[Surveys of the treatment and socio-professional future of patients with spondylarthritis. Our impressions in 1986]. / Enquêtes sur le traitement et le devenir socio-professionnel des spondylarthritiques. Nos impressions en 1986.

After a brief historical reminder, the authors emphasize the difficulties of such investigations; difficulties of realization, analysis and synthesis since the results depend on ethnic and socio-cultural origins, socio-professional factors, primary or secondary forms or the length of evolution of the disease. From their experience, the authors draw a certain number of figures which they compare to those from other authors, especially concerning factors which aggravate the functional prognosis of the disease, or condition its complications. As for the therapy, considering the divergent opinions expressed about the results obtained with modern treatments, and used for thirty years, the authors have initiated an opinion survey among the members of the FSR (French Society of Rheumatology). The analysis of personal cases, the synthesis of various publications, the results of their survey, lead them to conclude that the problem of the treatment of ankylosing spondylo-arthritis and its professional consequences, is currently still more medico-social than scientific. The picture of rheumatoid pelvispondylitis seems less severe today than before, but it is necessary to have a longer follow-up to evaluate it statistically.

[Centrosomatic tuberculous vertebral osteitis. General review apropos of 4 cases]. / L'ostéite vertébrale tuberculeuse centro-somatique. Revue générale à propos de 4 cas.

Defined by the localisation of tuberculous infection in the vertebral body, centrosomatic tuberculous vertebral osteitis, which is rarer than Pott's spondylodiscitis, is more frequently seen in the cases of multifocal tuberculosis occurring preferentially in male black African immigrants approximately 30 years of age. Central area destruction, which has been the initial and pathognomonic radiological sign since its description by Calve and Galland , may progress towards wedging of the vertebral body, and even to its complete disappearance, accompanied by reactive osteocondensation . Infection from this particular localisation of vertebral tuberculosis may spread via arterial branches posterior to the vertebral bodies.

[The outcome of reactive arthritis]. / Le devenir des arthrites réactionnelles.

Cases of reactive arthritis generally have a favourable short-term outcome, within 1 to 6 months in 50 to 70 per cent of cases. The curable nature of the disease and its short clinical course mean that the therapeutic approach should be devoid of risks. Antibiotics, which are necessary for the mucosal lesion, are ineffective in the joint involvement. Non-steroidal anti-inflammatory agents, sometimes in combination with intra-articular steroid injections, seem to be sufficient in the simple forms. In the more chronic, polyarticular forms, gold therapy would appear to be preferable to the use of drugs which act on the immune system. However, the favourable short-term course is overshadowed by the incidence of relapse (30 to 50%), which are sometimes multiple, and by the subsequent development of pelvispondylitis (30% of cases) after an average of about 6 years. Permanent or recurrent peripheral joint manifestations can be seen. The clinical course of these conditions is very similar, whatever the causative agent.

[Results of a regional survey on the treatment of rhizomelic pseudopolyarthritis and temporal arteritis. Apropos of 242 cases treated by various modalities with synthetic antimalarials, corticoids and non-steroidal anti-inflammatory agents]. / Résultats d'une enquête régionale sur le traitement de la pseudopolyarthrite rhizomélique et de l'artérite temporale. A propos de 242 observations traitées selon diverses modalités par les antipaludéens de synthèse, les corticoïdes et les anti-inflammatoires non stéroïdiens.

The authors report the results of a retrospective therapeutic survey concerning 176 cases of rhizomelic pseudopolyarthritis (RPP) and 66 cases of temporal arteritis (TA). Of 128 cases of RPP treated initially by synthetic anti-malarials (SAM) and non-steroidal anti-inflammatory agents (NSAI), 66 were followed up until cure which was obtained after a mean of 23 months and 3 subsequently received brief steroid therapy. 45 cases of RPP were treated initially with corticosteroids. They were generally associated with SAM which enabled early weaning of the steroids, towards the 8 th month, or at least reducing the dose. Cure was obtained within 24 months. Three patients were treated by NSAI and gold therapy. After cure, 5 cases of recurrence and 1 case of TA were observed. 40 cases of TA were initially treated with SAM and NSAI. Twenty cures were obtained within a mean of 28 months. 4 patients later received brief corticosteroid therapy because of an extension of the signs, including two cases of ocular manifestations with a resolving course. Of 25 cases of TA initially treated with steroids, 20 received SAM in combination, or in relay which enabled either steroids, weaning towards the 14th month or a reduction in the dose of steroids. Cure was obtained in an average of 35 months. One case of impaired visual acuity occurred during corticosteroid treatment. Immunosuppressants were used in one patient. No cases of recurrence were observed. Iatrogenic complications with SAM were rare, generally benign and reversible, in contrast to those associated with corticosteroid therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bone mastocytosis and osteomalacia. Apropos of a case with histodynamic analysis on non-decalcified bone]. / Mastocytose osseuse et ostéomalacie. A propos d'un cas avec étude histodynamique sur os non décalcifié.

