Seventeen patients with steroid-refractory rheumatoid arthritis were treated with a monoclonal antibody: anti-T CD4/B-F5 (IgG1) for 10 days. The daily dose was 20 mg. No severe side effects were observed and clinical improvement was seen in 15 patients, accompanied by a steep decline in C reactive protein levels. This improvement persisted as long as 12 months in 3 patients. A decline in lymphocyte counts was observed 2 hours after infusion. CD3+, CD4+, CD8+ and B cells were affected. Monocyte levels also decreased, whereas NK cell levels remained unchanged. After 24 hours a subsequent recovery of lymphocyte cell numbers made it possible to return to pre-treatment levels. Residual CD4+ cells coated with CD4 antibody were sporadically found even if residual antibody could be detected in the serum. These results indicate insufficient mAb concentrations. No patients developed detectable anti-mouse Ig antibodies during the treatment period, but 5 patients developed antibodies 15 to 30 days after the end of the treatment. Proliferative responses (mainly the response to ConA) were reduced at the end of the treatment. One month later the proliferative response returned to pre-treatment levels. mAb treatment did not induce long lasting cell activation, as indicated by the low levels of CD25+ or DR+ cells. Soluble IL2 receptor levels were significantly higher before treatment, but did not change after treatment. Soluble CD8 and soluble CD4 molecules were also more numerous before treatment and this increase was correlated with clinical parameters. Of interest was the correlation between the variations in soluble CD8 and the Ritchie index during treatment. The increased levels of serum TNF alpha and IL6 were not modified by treatment. A randomized study now appears necessary to prove the efficacy of the treatment. Such a study would also provide biological data and thus help to define factors predictive of a response in this heterogeneous disease.

Adult↗

PubMedDate not supplied

Transient efficacy of pulse pamidronate treatment in active spondylarthropathies: an open study of 35 cases.

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Adult↗

PubMedDate not supplied

[IgA nephropathy and ankylosing spondylitis].

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Adolescent↗

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[Metastatic chordoma. General review apropos of 2 cases].

The authors report on two cases of sacrococcygeal chordoma, with complications involving visceral organ metastases and distal bony metastases. Chordomas are malignant tumors which develop in adult subjects which originate from remnants of the embryonic notochord. Sacrococcygeal localization is found in 50% of the 1,300 cases reported in the medical literature, which represents 20% of sacrococcygeal tumors observed. The difficulty and the delay in diagnosing these tumors should decrease by routine CAT scan examination. Diagnostic certainty is based on histological examination, often suggestive of the diagnosis (physaliphore-like cells), possibly combined with ultrastructure and immunohistological study. The clinical course involves local recurrences, but there is a real risk of metastatic development, notably in the case of sacrococcygeal chordomas, with their incidence estimated at 17.5% of cases. Sometimes developing in later stages of their course, histological findings are similar to those of the initial lesion. Organs which are frequently the sites of metastases are the lung (48% of cases) and bone (26%), then the lymphatic organs, the liver, and subcutaneous tissue... Therapeutic management is unsatisfactory, with ideally, complete surgical excision of the initial tumor of its size permits and hence early diagnosis of this condition is a prerequisite for good results.

Aged↗

PubMedDate not supplied

[Intravertebral gaseous lucency. Apropos of 7 new cases].

The authors report a personal series of 7 new cases with an appearance of intra-vertebral gaseous lucency, which was described by Maldague et al. [16] in 1978. They found the majority of the features of the disease as described in the 44 cases reported in the literature: advanced age, female predominance, predilection for the thoraco-lumbar junction, constancy of diffuse bony demineralization and the possibility of metabolic disturbances. Case no 2 suggests the hypothesis of a pathology induced by bismuth salts and cases no 3 and 4 raise the question of the benign nature of this appearance. Finally, the authors show that this image is not so much rare as mis-diagnosed. 4 of the 7 cases were found during a retrospective study of 140 case-files.

Adult↗

PubMedDate not supplied

Crohn's disease associated with seropositive rheumatoid arthritis.

