[Treatment of algodystrophy. A randomized study of 95 cases with 3 treatments: Calsyn 100, Visken, Grisefuline and Penthonium]. / Thérapeutique des algodystrophies. Etude randomisée sur 95 cas de trois traitements: Calsyn 100, Visken, Griséfuline et Penthonium.

Three randomised therapeutic protocols were studied: thyrocalcitonin, beta-blockers and the combination of Grisefuline + Penthonium, in a group of 95 cases of algodystrophy (64 women, 31 men). These cases were divided into four groups: upper limb, lower limb, "recent" or "long-standing". The results were assessed after one month of treatment. A positive result was defined as being an improvement of more than 50 p. cent of the clinical subjective and objective criteria; less than that, the activity is uncertain or nil. Comparison of the results did not reveal any statistically significant difference between the three proposed treatments, whether we consider the whole group of patients or each sub-group separately (overall positive results: Calsyn 100 = 53 p. cent, Visken = 42,5 p. cent, Grisefuline + Penthonium = 53 p. cent). The important role played by rehabilitation must be stressed. It should be discontinued during the acute phase and instituted in the later phase. Cure is obtained after an average of 4-5 months of treatment. 10 patients were left with major trophic sequelae after 2 years of the disease; all involve the hand.

[Follow-up study of patients with rheumatoid arthritis over a period of more than 10 years (1966-1978): analysis of disease progression and treatment in 100 cases (author's transl)]. / Polyarthrites rhumatoïdes évoluant depuis plus de 10 ans (1966-1978). Analyse de l'évolution et des traitements de 100 cas.

A follow-up study was conducted in 100 rheumatoid arthritis patients, treated over the last 10 years with currently accepted therapy, after a period varying from 10 to 15 years following the onset of the disease: 20 p. cent were in Steinbrocker's stage I, 60 p. cent in stage II, 16 p. cent in stage III, and 4 p. cent in stage IV. When compared with a similar study conducted between 1948 and 1958, results demonstrated that the percentage of patients in stage I had not varied, but that only half as many patients were disabled (stages III and IV), due to insertion of lower limb surgical prostheses. Corticoid therapy had been necessary in 84 p. cent of the patients for variable periods. The 50 p. cent duration of the different treatments proposed during this 10-year period was 12 months for antimalarial drugs, 8 months for gold salts, and 12 months for D-penicillamine. Therapy was still effective after one year in 30 p. cent on antimalarial drugs, 27 p. cent on gold salts, 51 p. cent on D-penicillamine, and 21 p. cent on chlorambucil. Duration of efficacy of basic treatments is too short to cover the long progression of rheumatoid arthritis. New treatments are necessary, as the functional prognosis of this disease has not changed fundamentally over the last 15 years.

[Hydroxyapatite rheumatism (multiple tendon calcification disease). II. - Microscopic study - HL-A antigen - Experimental arthritis - Pathogeny]. / Le rhumatisme à hydroxyapatite (la maladie des calcifications tendineuses multiples). II - Etude microscopique - Antigène HLA - Arthrite expérimentale - Pathogénie.

Optical and electron microscopic studies of the articular fluid in multiple calcification disease reveals the existence of rounded intra- and extracellular crystalline formations. These crystalline formations of calcium and phosphorus are made up of accumulations of tiny crystals shaped like fine needles 200 nm X 15-20 nm and are highly suggestive of hydroxyapatite. Crystals injected into the plantar pads of rats or the knees of rabbits induce an acute inflammatory reaction maximal at 5 hours and recovering in 24 72 hours. Hydroxyapatite crystals are swiftly dissolved in serum and more rapidly still when cells are present. Their dissolution releases calcium into the surrounding area. HLA typing of patients with multiple tendinous calcification (28 cases) or single tendinous calcification (10 cases) shows an increased frequency of HLA A2 and BW 35 in comparison with controls.

[Hydroxyapatite rheumatism (multiple tendon calcification disease). I.- Clinical study]. / Le rhumatisme à hydroxyapatite (la maladie des calcifications tendineuses multiples). I-Etude clinique.

A study was made of 45 patients suffering from hydroxyapatite rheumatism (multiple tendon calcifications disease). There were 36 women and 9 men aged between 15 and 61 years with an average age of 14. The following joints were involved (the first figure refers to clinical affection, that between brackets to radiologically demonstrable calcifications): shoulder 34 (36); neck 14 (15); wrist 18 (11); fingers 19 (17); hip 11 (29); knee 14 (18); ankle 10 (14); foot 5 (6); spinal column 16 (24). In 30 patients the disease manifested itself in the form of acute recurrent migratory arthritis resembling gout. In 8 cases, it developed in the form of acute recurrent migratory arthritis resembling gout. In 8 cases, it developed in the form of acute polyarthritis and in 7 as rheumatoid arthritis without radiological lesions. Thirty-two patients could be followed up. Four of them were cured, 9 showed improvement but still suffered attacks of pain. Eighteen patients were not improved, their pains growing more chronic. Four patients had a family history of multiple tendon calcifications disease.

Hydroxyapatite rheumatism and HLA markers.

HLA typing of 38 patients suffering from calcific periarthritis (hydroxyapatite rheumatism) showed an increased prevalence of HLA A2 (66 per cent) and HLA BW35 (34 per cent) vs 44 per cent and 19 per cent in 591 controls (p less than 0.01 and p less than 0.03 respectively). These preliminary results suggest a possible association between factors controlling susceptibility to the disease and some HLA markers. Larger series of patients and family studies are required to confirm this hypothesis.

[A new case of sarcomatous degeneration of the spine in Paget's disease of bone]. / Nouvelle observation de dégénérescence sarcomateuse du rachis Pagétique

In referring to a personal observation the authors recall the rarity of malignant degeneration of lesions of the spine caused by Paget's disease. In the majority of cases these consist of multiple centred osteo-sarcomatosis. The lumbar spine is the most often affected. The clinical picture is essentially a syndrome of radiculomedullary compression. Rapid aggravation of the condition usually leads to a neurosurgical operation, which will confirm the existence of the osteo-sarcomatous process. The evolution is always fatal.