[Gonococcal arthritis]

Gonococcal arthritis, a rare complication of gonorrhoea, more frequent in women, causes polyarthritis in 75% of cases or monoarthritis. An erythematous skin rash or acute pustular rash (40%), recent signs of genital infection (75% of cases in man, less than 50% in women) suggest the diagnosis. The gonococcal nature of the arthritis is confirmed by isolation of the germ in the joint fluid, the blood and the skin biopsies. In about half the cases, these bacteriological investigations are negative, but the diagnosis remains very probable if the germ is isolated from one or other of the primary foci of the infection: ureter, cervix, vagina, rectum and even pharynx. The rapidly favourable course under antibiotic treatment with penicillin or ampicillin confirms the diagnosis. The pathogenesis of arthritis is a direct toxic action of the gonococcus on the synovial membrane and the periarticular structures. The role of circulating immune complexes recently demonstrated in gonococcemia is probably not relevant.

Action of vitamin D metabolites on PTH secretion in man

We have examined the effects of metabolites of vitamin D [25OHD3, 1,25(OH)2D3, 24,25(OH)2D3, and 25,26(OH)2D3] on serum calcium and iPTH in human deficient-D osteomalacia. The four metabolites decreased iPTH, but only for 1,25(OH)2D3 was a significant correlation between increase of serum calcium and decrease of iPTH observed. The 24,25(OH)2D3 and 25,26(OH)2D3 decreased iPTH despite a decrease of serum calcium at the beginning of treatment. The 25OHD decreased iPTH before increased serum calcium. These results could be interpreted as a direct effect of metabolites of vitamin D on PTH secretion. However, the conversion of other metabolites and the calcium concentration in parathyroid cells must be determined before this hypothesis can be accepted.

Relapsing polychondritis. An ultrastructural study of elastic and collagen fibres degradation revealed by tannic acid

In a case of relapsing polychondritis, ultrastructural study of ear cartilage using tannic acid staining showed patterns of degradation of elastic and collagen fibres. The participation of macrophages and chondrocytes in the resorption of ear cartilage is discussed.

Bone histomorphometry in hemodialysed patients

We performed bone histomorphometry in thirty hemodialysed patients. Ten patients had a double iliac bone biopsy to estimate bone histomorphometry reproductibility. There was no difference between the mean results for each of the 10 patients at each site. However, there was an intra-individual variation which was small for the parameters of formation and particularly osteoid thickness and mineralizing rate and greater for resorption parameters. Mineralization rate appeared the most reliable and discriminant parameter. These 30 patients were separated in two groups according to their mineralizing rate (MR); patients with an MR greater than 0.3 mu/day were in group I and had severe hyperparathyroidism without major impairment of bone mineralization and high formation rate. They also had high serum alkaline phosphatases and high serum parathyroid levels measured with a COOH terminal antibody (iPTH). Patients with a low MR less than 0.3 mu/day (group II) had a severe mineralization defect with low formation rate, normal alkaline phosphatase and significantly lower levels of iPTH than in group I. This last type of histological bone lesion could not be due to aluminum intoxication since the level of serum aluminum was the same in the two groups. The mineralizing defect appeared to be inversely correlated with the percent of osteoid surfaces covered by osteoblast and with the iPTH level. These data suggest that during the course of renal osteodystrophy PTH stimulates not only bone resorption but also bone mineralization by increasing osteoblastic number.

Bone histomorphometric reproducibility in normal patients

To study bone histomorphometry reproducibility in normal subjects, we performed during orthopedic surgery bone biopsies in 16 postmenopausal women. Each woman had four bone biopsies, two at the usual site in the iliac crest, one on the left and one on the right side, and two other biopsies just behind the usual site, one at each side. We performed measurements of trabecular bone volume, relative osteoid volume, osteoid surfaces, osteoclastic resorption surfaces and calcification front. The average values of the 16 patients were compared, on the one hand, two by two, by a student test, and on the other hand, by a variance analysis. By these two methods the results showed no significant difference between the average values of the 16 patients at each location for any of the histomorphometric parameters studied. However, there was a location variation which was estimated by the intra-individual variation for a given patient. On the other hand, we calculated from the variance analysis the location variance for a group of 10 to 100 patients. In any case all the parameters had a location variation which was high for osteoclastic resorption surfaces and relative osteoid volume when expressed in % of the absolute value of these parameters. The variation of the trabecular bone volume was 0--46. 15% (95% confident limit interval) in a single patient and the hypothetical value of the location variation was 41.6% for a group of 10 patients and 13.0% for a group of 100 patients.