We report two cases of rheumatoid arthritis (RA) associated with Crohn's disease (CD). The first case was a 60-year-old man with longstanding CD who next developed a seropositive, nodular RA. This patient also had bilateral sacroiliitis, but without positive HLA B27. The second was a 65-year-old female with a 15-year history of seropositive RA who presented secondarily a CD. No sacroiliitis or nodules were found in this patient. Both patients were DR1 (DRB1* 0101). Gold salts were only given in the second case and were stopped many years before the gastrointestinal symptoms. A similar case report has been previously described consisting in an ulcerative colitis complicating a seronegative HLA-B27 RA with sacroiliitis. The gastrointestinal involvement in RA may be broad and includes many causes: drug-induced colitis (including gold enterocolitis) vasculitis and amyloidosis located in the gut, associated bowel disease such as collagenous colitis, and also infectious agents. In addition, erosive polyarthritis associated with gastrointestinal manifestations can present a problem in the differential diagnosis between RA and an enteropathic arthritis. Finally, the coexistence by chance of inflammatory bowel disease and RA is suggested by the low occurrence of these two conditions in the same patient.

Aged↗

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Do minocycline and other tetracyclines have a place in rheumatology?

Tetracyclines are a family of antimicrobials with activity against a broad range of organisms including those that develop intracellularly. Links have been reported between some infections and some inflammatory joint diseases, with the most notable example involving mycoplasmas and rheumatoid arthritis. Reactive arthritides are known to be triggered by organisms found in the gastrointestinal or genitourinary tract, and antigenic material from these organisms has recently been demonstrated in synovial tissue from patients with reactive arthritis. These facts led to the hypothesis that tetracyclines may be useful in rheumatoid arthritis and reactive arthritis. Two controlled studies found that minocycline benefited rheumatoid arthritis patients when it was given either as an adjunct to another second-line treatment or as the only slow-acting drug. Lymecycline has been found to expedite recovery from reactive arthritis due to Chlamydia trachomatis, and tetracycline to decrease the incidence of reactive arthritis due to sexually-transmitted diseases. The safety profiles of these treatments were acceptable in all available studies but require further investigation during long-term administration. The benefits may be related to the immunomodulating effects of tetracyclines and/or to their ability to inhibit metalloproteases such as collagenases. Whether tetracycline therapy influences the course of radiologic lesions in rheumatoid arthritis remains unknown. However, minocycline therapy has given sufficient proof of its efficacy to make it an attractive alternative in rheumatoid arthritis.

Anti-Bacterial Agents↗

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Prospective study of the prevalence of bronchiectasis in rheumatoid arthritis using high-resolution computed tomography.

A prospective study of the prevalence of bronchiectasis in rheumatoid arthritis was conducted over an 18-month period in 46 patients (34 women and 12 men with a mean age of 60.1 years) meeting 1987 American College of Rheumatology criteria for rheumatoid arthritis. All patients underwent high-resolution computed tomography of the chest, whose results were confronted with a number of clinical, laboratory test and lung function testing parameters. Bronchiectasis or bronchiolectasis was found in 23 patients (50%) and was the most common abnormality detected by high-resolution computed tomography. When the four patients with isolated bronchiolectasis were excluded, the prevalence was 41%. Eighteen of the 23 patients had not been diagnosed with bronchiectasis before the study and 13 were free of respiratory symptoms. No significant differences were found between the 23 patients with and the 23 patients without bronchiectasis for age at onset or duration of the rheumatoid arthritis, extraarticular involvement, positive rheumatoid factors, bony erosions, use of corticosteroids or immunosuppressives, respiratory manifestations, smoking, or spirometry parameters. Patients without bronchiectasis were more likely to have impaired diffusion of carbon monoxide across the alveolar-capillary membrane. Among the patients with bronchiectasis, those with respiratory symptoms (n = 10) were more likely to have a history of lung disease and those without respiratory symptoms (n = 13) were more likely to have a diagnosis of bronchiectasis secondary to rheumatoid arthritis; no other differences were found between these two subgroups. Routine use of high-resolution computed tomography, a technique capable of demonstrating silent bronchiectasis, showed that bronchiectasis was the most common lung change in rheumatoid arthritis in our study. At the time of the study, there was no evidence that presence of bronchiectasis was associated with more severe joint or lung symptoms.

Adult↗

PubMedDate not supplied

Primary biliary cirrhosis and systemic lupus erythematosus. A new case report.

Systemic lupus erythematosus and primary biliary cirrhosis are two autoimmune disorders that rarely occur in the same patient. Ten well-documented cases have been reported to date. We add the case of a woman who was diagnosed with systemic lupus erythematosus at 54 years of age then with primary biliary cirrhosis 18 years later. Interestingly, primary biliary cirrhosis antedated the systemic lupus erythematosus in all the other reported cases. The possibility that a patient may develop more than one autoimmune disorder should be borne in mind.

Autoimmunity↗