Experimental model of disc herniations in rats for study of nucleolytic drugs

An experimental model of disc herniation in tail discs of rats is described. Constant result on nucleus hernia and intervertebral narrowing were obtained by an easy manipulation on numerous rats. Intradiscal injection of aprotinin produced a widening of the disc height. Trypsin, collagenase, chymopapain, and hyaluronidase induced a narrowing of disc height; trypsin induced macroscopic necrosis of the soft surrounding tissues; and collagenase had a destructive effect on nucleus pulposus, annulus fibrosus, and even on end-plates. Chymopapain and hyaluronidase acted mainly on nucleus pulposus. Hyaluronidase could be of interest as a nucleolytic drug and needs further studies on optimal dosage and lack of side effects in the surrounding tissues before injecting it into human discs.

Nonathymulin in rheumatoid arthritis: two double blind, placebo controlled trials

Two randomised double blind, placebo controlled trials have been carried out to assess the effectiveness of nonathymulin, a synthetic thymic peptide hormone, in the treatment of rheumatoid arthritis (RA) and to compare three different dosage schedules (1, 5, and 10 mg/day). Nonathymulin 5 mg proved to be the most efficient dose, providing significant clinical improvement as evaluated by the global assessment of all patients who entered the trials (56% v 17% in the placebo group) (p less than 0.02) and by four objective parameters. This effect was accompanied with minimal adverse effects and was not associated with clear changes in immunological parameters. A significant correlation was observed, however, in clinical response to nonathymulin, and T cell subset imbalance was assessed using monoclonal anti-T cell antibodies and a functional suppressor T cell assay.

[Monocytic arthritis. Study of their clinical significance apropos of 43 cases]

The clinical significance of synovial monocytosis (greater than 50 p. cent) of inflammatory fluids (greater than 1,000 elements per mm3) was studied retrospectively in 43 patients. An accurate diagnosis was made 35 times: rheumatoid polyarthritis (13 cases), lupus disease (1 case), Gougerot-Sjögren syndrome (1 case), isolated infantile monoarthritis (1 case), sarcoidosis (1 case), seronegative spondylo-arthropathy (3 cases), microcrystalline arthritis (5 cases) arthritis revealing a blood disease (2 cases), idiopathic "lymphocytic" arthritis (3 cases), eosinophilic pseudo-allergenic arthritis (2 cases), aseptic osteonecrosis of the medial condyle (1 case), femoro-patellar arthrosis (1 case). Among the 8 other patient for whom no diagnosis was made, 6 had a spontaneously resolving acute affection, evoking the possibility of a viral etiology.

[Nicardipine in the treatment of Raynaud's phenomenon]

The efficacy of the calcium-channel blocker nicardipine in the treatment of Raynaud's phenomenon was assessed in a double-blind, randomised, crossover trial in 20 patients. Each patient received 2 weeks of nicardipine 20 mg three times daily and 2 weeks of placebo. Nicardipine significantly improved the frequency and severity of Raynaud's phenomenon. An open study during 2 months in 30 patients confirmed the effectiveness of nicardipine (20-40 mg 3 times daily). Side effects (headache, flushing, ankle oedema) were frequent but usually mild. We conclude that nicardipine is effective in the treatment of Raynaud's phenomenon.

[Specific antibodies of soluble nuclear antigens in autoimmune vasculitis]

