Nodular progression of lentigo malignant melanoma during a treatment with tocilizumab: cause or coincidence?

Tocilizumab is an anti-interleukin (IL)-6 receptor monoclonal antibody, used since 2010 for the treatment of severe rheumatoid arthritis (RA). It is known to induce infection, similarly to other biotherapies which modulate immune response and cytokines. Few cases of malignancy, however, have as yet been reported. We describe here the case of a patient with severe RA, previously treated with prednisolone, methotrexate, leflunomide, etanercept, and rituximab, who, after 8 months of treatment with tocilizumab, developed rapidly progressive nodular melanoma on a preexisting pigmented lesion on her left cheek. Recently, another case of nodular melanoma under tocilizumab has been published. The possible causative role of tocilizumab and other immunomodulatory agents in the development of this malignancy is discussed. Based on the present case, dermatologic screening is recommended before initiation of tocilizumab.

Influence of the quality of tibial plateau alignment on the reproducibility of computer joint space measurement from Lyon schuss radiographic views of the knee in patients with knee osteoarthritis.

RATIONALE: The quality of medial tibial plateau (MT-Plateau) alignment is one of the key elements for accuracy and sensitivity to change of knee radiography in knee osteoarthritis (OA). AIM: To evaluate the influence of the quality of the MT-Plateau alignment on the reproducibility of joint space width (JSW) measurement in knee radiographs. METHODS: One hundred and twenty-seven knee radiographs (99 OA), performed using a standardized radiographic procedure (Lyon schuss (LS) view). Evaluation of the quality of MT-Plateau alignment. Computerized measurement of the JSW, twice, 1-month apart, using a semi-automated and an automated method of measurement. Assessment of the reproducibility of repeated measurements: calculation of intra-observer coefficient of correlation, smallest detectable difference (SDD) and coefficient of variation (CV). RESULTS: MT-Plateau alignment was satisfactory in 99 radiographs (77.9%). Reproducibility was excellent in both satisfactory and non-satisfactory radiographs, irrespective of the method of measurement used. The automated measurement was more reproducible than the semi-automated one (CV 1.15% and 3.23%). SDD and CV were better in satisfactory than in non-satisfactory MT-Plateau aligned radiographs. CONCLUSION: These results confirm that computer measurement of the medial tibio-femoral JSW, from LS digitized radiographs, is highly reproducible, irrespective of the quality of the radiograph. However, the quality of the MT-Plateau alignment influences the reproducibility of JSW measurement. The automated measurement was more reproducible than the semi-automated one.

Serum levels of YKL-40 and C reactive protein in patients with hip osteoarthritis and healthy subjects: a cross sectional study.

BACKGROUND: YKL-40 is a 40 kDa glycoprotein secreted by chondrocytes and synoviocytes. It has been suggested that it is a surrogate marker of synovial inflammation and joint destruction in rheumatoid arthritis (RA) and osteoarthritis (OA) and related to C reactive protein (CRP) serum levels in RA. OBJECTIVE: To study serum levels of YKL-40 in patients with hip OA and its relation with CRP. METHODS: YKL-40 and CRP were assayed in serum samples from 45 patients (24 women, 21 men, mean age 65) with symptomatic OA of the hip and 33 healthy controls. YKL-40 was assayed by immunoassay and CRP by ultrasensitive immunonephelometry. OA severity was assessed by the measurement of joint space width with a computer analysis system of digitised hip radiographs. Statistical analysis was performed to determine correlations between serum markers and radiological joint space width. RESULTS: The mean (standard error) YKL-40 level was 90.3 (8.2) ng/ml in patients with hip OA and 66.9 (8.2) ng/ml in controls (p=0.03). The mean CRP level was 2.93 (3.03) mg/l in OA and 1.40 (1.61) mg/l in controls (p=0.006). The serum levels of YKL-40 and CRP increased with age and were significantly correlated (Spearman test: r(s)=0.42, p=0.005) in patients but not in controls. Neither YKL-40 nor CRP correlated with radiographic joint space width. CONCLUSIONS: Serum YKL-40 was significantly increased in patients with hip OA. The correlation between YKL-40 and CRP suggests that YKL-40 may be a marker of joint inflammation in OA. Longitudinal studies are required to assess the usefulness of YKL-40 in the monitoring of patients with hip OA.

[Primary bone lymphoma disclosed by osteolytic lesion of the femoral head]. / Lymphome osseux primitif révélé par une lésion ostéolytique de la tête fémorale.

A case of primary lymphoma of the bone is reported. The unusual site of the tumor in an epiphysis (head of femur) led to unconventional therapy by resection and hip replacement. Emphasis is put on the value of immunolabelling studies for the etiologic diagnosis.

Serum N terminal procollagen III fragment: a predictive marker of joint destruction in rheumatoid arthritis?

The level of the N terminal fragment of procollagen III (P3NP) levels of 100 consecutive patients affected by rheumatoid arthritis (RA) were evaluated in comparison with disease activity markers (erythrocytes sedimentation rate, C reactive protein), immunological status (rheumatoid factors, immune complexes) and joint destruction (assessed according to the Steinbrocker index). P3NP levels showed no significant relationship either to disease activity or to immunological status; however, a strong association was fond between X-ray grade and P3NP values. A two-year retrospective study of 32 patients belonging to the original 100 patient population allowed us to assign a predictive value for joint destruction to the P3NP level in the early stage of the disease.

Evaluation of the efficacy and safety of oral tiludronate in Paget's disease of bone. A double-blind, multiple-dosage, placebo-controlled study.

