Magnetic resonance imaging and axial involvement in spondylarthropathies. Delineation of the spinal entheses.

We used magnetic resonance imaging in a prospective cross-sectional study to evaluate the components of axial involvement in spondylarthropathies, to determine whether the entire intervertebral disk is an enthesis and to gauge how useful this imaging technique is in detecting enthesitis of the spine. Thirty-one patients with spondylarthropathies and 14 controls with mechanical spinal disease were included. Images of the thoracic and lumbar spine were obtained using plain radiography, radionuclide bone scanning, and magnetic resonance imaging (sagittal sections, T1-weighted sequences before and after gadolinium injection and fat saturation and T2-weighted sequences). Magnetic resonance imaging signal abnormalities reflected inflammation and hypervascularization of the subchondral bone underlying the affected entheses (low signal enhancing after gadolinium and fat saturation on T1 images, high signal on T2 images). These abnormalities were often visible early in the disease process, at a time when there were not yet any clinical manifestations or radiographic or bone scan changes. In addition to showing involvement of the classic spinal entheses, magnetic resonance imaging also demonstrated evidence of inflammation and hypervascularization of the central part of the vertebral endplates and intervertebral disks, confirming that the center of the disk is an enthesis and that inflammatory enthesitis is the mechanism underlying at least some cases of discitis seen in patients with spondylarthropathies.

Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis.

A prospective study of anterior chest wall involvement was conducted in 50 ankylosing spondylitis patients and 50 psoriatic arthritis patients in the absence of palmoplantar pustulosis. All patients underwent a physical examination, tomograms, and a radionuclide bone scan. Magnetic resonance imaging with gadolinium was done in some cases. Half the patients in both groups had anterior chest wall involvement. Enthesitis was the mechanism of the lesions. The manubriosternal symphysis and sternocostoclavicular joints were the most common sites of involvement, although other entheses in the region were affected in some patients.

Tumor-like bone dystrophy and peripheral joint fusion in a patient with Paget's disease of bone.

The authors report an 80-year-old woman who was evaluated for pain in her left leg and ankle. Sixteen years earlier, she had received a diagnosis of monostotic Paget's disease at the same site, based on roentgenographic changes. The lesion was very unusual, with tumor-like lysis of the affected area and fusion of the tibia, fibula, and talus.

CT and MRI of massive osteolysis of Gorham.

Massive osteolysis of Gorham is a clinical, radiographic, and histologic entity characterized by histologically benign vascular proliferation involving bone associated with extensive osteolysis. We present CT and MRI findings of the disease and serial radiography following the progressing bone destruction.

Sulfasalazine induced lupus in rheumatoid arthritis.

We describe 2 cases of a lupus syndrome induced by sulfasalazine in rheumatoid arthritis. All symptoms resolved and antihistone antibodies disappeared when sulfasalazine was discontinued. In one patient, perinuclear antineutrophil cytoplasmic antibodies with specificity for myeloperoxidase were found critically increased just before the occurrence of vasculitis.

[Treatment of Horton disease. Value of synthetic antimalarials. Apropos of a retrospective study of 36 patients]. / Traitement de la maladie de Horton. Intérêt des antipaludéens de synthèse. A propos d'une série rétrospective de 36 patients.

Thirty-six patients with giant cells arteritis were studied retrospectively. Histological examination of the temporal artery or another artery was positive in 95% of cases. Mean follow-up was five years. A synthetic antimalarial was used in every case. Two groups were differentiated. One (Group I) was composed of 21 patients who were given the antimalarial drug as part of the first-line therapy, either with a corticosteroid in a mean dose of 36 mg/d (18 patients) or with a nonsteroidal antiinflammatory agent. The other group (Group II) included 15 patients in whom the antimalarial was used after a period of corticosteroid therapy, because of steroid-dependency (n = 5) or adverse effects (n = 9), or as part of a routinely used protocol (n = 1). Withdrawal of the corticosteroid was achieved in 81% of cases, after a mean interval of 15 months. Many patients discontinued the corticosteroid after less than one year. The 18 Group I patients who were given a corticosteroid were all able to discontinue this drug. The overall recovery rate was 58%; mean time to recovery was 33 months with a mean follow-up of 52 months. There were no recurrences at discontinuation of the treatment. Adverse effects of antimalarial therapy were recorded in 30.5% of patients and required discontinuation of the drug in 19%. The most often used regimen was hydroxychloroquine (40 mg/d) for at least two years and prednisone 20 to 30 mg/d for two months, in the absence of vascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)