[Hemopigmented villonodular synovitis: ultrastructural study and a comparison with hemophiliac synovitis]

In a study of the ultrastructure of two cases of villonodular synovitis and two cases of haemophiliac synovitis, the authors observed very similar lesions. In both diseases, the lesions of the superficial layer of the synovium consisted of intermediate type (type C) synoviocytes loaded with iron pigments or lipid vacuoles. In the deep layer, the authors observed numerous macrophages loaded with siderosomes, lipid inclusions or phagocytosed red blood cells, giant cells and capillaries with a thickened basement membrane with a layered appearance. The cytoplasmic membranes of the synoviocytes were joined by desmosomes or filopodal digitations. The similarity of the lesions in the two diseases suggests a common histogenetic mechanism for the synovial lesions: chronic haemarthrosis.

Vascular endothelial cell injury in progressive systemic sclerosis and other connective tissue diseases

The growth inhibition of in vitro vascular endothelial cell cultures by sera from patients with connective tissue diseases was studied. Seven out of 30 sera from patients with progressive systemic sclerosis (PSS) exhibited a cytotoxic effect. The cytotoxic serum factor(s) was not specific to patients with PSS, it was also demonstrated in sera from patients with other connective tissue diseases with vascular symptoms (11 out of 27 sera from patients with a mixed connective tissue disease, MCTD; 5 out of 34 sera from patients with a systemic lupus erythematosus, SLE). The cytotoxic effect was not specific for vascular endothelial cells, it was also found on fibroblast cells cultures. Inhibitor(s) of cell growth in vitro was independent of antinuclear and anticytoplasmic antibodies and appeared as a common feature of all connective tissue diseases with vascular symptoms.

[Significance of reduced complement level in the articular fluid. 81 cases]

Based on their own experience, the authors report that a fall in the complement level of joint fluid, which is particularly common in rhumatoid arthritis, is also seen in cases of systemic lupus eryrthematosis and a variety of arthritis: infectious arthritis, gout, articular chondrocalcinosis and psoriatic rheumatism. This should be taken into account when evaluating the diagnostic value of this test in rheumatoid arthritis.

[Bone and phosphoro-calcium metabolism in reflex sympathetic dystrophy]

A combined study organised by the French Society of Rheumatology was devoted to the investigation of bone and phosphoro-calcium metabolism in cases of reflex sympathetic dystrophy. The following observations were made: the usual phosphoro-calcium parameters are not altered, apart from a slight elevation of the urinary calcium in multifocal forms of the disease, during the 3rd and 4th months; the level of PTH, studied in 11 patients, was normal in each case; the examination of 8 bone biopsies, one performed in the 7th week and six others performed during the 3rd and 4th months of the disease, showed, initially, invasion of the spongy tissue by oedema, signs of marrow stress and bone stress, with a reduction in the number of osteoblasts, without any marked alteration of bone remodelling. At a later stage, the biopsy shows intense bone remodelling with hyperosteoclastosis and hyperosteoblastosis and the formation of irregular bone tissue which later becomes lamellar. Electron microscopic study of two biopsies revealed signs of acellular demineralisation with normal appearance of the osteoblasts and osteoclasts.

HLA system and side effects of gold salts and D-penicillamine treatment of rheumatoid arthritis

Among 67 patients with rheumatoid arthritis treated with gold salts (aurothiopropanol sulphonate) a significant correlation (p less than 10(-2)) was noted between gold toxic reactions, whatever their type, and the HLA antigens A1, B8, Cw7, and DR3. Forty-two patients were genotyped, and a correlation was observed between gold side effects and the haplotype A1 Cw7 B8 DR3 (p less than 10(-2), RR = 8.0). In addition 3 out of 4 cases of renal intolerance to D-penicillamine were observed in patients possessing the Cw7 B8 DR3 haplotype.

[Response of the joint tissues to the presence of a foreign body implanted into the rabbit knee. A new model of experimental arthrosis]

The joint tissues (synovium, articular cartilage and bone), respond rapidly and consistently to the presence of a piece of polypropylene surgically implanted into the Rabbit knee joint. In the contact of a foreign body, a synovium proliferates in an attempt to isolate and exclude the intruder from the joint cavity. The articular cartilage degenerates at the sites of maximal pressure. Its superficial layer undergoes cell necrosis and fibrillation and is progressively destroyed in the process of mechanical grinding. At the sites of lower pressure, the chondrocytes proliferate and form the metabolically hyperactive clones which have increased capacity to incorporate tritiated thymidine and radioactive sulfate. The glycosaminoglycan content of articular cartilage, compared to the shamoperated control side, rapidly decreases after operation as suggested by a loss of metachromatic staining and lower per unit weight concentration of uronic acid and hexosamine. In addition to the above changes, the osteophytes quickly develop at the articular margins from the proliferating synovial tissue while underlying bone become thicker and eburnated. These foreign body induced changes in articular morphology and metabolism resemble closely those observed in osteoarthrosis. The present model therefore may prove useful in studying the latter condition.

