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The association psoriasis and systemic lupus erythematosus (SLE) is a very uncommon association. We report three cases, diagnosed in an Internal Medicine department between 1993 and 2000. Few cases of psoriasis/SLE have been published in the literature. Psoriasis generally precedes the diagnosis of SLE. Psoriasis can also be associated with discoid lupus erythematosus. In some cases, SLE appears as a complication of ultraviolet phototherapy indicated for the psoriasis. The association psoriasis/SLE does not seem to have distinctive immunologic features. Specific therapeutic difficulties may occur. Indeed, hydroxychloroquine may exacerbate the psoriasis. Systemic use of corticosteroids raises the risk of severe psoriasis relapse during withdrawal. In addition, the diagnosis of psoriasic arthropathy is more difficult in this setting. The psoriasis/SLE association might be a good indication for using methotrexate.

The aim of this study was to reduce the side effects of corticosteroid therapy responsible for high morbidity in giant cell arteritis. Nine patients were admitted consecutively for temporal arteritis (7 cases) or polymyalgia rheumatica (2 cases) without ocular involvement (mean age: 69.3 years; positive temporal biopsy: 6 cases). The following protocol was used: methylprednisolone, 500 mg/d, i.v., for 3 consecutive days, then low doses (an average of 22.5 mg/d) of prednisone or an equivalent drug. The mean length of follow-up was 15.1 months (range: 6-22 months). The mean lapse of time until the erythrocyte sedimentation rate returned to normal was 10.6 days (range: 3-30 days). The mean dose of prednisone or an equivalent drug at 6 months was 13 mg/d (range: 5-22.5 mg/d). One patient was cured after 17 months of treatment. Another suffered a biological relapse after 13 months of treatment. All the other patients were asymptomatic with no biological signs of an inflammatory syndrome. The complications included: electrocardiogram modifications without necrosis during pulse therapy in 1 woman; unstable angina developed 2 months after the onset of treatment in 1 man; recurrent urinary infections in 1 predisposed male patient. No bone or metabolic side effects have been noted to date. We think that 3 days of intensive intravenous corticotherapy followed by low doses of corticoïds per os constitute an effective and well-tolerated regimen. Additional studies including comparison with conventional treatments should be carried out to confirm these results and, even better, to evaluate the long-term benefits of this protocol in terms of side effects.

A 69 year-old woman with no previous history of lung disease was treated with 500 mg of Amiodarone per week. After 21 months of treatment, she developed a clinical picture of alveolitis with fibrosis, which was confirmed by histological examination. No other drug known for its fibrotic properties had been administered. Treatment with Nifedipine and Isosorbide dinitrate had been prescribed prior to the Amiodarone. Simply stopping the Amiodarone led to a regression or disappearance of the clinical, radiological and functional signs. Immunological investigations revealed the presence of antinuclear antibodies and a positive lymphoblastic transformation test for the drug, which are the abnormalities that one finds in other types of drug-induced fibrosis (nitrofuradantin). A new finding was the presence of cutaneous immunofluorescence of granular deposits of IgG, IgM and complement at the dermo-epidermal junction. So far, there have been 13 cases of lung disease related to the administration of Amiodarone reported in the literature.

In two patients with similar symptoms (fever, very poor general condition, skin rash, pulmonary involvement, multiple lymphadenopathy and phlebitis) pathological examination disclosed angioimmunoblastic lesions in lymph nodes and leucocytoblastic vascularities in the skin. While all cases published so far were exceptional, the clinical and pathophysiological findings were strikingly similar in these two cases, and the possibility of a special nosological entity is considered. If relapses are to be avoided, both patients will require continuous high dosage corticosteroid therapy, which aggravates the long-term prognosis.

Over a 3 years period, PTH, 25 OHD, calcium and phosphate levels were measured in all patients admitted to a department of Internal Medicine with abnormal phospho-calcic metabolism or bone disease. The diagnostic value of iPTH was analysed, especially in cases of hyper- and hypocalcaemia. In hypercalcaemia, the iPTH did not differentiate between the two main differential diagnoses: hyperparathyroidism and cancer. In patients with a negative calcium balance, the iPTH level is often raised and many help towards diagnosis. However, it should first of all orientate the clinician towards the detection of renal failure which is a common cause of this condition.

A 73-year-old woman with severe, old standing thyrotoxicosis developed osteosis with deformities of the lower limbs and spine resembling osteomalacia. All the well-known radiological, and histomorphometric features of thyroid osteosis were caricaturally present in this patient who, in addition, exhibited curvatures of the lower limbs that are exceptionally described in hyperthyroidism. A study of standard phosphorus/calcium values, 25 OH D values, circulating parathyroid hormone levels and fractional absorption of 47Ca before and after thyroidectomy enables the authors to discuss the current pathophysiological concepts concerning phosphorus/calcium and bone metabolism in hyperthyroid conditions. A possible action of thyroid hormones on vitamin D metabolism or peripheral effects is envisaged.

Two patients presenting ocular complications of hyperviscosity syndrome in Waldenström's macroglobulinemia have been treated by plasmapheresis after inefficiency of immunosuppressive therapy. Plasma exchange seems an useful treatment as shown by clinic and angiographic improvement. In each case improvement of retinopathy was correlated with decrease of serum IgM level and blood viscosity measured by isotopic method. Fluorescein angiography, easily repeated, seems a very good method for following hyperviscosity syndrome in Waldenström's macroglobulinemia.

Raynaud's phenomenon is studied in three patients after cancer chemotherapy. In these cases, Raynaud's phenomenon occurs as: a true coincidence, a secondary complication of which neoplastic biological signs are thrombocythemia, hyperfibrinemia, immune complexes, cryoglobulinemia..., a therapeutic implication. The rate of therapeutic implication is difficult to precise. Raynaud's phenomenon is a little symptom over a severe illness. Several drugs are responsible for this fact. A literature review mentions Vincristine, Bleomycin, Cisplatin... For our three patients as in the literature review the tumoral nature is less important than the drug type. For us Bleomycin alone as in association is able to induce Raynaud's phenomenon. The occurrence of single Raynaud's phenomenon may be a systemic scleroderma is first sign. However it is important to affirm the true single Raynaud's phenomenon. In this case there is a lack of signs: scleroderma may be paraneoplastic, drugs may be pulmonary toxic, anticentromere antibodies may be positive during antineoplastic treatment. The pathogenesis for Raynaud phenomenon drug induction is unknown. For Bleomycin action the role of skin concentration, fibroblastic lesion, and vascular disturbance is discussed.