A patient presented with cutaneous mastocytosis, bone pains, biologic disorders typical of osteomalacia, and intestinal malabsorption. Bone biopsy with histomorphometric analysis and measure of calcification rate on undecalcified bone, confirmed the diagnosis of bone mastocytosis and osteomalacia. There are only 2 other reports of osteomalacia caused by malabsorption. The latter is possibly bound to a mast-cell infiltrate of the intestinal mucosa. Sometimes only villosity atrophy or oedema of the mucosa are observed.

[Osteomalacia. Histologic definition and significance of the histodynamic analysis on undecalcified bone]. / L'ostéomalacie. Définition histologique et intérêts de l'étude histodynamique sur os non décalcifié.

Bone histomorphometry has a major significance in metabolic bone diseases, and especially in osteomalacia. This technique needs a strict methodology with quantitative analysis on undecalcified bone and measure of calcification rate. Histologic definition of osteomalacia includes hyperosteoidosis, characterized by thickened osteoid edges, and decrease of calcification rate. Histodynamic analysis on undecalcified bone provides interest in diagnosis, prognosis and supervision of this affection.

[Tolerability of pirprofen during prolonged treatment]. / Etude de la tolérance du pirprofène lors de traitements prolongés.

During a non-comparative multicentric study, 70 patients suffering from various rheumatological diseases were treated by pirprofen for an average duration of 32 weeks (from 1 to 121 weeks). The daily dose varied from 400 to 1200 mg. Efficacy was judged good or excellent in 53 of the 70 patients (75%). Side effects, especially digestive, were noted in 27 patients (38%). They only caused discontinuation of treatment in 9 patients (13%). Amongst the 38 side effects, 26 occurred during the first 8 weeks of treatment. Despite the long duration of the treatment, the overall tolerance of pirprofen was good or acceptable in 87,5% of patients. The very high level of compliance in this long-term treatment attests to the good tolerance of pirprofen.

[Critical study of patella alta. I. Comparison of results of methods for measuring patellar height in 100 control subjects]. / Etude critique de la patella alta. I. - Résultats comparatifs des méthodes de mesure de la hauteur rotulienne de 100 sujets témoins.

The vertical patellar position is a function of patellar tendon length. Various easily-performed radiological techniques can be used to establish indices which define patellar height. 200 measurements were carried out on 100 control subjects who were free of knee joint pathology, and the various techniques were subsequently compared. Insall's index which is calculated as patellar tendon length over patellar length appears to be the most convenient measurement to use. When it is difficult to precisely determine the patellar tendon's lower insertion on the tuberosity of the tibia, Caton's or Blackburne and Peel's indices are preferable. Blummensaat's line does not seem to be dependable in view of the variations which were observed.

[Critical study of patella alta. II. Patella alta and femoropatellar pathology]. / Etude critique de la patella alta. II. - Patella alta et pathologie fémoro-patellaire.

Patella alta is radiologically defined by an Insall index equal to or greater than 1.3. In 50 patients suffering from pain of the femur and patella, roentgenographic studies consisting of a simple profile view and occasionally completed by a view through Smillie's angle with the knee hyperextended, revealed patella alta. The stretching of the patellar tendon is facilitated by excessive tension during growth and by excessively strenuous physical exercises; patella alta can occasionally be complicated by Osgood-Schlatter's or Sinding-Larsen Johansson's disease. Ruptured tendons have occasionally been observed. Genu recurvatum can also lead to patella alta. The joint should be routinely examined for excessive mobility. Patella alta is often associated with various affections of the extensor apparatus of the knee: pathology secondary to injury, external malposition, gonarthrosis, supratrochlear erosions of the femur. The importance of the role of this condition with respect to patellar chondromalacia has been estimated to varying degrees. The diagnosis of patella alta should be considered in all cases of knee pain.