In order to assess the clinical value of antinuclear antibody (ANA) assays in classifying vasculitis, 136 sera from 28 patients with cutaneous vasculitis alone, and 80 patients with vasculitis associated with a connective tissue disease or an unclassified arthritis were tested. ANAs were assayed by indirect immunofluorescence, anti-ENA and anti-histone antibodies were tested by immunodiffusion. ANAs are seldom in patients with cutaneous vasculitis alone (1 positive serum/28 = 3.5%). ANAs are more generally observed in vasculitis associated with systemic lupus erythematosus (SLE) (15 positive sera/16 vasculitis associated with SLE = 94%), rheumatoid arthritis (RA) (8 positive/30 RA with vasculitis = 27%), or a Sjögren syndrome (SS) (9 positive/19 vasculitis with SS = 47%). ANAs in SS are correlated with vasculitis or Raynaud's phenomenon. ANAs are not detected in vasculitis associated with other connective tissue diseases or unclassified arthritis. Anti-ENA antibodies are only found in vasculitis associated with SLE (11 positive sera/13 = 85%) or SS (3 positive sera/19 = 16%). Contrasting with the findings of other groups, our results show no anti-ENA antibodies in RA with vasculitis. Anti-RNP in SLE are correlated with cutaneous vasculitis (p less than 0.005). An antibody different from anti-Ro (SS-A) antibodies but precipitating with a trypsinized human spleen extract was observed in 2/11 sera from RA with vasculitis and not in other sera. Its significance is not established yet; this antibody would have a clinical interest only if further studies showed a high prevalence in rheumatoid vasculitis.

Nicardipine in the treatment of Raynaud's phenomenon: a randomized double-blind trial

The efficacy of the calcium-channel blocker nicardipine in the treatment of Raynaud's phenomenon was assessed in a prospective, double-blind, randomized, crossover trial in 20 patients. Each patient received nicardipine 20 mg or placebo three times a day for two weeks and then was crossed over for two weeks. Nicardipine significantly decreased the frequency and severity of Raynaud's phenomenon as compared with placebo. The authors conclude that nicardipine is effective in the treatment of Raynaud's phenomenon.

[Sciatica caused by synovial cysts and lumbar articular diverticula with intraspinal development. Saccoradiculographic, computed tomographic and arthrographic study]

The authors report 8 cases of patients with synovial cysts (3 cases) or diverticuli (5 cases) of the lumbar joints, compressing the sciatic roots. They describe the radiological aspects of the two sides of the degenerative pathology of the posterior articular processes, which are relatively unrecognized (14 cases in the literature). They insist on the advantage of saccoradiculography which is the only test to be able to demonstrate dynamic alterations in relation with diverticuli, if performed in a standing position. The authors show the advantage of tomodensitometry which supports the diagnosis of cyst in the presence of a fibrous wall image. They emphasize the value of the arthrography of the posterior joint; it presents a diagnostic role by visualizing the cavities, and a therapeutic role by permitting the injection in situ of steroids and/or local anesthetics.

[Lower costovertebral arthritis in rheumatic pelvispondylitis. Pseudourologic manifestation]

Costo-vertebral and costo-transverse joints are often involved during rheumatoid pelvispondylitis. Their involvement may lead to thoracic ankylosis and decreased respiratory capabilities. These arthritis may also cause intercostal or pseudo-visceral pains. The authors report three cases of lower costo-vertebral arthritis, revealed by pseudo-urological, acute or subacute pains. The diagnosis was made on clinical findings (especially mobilization of the lower ribs) and confirmed by X-Rays (especially tomodensitometry). One of the cases presents an image of unilateral pedicle opacity secondary to costovertebral arthritis. The pseudo-urological manifestation of the pain is likely explained by the anatomical relationship between costo-vertebral joints and the sympathetic communicating rami. This close anatomical relationship was confirmed by dissection. Through the communicating rami, the costo-vertebral joints are thus in relation with the sympathetic system, which is responsible for the sensory innervation of the renal space. The pseudo-urological revelation of this arthritis should be compared to that of costal sprains.

