Silica-associated connective tissue disease. A study of 24 cases.

We prospectively studied all patients hospitalized for connective tissue disease (CTD) in our French rheumatology clinic from January 1979 to December 1989. Our aims were 1) to determine if CTDs associated with occupational exposure to silica (Si) are currently observed in a rheumatology clinic, and, if so, 2) to describe the major features of Si-associated CTD, and 3) to specify which individuals are affected by Si-associated CTD. Patients were divided into 2 groups based on their responses to a questionnaire: those who had been exposed to Si, and those who had no occupational exposure to Si. Among the 764 patients with CTD studied, 24 (3%) were patients with Si-associated CTD and 740 (97%) were patients with non-Si-associated CTD. The sex ratio between the 2 groups was significantly different with a high frequency of men and of immigrants in the Si-associated CTD group. Two thirds of the patients exposed to Si were male miners or sandblasters, but the other third had more unusual exposures to Si, which may involve members of all socio-economics sectors and both sexes, such as sculpture or exposure to abrasive powders. Progressive systemic sclerosis (PSS) was significantly more prevalent in the Si-associated CTD group. This group also consisted of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis (DM), and other autoimmune diseases. Si-associated CTD was characterized by the frequency of radiologic lung fibrosis, impaired pulmonary function tests, secondary Sjögren syndrome, and antinuclear antibodies. The number of mineral particles and crystalline Si content were raised in all the bronchoalveolar lavage specimens of Si-exposed patients but in none of those of nonexposed patients. In some cases of Si-associated CTD, the disease was reversible after early cessation of Si exposure. Epidemiologic studies are required to confirm our hypothesis that not only PSS and RA but also SLE and DM are associated with occupational exposure to Si. Pending such results, exposure to Si should be sought in the history of any patient with CTD, especially in a male patient with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposed to Si in all environments have adequate protection.

[Association of lumbar canal stenosis and ankylosing vertebral hyperostosis. Results of a multicenter study]. / Association sténose du canal lombaire-hyperostose vertébrale ankylosante. Résultats d'une enquête multicentrique.

The authors report data collected in a study of the association of narrow lumbar canal and vertebral hyperostosis. Five centres (Montpellier, Toulouse, Lille, Lyons and Paris) participated in this cooperative study which was both retrospective and prospective. Grid case forms were sent to homogenise the date provided. Two hundred and sixty nine cases of symptomatic lumbar canal stenosis were collected; 89 (33 per cent) had hyperostosis. Hyperostosis was definite in 74 cases and probable in 15 other cases. Certain radiological and/or CT scan morphological factors seen frequently in the hyperostosis patients group led us to undertake a second study in 2 of the 5 centres (Montpellier and Toulouse) in order to identify their specificity. Twenty eight items were adopted and studied by 3 different evaluators (2 rheumatologists and one radiologist) in the X-ray films and CT scan documents of 100 patients with acquired lumbar canal stenosis with or without hyperostosis (46 and 54 cases respectively). The most discriminative appearances, which we suggest as diagnostic criteria of narrow lumbar canal with hyperostosis concern anterior and/or posterolateral marginal somatic bone proliferations on the non-articular surfaces of the posterior apophyses and ossifications of the posterior joint capsule and of the ligaments (ligamentum flavum--posterior longitudinal ligament--supraspinous ligament). Four of these 6 criteria are necessary to make the diagnosis of lumbar stenosis with hyperostosis. The radiological and CT scan appearances of lumbar hyperostosis appear to differ from ordinary degenerative changes of osteoarthrosis and hyperostosis may be held responsible for compression of the dural cul-de-sac.

[Elevation of atrial natriuretic factor in alveolo-interstitial lesions of connective tissue diseases]. / Elévation du facteur atrial natriurétique au cours des atteintes alvéolo-interstitielles des connectivites.

Plasma levels of the atrial natriuretic factor were prospectively measured in 15 patients suffering from connective tissue disease with alveolar-interstitial lung lesions. The mean level was significantly higher in these patients than in 12 patients without known lung lesions (74.8 +/- 20.7 pg/ml versus 30.8 +/- 12 pg/ml; P less than 0.01) and in 18 healthy subjects (25.4 +/- 12.6 pg/ml). There was no correlation between these levels and lung function tests. Three patients with isolated lymphocytosis in the alveolar lavage fluid had a high level of atrial natriuretic factor.

