[Hand disorders in pianists]. / Pathologie de la main du pianiste.

During the past 10 years numerous studies have been devoted to the pathology of musicians. A few of these studies exclusively concern pianists. From a questionnaire filled and returned by 44 pianists we were able to determine the type and frequency of the symptoms encountered. Pain and stiffness are the principal symptoms, the 4th and 5th fingers being those most affected. Three pathologies predominate in the literature: overuse syndrome, entrapment neuropathy and functional dystonia. The often long and difficult curative treatment rests on rehabilitation. Training in the fundamental postures the pianists must adopt should enable them to reduce the occurrence of these pathologies.

[Update on the treatment of systemic scleroderma]. / Actualités dans le traitement de la sclérodermie systémique.

Renewed clinical trials of drugs used for many years and the availability of new symptomatic therapies allows selection of appropriate treatment for progressive systemic sclerosis. Colchicine damages intracytoplasmic microtubules and when administered at a dose of at least 1.5 mg per day during early stages of the disease reduces cutaneous sclerosis without improving other manifestations of scleroderma. D-penicillamine inhibits bridge formation during collagen maturation, acting mainly on cutaneous infiltration with more uncertain effects on visceral localizations of the disease. It can be effective against pulmonary lesions but, as with colchicine, must be prescribed early. Its action is delayed and its side effects limit its use. Corticoids are of very limited efficiency and although they may be useful for relief of muscular and articular localizations they have been accused of precipitating onset of renal insufficiency. Immunodepressants have until now been assessed as ineffective. The demonstration in patients with progressive systemic sclerosis of abnormal activation of immunity system cells suggested the use in this collagen disease of a new immunosuppressive agent, cyclosporine A, but clinical utility of this drug remains to be demonstrated. In systemic sclerosis efficacy of plasma exchange is mainly directed against vasomotor disorders and digital ulcerations, but study results are difficult to assess because of associated therapies. Constraints and risks of this treatment also considerably reduce its interest. The coagulation factor XIII acts as a stabilizing factor of collagen. It reduces cutaneous infiltration but its efficacy is based on results of a single controlled trial and its use is limited by the need for repeated intravenous injections.(ABSTRACT TRUNCATED AT 250 WORDS)

[HLA complexes and psoriatic rheumatism]. / Complexes HLA et rhumatisme psoriasique.

A study of the HLA system during psoriasis and psoriatic rheumatism demonstrated several genetic markers. The associations of psoriasis with antigens of locus B are feeble (HLA B 13, HLA B 17) or incontant (HLA B 37, HLA W 16). On the other hand, there existe a very strong link between psoriasis with an antigen of locus C (HLA CW6) found in all races and with antigens of locus C (HLA DMO, HLA DW 11). During psoriatic rheumatism, antigen HLA B27 is present mainly in the forms with spinal involvement. No peripheral marker of arthritis has been demonstrated until now, the increased frequency of BW 38 does not seem specific of the joint involvement.

[Axial osteosclerosis with autosomal dominant transmission: a new entity?]. / Une ostéosclérose axiale de transmission dominante autosomique: nouvelle entité?

The authors report on the case of a 26-year-old woman and three members of her family suffering from a benign condensing osteopathy, of dominant autosomic transmission, characterized mainly by a non homogenous hyperopacity of the spine and the pelvis, without alcaline hyperphosphatasemia, and which seems to them different from the condensing ostepathies described up to now.

Lymphocyte tubular structures in rheumatoid arthritis.

Two types of lymphocyte tubular structures were studied by electron microscopy in 80 patients with classic or definite rheumatoid arthritis (RA). Fifteen patients with unequivocal systemic lupus erythematosus (SLE) and 10 healthy persons were studied as controls. Lymphocyte tubulo-reticular structures were found in 13 of the 80 patients with RA and in 10 of the 15 patients with SLE. No tubuloreticular structures were found in any of the healthy subjects. In the RA patients antinuclear antibodies, LE cell phenomenon, and chlorambucil treatment were associated significantly with these inclusions but disease activity was not related to their presence. In cases in which tubuloreticular structures were present the number of cells containing inclusions was on average much lower in patients with RA than in those with SLE. Lymphocyte tubular parallel arrays were found in all the patients with RA and SLE and in all the healthy persons. In all three groups the average number of cells containing parallel tubular arrays was similar.

