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Bone mineral density (BMD) was measured in 1992-93 in 129 nuclear families, including 258 parents and 183 children, and was analyzed for familial resemblance factors. BMD measurements were adjusted on weight and age. Segregation analysis rejected the monogenic hypothesis and exhibited a strong polygenic component. Variance components analysis was then used to estimate the parameters of a multivariate normal model including an additive polygenic component, a common environment factor, and a residual specific to each individual. The genetic component was independent of sex and age. The common environmental factor was not significant. The variance of the residual specific factor appeared to be a quadratic function of age, reaching its minimum value at 26.4 years. Consequently, the maximum value for heritability (ratio of genetic variance to total variance) is observed at this age (h2 = 0.84). According to this model, the correlation between two relatives is a function of the ages of each individual in the pair.

Resume Objectif Evaluer l’influence de l’epanchement articulaire sur la reponse clinique a une injection unique d’Hylane GF-20 chez des patients souffrant de coxarthrose. Methode Patients souffrant de coxarthrose inclus prospectivement pour traitement intra-articulaire par Hylane GF-20. La severite de la coxarthrose a ete appreciee par le stade radiographique de Kellgren et Lawrence. La presence d’un epanchement a ete objectivee par echographie (epanchement articulaire : Ep+ ; absence d’epanchement : Ep−). Les parametres suivants ont ete evalues a l’inclusion, un (m1), trois (m3) et six mois (m6) apres l’injection : EVA douleur, indice algofonctionnel de Lequesne (IAFL) et score de WOMAC. La proportion de patients repondeurs selon les criteres OARSI ou ayant atteint les valeurs du patient acceptable symptom state (PASS) a ete analysee dans la population totale et selon la presence ou non d’un epanchement echographique initial. Resultats Sur les 55 patients inclus, 24 (44 %) presentaient un epanchement articulaire. Dans ce groupe, l’IAFL etait plus eleve a l’inclusion que dans le groupe sans epanchement (11,9 ± 3,6 versus 8,4 ± 4,5) ( p = 0,003). Dans la population totale, la proportion de repondeurs (criteres OARSI) etait a m1, m3 et m6 respectivement de 31,8, 39,4 et 14,8 %. De meme, la proportion de patients atteignant les valeurs du PASS douleur et fonction etait respectivement a m1, 52,4 et 50 %, a m3, 67,7 et 54,5 %, et a m6, 60 et 50 %. La presence d’un epanchement n’a pas modifie la reponse au traitement. Conclusion La presence d’un epanchement articulaire est associee a un retentissement algofonctionnel initial plus severe mais n’influence pas la reponse a l’Hylane GF-20 dans la coxarthrose.

Only about 40 cases of septic arthritis of the facet joints have been reported to date. We report 6 new cases including 2 at the cervical spine, which is rarely involved. Mean age was 61.5 years; there were 5 men and 1 woman. Spinal pain and stiffness, fever, and asthenia were the presenting manifestations. Laboratory tests consistently showed inflammation. Among classical risk factors for infection, only noninsulin-dependent diabetes was noted, in a single patient. Mean time to the diagnosis was 42 days. Discitis, a far more common condition, was considered initially, and early radiographs were of limited diagnostic assistance. Radionuclide bone scans identified the site of the infection and served to look for other foci. Magnetic resonance imaging was effective in confirming the diagnosis at an early stage and in looking for local spread (muscles, epidural space, and disk). L3-L4 was involved in 3 patients, C4-C5 in 2, and L4-L5 in 1. Direct inoculation during mesotherapy sessions was the cause in 1 patient. Cultures of blood and needle biopsy samples were positive in all 6 cases; Staphylococcus aureus was the causative agent in 3 patients. The risk of local and systemic complications governs the prognosis of facet joint infection. Of our 6 patients, 4 experienced complications: there was 1 case each of discitis, epidural infection, endocarditis, and septic arthritis of the acromioclavicular joint. Fatal multiple organ dysfunction occurred in 1 patient. In the other 5 patients, antimicrobial therapy and protection from weight-bearing for 3 months ensured a favorable outcome.

