[Severe psoriatic rheumatism. Treatment with azathioprine. Report of 11 cases].
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Biomedical subjects
Publications and source records attributed to B Amor.
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The inflammation seen in spondyloarthropathy has very distinctive features; it is preferentially located at the sites of attachment of muscle or ligament to bone, where ectopic ossification occurs; it particularly affects men, and usually starts after growth has ended; phagocytes clearly predominate over lymphocytes at sites of inflammation; microorganisms come into play when there is a favorable genetic predisposition; and, lastly, the inflammation of spondyloarthropathy is highly sensitive to non-steroidal anti-inflammatory agents. A better comprehension of the mechanisms of inflammation would help in understanding the pathogenesis of spondyloarthropathy.
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The early diagnosis of osteo-arthritis of the hip and knee rests on the following findings: mechanical pain in the joint and/or intra-articular effusion of the mechanical type (i.e. less than 1000 cells/mm3, with less than fifty per cent polymorphonuclears); or narrowing (no matter how small) of the articular space; or normal radiography with stage two osteo-arthritic lesions in an otherwise normal arthroscopy; or normal X-ray films and normal bone scintigraphy in a subject over 50 years of age.
Treatment of rheumatoid arthritis (RA) with cyclosporin A (CsA) has been successful, but the adverse effects of the drug have limited its use. We investigated the capacity of another immunosuppressive agent, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], to augment the effects of CsA on in vitro T cell functions. Exposure of CD4+ cells from RA patients or from normal subjects to either molecule alone resulted in a dose-dependent inhibition of phytohemagglutinin stimulation and interleukin-2 (IL-2) production that was more pronounced in cells from RA patients than in cells from normal subjects. Moreover, the action of CsA and 1,25(OH)2D3 on RA patient T cell functions in vitro was synergistic. Thus, in the presence of the vitamin D3 metabolite, only one-hundredth the concentration of CsA was required to produce the same effect on IL-2 production as that produced by CsA alone. IL-2 receptor expression was also reduced by the addition of both drugs. In contrast, IL-1 production by RA monocytes was not affected by CsA and 1,25(OH)2D3, either together or alone, and addition of IL-1 did not restore the ability of CD4+ cells from RA patients to secrete IL-2. Exogenous IL-2 reversed a large part of the inhibitory effect induced by both CsA and 1,25(OH)2D3, indicating that the immunosuppressive properties of these agents are mediated by the inhibition of IL-2 secretion. This synergy between 2 molecules that are biochemically very different suggests the existence of one or several sites of interaction that take place during the early stages of T cell activation.
The expression of c-myc, c-myb, and c-ras proto-oncogenes, determined using RNA hybridization techniques (slot-blot), was significantly increased in peripheral blood T lymphocytes, but not in B cells, from 17 patients with systemic sclerosis with diffuse scleroderma, compared with the expression in normal control subjects. The magnitude of expression of c-myc and c-myb tended to be higher in patients with early, active disease. These results demonstrate an in vivo activation of T cells from systemic sclerosis patients, which may play an important role in the pathogenesis of the disease.
The authors undertook a morphometric study of the intervertebral foramina in anatomic specimens of spines unaffected by degenerative lesions. They studied the variations in shape and size of 38 intervertebral foramina during flexion-extension movements and following an isolated disc collapse. The cast technique takes into account the bony prominences, the bulge of the disc anteriorly and of the capsulo-ligamentous structures posteriorly. In flexion, all the diameters of the foramina are maximal. In full extension all the diameters decrease significantly: the pedicles come closer together, the disc bulges posteriorly and the ligamentum flavum is pushed forward by the superior articular process of the underlying vertebra. A disc collapse of 4 mm decreases all the diameters, and in this case lumbar extension results in a sufficient decrease of foraminal diameter to threaten the nerve root.
Evanescent arthralgias and myalgias are common early symptoms of Lyme disease. Transient, intermittent episodes of monoarticular, oligoarticular, or sometimes migratory polyarticular arthritis, lasting weeks to months, with disease-free intervals, are frequently observed in untreated patients with erythema chronicum migrans. A minority of patients develop chronic joint involvement, most commonly affecting the knee. Antibiotic therapy given during erythema chronicum migrans is often protective with regard to late joint manifestations. In chronic Lyme arthritis, however, the response to antibiotics is variable.
