Revue du rhumatisme et des maladies osteo-articulaires最新文献

A case of reflex sympathetic dystrophy involving the hip with a pathologic fracture of the femoral neck in a pregnant patient is reported. The low incidence of this condition is underlined and its characteristics are reviewed. The role of increased fragility related to pregnancy is discussed.

A study was carried out to determine the frequency and semiological characteristics of gout in patients attending a hospital clinic in Lomé, Togo. Gout was diagnosed in 71 of the 1,821 patients seen from october 1989 through october 1991. Clinical findings and increased serum uric acid levels were the basis for the diagnosis of gout in 63 patients; in addition, in the eight other patients monosodium urate crystals were demonstrated in joint fluid. All gout patients were male and mean age at onset was 45 years. Mean duration of the disease was 8.5 years, Forty-seven patients had normal hemoglobin, whereas a hemoglobinopathy was present in the 24 other subjects (hemoglobin AS: 15 cases; hemoglobin AC: 7 cases; hemoglobin CC: 2 cases). Twenty-seven patients (38%) were obese and 24 (34%) had hypertension. Forty-six patients (65%) were habitual drinkers. Twenty patients (28%) had tophi. None of the patients had a history of renal colic. The other clinical features of the disease were similar to those seen in Western countries. Results of this study are in striking contradiction with the common belief that gout is exceedingly rare in black Africa.

Primary fibromyalgia may involve an anomaly in the metabolism of serotonin responsible for the sleep disorders and diffuse pain. Effectiveness of an agent with pure serotonin-agonist properties (fluoxetin hydrochloride) was evaluated in 23 patients during a three-month open study. Treatment had no effect on pain severity, number of tender sites, or pain score. Sleep disorders improved and 57% of patients believed the treatment was effective. Adverse events were recorded in 43.4% of patients, with the most common being nausea (21.7%). Effectiveness and tolerance of fluoxetin hydrochloride in fibromyalgia are mediocre. A double-blind placebo-controlled trail versus a placebo is needed to clarify these preliminary findings.

Two cases of myeloma with roentgenographic evidence of bone sclerosis confirmed by iliac histomorphometric measurements are reported. In one patient, increased resorption, major depression of osteoblast activity, initial intense myelofibrosis, and myeloid deposits were found. The other patient had both increased resorption and increased osteoblast activity with clinical manifestations suggestive of POEMS syndrome. These two cases are compared with 116 cases previously published in the occidental medical literature and with five histomorphometric studies demonstrating increased bone trabecula volume (BTV). Conventional histologic studies suggest several mechanisms as possible explanations for the occurrence of bone sclerosis, including increased modeling unit activity, isolated osteoblast activation, metamorphic neoosteogenesis in myelofibrosis foci, and, in exceptional cases, inhibition of resorption due to increased production of calcitonin. The diversity of bone modeling patterns evidenced by the seven histomorphometric studies reviewed in this article is striking. Bone modeling patterns provide only a snapshot of bone modeling units and may vary over time in a given patient. Reported cases are too few to allow conclusions but emphasize the need for performing further histomorphometric investigations.

Histologic and biochemical anomalies of muscle mitochondria were identified in four patients with predominantly rhizomelic myalgia clinically suggestive of an inflammatory disease but inconsistent biologic evidence of inflammation. This clinical pattern was initially suggestive of atypical polymyalgia rheumatica and could not be ascribed to any other disease. To explain this combination of anomalies, several hypotheses can be put forward, including coincidence, aging, and nonspecific mitochondrial anomalies resulting from immunologic or inflammatory disease. The speculation that these patients have an autonomous syndrome cannot be outruled but should be considered with caution. A therapeutic trial with coenzyme Q is under way.

Among 105 cases of infectious spondylitis diagnosed and treated from 1971 through 1990, 23 were due to tuberculosis (TS) and 82 to other causes (NTS). The annual number of cases of NTS rose over the study period, partly because of an increase in iatrogenic spondylitis, whereas the number of TS cases fell. In both groups, mean age of patients was higher than in earlier studies. The leading causative agents in NTS were staphylococci, followed by streptococci, then Escherichia coli. Diagnosis of spondylitis was dependent on the imaging techniques used; among available methods, the most reliable was magnetic resonance imaging which improved diagnostic performance by detecting early, specific changes. Except in patients with positive blood cultures and in TS patients with Koch bacilli recovered from other visceral foci, bacteriologic diagnosis rested on studies of samples taken from the spinal infection site. Half the subjects underwent discovertebral needle biopsy, with a success rate of 47.5%, a figure comparable with those reported in other studies. In 30% of patients, bacteriologic documentation of the infection was not obtained and diagnosis rested on a set of clinical, biological, and radiological criteria.