[Articular and muscular manifestations of bacterial endocarditis. 11 cases (author's transl)]

We report 11 cases of bacterial endocarditis with muscular and articular manifestations seen over the past ten years. There was arthralgia in 7 cases, vertebral pain in 7 cases and myalgia in 3 cases. Arthritis consisted of a monoarthritis of the ankle in 2 cases and oligoarthritis in 2 cases. There were also 2 cases of lumbar spondylodiscitis and 1 of finger clubbing in the series. The underlying heart disease was a valvular lesion of the left side of the heart in 10 cases out of 11 and the organism isolated by blood culture was a streptococcus in 9 cases and a staphylococcus in 11. We emphasis the need for early diagnosis and appropriate antibiotic therapy, in the absence of which the course may be fatal in the short term, as it was the case in one of our own 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 628 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.

Clinical significance of antibodies to soluble extractable nuclear antigens (anti-ENA)

Clinical and biological manifestations have been studied in 134 patients whose serum had antibodies to soluble extractable nuclear antigens (ENA). 85 of the patients had anti-RNP antibodies, 18 had anti-Sm antibodies, and 31 had antibodies to one or more soluble nuclear antigen. In all groups, the predominant clinical manifestations were polyarthritis, Raynaud's phenomenon, fever, and skin involvement. Renal disease was less common in those patients with anti-RNP antibodies than in the other patients. Most patients with definite renal disease (13 out of 15) also had circulating anti-DNA antibodies. The final diagnoses in these 134 patients were well defined connective tissue disease in 59; overlap syndromes in 34; a limited clinical syndrome made up of polyarthritis Raynaud's phenomenon--often with swollen fingers--and/or hypergammaglobulin-aemia in 31, and various other clinical conditions in 10.

[Post-salmonella rheumatism: case report]

A twenty seven year old man had polyarthritis following diarrhoea due to Salmonella typhimurium. The role of the salmonella infection in the pathogenesis of this joint problem would appear to be confirmed by the detection of the organism on stool culture and a positive reaction for specific antigens in the blood. The arthritis was cured in six weeks under the influence of non-steroid anti-inflammatory agents.

[Contribution to the study of scapulo-humeral periarthritis: anatomical lesions of simple chronic painful shoulder]

The authors restate that simple pain of the shoulder, which is a form of scapulo-humeral periarthritis characterized by the existence of pain without limitation of movement, is almost always associated with lesions of the tendons of the short muscle teres of the shoulder. They term chronic simple pain of the shoulder the rare cases where, despite therapy that is reputed to be efficient, there is a gradual development lasting more than one year, either continuously or with relaps periods of less than three weeks. They show that these chronic shoulders are practically always associated with a rupture of the coat of the muscle teres or a calcification of the tendons of the teres coat. Ruptures are as much frequent in men as in women and calcifications definitely more frequent in women (60%). Before 30 years of age, the most frequent lesion is almost always a calcification, and after 65 rupture is more common. Between 30 to 65, the probability of a calcification in a chronic simple painful shoulder, goes from 100% to 0, while the probability of a rupture increases from 0 to 100%.

[The clinical significance of soluble nuclear antigen specific antibodies (author's transl)]

Anti-ENA antibodies have been found in 176 sera which nearly all contained antinuclear antibodies giving a speckled pattern of nuclear fluorescence. The charts of 134 of these 176 patients were available for a thorough clinical study. Among these 134 patients, 59 had a well defined Connective Tissue Disease including 40 SLE, 31 had a limited clinical syndrome made of Raynaud's phenomenon, inflammatory polyarthritis, swollen fingers and hyperglobulinemia and 34 had a complex clinical picture associating signs of more than one connective tissue disease. Some of the patients in this third group could be considered as-having the Mixed Connective Tissue Disease (MCTD) described by Sharp et al. Anti-RNP antibodies were more common in this series than the other anti-ENA antibodies. However, no narrow specificity could be assigned to any of these antibodies. This is true of the non anti-RNP antibodies, the anti-Sm in particular, which were found in 49 patients of whom 32 had SLE existing alone or in association with features of other connective tissue diseases and 17 had another connective tissue disease or the afore-mentioned limited clinical syndrome. In any case, the anti-ECT antibodies never reach the diagnostic value of the anti-DNA antibodies.

[Articular chondrocalcinosis after 80 years of age]

In 108 women over 80 (mean age 88,4 years, extremes 80 and 99 years) hospitalized in a geriatric service for various reasons, radiograms were made of both knees in the frontal aspect on standard film to detect calcinosis of the meniscus and chondrocalcinosis of the joint. In 25 women (23.1%) the radiographs revealed calcinosis of the meniscus with or without chondrocalcinosis. In these 25 cases a lateral X-ray was also made of the two knees, frontal X-rays were made of the pelvis, thumbs and shoulders. In 22 cases (88%) these revealed calcification of the fibrocartilages or articular cartilages in joints other than the knee. Seven of the 25 women had at least one attack of articular inflammation (especially of the knee) resembling a pseudo-gout crisis. The frequency of chronic arthropathies resembling arthroses was high in the 25 patients with chondrocalcinosis: 8 (32%) had an internal or external femoro-tibial arthrosis, as against 11 of the 83 patients (13%) of the same age without chondrocalcinosis, a significant difference. Eleven of the 25 women had signs of femororotular arthrosis on the lateral X-rays of the knees, 5 had coxarthrosis (with in 3 cases a radiological image of fibrocartilaginous or coxofemoral cartilaginous calcification). One women had chronic radiocarpal arthropathy evocative or chondrocalcinosis. Ten had a scaphotrapezoidal arthrosis, 5 arthrosis of the shoulder, 3 with radiological aspect of glenohumeral chondrocalcinosis.