The diagnosis of Sjögren's syndrome is sometimes difficult. We have previously demonstrated the diagnostic value of salivary immunoglobulins IgG and IgM in Sjögren's syndrome. In the present study, we assessed both lacrimal immunoglobulins (1 Ig) and salivary Ig (s Ig) in Sjögren's syndrome. We studied 112 patients: 71 had rheumatoid arthritis (57 sero positive), 19 had connective tissue diseases or vasculitis (six Sjögren's syndrome alone, six systemic sclerosis, three mixed connective tissue diseases, three polyarteritis, one relapsing polychondritis), and 22 patients had other inflammatory, metabolic or degenerative joint diseases. Lacrimal Ig and salivary Ig were assessed by double immunodiffusion with antisera specific for IgG, IgM and IgA. Each Ig class was scored on a scale ranging from 0 to 3 plus without knowledge of the patient's diagnosis. The results of factorial analysis demonstrated a strong relationship between xerophtalmia, positive Schirmer's test, s IgG, s IgM, 1 IgG, and 1 IgM in patients with seropositive rheumatoid arthritis or other connective tissue diseases. Analysis of individual parameters showed a significant relationship between 1 IgG and ocular complaints (P less than 0.01), positive Schirmer's test (P less than 0.05), positive rose bengal dye test (P less than 0.05), 1 IgM (P less than 0.01), s IgG (P less than 0.01) and s IgM (P less than 0.05). A significant relationship was also found between s IgG and ocular complaints (P less than 0.02), positive rose bengal dye test (P less than 0.01), positive minor salivary gland biopsy (P less than 0.05), s IgM (P less than 0.01), and 1 IgM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: Recombinant interferon-gamma (IFN-gamma) is a potent and selective inhibitor of collagen production by dermal fibroblasts in vitro and has numerous immunoregulatory activities. We assessed the effects of recombinant IFN-gamma in the treatment of patients with systemic sclerosis. PATIENTS AND METHODS: Ten patients entered the study and nine completed the six-month study period. Recombinant IFN-gamma was administered once daily for seven days per week by intramuscular injections: 10 micrograms/day for 10 days, 25 micrograms/day for 10 days, 50 micrograms/day for 10 days, and 100 micrograms/day for the next five months. RESULTS: After the six-month treatment period, a significant improvement, as compared with base-line values, was observed in total skin score, maximal oral opening, range of motion of wrists and elbows, grip strength, functional index, dysphagia, and creatinine clearance. No serious side effects were observed; however, a significant decrease in white blood cell counts and in peripheral blood lymphocytes was noted. CONCLUSION: These results suggest that recombinant IFN-gamma may be beneficial in the treatment of patients with systemic sclerosis.
Giant cell arteritis with coronary involvement is an uncommon event, often discovered at autopsy after a myocardial infarction. We report the case of a 70-year-old female with unstable angina pectoris persisting despite angioplasty and antianginal treatment, associated with chronically increased erythrocyte sedimentation rate. Temporal artery biopsy was negative but ophthalmic assessment showed sequelae of ischaemic optical neuritis. Response to prednisone therapy was striking, with complete disappearance of angina pectoris, normalization of erythrocyte sedimentation rate and decreased thallium uptake at scintigraphy. This is the first case of giant cell arteritis of the coronary arteries seen after attempted therapy with percutaneous transluminal coronary angioplasty. Such findings justify considering giant cell arteritis each time a case of coronary manifestations with increased erythrocyte sedimentation rate resists medical treatment, or recurs after coronary angioplasty.
The efficacy of cyclosporin in a double blind, placebo controlled trial of four months' duration has previously been reported by us. To assess the benefit-to-risk of cyclosporin this study was followed by a one year open trial including 49 of the previous 52 patients. Cyclosporin was given at an initial dosage of 5 mg/kg/day and then modulated on the basis of efficacy and renal toxicity. During the study the drug had to be discontinued in 32 patients: because of inefficacy in 10, side effects in 11, both in nine, and in two because of unrelated events. The significant clinical improvement noted at four months persisted through one year in the 17 patients who continued to receive treatment. Nephrotoxicity of the drug (24 patients) required constant and close monitoring as well as modulation of daily drug dosage during the trial. This study indicated that cyclosporin might be valuable in the treatment of patients with advanced rheumatoid arthritis, in whom other second line agents have failed.
The authors report 8 cases of sciatica secondary to a posterior articular cyst. They emphasize the clinical manifestations permitting to suspect this etiology of root compression, which, until now, was rather unusual. Computerized axial tomography makes the diagnosis possible along with posterior arthrography. This arthrography represents the first stage of the medical treatment by posterior joint infiltration of a steroid derivative. In 60 p. cent of the cases, a definite and persisting improvement permits to avoid a surgical procedure.
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