[Articular infections in adults. Peripheral and vertebral involvement with common bacteria and tubercle bacteria]. / Les infections articularies chez l'adulte. Atteintes périphériques et vertébrales à germes banals et à bacilles tuberculeux.

2,166 cases of joint infection in adults were reviewed during a national inquiry. The peripheral infections due to common germs (1,080 cases) and tubercle bacilli (260 cases) were characterised by their frequency after the age of 60, the role of corticotherapy in onset of the infection and the predominance of staphylococci (60%) in pyogenic infections, the low proportion of deaths (4%) and the necessity of early treatment to observe better functional results. The vertebral lesions due to common bacteria (491 cases) were mainly localised in the lumbar regions (70%) whereas tuberculous infections (335 cases) usually affect the lower dorsal vertebrae (50%). Neurological signs and abscess were more frequent during tuberculous involvement. Needle puncture of the vertebral focus should be recommended owing to its help in etiological diagnosis. A cure was generally obtained without operation in the form of complete or incomplete block, this appearance is, however, less frequent than radiological signs of fixed osteolysis. The mortality is just as low as in peripheral infections.

[Fiessinger-Leroy-Reiter disease seen in a rheumatology unit. Apropos of 71 cases]. / La maladie de Fiessinger-Leroy-Reiter vue dans un service de rhumatologie. A propos de 71 cas.

71 cases of Reiter's disease have been observed since 1972. After a study of the clinical characteristics of these cases, we report the results of 3 laboratory examinations which, grouped together, facilitate the diagnosis of the complete forms, but, above all, of the incomplete and synovial forms. The search for chlamydia cell inclusions was positive in 80% of cases where carried out. The lymphocyte transformation test with the chlamydia antigen was positive in 72% of cases. The search for HLA B27 was positive in 78% of cases.

[Multifocal tuberculous osteoarthritis and synovitis. 10 cases]. / Les ostéo-arthrites et synovites tuberculeuses a foyers multiples. A propos de 10 observations.

Synovial or osteo-articular tuberculosis is multifocal in about 10 percent of cases. Here, this form strikes older people and quite frequently the patients receive corticotherapy because of confusion with rheumatism. This premature treatment delays the diagnosis and at the same time favors the spreading of the germ. The 10 patients observed in this study had an average of 3 focuses simultaneously, the sites most often involved being the synovialis of the flexors of the fingers, the discovertebral articulations, the knee and the tibiotarsalis. The diagnosis is based on the presence of fistula (4 times out of 10), x-ray of the lungs (4 miliaries and 1 infiltrate), films of the spine (characteristic images of Pott, 6 times), the bacteriological study (recovery of Koch bacillus 3 times upon direct examination and 6 times after culture) and finally the biopsy of the synovialis (specific synovitis 3 times out of 4 biopsies). Antituberculosis treatment often involved tolerance problems. It helped to cure 7 patients with few sequelae on the whole. The 3 other patients died either because of old age or complications due to corticosteroids.

Manifestations articulaires au cours de deux cas de lèpre

Deux observations d'arthrosynovite survenant au cours d'une > sont rapportées: l'une concerne un cas de lèpre nerveuse où une monoarthrite d'un genou succède à une intradermo-réaction de lépromine; l'autre un cas de lèpre lépromateuse où, quelques mois après l'administration de disulone, survient une atteinte polyarticulaire au cours d'un érythème noueux. Divers cas relevés dans la littérature sont analysés. Les désorders immunitaires observés au cours de la réaction lépreuse fournissent l'explication la plus satisfaisante. La rifampicine, utilisée avec succès dans l'un des cas rapportés, completè lers moyens thérapeutiques de la réaction lépresuse où corticoides, thalidomide, lamprène, sont doués d'une réelle efficacité.