Central spinal stenosis due to pseudogout.
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Biomedical subjects
Publications and source records attributed to J Dehais.
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Methotrexate is the drug with the highest long-term continuation rate in rheumatoid arthritis patients. However, toxicity is the main reason for methotrexate withdrawal. Most adverse effects are mild abnormalities, such as digestive symptoms, stomatitis, elevations in transaminase levels, and moderate decreases in peripheral blood cell counts. Potentially life-threatening effects include hypersensitivity pneumonitis and pancytopenia. Cirrhosis is less common than in patients with psoriasis. Opportunistic infections and Epstein-Barr virus-related lymphomas have been reported. Neurological disorders, cutaneous reactions and renal lesions have been ascribed to low-dose methotrexate. Prior renal dysfunction and concomitant administration of a number of drugs, including cotrimoxazole, have been shown to increase methotrexate toxicity. However, susceptibility to the toxic effects of methotrexate varies widely across individuals. The effectiveness of folate supplementation in preventing methotrexate toxicity remains controversial.
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A deforming arthropathy confined to the hands developed in a woman with polymyositis of three year's duration. Roentgenograms showed distal subluxations of several fingers, especially the thumb, asymmetrical marginal erosions of the phalanges and periarticular calcifications. These roentgenographic findings are considered to be specific of polymyositis associated with anti-Jo-1 antibody.
According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" acting drugs. Conversely, most of these compounds were shown to easily cross the blood-brain barrier, and hence partly produce their effects by a central mechanism. The relative contribution of each site of action may vary from one drug to another. Aspirin-like drugs may act by inhibiting arachidonate cyclooxygenase in both the damaged tissues and the central nervous system. Finally, these drugs appear to be either selective, or dose-dependent, or nonspecific inhibitors of prostaglandin-synthetases.
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Experimental investigations suggest that NSAIDs may exert a dose-dependent effect on cartilage metabolism. The cartilage concentrations achieved in vivo may thus be useful for in vitro studies. Unfortunately, the concentrations of NSAIDs in human joint cartilage have been scarcely determined. Moreover, the methodologies used were heterogeneous. Guidelines to further studies are therefore proposed.
Two cases of acute chondrolysis of the upper femoral epiphysis associated with protrusio acetabuli are reported in two girls respectively 13 and 12 Y.O. The disease was unilateral in one patient and bilateral in other. Acute chondrolysis is characterized by onset of pain, restricted movements of the hip and evolution to an hip ankylosis within a few months. As usual no evidence of inflammatory disease could be shown at biology or at pathology of synovial membrane or of femoral head. CT and MR studies proved to be contributive in the first case. It's the author's opinion that in these 2 cases, chondrolysis appears as a complication of preexistent Protrusio Acetabuli.