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Objective: The relationship between acetabular dysplasia (HD) and hip osteoarthritis (OA) remains unclear, especially for mild forms of dysplasia. Our objectives were to estimate the prevalence of HD in a population-based sample with symptoms and to evaluate potential associations linking HD, hip OA, and hip pain., Methods: Individuals 40 to 75 years of age with symptoms in 1 or both hips were recruited during a multiregional prevalence survey. All study participants underwent examination and radiographs. Radiographs were evaluated using Kellgren-Lawrence staging (with stages ≥ 2 indicating hip OA) and HD measures [center-edge (CE) angle, acetabular inclination angle (HTE), acetabular depth (AD), and vertical center-anterior margin angle]., Results: We studied both hips of 842 individuals (1684 hips), among whom 203 had hip OA. Compared to left hips, right hips had significantly smaller CE angles and significantly greater AD and HTE values (p ≤ 0.001). Overall, the prevalence of HD ranged from 7.6% to 22.2% of the hips depending on the measure used. The prevalence of HD was higher in individuals with hip OA, with significant differences for abnormal HTE (19.1% vs 11.4%; p < 0.0001) and abnormal CE (11.3% vs 7.5%; p = 0.04). By logistic regression, only abnormal HTE remained associated with OA. Same-side hip pain was not statistically more common in individuals with HD after stratification on OA status (p = 0.12)., Conclusion: Our study confirms the relationship between OA and HD, particularly as defined based on the HTE angle.

Objective: To evaluate the efficacy and safety of rituximab (RTX) in several subsets of spondyloarthritis (SpA) using the data of the AIR (Autoimmunity and Rituximab) registry., Methods: All patients receiving RTX for SpA, and prospectively included in the AIR registry from September 2005 to September 2010, were retrospectively analyzed. The response to treatment was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index for axial disease, joint count for peripheral disease, and C-reactive protein reduction., Results: Among the 595 patients included in the AIR registry, 26 patients with SpA from 13 centers were reported: ankylosing spondylitis (10), undifferentiated SpA (7), and psoriatic arthritis (9). Mean disease duration was 8.8 years (range 1-40). The extraarticular features found were psoriasis, 12 cases; uveitis, 4 cases; and Crohn's disease, 3 cases. The mean number of disease-modifying antirheumatic drugs before RTX was 2.4; previous anti-tumor necrosis factor (TNF) agents were taken in 23 cases. The mean number of RTX courses was 1.5 (range 1-5), with a total of 35.6 patient-years. Efficacy was noted in 11/23 cases: 3 out of 3 anti-TNF-naive patients and 8 out of 20 anti-TNF nonresponder patients. No predictive factors of response could be identified, particularly in diagnosis subsets or clinical presentation (axial or peripheral)., Conclusion: In this nationwide study of several subsets of SpA, RTX had only a moderate efficacy that was more marked in patients who were anti-TNF-naive.

Objective: We propose a composite index for considering total hip arthroplasty (THA) in hip osteoarthritis (OA)., Methods: We carried out a 3 year longitudinal study of patients with painful hip OA from 137 centers. Clinical data were collected at baseline and every 3 months; radiographs were taken at entry and each year. The decision to have surgery was made by the patient, the rheumatologist, and the surgeon, with no reference to outcome measures. Statistical analysis included discrete Cox analysis with time dependent covariates, on 3 month interval grouped data. The dependent variable was THA during the 3 months following the evaluated visit. Time dependent covariates collated at each evaluated visit included radiological joint space width (JSW), percentage decrease in JSW during the year preceding, patient's global assessment. Lequesne index, pain, and nonsteroidal antiinflammatory drug and analgesic intake. We compared 2 analyses differing in symptomatic variables entered: values obtained at a single time point vs mean values between 2 visits at a 3 month interval. Selection of the index was based on the best combination of variables to predict occurrence of THA., Results: Of the 508 patients recruited for study, 42 were excluded. During the 3 year followup, 75 patients underwent THA. Symptomatic, therapeutic, and radiological variables were included in the index resulting from the 2 analyses. Based on the selected cutoff, the positive and negative predictive values for occurrence of THA in the 2 years following were 54.3 and 90.6%, respectively (single point model), and 52.9 and 86.7%, respectively (model using mean values of symptomatic variables between 2 visits)., Conclusion: The poor positive predictive value of the composite indices obtained in this study suggests that there are other unmeasured factors determining access to surgery. On the other hand, the high negative predictive values suggest that these composite measures should be used by clinicians to determine which patients should not be referred to THA.