OBJECTIVE: To assess the optimal dosage of oral tiludronate in Paget's disease of bone. METHODS: We studied 149 patients with Paget's disease, in a double-blind, randomized, placebo-controlled trial. Patients were randomly assigned to 1 of 5 therapeutic groups: a daily dose of 100 mg, 200 mg, 400 mg, or 800 mg of oral tiludronate, or a placebo. Treatment was for 3 months, followed by 3 months of placebo-controlled followup. Serum alkaline phosphatase activity (SAP) and fasting urinary excretion of hydroxyproline/creatinine (OH/Cr) were measured monthly, as were biochemical parameters reflecting renal, hepatic, and hematologic functions. Analgesic efficacy was self-evaluated from a visual analog scale and a global pain index. RESULTS: Statistical analysis revealed that beginning at a dosage of 200 mg/day, there was a direct dose-dependent effect on the reduction of SAP and OH/Cr levels. Reduction of SAP levels was clinically significant at a dosage of 400 mg (44.9 +/- 4.2% reduction at 90 days and 49.2 +/- 4.5% at 180 days, mean +/- SEM) and at 800 mg (53.4 +/- 5% at 90 days and 59.3 +/- 4.6% at 180 days). There was a significant reduction in pain in all groups, including the group taking placebo. In only those taking 800 mg/day of tiludronate was there a significant frequency of complete resolution of pain (versus placebo). Aside from mild gastrointestinal disturbances, as experienced with other oral bisphosphonates, clinical tolerance of all 5 regimens was good. Exhaustive biochemical investigations failed to reveal significant toxicity of tiludronate up to the 800-mg daily dose investigated. CONCLUSION: Because of its significantly better antiresorptive effects and greater analgesic properties (compared with lower dosages), combined with the excellent clinical and biochemical tolerance, the 800-mg daily dose of tiludronate appears to be optimal for the treatment of Paget's disease of bone.

[Vertebral osteosclerosis, sacro-iliitis and palmoplantar dermatitis. Apropos of a case]. / Condensation vertébrale, sacro-iléite et dermatose palmo-plantaire. A propos d'une observation.

The authors report a case of aseptic vertebral osteitis which they classify in the context of SAPHO in view of the association with unilateral sacro-ileitis and palmoplantar dermatitis. They stress the importance of recognizing this disease which is initially suggestive of either a bone disease (Paget's disease, bone metastasis) or infectious discospondylitis.

Serum IL-2 level in rheumatoid arthritis: correlation with joint destruction and disease progression.

Understanding of T cell dysfunctions in rheumatoid arthritis (RA) may help to elucidate the pathophysiology of this disease. Cytokines determinations may be a promising approach and could represent a simple mean of quantifying RA immunological dysfunctions. In this study, interleukin-2 (IL-2) measurements were performed in sera of 74 RA patients to evaluate the potential use of this method to monitor "disease activity" and/or prognosis. Although the serum IL-2 levels of patients in active disease stage proved to be somewhat lower than those from patients with inactive disease, the difference was not significant. In our study, however, the serum IL-2 concentration was correlated with the circulating immune complexes level. In addition, patients with the highest serum IL-2 levels exhibited the poorest radiological stages and these same patients were often not receiving any disease modifying antirheumatic drugs (DMARD). Our results demonstrate that serum IL-2 level may be elevated in certain RA conditions. A better understanding of this phenomenon, especially the consequences of disease duration, could be of interest in the follow up and the prognosis of the disease.

Sternoclavicular pustulotic osteitis (SAPHO). 20-year interval between skin and bone lesions.

In 2 cases of palmoplantar pustulosis, a 20-year interval was observed between the skin lesion and the bone involvement. In one case, the bone lesion came first. In the other a skin lesion was seen for 3 weeks without subsequent relapse. The 2 cases underline the multifaceted presentation of the condition for which we have coined the name synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome.

[Magnetic resonance imaging and lupus erythematosus of the nervous system]. / Imagerie en résonance magnétique et neurolupus.

Magnetic resonance imaging (MRI) was assessed in the management of neuropsychiatric manifestations occurring in 6 SLE patients. The MRI scans were normal in 3 cases and was associated with remission of the symptoms except for a patient who experienced a chorea at the time of the examination. Abnormal MRI scans always revealed more lesions than CT scan. 2 different patterns of abnormalities seem to correspond to 2 specific disorders. In 2 patients with clinical presentation suggesting a cortical ischemia by vascular thrombosis, both MRI scans showed areas of abnormal high signal intensities located in the subcortical white matter. In one last patient, MRI scan revealed multiple focal areas of high signal intensities (on T1 weighter scans) disseminated not only in the deep white matter but also in the gray one. These lesions could be depend upon demyelinisation which may occur by a local vascular process. This serie confirm the interest of MRI in the management of SLE brain involvement as well as it points out some problem of interpretation. This suggest further comparative studies especially at the real onset and during the course of neuro-psychiatric manifestations. At last, the coronal sections may be more informative for the diagnosis and pathophysiology than the horizontal ones.

The rheumatoid heel: its relationship to other disorders in the rheumatoid foot.

Four-hundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p less than 0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneitis and tarsal arthritis (p less than 0.0001), and calcaneitis was more frequent among marked valgus (p less than 0.001). These results are compared with findings of other works. Therapeutic consequences are evoked.

Brachial plexus compression by an iatrogenic arteriovenous fistula.

A case of left brachial plexus compression by an iatrogenic arteriovenous fistula was treated by detachable balloon technique with immediate relief of pain. Good results on paresia were obtained in a few weeks.