Biomedical subjects
Publications and source records attributed to J C Gerster.
We present two cases of destructive and hypertrophic arthropathy of the atlanto-axial joint in patients with calcium pyrophosphate dihydrate deposition disease. The clinical symptoms were mild and intermittent in spite of severe radiographic changes.
Two patients are described who presented with a chronic effusion with calcium containing particles, considered as apatite, in one finger joint. After a followup of several years, these joints presented erosive changes on radiographs, which raises the question of the pathogenic role of apatite crystals.
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A monoarthritis may correspond to a localized inflammatory process or to the onset of rheumatoid disease that may later on spread over few or several of the other joints. In this article the different diagnostic and therapeutic steps to approach monoarthritis are presented. One of the first investigations consists in an analysis of the synovial fluid. It should take place before any therapeutic step is initiated and may allow to diagnose a microcrystalline or a septic arthritis. By means of a literature review monoarthritis is described as a disease, whose cause remains often undisclosed inspite of intensive investigations, whose further course, however, is often favorable.
The authors report four cases of stress fracture of the distal tibia simulating acute arthritis of the ankle. Two patients had a noninflammatory tibiotarsal joint effusion whose cause is discussed.
An insufficient compliance is regularly observed in 30% of outpatients. In chronic rheumatic diseases such as rheumatoid arthritis a poor compliance is often associated with alleviation of symptoms whereas symptomatic patients tend to take their medication more regularly. Drug abuse, mainly corticosteroids, can often not be avoided. The latter may 'particularly in women' lead to osteoporosis with subsequent fractures. In patients with fibrositis compliance is often a poor because of digestive problems associated with NSAIDs and the bad response to drugs and adjuvant therapies.
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Whipple's disease is a worrying disease because of its protean manifestations. It may sometimes take on the appearance of sarcoidosis with polyvisceral granulomatous dissemination. We describe 2 cases of sarcoid-like Whipple's disease including one with synovial granulomatous involvement. It therefore appears to be essential, in view of the therapeutic possibilities, to perform periodic acid Schiff stain on all granulomas and duodenal fibroscopy with biopsies, even in the absence of any gastrointestinal symptoms, before concluding that the diagnosis is sarcoidosis.
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Metabolic disorders including diabetes mellitus, glucose intolerance, dyslipidemias, hyperuricemia, and hypervitaminosis A have often been mentioned in association with diffuse idiopathic skeletal hyperostosis (DISH). Production of bone under the influence of insulin or retinol has been suggested as a possible mechanism for this disease. We prospectively studied metabolic disorders in 25 patients with DISH and 25 controls matched for age, sex, and body mass index. Correlations between simultaneously evaluated parameters were looked for. Obesity was prevalent in both groups. Serum levels of glucose, insulin, glycated hemoglobin, total cholesterol, HDL cholesterol, triglycerides, uric acid, retinol, and retinol binding protein were similar in the two groups. A positive correlation was found between body mass index and serum insulin. We found no correlation between serum levels of insulin and retinol. None of the metabolic parameters studied showed alterations likely to explain the development of hyperostosis. Other growth factors such as retinoic acid or insulin-like growth factor 1, perhaps produced on a paracrine basis, may be the cause of increased bone at enthesis production.
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Rapidly destructive spondyloarthropathy occurring in the lumbar spine of 2 chronically hemodialysed patients is reported. These lesions resembled infectious spondylitis. Histological examination revealed deposits of amyloid in the L3-L4 intervertebral space in one patient, which could be a causative factor in the joint destruction. The other favouring circumstances and pathogenesis of this condition are discussed.
Three cases of undiagnosed primary hypothyroidism with high thyroid stimulating hormone values presented destructive arthropathy of the proximal interphalangeal joints. None had chondrocalcinosis, neuropathy, myopathy or sicca complex. Quick improvement followed hormonal therapy, which suggests that hormonal imbalance could be responsible for this particular rheumatic condition.
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An 83-year-old lady was admitted for bilateral pain and weakness of the shoulder and hip girdles. These symptoms suggested a Polymyalgia rheumatica (PMR) but there was no response to corticosteroids. A pulmonary adenocarcinoma without any metastasis was then diagnosed. The excision of this tumor was followed by prompt and complete recovery. The erythrocyte sedimentation rate became normal within a few days, also. Such an issue seems to prove that PMR may occasionally be associated with neoplasia. This association appears anecdotal in the literature and remains without clear explanation.