[Radioimmunologic determination of plasma parathormone in hypercalcemia caused by cancer with osseous metastases]

The plasma parathormone was measured by radioimmunological determination in 23 cases of cancer with bone metastases, 8 of mammary origin. In 11 cases the plasma parathormone (iPTH) was less than 4 ng/ml (lower normal limit), as might be expected in view of the hypercalcemia. In 12 cases the iPTH was higher than 4 ng/ml, in 8 of these higher than 8 ng/ml (upper normal limit). These results are suggestive of the role of a substance analogous to parathormone in the genesis of the hypercalcaemia and peritumoral bone resorption of bone metastases of solid tumors.

[Treatment of rheumatic polyarthritis with levamisole in 26 patients]

Twenty-six patients with rheumatic polyarthritis (serologically positive) were treated with levamisole at a daily dosage of 150 mg. Treatment was continuous for 3 months and 2 days weekly afterwards. Although improvement may appear from the 1st month onwards, it is more frequent between the 1st and 3rd month (13 good or very good results among the 16 patients still treated) and may even improve afterwards (11 good or very good results among the 11 patients still treated in the 6th month). However, the value of levamisole, which appears to be an active drug against rheumatic polyarthritis, is limited by the frequency of side-effects. In 17 cases the trial had to be discontinued for this reason. The most serious side-effects were of haematological nature (2 leukopenias, 1 thrombocytopenia), but in these patients agranulocytosis was not found.

[HLA markers and periodic disease [familial Mediterranean fever (F.M.F.)] (author's transl)]

Thirty-one unrelated patients, 15-52 years old, were typed by microlymphocytotoxicity for 27 alleles of the HLA system. In addition, 12 families including 1 or more patient were also analysed. This criteria for diagnosis were those of Sohar et all. (Am. Intern. Med., 1967, 43, 227-253). All patients were of Israelite-Sephardin origin except two (Armenian and French); they were from North-Africa (Tunisia, Morocco and Algeria) and Israël. The results were compared to the antigen frequencies of 3 reference normal populations. The frequencies of the studied alleles do not differ from those of controls, except for HL-A28 and B14 slightly increased when compared to the normal frequencies. The study of 7 families with at least two sibs suffering from FMF shows a random distribution of the genotypes : 2 HLA identical, 6 different and 10 haploidentical diseased sibs. This distribution differs significantly (p less than 0.01) from that expected in the case of a recessive inheritance. These data do not support the hypothesis of a linkage between genes controlling FMF and HLA genes.

Lymphocyte tubular structures in rheumatoid arthritis

Two types of lymphocyte tubular structures were studied by electron microscopy in 80 patients with classic or definite rheumatoid arthritis (RA). Fifteen patients with unequivocal systemic lupus erythematosus (SLE) and 10 healthy persons were studied as controls. Lymphocyte tubulo-reticular structures were found in 13 of the 80 patients with RA and in 10 of the 15 patients with SLE. No tubuloreticular structures were found in any of the healthy subjects. In the RA patients antinuclear antibodies, LE cell phenomenon, and chlorambucil treatment were associated significantly with these inclusions but disease activity was not related to their presence. In cases in which tubuloreticular structures were present the number of cells containing inclusions was on average much lower in patients with RA than in those with SLE. Lymphocyte tubular parallel arrays were found in all the patients with RA and SLE and in all the healthy persons. In all three groups the average number of cells containing parallel tubular arrays was similar.

[Effect of cortisone on calcium metabolism. Attempt at correction by 5,6 trans 25-hydroxycholecalciferol, 25-hydroxycholecalciferol and vitamin D2]

14 patients receiving small doses of predisolone and 7 high doses were divided at random into three groups. Each group received for four weeks, 100 microgram of vitamin D2 or 25 hydroxyvitamin D3 or 5,6 trans-25 hydroxyvitamin D3. The 25 hydroxy and 5,6 trans-25 hydroxyvitamine D3 were able to increase intestinal calcium absorption. 25 Hydroxyvitamin D3 had an osteolytic action, increasing urine calcium and hydroxyproline and, once, in a patient slight hypercalcemia was observed. By constrast, 5,6 trans-25 hydroxyvitamin D3 decreased PTH and caused a significant decrease in urine hydroxyproline.

[Diagnostic value of synovial membrane immunofluorescence]

The immunofluorescent study of 93 synovial membranes of persons suffering from various types of arthropathy has shown that the only element sufficiently specific to have real diagnostic value is the presence of cells with a fluorescent cytoplasm. This appearance was in fact found in 63% of the cases of rheumatoid arthritis, irrespective of their being either seropositive or seronegative, in 69% of the cases of probable rheumatoid arthritis, in only 15% of the unclassified cases of arthritis, in 28% of the cases of various types of arthritis (20% with exclusion of a case of mixed connectivitis and of a case of Waldenström's macroglobulinemia with rheumatoid arthritis) and in 0% of the cases of mechanical arthropathy. The results of immunofluorescent examination compare favorably with those of standard histology: the classical histologic appearance of rheumatoid synovitis with a node-forming tendency of the infiltrate was observed in only 36% of the verified cases of rheumatoid arthritis, while immunofluorescence was positive in 63% of the cases in this group. In the category of unclassified arthritis, these percentages were comparable, viz. 19% and 20%, repectively. The presence of cells with fluorescent cytoplasm during immunofluorescent examination of the synovial membrane may be regarded as an additional criterion supporting the diagnosis of rheumatoid arthritis.