Light and electron microscopy study of capillaries in normal and inflammatory human synovial membrane.

Synovium aspirated from the knee joint by trochar was studied by light and electron microscopy in 40 cases of inflammatory arthritis and in 10 controls. The morphology of synovial capillaries, extravascular plasma diffusion, interendothelial vascular gaps, extracapillary blood cell migration, vascular congestion, endothelial hyperplasia, and obliteration of the capillary lumen by endothelial cells were compared in normal and inflammatory synovia. Inflammatory synovitis was characterised by the number and diversity of blood cells migrating through the interendothelial pathway out of the capillary lumen. Polymorphonuclear leucocytes were the blood cells most often seen at interendothelial junctions. No other capillary changes that might be related to synovial inflammation were found.

Ultrastructural study of human synovial membrane with immunoperoxidase.

An ultrastructural immunoperoxidase study of human synovial membrane biopsies performed in 16 patients with rheumatoid synovitis and in 14 control patients showed that: (1) plasma immunoglobulins have an intercellular distribution and seem to diffuse mainly by an intercellular rather than by a transcellular pathway; and (2) there is a difference in the distribution of plasma IgG and IgM. IgG was found in intravascular and extravascular spaces in all biopsies. IgM was found only in intravascular spaces in control biopsies, but in rheumatoid synovitis it was present in both intravascular and extravascular spaces. This difference in distribution may be due to increased vascular permeability in inflammatory synovitis.

[HL-A antigens in patients with psoriatic rheumatism]. / Antigènes HLA chez les malades atteints de rhumatisme psoriasique

The authors studied HLA tissue groups for 28 specificities in 70 patients with psoriatic arthropathy (44 with pure peripheral arthropathy and 26 with axial involvement, 19 of whom also had peripheral lesions). Four antigens of this system were found with a significantly increased frequency in 70 patients in comparison with a control group of 152 normal subjects. For antigen HLA-B27, the frequency seemed very significantly increased in patients with axial involvement as compared with those without axial troubles (pc less than or equal to 0.0001) and with the controls (pc less than or equal to 0.0001). For antigen HLA-B13, the frequency was significantly increased in patients with axial involvement as compared with the controls (pc less than 0.05). Antigen HLA-Bw17 was present with significantly increased frequency as compared with the controls in the patients with peripheral involvement (pc less than 0.001). For antigen HLA-Bw38 (W16.1), the frequency in patients with or without axial involvement was significantly increased in comparison with the controls (pc less than 0.001). The interpretation of these results is discussed and the association of antigen HLA-B27 with sacro-iliac involvement once again stressed.

[Psoriatic rheumatism. Prospective study of 50 cases, without sacroiliac involvement and without rheumatoid factor, compared with 50 cases of rheumatoid arthritis]. / Rhumatisme psoriasique. Etude prospective de 50 cas, sans atteinte sacroiliaque et sans facteur rhumatoïde, appariés à 50 cas de polyarthrites rhumatoïdes

The authors report the results of a prospective study comparing 50 cases of psoriatic arthropathy with peripheral articular involvement only and negative rheumatoid serology with 50 cases of classical or definite rheumatoid arthritis paired according to sex, age and the duration of the disease. The results were studied using the X2 test of statistical significance. Despite frequent similarity with rheumatoid arthritis, psoriatic arthropathy differs from it significantly on the basis of a series of characteristics which may be summarised as follows: less wide dissemination and decreased severity of clinical and radiological articular lesions; more gradual progression by attacks separated by periods of remission, often total, resulting in less severe degree of invalidity than rheumatoid arthritis and therefore requiring less often the use of oral corticosteroids. The authors discuss the case of psoriatic arthropathy with positive rheumatoid serology and that of psoriatic arthropathy with combined peripheral and vertebral column involvement.