[Streptococcal rheumatic fever in adults]

Thirty-seven cases of streptococcal rheumatic fever in adults (20 women and 17 men; mean age 33 years) are reported. Only 3 patients had a history of previous rheumatic fever. In 73% of the cases untreated sore throat had occurred 8 to 30 days before the condition developed. Throat swabs taken during the rheumatic attack were positive for Streptococcus haemolyticus in only 5 out of 22 patients. The joints most commonly affected were those of the lower limbs and the symptoms were severe; in 2 out of 3 patients other joints were subsequently involved. Five patients had stable mitral regurgitation of undetermined duration, with systolic murmur. ECG abnormalities were noted in 7 patients, including 5 with prolongation of the PR interval and 2 with moderate elevation of the ST segment; these abnormalities regressed in all cases. No specific skin lesions were observed. The streptococcal infection was associated with a rise in antistreptolysins in 73% of the cases, a rise in antistreptokinases in 80% and a rise in both types of antibodies in 97%. Response to antibiotics and anti-inflammatory drugs was satisfactory in all cases. Cure was achieved within less than one month in 57% of the patients, but the condition lasted three years in 3 patients.

[Rheumatoid arthritis and HLA system. A search for correlations between histocompatibility antigens and characteristic features of the disease]

Possible correlations between the HLA antigens A, B, C and DR and the clinical and biological features of rheumatoid arthritis were investigated in 74 patients with positive serology. The DR 4 antigen was present in 46 of these patients (62%), being apparently more frequent in those whose disease had begun before the age of 35 (p less than 0.05). DR 4 was also more common in pure rheumatoid arthritis than in forms associated with Gougerot-Sjogren's syndrome (p less than 0.05). No correlation could be found between the HLA phenotype and the other parameters studied, i.e. sex, corticosteroid therapy. Steinbrocker's radiological stages, plasma levels of rheumatoid factor and gammaglobulins and presence of antinuclear antibodies.

[Erythrocyte sedimentation rate in a population of 47,205 adults. Variation with age]

The authors studied the mean ESR and its variations between the ages of 20 and 89 by groups of 5 years in a population considered to be healthy of 20.743 women and 26.462 men. The mean ESR rises with age. In women it is 7.2 mm between 20 and 24 and changes minimally until the age of 45. It rises to 8.9 mm between 50 and 54, 11.6 mm between 70 and 74 and 15.4 mm between 80 and 84. In men, it is lower: 4.1 mm between 20 and 24, 6.1 mm between 50 and 54, 8.8 mm between 70 and 74 and 10.9 mm between 80 and 84.

Nonosteomalacic osteopathy associated with chronic hypophosphatemia

We studied bone histomorphometry in 19 patients with chronic hypophosphatemia related to an idiopathic renal phosphate wasting and without histological osteomalacia. Nine patients had renal lithiasis (group 1), three had radiological osteoporosis (group 2), and seven had lumbar pain (group 3). In the whole group of 19 patients, serum phosphate levels were low (24.9 +/- 2.1 mg/l), calcium in blood was normal, calcium in urine was increased, and iPTH was low. Histomorphometric data showed decreased osteoblastic surfaces with normal resorption surfaces, normal osteoid volume and calcification front. There was no correlation between serum phosphate level and histomorphometric parameters. There was no statistical difference between the data of the 3 groups of hypophosphatemic patients. We concluded that chronic hypophosphatemia in the adult doses not always lead to osteomalacia but to an unusual osteopathy characterized by an osteopenia due to an isolated decrease in bone formation. The respective importance of phosphate deficiency and of decreased iPTH level in the pathogenesis of this osteopathy is uncertain.