Resume L’arthrite septique des articulations inter-apophysaires posterieures est rarement decrite dans la litterature, puisque seule une quarantaine de cas sont rapportes a ce jour. Cependant, nous presentons six nouvelles observations, dont deux localisations inhabituelles au rachis cervical. Les patients presentaient douleurs et raideur rachidiennes, fievre et asthenie. Le premier diagnostic evoque etait une spondylodiscite, compte tenu de sa frequence plus elevee. Cinq hommes et une femme, âges en moyenne de 61,5 ans ont ete affectes. Parmi les facteurs de risque classiquement decrits, seul un diabete non insulinodependant a ete retrouve chez un patient. Les marqueurs biologiques de l’inflammation etaient constamment eleves. Le diagnostic est fait avec retard (42 jours) et le bilan radiographique initial est peu contributif. La scintigraphie osseuse permet de localiser l’atteinte septique et de detecter d’autres localisations. L’IRM confirme le diagnostic precocement et recherche des complications locales (pyomyosite, epidurite et spondylodiscite). L’atteinte L3-L4 est la plus frequente (n = 3), suivi de C4-C5 (n = 2) et L4-L5 (n = 1). Dans un cas, il s’agissait d’une contamination directe a la suite d’un traitement par mesotherapie. Les hemocultures et ponction-biopsies ont permis d’identifier l’agent pathogene dans tous les cas (Staphylococcus aureus dans 50 %). La severite de cette pathologie reside dans ses possibles complications locales et systemiques, observees chez quatre de nos patients : spondylodiscite, epidurite, endocardite et arthrite septique de l’articulation acromioclaviculaire. Hormis le deces d’un patient par defaillance multiviscerale, tous les patients se sont ameliores progressivement sous traitement antibiotique et decharge pendant trois mois.

The diagnosis of Lyme borreliosis in case of joint and muscular presentations is generally suggested by epidemiological factors. However, as a rule, laboratory testing is required to confirm the diagnosis. When considering the epidemiology of Lyme borreliosis in France, the only areas free of ticks infected by Borrelia burgdorgeri sl, are those close to the Mediterranean sea or at high altitude. The risk is greatest in the Alsace region. Exposure is particularly high among forest workers and people who use the countryside for their leisure activities. The likelihood of infection following a tick bite is difficult to assess; indeed, the bite site may remain unnoticed. A medical history of erythema migrans, if untreated, is a major diagnostic clue, although the association appears to be less consistent in France than in the US. Lyme arthritis generally arises apparently spontaneously. It is characteristically mono- or oligo-articular, asymmetrical, predominantly affects the knee, and has an intermittent course. Synovial cysts and enthesitis are common. Myositis is rare, polymorphic, and has been linked to other symptoms in the same localizations. Minor arthralgia and myalgia frequently occur, principally early in the course of the infection. It was suggested that sequels of the disease include so-called fibromyalgic syndromes. The principal differential diagnosis as far as arthritis is concerned, is made on spondylarthropathy and chronic juvenile arthritis. Rheumatoid arthritis is another pathology, although Lyme arthritis does sometimes evolve to chronicity.

La borreliosis de Lyme es una zoonosis, transmisible al ser humano por la picadura de garrapatas. Se debe a un complejo bacteriano, Borrelia burgdorferi sensu lato, compuesto por tres especies patogenas principales con distinto organotropismo: Borrelia burgdorferi sensu stricto solo se aisla en Estados Unidos, mientras que Borrelia garinii y Borrelia afzelii tambien provocan la enfermedad en Europa. Las manifestaciones clinicas son diversas y suelen presentarse de forma aislada. El eritema migratorio es el signo fundamental despues de la inoculacion del microorganismo. La diseminacion de Borrelia burgdorferi puede provocar en primer lugar manifestaciones neurologicas (meningorradiculopatias) y, despues, manifestaciones articulares (artritis de Lyme). La acrodermatitis cronica atrofiante, que es tardia, se observa en Europa. El sindrome «post-Lyme», parecido a las fibromialgias y al sindrome de fatiga cronica, sigue siendo controvertido. El diagnostico se basa sobre todo en la demostracion de anticuerpos especificos, que se buscan en dos etapas: analisis de inmunoadsorcion ligada a enzimas (ELISA) de deteccion selectiva, e Inmunoblot de confirmacion, en presencia de una manifestacion clinica sugestiva. En caso de artritis de Lyme, suelen detectarse anticuerpos de tipo inmunoglobulina G (IgG). Las neuroborreliosis se confirman por la demostracion de la sintesis intratecal de anticuerpos. La amplificacion genica por reaccion en cadena de la polimerasa (PCR) en una muestra sinovial puede contribuir al diagnostico de las artritis. En las zonas de endemia, la seropositividad es elevada en la poblacion general, lo que sugiere que existen contactos con el microorganismo sin consecuencias clinicas. El tratamiento se basa en las medidas preventivas, sobre todo en informar a la poblacion y en la busqueda de las garrapatas, que debe efectuarse de forma sistematica tras las actividades de exposicion. El tratamiento antibiotico solo debe iniciarse si existen manifestaciones clinicas probadas y no esta justificado por el descubrimiento fortuito de una serologia positiva. Asegura la curacion en el estadio de eritema migratorio, pero algunas artritis son refractarias, por motivos que no se han aclarado: persistencia del microorganismo, autoinmunizacion, etcetera.

