[Pregnancy, low-back pain and pelvic girdle pain]. / Grossesse et douleurs rhumatologiques lombaires basses et de la ceinture pelvienne.

Prevalence and factors influencing pelvic joint and low-back pain during pregnancy are hereby reported. They can be associated with considerable disabilities as far as daily activities are concerned. They may be reduced by appropriate measures. Disc herniation rarely occurs during pregnancy and can be treated by oral or epidural steroid administration. Surgical intervention is scarcely indicated. In these cases MRI may be used, but only after the first trimester. Though uncommon, osteoporosis leading to vertebral or hip pain and fracture can occur during pregnancy and breastfeeding. Women concerned may have a pre-existing bone disease revealed by the physiological bone loss that occurs during pregnancy and breastfeeding. Other factors may influence bone mineral density variation such as osteomalacia, steroid or heparin administration. The relationship between transient osteoporosis of the hip and osteoporosis is discussed. Bone investigations and bone mineral density measurement after delivery are required.

Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases.

We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.

[Normal phosphorus and calcium metabolism during pregnancy and breast feeding]. / Métabolisme phosphocalcique normal pendant la grossesse et l'allaitement.

Calcium homeostasis is stressed considerably during pregnancy and lactation. Important regulatory mechanisms are needed both for meeting the fetal requirement for calcium and for protecting the maternal skeleton from excessive resorption. For the past 10 years, more and more publications have deal with the involved mechanisms of regulation. The authors have reviewed these publications and tried to answer important questions: is there some irreversible bone loss related to pregnancy and/or lactation? How can such bone loss could be prevented?

Mesalazine-induced lupus.

We report a case of lupus induced by mesalazine therapy taken for over a year for Crohn's disease. The patient had polyarthritis, alopecia, lymphoneutropenia, antinuclear factors, anti-histone antibodies, anti-Sm and anti-RNP. Discontinuation of mesalazine was followed by rapid resolution of the joint manifestations, alopecia and lymphoneutropenia; the anti-histone antibodies fell to undetectable levels and the titers of the other auto-antibodies decreased gradually.

Acetabular fractures due to bone insufficiency. Two case-reports.

Acetabular fractures due to bone insufficiency are rare and difficult to diagnose based on clinical findings alone. Plain films are often normal for a long period of time. We report two cases of acetabular fractures in women aged 78 and 90 years, respectively. An acetabular fracture should be considered in elderly females with sudden onset of pain in the groin occurring immediately upon weight-bearing, a clinostatic syndrome, and increased radionuclide uptake by the acetabulum. Computed tomography and magnetic resonance imaging are useful when the diagnosis remains in doubt.

Metabolic arthropathies.

In this article, recent advances in the understanding of some of the metabolic arthropathies are reviewed. Among hemoglobinopathies, sickle-cell disease is frequently the source of rheumatic syndromes, as emphasized in recent epidemiologic studies. Avascular necrosis is one of the most common features and may be disabling, leading to total joint replacement of the hip or knee. Joint effusions more rarely are observed and have been associated with subchondral bone infarctions. The clinical and radiologic presentations of the arthropathy of hemochromatosis have been extensively reviewed. Screening for the disease appears important, because it is the only way to prevent progressive worsening of organ involvement and arthropathy in particular. The rheumatic involvement in type IIa and type III hyperlipoproteinemias recently was confirmed in a case-control study. Magnetic resonance imaging appears to be useful in assessing the extent and activity of bone marrow involvement in Gaucher's disease. Replacement therapy is developing. Dialysis-associated amyloidosis remains the target of active research, which recently led to the identification of several newly recognized components, including alpha 2-macroglobulin and hyaluronan. The main component of this amyloid, beta 2-microglobulin, has been shown to be modified by advanced glycosylation products, and these changes appear to confer inflammatory properties on the molecule.

[Bone metastases in epidural invasion of gastrinoma]. / Métastases osseuses avec extension épidurale d'un gastrinome.

Malignant gastrinoma is a nonbeta islet cell tumor which rarely disseminates to the bone. However, in the case reported herein, diffuse metastatic bone disease with symptomatic epidural spread developed. Somatostatin and 99mTc-HDP bone scans demonstrated hot spots in the same sites, establishing that the bone lesions contained somatostatin receptor. Irradiation was effective in relieving pain.