[Mechanisms and prognosis of neutropenia in Felty's syndrome. 27 cases (author's transl)]

Twenty patients with Felty's syndrome were investigated. Isotopic studies of polymorphonuclear neutrophils, bone marrow biopsies and autoradiographies, and cultures of granulous stem cells showed that neutropenia resulted from three mechanisms acting simultaneously: hypermargination of the neutrophils predominantly in the spleen, decreased production of granulocytes in the bone marrow, and peripheral hyperdestruction of the neutrophils. Anti-granulocyte antibodies were detected in 3/12 patients. Other factors present in the serum of 2/4 patients seem capable of inhibiting the growth of granulocytic stem cells. Secondary bacterial infection (77%) may explain the severity of the prognosis: 13 out of 27 patients died 4 years on average after neutropenia was diagnosed.

[Soluble SS-A, SS-B and RNP antinuclear antigen antibodies in 66 cases of pure or associated forms of Gougerot-Sjögren syndrome]

In a prospective study, 66 patients fulfilling the criteria of Sjögren's syndrome were evaluated from the standpoint of the presence of soluble SS-A, SS-B and RNP specific nuclear antigen antibodies. There were 25 cases of pure Sjögren's syndrome and 41 cases of this syndrome associated with a connective tissue disease. Anti SS-A antibodies were found in 10 per cent of cases and anti SS-B in 21 per cent, without there being any significant difference in prevalence between pure and associated forms of Sjögren's syndrome. Three patients simultaneously showed anti SS-A and anti SS-B antibodies, four had only anti SS-A and eleven anti SS-B. Amongst the forms associated with a connective tissue disease all of the latter were represented with an equivalent prevalence. 18 per cent of the patients had anti-RNP with a majority of associated forms of Sjögren's syndrome. In this population of 66 patients with Sjögren's syndrome, no clinical manifestation appeared to be correlated with the presence of anti SS-A and SS-B antibodies. Amongst the laboratory features, only cryoglobulins were significantly more frequent.

[Twenty-three cases of gonococcal arthritis (author's transl)]

Twenty-three cases of gonococcal arthritis involving 10 men and 13 women aged from 18-81 years (mean, 32 years) are reported. Seven of the men had developed urethritis 3 to 21 days previously. Seven of the women had no signs or symptoms of genital infection. Twelve patients presented with polyarticular lesions and 7 with monoarticular lesions heralded by migratory arthralgias. The joints most commonly affected were the knees, fingers, wrists and ankles. Ten patients had tenosynovitis of the flexor muscles of fingers, and 10 exhibited a skin rash suggestive of the condition. Haemocultures were positive for N.gonorrhoeae in 4 out of 12 patients. The organism was isolated from synovial fluid in 7/11 cases and from urethral and vaginal secretions in 9/20 cases. All patients were cured rapidly and without sequelae with penicillin or ampicillin.

[Rheumatoid arthritis with antinuclear factor. A prospective study of 50 cases (author's transl)]

The clinical and laboratory features of rheumatoid arthritis (RA) with antinuclear factor (ANF) were prospectively analyzed in 50 patients and compared with those of another series of 50 patients of similar age, sex and duration of disease, but without ANF. The severity of articular lesions was about the same in both series, but systemic symptoms and Gougerot-Sjögren syndrome occurred more frequently in patients with ANF. Gold compounds and D-penicillamine appeared to be well tolerated by all patients. RA patients with ANF had more strongly positive responses to latex and Waaler-Rose tests. Farr's radioimmunoassay was sometimes positive (11/49), but as a rule, the degree of positivity was inferior to 50%.

[Unclassifiable inflammatory rheumatism with HLA B27]

The authors report on 25 patients carrying the HLA B27 histocompatibility antigen and suffering from un-classifiable inflammatory rheumatism. The group included 12 men and 13 women. At the time of the initial observation, the inflammatory rheumatism was localised particularly in the lower limbs, knees, ankles and heels, in 14 of the cases; 7 of the cases revealed chronic polyarthritis, with a largely symmetrical involvement of the joints in the fingers. At the end of the observation period, which lasted 38 months, on average (from 6 months to 1 1/2 years), the series included 3 cases of sero-negative polyarthritis, with symmetrical involvement of the fingers and bony erosions which can probably be classified with cases of rheumatoid polyarthritis (HLA B27 being a coincidence), 2 certain and 3 possible cases of ankylosing spondylarthritis. For several years following the onset of the disease, the majority of the other patient continued to suffer rheumatism of the lower limbs in exacerbations and often accompanied by talalgia.