RESUME Les formes familiales de chondrocalcinoses articulaires sont une maladie chronique caracterisee par des acces articulaires aigus, la presence de cristaux de pyrophosphate de calcium dihydrate dans le liquide synovial, le cartilage et les tissus peri-articulaires et, sur les radiographies, une incrustation calcique des cartilages et fibrocartilages de l’organisme. Nous avons etudie une famille alsacienne dans laquelle la transmission est autosomique dominante. L’analyse genetique entreprise a permis de montrer, comme dans les familles anglaises et argentines, une liaison avec le bras court du chromosome 5p, suggerant qu’une anomalie d’un gene situe dans cette region pourrait etre impliquee dans ces formes familiales.

SUMMARY This study investigates the seroreactivity to Borrelia burgdorferi antigens of patients suAering from rheumatoid arthritis (RA) for

Objective. To evaluate the relative importance of environmental and genetic factors in the determination of bone mineral density (BMD) and to quantify the risk of low BMD in healthy young adults in relation to the BMD of their parents. Methods. Dual-energy x-ray absorptiometry study of a series of 129 nuclear families (441 subjects), including 183 children over age 15, was performed. Correlation of BMD in children with BMD in their parents was studied in a linear model, taking into account environmental factors. Logistic regression was used to quantify the relative risk of lower BMD according to the parents' BMD level. Results. BMD was significantly correlated with weight, height, and body mass index (BMI) in all family members, and with parents' alcohol consumption and with physical activity in fathers and sons. The BMD of the children correlated with that of their parents (r = 0.27). The child's BMI, his/her father's BMD and daily calcium intake, and his/her mother's BMD, BMI, and body fat accounted for 41.4% of the variance in the child's BMD. A son had a 3.8 times higher risk of having a low BMD if his father had a low BMD, and a daughter had a 5.1 times higher risk if her mother had a low BMD. Conclusion. The BMD of children in healthy families was related to the BMD of their parents as well as to environmental factors, confirming the contribution of genetic inheritance in the determination of bone density in young adults, especially in girls.

Tumor necrosis factor-α (TNF-α), a proinflammatory cytokine, plays a key role in the pathogenesis of many inflammatory diseases, including arthritis. Neutralization of this cytokine by anti-TNF-α antibodies has shown its efficacy in rheumatoid arthritis (RA) and is now widely used. Nevertheless, some patients currently treated with anti-TNF-α remain refractory or become nonresponder to these treatments. In this context, there is a need for new or complementary therapeutic strategies. In this study, we investigated in vitro and in vivo anti-inflammatory potentialities of an anti-TNF-α triplex-forming oligonucleotide (TFO), as judged from effects on two rat arthritis models. The inhibitory activity of this TFO on articular cells (synoviocytes and chondrocytes) was verified and compared to that of small interfering RNA (siRNA) in vitro. The use of the anti-TNF-α TFO as a preventive and local treatment in both acute and chronic arthritis models significantly reduced disease development. Furthermore, the TFO efficiently blocked synovitis and cartilage and bone destruction in the joints. The results presented here provide the first evidence that gene targeting by anti-TNF-α TFO modulates arthritis in vivo, thus providing proof-of-concept that it could be used as therapeutic tool for TNF-α-dependent inflammatory disorders.

A sensitive and valid instrument is needed in the earliest stages of rheumatoid arthritis (RA) for the measurement of functional disability. A French version of the Health Assessment Questionnaire Functional Disability Index (HAQ) has been developed, validated in an early RA sample (i.e. with disease duration less than 5 yr; n = 50), and compared with longstanding RA (n = 32) and control subjects (n = 59). Five factors provided by principal components analysis accounted for 75% of the variability of the HAQ score (construct validity). It appeared to be significantly correlated with clinical and radiological variables and to be reproducible (r intraclass = 0.964). It proved to be discriminant in groups with various levels of disability (HAQ score = 1.332 in early RA, 1.745 in longstanding RA, and 0.152 in controls; p less than 10(-5). Finally, the validity of the original scoring method of the HAQ, as compared with other scoring methods, was confirmed.

The diagnosis of Lyme borreliosis in case of joint and muscular presentations is generally suggested by epidemiological factors. However, as a rule, laboratory testing is required to confirm the diagnosis. When considering the epidemiology of Lyme borreliosis in France, the only areas free of ticks infected by Borrelia burgdorgeri sl, are those close to the Mediterranean sea or at high altitude. The risk is greatest in the Alsace region. Exposure is particularly high among forest workers and people who use the countryside for their leisure activities. The likelihood of infection following a tick bite is difficult to assess; indeed, the bite site may remain unnoticed. A medical history of erythema migrans, if untreated, is a major diagnostic clue, although the association appears to be less consistent in France than in the US. Lyme arthritis generally arises apparently spontaneously. It is characteristically mono- or oligo-articular, asymmetrical, predominantly affects the knee, and has an intermittent course. Synovial cysts and enthesitis are common. Myositis is rare, polymorphic, and has been linked to other symptoms in the same localizations. Minor arthralgia and myalgia frequently occur, principally early in the course of the infection. It was suggested that sequels of the disease include so-called fibromyalgic syndromes. The principal differential diagnosis as far as arthritis is concerned, is made on spondylarthropathy and chronic juvenile arthritis. Rheumatoid arthritis is another pathology, although Lyme arthritis does sometimes evolve to chronicity.