Multiple site avascular necrosis in HIV infected patients.

We describe avascular necrosis at multiple sites in 2 young adults. This is a condition rarely seen except in hypercortisonism or hemoglobinopathies. In one case, it occurred in the first trimester of pregnancy. No obvious cause of osteonecrosis could be found but both patients were infected by the HIV. The role of the latter in the bone necrosis is questionable.

[Paget's disease and metastatic epithelioma on the same bone. 11 new cases and review of the literature]. / Maladie de Paget et métastase d'épithéliomas sur le même os. Onze nouvelles observations et revue de la littérature.

The authors collected observations concerning 11 newly histologically proved cases of a combination of Paget's disease and carcinoma metastatic to bone on the same bone from members of the French Rheumatology Society. The most frequent locations can be specified from their analysis and an analysis of 26 detailed cases from the literature, i.e. pelvis, femur, rachis, tibia, humerus, and the cancers most frequently involved--prostate, bronchi, kidney, breast and intestine. The most usual histological appearance is osteolytic, except in the case of prostatic carcinoma. The metastasis reveals the presence of cancer in 2 cases out of 3, whereas Paget's disease is most often already diagnosed. A histological examination is necessary because of the risk of non recognition of such metastases or of confusion with sarcomatous degeneration. It does not appear to be exceptional to find Paget's disease in combination with a metastasis on the same bone. Although six of the cases concern metastases only located at sites of Paget's disease, an analysis of all the cases does not seem to indicate that Paget bone is more exposed to metastases than normal bone, since both diseases in fact locate preferentially at the same sites on the skeleton.

[Prognosis of canal treatment. Success and failure]. / Pronostic du traitement canalaire. Reussites et échecs.

This clinical review confirms the very positive prognosis for endodontic therapy, conditional to strict compliance with imperatives. Endodontics failures are transient and can be remedied. The authors define the attitude to be adopted and the measures to be taken in accordance with the type of difficulty encountered.

[Primary hyperparathyroidism: value of "intact parathormone" assay (PTH 1-84)]. / Hyperparathyroïdie primaire: apports du dosage de la parathormone "intacte" (PTH 1-84).

In a prospective study of 20 patients with primary hyperparathyroidism the diagnostic value of the intact parathormone assay was compared with that of intermediate fragment measurement and that of nephrogenic cyclic AMP determination. In the basal state, measuring the intact parathormone is the best way of separating hyperparathyroid patients form normal subjects. During calcium infusion tests, there is good concordance between changes in intact parathormone and in nephrogenic cyclic AMP. In addition, the intact parathormone assay enables a thorough study of the relationship between ionized calcaemia and parathyroid secretion to be performed and confirms the existence, in hyperparathyroid patients, of two types of secretory response to a rise in calcaemia. Being more reliable than the measurement of a C-terminal or intermediate fragment and easier to perform than nephrogenic cyclic AMP determination, the intact parathormone assay seems to be particularly suitable for the study of primary hyperparathyroidism.

Monocyte-derived clastogenic factor in rheumatoid arthritis.

Blood or lymphocyte cultures from patients with rheumatoid arthritis show increased chromosome breakage. This is due to the presence of a clastogenic factor (CF) inducing also chromosome damage in blood cultures of healthy persons. CF may be isolated not only from patients' plasma or synovial fluid, but also from the supernatant of blood or lymphocyte cultures. No CF was detectable, if the lymphocyte cultures were free of other contaminating blood cells. Addition of neutrophils did not considerably influence the production of CF, and platelets were without any effect. However, addition of increasing numbers of monocytes resulted in increasing clastogenic activity. Also monocytes in adherence, in absence of lymphocytes and without any chemical stimulant, produced CF. This indicates that monocytes are responsible for CF production. The protective effect of superoxide dismutase, as well against CF formation as against CF action on cells of normal subjects, suggests a role of the superoxide radical O2-. Inhibitors of arachidonic acid metabolism were only slightly anticlastogenic.

[Therapeutic management of rheumatoid polyarthritis (1988)]. / Conduite thérapeutique dans la polyarthrite rhumatoïde (1988).

The authors briefly remind of the broad outline of their therapeutic approach regarding rheumatoid polyarthritis, specifying their attitude towards the main medications currently available. They mainly stress the mistakes too often mad in the long-term treatment of the disease.