[Evolutive aspects of Sharp's mixed connective tissue disease. 23 cases (author's transl)]

Among 23 patients with Sharp's disease, 14 initially had only polyarthritis, Raynaud's syndrome and anti-ribonucleoprotein antibodies. During a mean 5.6 years (range: 1-7 years) follow-up these 14 patients, 2 cases of pericarditis, 1 case of trigeminal neuralgia, 2 cases of nephropathy and 1 case of pulmonary arterial hypertension were observed. The 9 remaining patients had symptoms of multiple collagen disease. They were followed up for a mean of 4.3 years (range: 3-7 years) and 3 developed pericarditis. We discuss the prognostic significance of anti-DNA antibodies (7 cases) and low serum complement (3 cases) which, when combined, seem to be associated with severe visceral lesions.

Relapsing polychondritis - pathogenic role of anti-native collagen type II antibodies. A case report with immunological and pathological studies

A patient with relapsing polychondritis and Sjogren's syndrome is reported. Diagnosis was confirmed by ear cartilage biopsy. Antibodies against rat costal cartilage were present in the patient's serum. Antinative collagen type II antibodies were detected using a passive hemagglutination technique and the titer grossly correlated with the clinical course. Direct immunofluorescence using the patient's ear cartilage as a target suggested that anti-collagen antibodies might play a major pathogenic role in the course of relapsing polychondritis.

[Synovial vascularization and inflammation. II. Electron microscopy study of capillary permeability using immunoperoxidase]

The distribution of IgG and IgM into the normal and rheumatoid synovial membrane have been studied by the authors by means of immunoperoxidase electron-microscopy. Within the normal synovial while the IgG are diffusing out of the capillary the IgG are kept in the vascular lumen. Within the rheumatoid synovia IgG and IgM widely diffuse out of the microvasculature. This finding suggest that the rheumatoid inflammation is raising the permeability of synovial capillaries towards IgM molecules.

[Villonodular synovitis of the knee]

The authors report the main results of a study of 12 cases of villous nodular synovitis of the knee. The distribution according to age and sex is in agreement with the data in the literature. The delay between the first sign and the first consultation was, on average, 1.5 years, varying from a few days to 12 years. This long history is due to the usual mildness of the symptoms. The delay between the first consultation and the diagnosis, less variable is, on average, 6 months; this is due to difficulty in diagnosis. More than the extent of the lesions, it seems that the macroscopic appearance dictates the symptoms: villous synovitis or sessile villonodular synovitis, whether diffuse or partial, manifests itself mainly by serous blood-stained effusions; pediculated nodular synovitis, diffuse or localised, is characterised by symptoms on movement. Straight X ray was negative in all the cases reported here. Arthrography gave the diagnosis in 6 of the 9 cases where it was carried out. Arthroscopy was the best examination; in all cases where it was carried out, the macroscopic appearance of the synovial membrane permitted the diagnosis which was confirmed by biopsy under direct vision. Synoviorthesis may give good results, especially radio-isotopic synoviorthesis.

Local hyperthermia and cartilage breakdown: histochemical and metabolic studies on rabbit articular cartilage in vitro

The hypothesis that local hyperthermia generated in inflamed joints may cause damage to the articular cartilage was tested in vitro using histochemical and isotopic methods. We found that this could be the case. Incubation temperatures above 38 degrees C in experiments of longer duration and 39 degrees C during shorter incubation times induced a loss of metachromasia, decreased rates of synthesis, and increased degradation of cartilage matrix macromolecules. It is postulated that local synovial hyperthermia might partly account for the cartilage degeneration that frequently occurs in rheumatoid arthritis as a result of a decreased synthesis and increased catabolism of matrix macromolecules.

[Results of the cytological examination of the synovial fluid in various arthropathies]

329 synovial fluids from various joint diseases were examined. 95% of the fluids from arthrosis contained less than 1 000 cells/ml, figure which seemed to us to be the limit which separates arthrosis from arthritis. Above 100.000 cells/ml, the diagnosis is always pyogenic arthritis. Between 50.000 and 100.000 cells/ml, one may find pyogenic arthritis but also a few cases of rheumatoid arthritis, psoriatic rheumatism, gout and pseudo-gout. In chondrocalcinosis, the fluid variable, often poor in cells. The percentage of polymorphs is of little diagnostic interest; it exceeds 50% in all cases of pyogenic arthritis. R.A. cells are almost constant in fluids with more than 1 000 cells/ml and their diagnostic interest is not great.