Objective To determine the magnetic resonance imaging (MRI), macroscopic, and microscopic characteristics of synovial membrane inflammation, to study the relationship between disease severity and the degree of synovial inflammation on MRI and on macroscopic and microscopic examination, and to look for colocalization of chondral lesions and synovial inflammation. Methods Thirty-nine patients with knee osteoarthritis (OA) were classified into 2 groups according to the severity of cartilage lesions as revealed by chondroscopy. Group 1 (n = 14) had mild cartilage lesion(s) without exposure of subchondral bone. Group 2 (n = 25) had severe cartilage lesion(s) with focal or diffuse exposure of subchondral bone. Synovitis was evaluated on T1-weighted MRI sequences according to the degree of synovial thickening on a 4-point scale (ranging from 0 to 3) in 5 regions of interest. Synovial membrane was macroscopically scored, and biopsies were performed on the 5 preselected sites for histologic scoring. Results The mean ± SD synovial thickening score on MRI was 1.55 ± 0.90, with no significant difference between groups 1 and 2. Intra- and interobserver reproducibility of the total synovial score was excellent, and interobserver reproducibility of the MRI grade was good. Synovitis was diffuse and associated with chondral lesions only in the medial femorotibial compartment (r = 0.49, P = 0.001). The degree of synovial thickening on MRI correlated with qualitative macroscopic analysis (rs = 0.58, P < 0.001) and with microscopic features (synovial lining cells [rs = 0.23, P < 0.007], surface fibrin deposition [rs = 0.12, P < 0.01], fibrosis [rs = 0.31, P < 0.006], edema [rs = 0.17, P = 0.07], congestion [rs = 0.30, P < 0.005], and infiltration [rs = 0.46, P < 0.0001]). Fibrin and infiltration parameters were more severe in end-stage disease (P = 0.009 and P = 0.02, respectively). Conclusion Synovitis may be present from the onset of OA and may be evaluated on MRI. MRI evaluation of synovitis could be used to classify OA patients in clinical trials and could help to identify those who could benefit from synovium-targeted therapy.

A rare case of patella tuberculosis in a 33-year-old man is presented. In the last two decades, tuberculosis has made a vigorous comeback, due mainly to large-scale migration of populations and the increasing number of immunosuppressed patients. Extrapulmonary tuberculosis accounts for less than 3% of cases, and sites like the patella are very rare. Fewer than 10 cases were found in the international literature. A 33-year-old man presented in our department with a 9-month history of pain and swelling of the left knee. Tuberculosis of the patella was diagnosed after biological and radiological investigations. Imaging studies, especially MRI, are of great interest for the diagnosis and to assess the extent of tuberculosis. Histology of the curettage specimen is also required to reach a definitive diagnosis and develop an adapted management strategy (chemotherapy and rehabilitation). Diagnosis and treatment should be urgent, including surgical debridement and well-conducted antitubercular therapy to yield a satisfactory functional outcome.

Familial articular chondrocalcinosis is a chronic articular disease characterized by acute intermittent attacks of arthritis, presence of calcium pyrophosphate dihydrate crystal in synovial fluid, cartilage and periarticular soft tissue and by x rays calcium deposition in articular cartilage. A family originating from Alsace, with an autosomal dominant transmission has been studied. As in English and Argentinean families, a linkage to the short arm of chromosome 5p has been found. These results suggest that a defective gene at this location may be related to the chondrocalcinosis in these families.

To examine the links between the quality of life (QOL) and season and weather conditions in ankylosing spondylitis (AS) patients.A cohort of 146 AS patients (67% males), with a mean age of 47.3 years and a mean disease duration of 12.8 years, answered a self-administered questionnaire, the AS-AIMS2 validated for AS, 4 times over a period of one year in a postal survey. Clinical measures were assessed in a subsample of the cohort. Meterological data including daily temperature, hygrometry, wind speed and atmospheric pressure were collected over the same period.In this cohort, 106 patients completed the follow-up. A higher lumbar spine flexibility (Schober index) was associated with a higher climatic temperature and lower wind speed. Physical QOL improved in the summer, as did Social Interaction in the summer and fall, while Role QOL decreased in winter. A lower perceived QOL was significantly associated with a higher temperature and wind speed over the past 4 weeks, and with a higher hygrometry and atmospheric pressure over the past 2 days prior to completion of the questionnaire.This study provides some support to the popular belief and frequent patient complaints of a link between health status and perceived quality of life, as assessed by a specific questionnaire, with season and weather conditions.