[Radiological study of painless knees in 50 men over 65 years of age. II. Axial projection and profile radiography (author's transl)]

Radiographs were taken in profile, and femoropatellar axial projection with 60 degrees flexion, in 50 men over 65 years of age who had never complained of symptoms related to their knees. Visible osteophytes of the patella are very frequently noted in profile radiography and were present in 35 subjects. Painless femoropatellar arthrosis is also frequent and this was noted on 60 degrees axial radiography in 7 subjects; unilaterally in 3 cases and bilaterally in 4 subjects. In 9 cases the femoropatellar arthrosis was external, while in 2 cases it was present both externally and internally. Detection of a patellar osteophyte on profile radiography does not necessarily imply the existence of femoropatellar arthrosis detectable radiologically on axial projection. This study was also able to define values for a certain number of the parameters of radiological morphology of the knee.

[HLA complexes and psoriatic rheumatism]

A study of the HLA system during psoriasis and psoriatic rheumatism demonstrated several genetic markers. The associations of psoriasis with antigens of locus B are feeble (HLA B 13, HLA B 17) or incontant (HLA B 37, HLA W 16). On the other hand, there existe a very strong link between psoriasis with an antigen of locus C (HLA CW6) found in all races and with antigens of locus C (HLA DMO, HLA DW 11). During psoriatic rheumatism, antigen HLA B27 is present mainly in the forms with spinal involvement. No peripheral marker of arthritis has been demonstrated until now, the increased frequency of BW 38 does not seem specific of the joint involvement.

[Radiological study of painless knees in 50 men over 65 years of age. I. Teleradiography in the frontal position with the patient standing (author's transl)]

Teleradiographic examinations of the lower limb, from the frontal position with the patient standing, were conducted in 50 men over 65 years of age who had never had painful knees. One knee (out of 100) was found to have an internal femoro-tibial arthrosis. The femoro-tibial angle in the arthrosis-free knees was -0.27" (+/- 2.83 degrees) on the right and -1.10" (+/- 3.05 degrees) on the left. The mean femoro-tibial angle was -0.68" (standard deviation 2.9 degrees), and normal values are therefore -5.5 degrees to +5.1 degrees. There was no evidence, therefore, of statistically significant physiological genu valgum in the population studied. Marginal osteophytes and tibial spines are frequently observed and have no pathological significance. A meniscochondrocalcinosis was present in 8 percent of the subjects.

[Synovial vascularization and inflammation. I. Morphologic study using light and electron microscopy]

The authors studied using light and electron microscopy, 40 cases of sub-acute inflammatory synovitis (including 24 cases of rheumatoid synovitis) and 10 normal synovia. In light microscopy, the study dealt with images of capillary congestion, endothelial hyperplasis and capillary obliterations. In electron microscopy the morphology of the capillaries, the images of plasmic exsudation, images of extravascular cell migration and vascular obliteration by the endothelial cells, were studied in comparison with the inflammatory synovitis and the normal synovia. Inflammatory synovitis are characterized by the frequency of extracapillary cell migrations without there being any other pathological change of the microvessels that can be attributed to inflammation.

[Our experience with surgery of the rheumatoid metatarsus. 150 cases]

The authors report on the results of their experience with surgery of the rheumatoid metatarsus (95 patients operated on--150 operations). The operation most frequently performed was the Lelievre metatarsian resection-alignment. They confirm the advantage of this type of surgery, which provides very handicapped patients with substantial relief, both of pain and of the functional troubles, despite the nature of the disease involved. Out of 80 patients operated on and followed up over a period of 2 to 14 years, and considering the correction of the deformities, the effect on pain and functional troubles, the authors report 103 very good and good results, and 18 poor results and failures. The good results obtained deteriorate only very little in the long run: after 10 years, the very good and good results involving effect on pain, has gone from 96 to 90%. On the other hand, as far as functional troubles are concerned, very good and good results go from 90% to 70%. The authors underline the advantage of a very through examination, in order to look for post-operatory risk factors (peripheral circulatory deficiency and poor resistance to infection). They insist for exercising great prudence when advising an operation consisting of the interposition of an endoprosthesis (Swanson's implant). Indeed, in subjects who are in any way fragile, delays in scarification, related to hematomas complicated or not with skin necrosis appear with increased frequency after interposition of the implant.

