[Quantitative bone scintigraphy in the study of the sacroiliac joint in chronic inflammatory rheumatism]. / Apport de la scintigraphie osseuse quantitative à l'étude des sacro-iliaques au cours des rhumatismes inflammatoires chroniques.

Scintillation counting of the sacro-iliac bones using technetium pyrophosphate or diphosphate is a simple examination without danger. The uptake opposite each sacro-iliac bone is assessed by reference to that of the lumbar spine visible on the film. A study of a control group of 81 subjects permits one to determine the existence of variations in relation to age: the fixation is high in subjects under the age of 20 years and reduced in adults aged over 50 years. The 44 controls from 20 to 50 years, permit one to retain as reference value, the ratio 1.14 for the right sarco-iliac bone and 1.11 for the left sarco-iliac bone with a confidence interval of 0.13. There was noted a significantly high uptake during arthritis. Whether this was the axial form (40 cases) or the peripheral from (7 cases) and during Reiter's syndrome (15 cases). This hyperfixation was more frequent and more important when the sacro-iliac involvements (whether accompanied or not by radiological signs) were the cause of inflammatory pain. Increased uptake was also noted during other forms of chronic inflammatory rheumatism: rheumatoid arthritis (10 cases). Chronic inflammatory rheumatism (unclassifiable) 20 cases. It thus seems that one may retain in many cases the existence of sacro-iliac inflammatory changes without the latter being necessarily accompanied by clinical or radiological signs. The discovery of hyperfixation of the sacro-iliacs during chronic inflammatory rheumatism is further evidence in favour of the diagnosis of sacro-iliac arthritis but should be interpretated in the light of the general context.

[Value of disk puncture in the diagnosis of infectious spondylodiskitis. Apropos of 48 punctures]. / Intérêt de la ponction discale dans le diagnostic des spondylodiscites infectieuses. A propos de 48 ponctions.

The authors report on their experience with discal puncture in the bacteriological diagnosis of 48 infectious spondylodiscites. This technique makes it possible to obtain a bacteriological certitude in 31 cases (65 per cent): Pott's disease (40 per cent) and 12 pyogene spondylodiscites (25 per cent), with 17 punctures remaining negative, including 5 technical failures, the needle not penetrating into the pinched disc. No incident was noted, demonstrating the harmless nature of this method. The authors insist upon the necessity of washing the disc in order to decrease the percentage of failures.

[Joint manifestations of Whipple's disease]. / Les manifestations articulaires de la maladie de Whipple

Of all the signs of Whipple's disease, the joint manifestations are among the most constant and the earliest to indicate the enteropathy, appearing long before the digestive and general signs. Essentially they consist of painful, peripheral joint manifestations: either simple arthralgia, or true arthritis differing in the degree of pain, the degree of the clinical signs accompanying the pain, the mode of evolution, and the number and the grouping of the joints affected, thus occurring in numerous clinical forms of which the two principal ones are subacute oligoarthritis with a tendency to migrate and chronic polyarthritis that gives rise to few definitive deformations. The radiographic appearance is usually normal. There is nothing specific about the laboratory aspects of the inflammatory syndrome. Synovial histology may in some cases clarify the diagnosis by demonstration of histiocytes with positive PAS granulations. The axial joint manifestations, which are always associated with the preceding ones, are infrequent and practically limited to unilateral or bilateral sacro-iliac lesions, with little or no clinical expression, that are discovered by standard radiology. Jejunal biopsy can be the key to early diagnosis. The pathogenesis remains obscure. The treatment is the same as for Whipple's disease, long-term antibiotic therapy.

[Further observations on the presence of iron in the articuler synovial membrane]. / Secondes vues sur la présence de fer dans la synoviale articulaire

In 1971, a study of 66 synovial biopsy samples indicated that the presence of ferric deposits in the subintimal synovial tissue was of real semiological value in the diagnosis of rheumatoid synovitis. In 1975, a study of 228 synovial biopsy samples led the authors to reconsider this finding: the presence of ferric deposits in the subintimal synovial tissue was far from being a constant feature in rheumatoid synovitis and it was seen with similar frequency in other forms of chronic inflammatory rheumatism and also in several other joint conditions. The origin of the synovial iron and the influence it may have on the development of the rheumatoid processes remain obscure.

[Sacro-iliac osteochondritis (author's transl)]. / L'ostéochondrite sacro-iliaque

Sacro-iliac osteochondritis is difficult to recognize, it is rather frequently a case of diagnosis by elimination, which can be only confirmed by the course. Its prognosis is excellent. The predominance of lesions on the iliac edge reflects the affinity of this epiphysitis for the accessory iliac ossification point.