To appreciate the evolution of serum angiogenic and/or adhesion molecules levels during a long term follow-up of rheumatoid arthritis (RA) patients.Serum levels of 5 soluble adhesion/angiogenesis glycoproteins (VEGF, CD31, CD54, CD62E, CD106) were measured in Elisa in samples collected over 6 years in a cohort of 43 RA patients with monitored clinical parameters of disease activity and severity.RA patients had significantly higher levels (p0.0001) of sCD106 (VCAM-1) than control subjects. Conversely, the levels of soluble VEGF, CD31, CD54 and CD62E were normal or lower than normal. No statistically significant time effect was noted. No effect either was noted as related to the therapeutic agents taken by the patients.The sustained elevated serum levels of sCD106 observed here imply that this molecule might be related to the chronicity and progression of RA.

To determine which signs are the most accurate in the diagnosis of sacroiliitis with MRI.40 consecutive patients with inflammatory low back pain underwent MRI at 1.5 T with FSE T2 and SE T1 weighted-images before and after Gadolinium-DOTA injection. 22 patients were suffering from spondylarthropathy while the other 18 patients constituted the control group. Each examination was interpreted by two independent observers who analysed 11 different signs.Intra and inter observer reproducibility were high (respectively 76% and 70%). Inter observer reproducibility was excellent for bone marrow edema (89%) but low for bone productions (38%). Three lesions displayed a high positive predictive value: ligamentous contrast enhancement (86%), bone marrow edema (80%) and bone erosions (70%). Intra articular enhancement of the sacro-iliac joint was a less sensitive sign than bone marrow edema.This study confirms the excellent positive predictive value of MRI for an early diagnosis of active sacroiliitis. Bone marrow edema seems to be a more pertinent sign than intra articular enhancement.

Septic sacroiliitis is an uncommon condition that is often diagnosed late. Two cases in the immediate postpartal period are reported. Magnetic resonance imaging contributed decisively to the early diagnosis.

Objective To develop a questionnaire measuring quality of life in ankylosing spondylitis (AS). Methods A focus group technique contributed to the generation of an AS-specific questionnaire using the Arthritis Impact Measurement Scales 2 (AIMS2) (12 dimensions), supplemented with items from the Health Assessment Questionnaire for the Spondylarthropathies, as well as original new items. Patients from a self-help group provided data to assess the validity (n = 146) and reproducibility (n = 43) of the AS-AIMS2. Results The focus group generated a thirteenth dimension including 6 items labeled “spine mobility.” Principal component analyses on AS-AIMS2 showed satisfactory dimensionality (74.1% of variance explained), high internal consistency (Cronbach's α = 0.78–0.91), significant convergent validity of the new dimension with spine pain and mobility, and good reproducibility in the 13 dimensions and 5 components (intraclass correlation coefficient = 0.7–0.9). The scores in each component of the AS-AIMS2 showed a marked deterioration of quality of life in these young patients. Conclusions The disease-specific AS-AIMS2 questionnaire should help improve care management in AS.

To determine the prevalence of amyloid deposits among patients with carpal tunnel syndrome (CTS) receiving dialysis, and to investigate the factors associated with amyloid and non-amyloid CTS.Subjects for this prospective study were dialysis patients who underwent surgery for CTS in the same surgical unit between 1989 and 1997. CTS was diagnosed from clinical and electromyographic (EMG) findings. Systematic standard radiographs and laboratory data were also obtained. Surgical investigations included systematic macroscopic examination and biopsy of the epineurium, flexor retinaculum, synovium, and flexor tendon sheaths. Samples were stained for amyloid and examined by plain and polarized light microscopy, immunohistochemistry, and electron microscopy.Forty-one samples from 30 patients (11 bilateral cases) were examined. Amyloid deposits were found in 26 samples from 18 patients (7 M, 11 F). Fifteen samples from 12 patients (3 M, 9 F) showed no amyloid deposits. Amyloid CTS was statistically significantly associated with arthralgia and longterm dialysis [mean 13.3 (range 5.5-23) vs 7.5 yrs (range 3 mo-14 yrs)] in non-amyloid CTS. Flexor tenosynovitis and carpal bone erosion occurred more frequently in amyloid CTS. There were no statistically significant differences between the 2 groups in clinical, laboratory or EMG findings, type of dialysis membrane, or frequency of ipsilateral fistula. Only amyloid CTS was recurrent.Amyloid deposits were confirmed microscopically in 63.4% of patients. The relatively large number of cases of non-amyloid CTS without signs of dialysis associated arthropathy suggests that CTS is not a satisfactory criterion for diagnosis of dialysis arthropathy or beta2-microglobulin amyloidosis unless the presence of amyloid has been confirmed or duration of dialysis treatment has been at least 15 years.