Objective: To assess if total hip arthroplasty (THA) is a valid outcome measure of hip osteoarthritis (OA), in respect to clinical and radiological assessments., Methods: A prospective 3 year study of patients who had painful hip OA with an initial radiographic joint space width > or =1 mm at the narrowest point. Dependent variable was THA. Patient data including body mass index, OA structural severity by radiograph, OA symptomatic severity (pain, function), and OA localization were recorded at entry. Pelvic radiographs were obtained before THA, when available, and once yearly during the study., Results: During the study 106 of 506 patients underwent THA. Risk was estimated (Kaplan-Meier method) to be 8+/-1, 16+/-2, and 23+/-2% after 1, 2, and 3 years, respectively. Factors predisposing to requirement for surgery were: age > or =70 years, female sex, superolateral migration of the femoral head, joint space width <2 mm, Kellgren-Lawrence grade > or =3, pain (visual analog scale) > or =50 mm, and Lequesne index > or =10 with a relative risk of 1.65, 1.71, 1.96, 1.85, 1.89, 1.86, and 2.59, respectively. Mean change in joint space width was 0.22+/-0.50 vs 0.97+/-1.35 mm/year in patients without and with THA, respectively (p<0.0001). Changes in radiological joint space width during the first year were highly predictive of requirement for THA during the 2 following years (risk of 5, 13, 25, and 79% in patients with a radiological joint space width worsening during the first year of 0, < or =25, >25 and < or =50, and >50%, respectively)., Conclusion: These data suggest that THA could be considered as a valid outcome measure in OA. However, further studies should be conducted in other countries with different health care systems to evaluate the inter-country reliability of this measurement.

Objective: To evaluate the performances of 4 sets of criteria proposed to define mixed connective tissue disease (MCTD): the criteria of Sharp, Alarcón-Segovia, Kasukawa, and Kahn. As anti-U1-RNP antibodies appear indispensable to establish the diagnosis of MCTD, we wished to reevaluate these sets of criteria in patients who all had anti-U1-RNP antibodies., Methods: We analyzed clinical and biological data to find which diagnostic criteria were met by 45 patients with anti-U1-RNP antibodies. We tested criteria for rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, polymyositis, Sjögren's syndrome, and 4 sets of criteria for MCTD., Results: The criteria that best identified patients with MCTD were those proposed by Alarcón-Segovia, with 62.5% sensitivity and 86.2% specificity, comparable to Kahn's criteria. The overlap with other connective tissue diseases was found to be 16%. These results could be improved by using the term "myalgia" instead of "myositis" in the definition. This increased sensitivity to 81.3%, with no decrease in specificity., Conclusion: Alarcón-Segovia's and Kahn's criteria are the best classification criteria to define MCTD.

Although the link between phosphate diabetes and neoplasm or benign mesenchymal tumors has been well documented, the nature of the phosphaturia factor remains unknown. We describe two cases of phosphate diabetes associated with bronchogenic cancer. In these case reports, we suggest that fibroblasts or osteoblasts synthesize a phosphate eliminating substance.

We describe a case of stress fracture of the roof of the acetabulum, in a woman with osteoporosis. Magnetic resonance imaging gave abnormally low signals in T1 weighted images and high signals in T2 weighted images.

Two cases of multifocal osteonecroses are described. Two hips were affected in one case, 2 hips and 2 shoulders in the other. In both cases osteonecroses developed after intraarticular instillations of long-acting corticosteroids.

Monoclonal antibodies and flow cytometry techniques were used to analyze and compare the distribution of lymphocyte subpopulations of peripheral blood and synovial fluid (SF) from 70 patients, 43 with rheumatoid arthritis (RA), 10 with ankylosing spondylitis (AS) or reactive synovitis, 10 with psoriatic arthritis and 7 with other inflammatory arthritic diseases. Patients with RA had significantly reduced number of CD8+ T cells and greater CD4/CD8 ratios in peripheral blood, a greater number of CD4+ T cells and lower CD4/CD8 ratio in SF. No significant difference was found between the groups with AS, reactive synovitis and psoriatic arthritis. The simultaneous analysis of peripheral blood and SF lymphocyte subpopulations allowed us to establish a transsynovial lymphocytic ratio which reflects CD4/CD8 variations on both peripheral blood and SF, 2 easily accessible compartments for physicians. This new ratio may distinguish RA from other inflammatory arthritic diseases.

A contusive procedure has been developed for the induction of a predictable and reproducible degenerative joint disease in knees of rabbits. Significant degeneration was observed in patella, condyles, and trochlea. These lesions included fibrillation, ulceration and erosion, clones of chondrocytes, and osteophyte formation. The incidence and distribution of lesions with time following contusion were also investigated. Lesions were observed as early as 1 day post-contusion and increased in number and severity. A global scoring system has been devised to permit comparisons of lesion incidence and severity, specially to test drug efficacy in this model of osteoarthritis.