The therapeutic action of cyclosporin A (Sandimmun): its application in rheumatoid arthritis.

The main properties, mechanism of action, mode of administration, side effects and therapeutic indications of Cyclosporin A are reviewed, with special emphasis on its applications in rheumatoid arthritis (RA). The drug administration in small doses, only in patients with severe RA, refractory to the usual antirheumatic therapy, was effective in a significant proportion of cases.

Hypertrophic osteoarthropathy secondary to bronchopulmonary cancer (our experience).

During 5 years (1986-1990), 81 of the patients under our care showed bronchopulmonary cancer diagnosed by clinical, x-ray and bronchoscopic examinations. Of these, 69 (85.2) were men and 12 (14.8%) women, with a mean age of 62 years; 72 patients (90%) were moderate or heavy smokers. Four of them (4.9%) presented the classical hypertrophic osteoarthropathy (HOA) described by Bamberger and Pierre Marie, i.e., finger clubbing, ossifying periostitis of the long bones, joint pains and swelling. Other 3 patients showed only finger clubbing, while 7 of 30 cases studied by systematic x-ray examinations of the long bones presented ossifying periostitis (5 cases) or hyperostosis (2 cases). It results that almost one third (31.6%) of the patients with bronchopulmonary cancer had a complete or incomplete Bamberger-Pierre Marie syndrome. It is concluded that HOA identification before the clinical and x-ray manifestations of bronchopulmonary cancer could contribute to an early diagnosis of this malignant disease.

[An association between ankylosing spondylitis and rheumatoid polyarthritis; comments on 3 cases]. / Asocierea între spondilita anchilozanta si poliartrita reumatoida; consideratii pe marginea a 3 cazuri.

The article is an analysis of 3 clinical cases, characterized by the presence of the lumbosacral axial involvement, with the radiological evidence of a bilateral sacroiliitis and a peripheral polyarthritis displaying a rheumatoid picture, with rheumatoid factors in the serum and in 2 of the cases also in the articular fluid. These cases belong to the HLA-27 B histocompatibility type, a feature which could be, according also to the data of literature, an explanation of the association of these two diseases.

Advances in the physicochemical, immunologic and cytologic investigation of the synovial fluid.

Investigations of the pathologic synovial fluid (SF), carried out by numerous research teams, have attempted to elucidate certain pathogenic mechanisms suggestive for diagnosis and treatment. Recent studies have tried to draw some biorheologic patterns of the SF, useful for diagnosis and for the evaluation of certain therapies (synoviorthesis). A systematization of the microcrystalline arthropathies has been possible by microscopic examinations of the SF. Enzymologic studies have demonstrated the properties of enzymatic inhibitors of some classical antirheumatic drugs, suggesting the introduction of new antienzymatic products, and have supported the indication for synoviorthesis. Studies of the SF oligoelements have established new criteria for differential diagnosis, have suggested new treatments (by zinc compounds) and have offered explanations for the good effects of some drugs, such as D-penicillamine. Knowing the role of the toxic oxygen radicals in the pathogeny of the rheumatoid synovial inflammation, drugs with a protective action against the effects of free radicals have been introduced in the antirheumatic therapy. Analyses of the various SF cellular populations, including complex immunologic, cytoenzymatic, optic and ultrastructural cytologic investigations, are opening new prospects of clinical application. The general review of the above-mentioned problems is based on the personal experience of the authors and on the latest data in the specialty literature.

[Study of cellular immunity in rheumatoid arthritis]. / Etude de l'immunité cellulaire dans la polyarthrite rhumatoïde.

The responsiveness to mitogens of the in vitro cultural peripheral blood lymphocytes from 60 patients with rheumatoid arthritis (RA) and from controls was evaluated in terms of H3 TdR uptake. The size of the response was tested for a correlation with the percentages of T and B lymphocytes, determined by E and EAC rosette test, as well as with the various alterations of the clinical and biological parameters. In the RA cultures an elevated level of spontaneous H3 TdR uptake was found, which could be an in vitro carry-over of an activation in vivo. No significant statistical differences were found between rheumatic and control groups as regards: 1 degrees--the H3 TdR uptake induced both by PHA and SLO; 2 degrees--the proportion of the circulating T and B lymphocytes. The only positive correlation evidenced by this study in RA patients was that between the proportion of B lymphocytes and the gammaglobulin level in the plasma.