Insufficiency fractures often occur in the sacrum and pubic rami but have rarely been reported in the ilium, where their frequency may be underestimated. We studied a series of 14 patients with insufficiency fractures of the ilium. Six patients had an oblique fracture through the wing of the ilium (which was bilateral in one case) and nine a supraacetabular fracture, with in one case a superomedial extension into the iliac wing. The initial radiographs were normal, making the diagnosis difficult. A linear area of sclerosis along the fracture line was seen after a few weeks. The radionuclide examination provided early detection and often demonstrated multiple insufficiency fractures (mean 2.1 per patient). Computed tomography missed some of the fractures, whereas magnetic resonance imaging proved a reliable diagnostic tool, especially in patients with supraacetabular fractures, showing the fracture as a line of low signal surrounded by an area of edema whose contours were exactly the same as those of the hyperactive focus on the radionuclide scan. Osteoporosis was a causative factor in all 14 patients and vitamin D deficiency in seven. Also, three patients had a history of fluoride therapy.

Objective. To compare the detection rates of chromosomal flagellin gene from Borrelia burgdorfen in synovial tissue (ST) and synovial fluid (SF) using polymerase chain reaction (PCR) techniques. Methods. B burgdorferi DNA was sought in SF and ST from 12 consecutive patients with Lyme arthritis and from 29 patients with noninfectious diseases (controls). Results. No DNA amplification was observed in samples obtained from the 29 control patients, whereas B burgdorferi DNA was detected in all ST and/or SF samples from the 12 patients with Lyme arthritis. Results from 1 ST sample were not interpretable because of PCR inhibitors. Among the 11 remaining patients, 10 had positive ST samples, whereas only 4 had positive SF samples (P < 0.05). Conclusion. These data suggest that detection of chromosomal B burgdorferi DNA may be more efficient in ST than SF.

UNLABELLED To investigate the prognostic value of therapy at 6 months on survival in multiple myeloma, to develop a new criterion assessing response to initial therapy at 6 months, and to compare it to a current criterion. The types of initial and 6-month therapy were considered in a prognostic factor analysis in 70 patients treated in routine practice. Using the response to initial therapy defined by the clinician's decision as grouping variable in this group, a discriminant analysis identified the characteristics of responder patients. The validity of the resulting criterion was tested in another test group. Its prognostic ability was compared to the CLMTF criterion (50% M-component reduction from baseline). The therapy at 6 months, reflecting the clinician's appraisal of response to initial therapy, predicted survival significantly. A criterion combining two variables (M-component change and haemoglobin level at 6 months) classified 70% and 72.4% of patients correctly regarding response status in the training and test groups respectively. This criterion was shown to perform better than the CLMTF criterion in predicting survival. CONCLUSION A new criterion for response to therapy at 6 months, also presented in a nomogram, combines M-component change and haemoglobin level at 6 months.

Articular manifestations of Lyme disease may be less common in Europe than in the United States, perhaps because European strains of Borrelia burgdorferi are characterized by greater genetic diversity and different organotropisms as compared with American strains. The diagnosis rests on clinical symptoms. A history of erythema migrans is pathognomonic. Isolated articular manifestations with no history of erythema migrans raise difficult diagnostic problems. Monoarthritis and asymmetric oligoarthritis is the most characteristic pattern; enthesitis can occur, a clinical feature shared with spondylarthropathy. Serologic tests (indirect immunofluorescence, Western blotting) have not been standardized and should be used only to confirm the diagnosis in patients with suggestive clinical manifestations. The interpretation of serologic test results is made difficult by the high seroprevalence rates seen among the general population in endemic areas, where subclinical Borrelia burgdorferi infection probably occurs. Detection of Borrelia burgdorferi DNA using polymerase chain reaction amplification is a potent tool both for diagnosis and for gaining insight into the pathophysiology of Lyme disease. However, difficulties subsist (risk of contamination of the specimens, inhibitory effects). Continued work is needed to determine which targets (chromosomal DNA, plasmidic DNA) and specimens (joint fluid and/or synovial membrane) provide optimal results.

