Rheumatoid pericarditis. A report of two cases.
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Biomedical subjects
Publications and source records attributed to J Dequeker.
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A 54-year-old male with a 10-year history of seropositive rheumatoid arthritis subsequently developed generalized osteoporosis, multiple cervical spine subluxation, vertebral collapses, and massive osteolysis of the humeral and femoral heads and carpal bones. These lesions were accompanied by neurologic manifestations in both the upper and lower extremities. Bone matrix collagen and noncollagenous proteins in this rare syndrome were analyzed. The pathogenesis of this rare phenomenon is discussed.
OBJECTIVE: The purpose of the present study was to investigate insulin sensitivity in adult rats after perinatal malnutrition. METHODS: Wistar rats were food-restricted (about 50% of normal food intake) during pregnancy (group A) or during pregnancy and lactation (group B) and compared with rats fed ad libitum during pregnancy and lactation (group C). The insulin sensitivity in the adult female offspring was assessed with the hyperinsulinemic euglycemic clamp technique in combination with isotopic measurement of glucose turnover. Hepatic and peripheral insulin sensitivities were determined in the basal state and after 3, 10, or 50 mU/kg/minute insulin. RESULTS: Group A and group B rats had lower non-fasting plasma insulin levels (0.15 +/- 0.07 and 0.15 +/- 0.01 nmol/L, respectively) than group C rats (0.26 +/- 0.03 nmol/L) (P < .001). During hyperinsulinemia, the steady-state glucose infusion rate was lower in groups A and B, with 10 and 50 mU/kg/minute insulin, indicating insulin resistance. Hepatic glucose production in the basal state was normal, but its suppression by 10 and 50 mU/kg/minute insulin was dampened in group A and B rats, indicating decreased insulin responsiveness of the liver. Peripheral glucose utilization, however, in the basal state and during hyperinsulinemia remained normal in groups A and B. CONCLUSION: After perinatal malnutrition, adult rats have decreased plasma insulin concentrations and exhibit insulin resistance, with decreased insulin responsiveness of the liver.
Thoracic kyphosis is clinically associated with osteoporosis as well as with osteoarthritis. Because misinterpretation of thoracic spine deformities on X-rays may lead to overdiagnosis of vertebral fracture, we studied morphological changes of the thoracic spine in a cross-sectional (n = 89) and longitudinal study (n = 38) in 30 women with established osteoporosis (OP), in 31 women with spinal osteoarthritis (OA), and in 28 normal women. Vertebral deformation was assessed on lateral roentgenograms of the thoracic spine from T-4-T-12. The anterior, middle, and posterior heights were measured using six points corresponding to the four corners of the vertebral body excluding osteophytes and the midpoints of the endplates. For the thoracic T-6-T-9 region, the mean anterior/posterior height ratio was 7.7% in the controls, 13% in osteoarthritis, and 21% in osteoporosis. For the mid-height/posterior height ratio the respective values were 13%, 12%, and 22%. The osteoporosis group differed significantly from the control and osteoarthritis group in anterior and in midheight reduction. The yearly mean anterior height reduction in the osteoarthritis group was 0.7% compared with 1.5% in the osteoporosis group. The mean yearly midheight reduction was, respectively, 0.5% versus 2.9%. The differences between the groups were significant. We conclude that vertebral deformity, in particular wedging, of the thoracic spine is not exclusively characteristic for osteoporosis and that certain vertebral deformities develop by mechanisms other than fracture. Osteoporotic fracture of the thoracic spine is characterized by an exaggerated reduction of the midheight to posterior height in addition to reduction of the anterior to posterior height.(ABSTRACT TRUNCATED AT 250 WORDS)
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The relation between bone mass and upper-extremity strength in 106 18-year-old boys was investigated. Bone mass was measured radiogrammetrically at the second metacarpal bone, and upper-extremity strength was measured by three power ability tests: vertical jump height, arm pull strength, and bent arm hang time. A significant correlation between arm pull strength and cortical thickness and cortical area was found. There was also a significant correlation between body weight, bone mass, and power tests. After partial correlation study, leaving out weight, a significant correlation between bone mass indices and arm pull strength remained. The larger bone mass in the above-average-fit boy is due to a larger periosteal diameter and smaller endosteal diameter. This study suggests that static strength is one of the determinants of bone gain before maturity.
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Intra-articular injections with steroids may offer additional help in the treatment of inflammatory joint diseases. The major side effects are the systemic effects of steroids, infectious arthritis and cartilage damage. These are infrequent, however, and to a great extent preventable. Steroids are of little effect in radiological progression and function, and this is the most important limitation on liberal use. On the other hand, they powerfully suppress inflammation and pain, for a varying length of time which depends on the preparation used.
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The effect of three different therapeutic regimens on bone mineral content at the radius and lumbar spine was studied in a group of 60 postmenopausal rheumatoid arthritis patients. Results were compared to those in a group of controls matched for sex, age, disease duration and menopausal state. Serum and urinary parameters of calcium metabolism were also evaluated in the three treatment groups. The three treatment regimens were: 1 alpha hydroxyvitamin D + calcium + placebo; 1 alpha hydroxyvitamin D + calcium + lynestrenol; and 1 alpha hydroxyvitamin D + calcium + sodium fluoride. In all treatment groups there was a positive effect of therapy compared to controls, though this was only significant in the 1 alpha hydroxyvitamin D + calcium + lynestrenol group at the axial skeleton after 1 and 2 years of treatment. Serum calcium rose significantly in the 1 alpha hydroxyvitamin D + calcium + placebo group and serum creatinin was raised in all the treatment groups during therapy. In the 1 alpha hydroxyvitamin D + calcium + lynestrenol group, serum alkaline phosphatase activity and urinary hydroxyproline excretion decreased significantly.
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