[Liver complications caused by D-penicillamine. Apropos of a case]. / Les complications hépatiques de la D-pénicillamine. A propos d'un cas.

The complications of D-penicillamine are rare. It generally consists of reversible cholestatic hepatitis which may, however, be fatal. The authors report a typical case with a benign outcome and with concomitant signs of cutaneous intolerance with eosinophilia. The definite role of D-penicillamine was confirmed by the re-introduction of the drug.

[Activated and cytotoxic-suppressive T cells in rheumatoid polyarthritis]. / Contribution à l'étude des cellules T activées et cytotoxiques-suppressives au cours de la polyarthrite rhumatoïde.

The authors studied the distribution of the sub-classes of T lymphocytes in the peripheral blood in 56 patients with rheumatoid arthritis (RA) by a technique of complement dependent lymphotoxicity, using monoclonal antibodies (ABm) which react with surface proteins p29/34 (HLA-DR) and Tp 30 (OKT 8-like). Classically, these ABm recognize the sub-groups of activated T cells (TA = TDR+) and cytotoxic/suppressive T cells (T c/s) respectively. In this study, normal levels of TDR+ and T c/s were found in 32% and 25% of patients respectively. However, the distribution of the values shows that 48% of the patients with rheumatoid arthritis have an increased level of TA/DR+, while 51 to 67% of patients with RA have reduced levels of T c/s, depending on which ABm was used, which suggests a heterogeneity in the T c/s sub-population. In this series, it seems that the two phenomena are preferentially associated in the small group of patients with early onset RA, while in patients with late onset RA, there is an isolated rise in the TA. These observations need to be confirmed before we can attribute an aetio-pathogenic role to the co-existence of these disorders. However, when the percentage of T c/s is greater than that of the TA, the RA has a longer clinical course than in the reverse case, which suggests the possibility of secondary immunological adaptation to the disease or an influence of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasma exchange and rheumatoid polyarthritis with vasculitis. Apropos of 6 case reports]. / Echanges plasmatiques et polyarthrites rhumatoïdes avec vascularite. A propos de six observations.

The authors present six cases of rheumatoid arthritis (RA) complicated by vasculitis of varying clinical presentation: 2 cases of polyneuritis, 5 cases of skin lesions (dry gangrene, ulcers, purpura). The severity of the clinical picture required, in addition to the usual treatment (corticosteroids, immunosuppressants), plasma exchanges. A clinical stabilisation was obtained in every case with good tolerance. The development of a vasculitis would appear to be the prime indication for the use of plasma exchange in rheumatoid arthritis.

HLA-DR typing in 58 cases of rheumatoid arthritis.

The results of a previous study led us to believe that the association of HLA-DR4 and rheumatoid arthritis could be of particular interest in our region. In this work we typed 58 caucasoid patients in the Marseilles area by microlymphocytotoxicity assay in B-cells. HLA-DR4 was found to be at the same level as that observed by the authors in the 8th Workshop of histocompatibility (1980) (X2:32.36, P less than 0.001) and very high in the seropositive patients (61.5 per cent). No correlation with sex was observed. We again found a low frequency of HLA-DR4 (15.8 per cent) in our controls.

[Rheumatoid polyarthritis and extensive necrotizing vasculitis. Apropos of 2 cases]. / Polyarthrite rhumatoïde et vascularite nécrosante extensive. A propos de deux observations.

The author reports two cases of severe rheumatoid arthritis (RA) where the manifestations of necrosis vasculitis consisted of extensive and bullous gangrene of the lower limbs. In one case, the laboratory picture was that of major complement consumption (CH50 unmeasureable, marked fall in various compounds including C3 and C4) with very high levels of circulating immune complexes. An attempt at treatment by plasmapheresis, immunodepressants and corticosteroids led to moderate stabilisation of the vasculitis (regression of purpura) but remained incapable of resolving the local problem of gangrene. The severity of the lesion led to amputation of both legs. In the other case, there as a fall in CH50 with the presence of circulating immune complexes. Similar treatment led to stabilization of the lesions but final amputation could not be avoided to deal with the residue. Interruption of treatment was followed by an inflammatory exacerbation which was satisfactorily dealt with by further sessions of plasmapheresis. The authors discuss the value of such immunodepressant therapy in severe RA in the light of these cases.

[D-Penicillamine treatment of painful lumbar syndromes caused by arachnoiditis]. / Traitement par la D-pénicillamine de syndromes douloureux lombaires par arachnoïdite.

The authors have been treating with a synthetic D penicillamine 12 patients affected with pains in the lumbar region or lumbosciaticas imputed to duroarachnoiditis in connection with surgical procedure or/and radiculosacography. The diagnosis is based on clinical arguments (3 cases), clinical and radiological arguments (radiculosacography : 3, phlebography : 3) and on surgical arguments (3 cases). The findings are good 5 times and incomplete twice. There are 4 failures and 3 interruption of treatment out of 6 intolerances. The effect of penicillamine upon collagen could perhaps be the explanation of these results.

[Study of the allogenic reactivity and suppression function of lymphocytes, in rheumatoid polyarthritis treated with cold salts, in mixed lymphocyte cultures]. / Etude de la réactivité allogénique et de la fonction suppressive des lymphocytes de polyarthrites rhumatoïdes traitées par sels d'or en cultures mixtes lymphocytaires.

In a group of 30 rheumatoid polyarthritis treated with gold salts, a determination of the T lymphocytes (sheep red cells) furnished in percentage normal values, and in absolute value a normal average value, with, however, a low level of T lymphocytes. In autologous lymphocyte cultures no spontaneous increase of DNA synthesis was registered. The allogenic response was normal, and in mixed culture with the addition of a third type of cells, a discrete specific suppressive activity appeared.