Cellular junctions in normal and inflammatory human synovial membrane revealed by tannic acid and freeze fracture

Cellular junctions between synovial cells and endothelial cells of the microvasculature were examined in 10 normal and 20 inflammatory human synovial membranes by means of tannic acid and freeze fracture, Gap junctions and desmosomes predominated on synovial cells, and tight junctions in the microvasculature. Comparison between normal and inflammatory synovial membranes did not demonstrate changes in cellular contacts that might be caused by inflammation.

[Antinuclear antibodies: immunological characteristics and clinical significance]

Fifty sera containing antinucleolar antibodies were o gathered in a routine laboratory during testing for antinuclear antibodies with indirect immun-fluorescence over a five-year period. The patients involved were suffering from sclerodermia (13 cases), rheumatoid arthritis (7 cases), polymyositis (3 cases), lupus (2 cases), various rhumatismal disease (59 cases) and non rhumatismal diseases in 16 cases, including 5 malignant diseases. In 80 per cent of the cases nucleolar fluorescence was combined with nuclear fluorescence of another type. The antibodies were almost always of the IgG category and belonged in 2/3 of cases to several immunoglobulin categories, most often IgG-IgA. Pretreatment of the liver cuttings with RNase always modifies the nucleolar fluorescence, most often making it negative, and pretreatment with DNase using a combination of enzymes 10 times higher also modifies it (more often decreasing it than making it negative), which indicates that the nucleolar antigen, probably an ARN with a low molecular weight, also depends upon the ADN.

[Axial osteosclerosis with autosomal dominant transmission: a new entity?]

The authors report on the case of a 26-year-old woman and three members of her family suffering from a benign condensing osteopathy, of dominant autosomic transmission, characterized mainly by a non homogenous hyperopacity of the spine and the pelvis, without alcaline hyperphosphatasemia, and which seems to them different from the condensing ostepathies described up to now.

[Serum and articular immune complexes detection by the antibody-dependent cytotoxicity inhibition reaction in inflammatory rheumatological conditions and connective tissue disorders (author's transl)]

Detection of circulating and intra-articular soluble immune complexes, has been done in 28 rheumatoid arthritis, 8 mixed connective tissue diseases and 8 other connective tissue diseases. The method used, is based on a competition reaction in the antibody dependent lymphocytotoxicity reaction (ADC). In rheumatoid arthritis serum immune complexes were detected in 75% of the seropositive cases and 66% of the seronegative ones. The mean level of complexes is higher in the former form of the disease. In a given patient, the concentration of immune complexes in joint fluid, is higher than in serum. Immune complexes were present in the serum of 75% of patients with mixed connective tissue disease, but, here, at a concentration lower than in rheumatoid arthritis and systemic lupus erythematosus. It is proposed that measurement of serum immune complexes, can also be an interesting parameter in the follow-up of the patients.

[Distribution and correlations of serum uric-acid in two French adult populations: 13,885 men and 6,861 women (author's transl)]

Distributions and correlations of serum uric acid (SUA) were studied in 13,885 men and 6,861 women who were between the ages of 20 and 90. In men and women the distribution of SUA is unimodal. The average SUA value is 6,28 mg/100 ml SD: 1,19) in men and 5,05 mg/100 ml (SD: 1,10) in women, 27% of the men and 4% of the women have a SUA level above 7 mg/100 ml. In men and in women correlations of SUA with an obesity index is strong (r = 0,272; r = 0,311). In men partial correlations between SUA and age, blood pressure, cholesterolemia, glycemia and hemoglobinemia diminish when obesity index is fixed. In women these correlations are stronger and do not vary when obesity index is fixed. In men and women the correlation between SUA and creatininemia is strong and do not vary when obesity index is fixed.

In vivo analysis of bone calcium by local neutron activation of the hand: results in normal and osteoporotic subjects

Mineral loss from bone can be measured accurately and reproducibly by neutron activation of the hand bones using a 5-min irradiation (10(6) n/cm2-sec) with two 200-microgram sources of Cf-252. The hand dose is 7.5 rad equivalent and the dose to the rest of body is 1.5 mrem. Controls (132) and osteoporotic patients (45) were compared. Between ages 20 and 60 the control group showed a bone calcium concentration of 0.177 +/- 0.025 g/cm3, independent of age. Between 60 and 70 the content remained unchanged in men but declined in women to 0.15 +/- 0.2 g/cm3. In all age groups osteoporotic patients in general showed lower calcium content. Comparison of our findings ("Ca") with estimates of bone mineral content obtained by photon absorptiometry ("BMC") yields 0.07 Ca + 0.262 (r = 0.87). Activation analysis of hand bone appears more precise than BMC for the monitoring of bone-mineral loss in each individual and as a measure of treatment efficacy.