The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone-associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2 * -weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture

To evaluate the relative importance of environmental and genetic factors in the determination of bone mineral density (BMD) and to quantify the risk of low BMD in healthy young adults in relation to the BMD of their parents.Dual-energy x-ray absorptiometry study of a series of 129 nuclear families (441 subjects), including 183 children over age 15, was performed. Correlation of BMD in children with BMD in their parents was studied in a linear model, taking into account environmental factors. Logistic regression was used to quantify the relative risk of lower BMD according to the parents' BMD level.BMD was significantly correlated with weight, height, and body mass index (BMI) in all family members, and with parents' alcohol consumption and with physical activity in fathers and sons. The BMD of the children correlated with that of their parents (r = 0.27). The child's BMI, his/her father's BMD and daily calcium intake, and his/her mother's BMD, BMI, and body fat accounted for 41.4% of the variance in the child's BMD. A son had a 3.8 times higher risk of having a low BMD if his father had a low BMD, and a daughter had a 5.1 times higher risk if her mother had a low BMD.The BMD of children in healthy families was related to the BMD of their parents as well as to environmental factors, confirming the contribution of genetic inheritance in the determination of bone density in young adults, especially in girls.

To investigate the articular toxicity of 2 aluminum derivatives, one insoluble (hydroxide) and/or the other soluble (lactate), after a single administration in rabbits and rats.First, aluminum levels in plasma, urine, synovial tissue, liver and kidney were measured in saline treated rabbits and 1 to 2 days after an articular injection of 75 mg of aluminum compounds into their right knee. The methodology used was argon plasma emission spectrometry. Thereafter, the joint toxicity of aluminum lactate at the same dose regimen was evaluated for 2 days by a qualitative histological examination of synovial tissue and articular surfaces and a colorimetric assay (1,9-DMB) of patellar articular cartilage proteoglycan content. Secondly, the single injection of 50 mg of aluminum derivatives as an inducer of inflammation was studied in the rat subcutaneous air pouch, a model for a synovial-like space. Leukocytes and eicosanoids levels were measured in pouch washout fluids from 1 to 72 h after injection.After injection into rabbit knee, aluminum lactate largely distributed within the body while hydroxide remained locally. However, aluminum lactate resulted in perivascular edema, sparse infiltration of inflammatory cells in the synovium and a hemorrhagic effusion. Proliferation of the synovial cell layer coexisted with an apparent loss of proteoglycan in superficial zones of tibial and femoral cartilages when patellar proteoglycan content remained unchanged. Aluminum hydroxide did not affect joint structures. In the air pouch experiment, aluminum lactate increased prostaglandin E2 (PGE2) levels from 3 to 10 h after its injection and less intensively leukotriene B4 (LTB4) levels after 6 h, in the absence of leukocytes migration into the cavity. In contrast, aluminum hydroxide increased leukocytes count in pouch-washout fluid from 3 to 24 h after its injection when PGE2 and LTB4 levels were little modified.Although some differences attributable to dissimilarities in the experimental model used, aluminum compounds, even in a soluble form, may damage joint structures either directly or through stimulating the secretion of eicosanoids by synovial-like cells.

The incidence of rheumatoid arthritis (RA) was estimated in the Lorraine district, eastern France, over the period 1986-1989. Cases were identified from in- and outpatients at the district Rheumatology Hospital Centre, private rheumatologists, general practitioners and by regional media announcements. Supplementary cases resident in the area were sought by extending the procedure to adjacent districts. The population count was obtained from the national Census. An overall age-adjusted incidence rate of 8.8/100,000 was found using the 1987 ACR criteria (12.7/100,000 in females, 4.7/100,000 in males; sex ratio = 2.65) and 9.5/100,000 using the 1958 ARA criteria (definite and classic RA). These rates were compared, using the same standard population, with the age-adjusted incidence rates in other incidence studies mainly conducted in Caucasian populations. The RA incidence rates appeared lower in France than in any other country in Europe, USA and Japan.

The value of scanning electron microscopy (SEM) in the study of crystals in articular diseases is underlined in several cases of examination of joint fluid, or crystal deposits in articular or periarticular tissues obtained by percutaneous or surgical treatment with chemical and crystallographic correlations. Apatite crystals. Two deposits of hydroxyapatite of the rotator cuff were studied by SEM, crystallographic techniques and chemical analysis. SEM study showed spherical aggregates of various size. Urate crystals. Three tophi were observed by SEM, with crystallographic techniques and chemical analysis. Their needle-shape and their great size (20 m) were characteristic. Calcium pyrophosphate crystals. In a case of typical clinical and radiological features, examination of joint fluid, with chemical correlation showed shorter and thicker crystals than those or urate. The precise identification of crystals is based on sophisticated crystallographic techniques such as X-ray diffraction, although SEM allows an accurate and quite simple morphologic study, most often sufficient.

