis (Sonozaki's disease) or severe forms of acne. In the absence of cutaneous signs, thoracic hyperostosis has been exceptionally described in cases of ankylosing spondylitis. It can also be integrated into a more autonomous context, associated with unilateral sacro-iliitis or with vertebral and peripheral osseous condensations. The pathophysiology of thoracic hyperostosis is unknown, but the HLA B27 phenotype does not appear to be involved.

[Multiple hyperostosis with unilateral sacroiliitis. A new spondyloarthropathy]. / Hyperostose multiple avec sacro-iliite unilatérale. Une nouvelle spondyloarthropathie.

Six patients (4 male and 2 female) presenting with an original, predominantly osseous disease are reported. The disease is characterized by a chronic inflammatory process affecting the thorax, the spine, the femur in 1 case and in all patients only one of the sacro-iliac joints. The condition had begun 11 to 28 years previously and had been active for 6 to 24 years. One case started with regressive polyarthritis. There was no visceral involvement. Radiograms showed bone condensation with hyperostosis, sometimes hypertrophic, unrelated to any articular space. Depending on each patient, the lesions involved the clavicles, the sternum, the posterior arch of the ribs, the vertebrae, the inferior femoral metaphysis. The only joints involved were the sacro-iliac and anubrio-sternal joints. The areas affected showed high radioisotope uptake. There was discrete biochemical inflammatory syndrome. Three of the 6 patients belonged to the HLA group B 27. The multiple biopsies performed showed no specific lesions. The disease proceeds by successive attacks lasting several months and responding poorly to anti-inflammatory drugs. One patient developed Crohn's disease, another, retroperitoneal fibrosis. In some respects, this condition is remindful of sterno-clavicular hyperostosis and of the osteo-arthropathy in palmoplantar pustulosis or acne conglobata. It seems to constitute a new variety of spondylo-arthropathy intermediate between the above-mentioned diseases and genuine ankylosing spondylitis.