We report a study of lymphocyte subsets in experimental arthritis induced in Wistar Furth rats by native human type II collagen and muramyl dipeptide. This experimental arthritis shares similarities with both the spondyloarthropathies and rheumatoid arthritis. Peripheral blood T lymphocytes, primarily the CD4+ cells (p = 0.01), were lower in arthritic rats than in the controls, although the difference in the CD4/CD8 ratio was not statistically significant. Splenic CD4 cells were significantly (p = 0.03) more numerous in arthritic rats, while the numbers of MHC class II positive cells (p = 0.002) and kappa-bearing B-cells (p = 0.0004) were significantly lower. Determination of peripheral blood and spleen lymphocytes subsets could therefore be used for the assessment of arthritis and for the evaluation of therapeutic agents. Thymic T-cell differentiation does not appear to be impaired in this model. These results differ from the peripheral blood disturbances described in the active stages of human rheumatoid arthritis and are more similar to those reported in ankylosing spondylitis patients. However, the absence of alterations in the Peyer's patches suggests that pathogeneic mechanisms involving mucosal areas and exogenous intestinal antigens are not reproduced in this model.

A hypothesis that the development of functional disability in rheumatoid arthritis (RA) would be more rapid at the beginning than in established disease was studied in a group of 82 patients with RA referred to the Rheumatology Unit of Nancy, France. The relationship between disease activity, articular destruction and functional disability indicated a significant interaction (moderating effect) of disease duration. Two different models are proposed to explain functional disability. A model for early RA (less than 5 years duration) includes biological activity, and a model for established disease (more than 5 years) includes disease duration, extraarticular lesions and radiographic damage. These models could be useful in designs of therapeutic trials.

We investigated the influence of human recombinant interleukin-1 beta (hrIL-1 beta) on the time-course of collagen induced arthritis (CIA) when injected concomitantly with the arthritogenic emulsion. Three sensitizing procedures were compared. The control group received type II collagen only. The other groups differed by the adjunction of demonstrated (MDP) or potential (IL-1 beta) adjuvant. No adjuvant effect of IL-1 was observed as judged on clinical or radiological scores. On the contrary, MDP significantly worsened the lesions of the injected right hindpaw, and increased the incidence of CIA. Surprisingly, humoral response to type II collagen was decreased in the group receiving IL-1 beta. This might be explained by a non specific increase of antigen clearance.

A dysregulation of B-cell differentiation and activation has long been evidenced in rheumatoid arthritis (RA). Such analyses have, however, usually focused on the latest stages of B-cell development. Using a classical technique of immunofluorescence labeling on cytospins, we investigated the presence of peripheral pre-B lymphocytes in 92 RA patients and 23 controls. Cells with intracytoplasmic μ chains were evidenced in 58.7% of the RA patients studied, ranging between 0 and 30%, while small numbers of c-μ cells, never exceeding 6% of peripheral blood lymphocytes, were observed in 9 controls. Relationships between this feature and clinical or laboratory data were investigated, showing a negative correlation between the percentage of c-μ+ lymphocytes and Ritchie's index ( P = 0.05), the number of tender or swollen joints ( P = 0.05), erythrocyte sedimentation rate ( P = 0.005), seropositivity ( P = 0.05), and disease duration ( P = 0.01).

The fractures by bony insufficiency are particularly well seen on MRI. On T1 weighted images they are detected as a very hypointense line surrounded by a hypointense area. On T2 weighted images, the hypointense line is also recognized and represents the fracture surrounded by a hyperintense area due to oedema or hemorrhage. Five cases of bony insufficiency fracture of the femoral head are reported. The features of the superior subchondral locations of these fractures and some primary and limited epiphyseal osteonecrosis are similar and consistent with a common pathogeny.

Prognostic factors for the occurrence of longterm disability and prolonged sick leave were determined in 182 patients with ankylosing spondylitis. A significant relationship appeared between functional disability (determined by the Stanford Health Assessment Questionnaire) and sex, age at disease onset, and the number of peripheral joints involved. Using a life-table approach, the probability of prolonged sick leaves was associated with peripheral joint involvement and work that involved carrying heavy loads. Long-term disability was more frequent after work involving exposure to cold conditions (relative risk [RR] = 2.01) and prolonged standing postures (RR = 1.34), while sedentary work (RR = 0.35) and formal vocational rehabilitation programs (RR = 0.57) seemed to protect against long-term disability.

Collagen induced arthritis (CIA) in rats is an experimental model that is characterized by an erosive synovitis associated with periostitis and both peripheral and axial ossifying enthesopathy. The influence of long-term therapy with sulfasalazine (80 mg/day on weekdays) on established CIA in Wistar Furth rats was investigated. Clinical and X-ray examination showed a significant improvement in the joint lesions of the uninjected paws in the treated rats as compared to controls. This effect was, however, delayed. On the other hand, periosteal new bone formation and caudal enthesopathy (spondylodiscitis) were not altered by the treatment.