[Ankylosing spondylitis with juvenile onset. Study of 62 cases]

The study of 338 files of patients hospitalized for ankylosing spondylarthritis between 1977 and 1985, has enabled to select 52 cases (15 p. cent) of juvenile forms (onset before the age of 16). An additional 10 cases followed in pediatric clinic are included. The male predominance is definite (88.7 p. cent); the onset is late (mean age: 11.6 +/- 3.2 years) and, most of the time, at the level of a peripheral joint (79 p. cent). The evolution, studied with a mean follow-up of 11.2 +/- 4.8 years, is usually manifested by bouts of peripheral and/or axial arthritis (82.2 p. cent). Joint involvement predominates in the lower extremities: knees (23 cases) and feet (21 cases). The late appearance of spinal and/or sacro-iliac joint involvement explains the late diagnosis (5.6 +/- 4.8 years). Visceral involvement is less frequent (12 cases of eye involvement). The functional prognosis is dominated by a severe involvement of the coxo-femoral joints (46.6 p. cent). Heel pain with posterior and/or inferior talus erosions (15 cases) are, because of their frequency, interesting for making the diagnosis. The total functional prognosis is relatively good: Steinbrocker stage 0-1 for 26 patients (44 p. cent). A bilateral arthroplasty was performed in 9 patients with an excellent result in 7 cases.

[Erythrocyte sedimentation rate and serum immunoglobulins in rheumatic pelvispondylitis]

Blood sedimentation rate and balanced titration of immunoglobulins were studied in 59 patients presenting a ankylosing pelvispondylitis: in 30 of them, these examinations were repeated at an interval of 3-6 months. The sedimentation rate (Sed. rate) and the level of immunoglobulins G and A increased in the course of the disease, but an elective increase of the level of immunoglobulins A was not demonstrated. Neither the Sed. rate, nor the level of IgA are correlated to evolution criteria of the disease; a positive correlation is only found with the platelets number, in a vertical study of 59 patients. Nevertheless, the variations of the immunoglobulins A is positively correlated with alterations of the clinical condition as demonstrated in the longitudinal study carried out in 30 patients. This finding supports physiopathological hypothesis which incriminates microbial intestinal infections at the origin of evolutive bouts of ankylosing pelvispondylitis.

[Systematic ileocolonoscopy in seronegative spondylarthropathies]

An inflammation of the ileum was observed by Mielants and Veys in patients suffering from reactional arthritis associated to HLA B27 antigen. We thought it would be interesting to perform a systematic ileo-colonoscopy in patients suffering from seronegative spondylo-arthropathy, whether it was an axial or a peripheral form of the disease, or it was associated or not to HLA B27 antigen. The results observed in 30 patients who responded to the criteria of Wright and Moll for the diagnosis of seronegative spondylo-arthropathy, were compared to those of 18 patients suffering from various gastro-intestinal disorders. Macroscopically, a minimal abnormality (erythematous patches and/or micro-ulcerations) was observed in 10 out of 30 patients, and never in the reference group (p less than 0.02). The histological examination demonstrated, in patients suffering from spondylarthritis, a higher frequency of minimal signs of inflammation (lympho-plasmocytes infiltration) at the level of the ileum (in 18 out of 19 patients versus 11 out of 18 patients in the reference group, p less than 0.05) and at the level of the rectum (in 15 out of 19 patients, versus 8 out of 17 patients in the reference group, p less than 0.05). This study suggests therefore the presence of minimal ileorectal inflammation in patients with seronegative spondylo-arthritis, which could have an influence on the pathogenesis and/or the evolutive course of the disease.

[TaqI restriction polymorphism and the HLA-B27 allele in ankylosing spondylitis]

The restriction polymorphism Taq I of the 3.5 kb fragment of Class I HLA sequences is tested in patients suffering from ankylosing spondylarthritis, with or without antigen HLA B27. In a reference population, the frequency of this polymorphism is higher than that of allele B27. All B27 individuals, ill or not, present the polymorphic band, also present in some individuals B12. The distribution of this band is studied, in unrelated individuals serotyped for HLA B as well as members of families with spondylarthritis. The presence of the variable 3.5 kb band is not automatically correlated with the gene of the disease in corresponding individuals.

[Treatment of ankylosing spondylitis with salazosulfapyridine. A controlled double-blind study in 60 patients]

The efficacy of salazosulfapyridine (SI) has been recently reported in the course of peripheral arthritis in ankylosing spondylarthritis (SPA), but is action on the axial forms of the disease was not known. We have therefore conducted a therapeutic trial in 60 patients suffering from SPA, without peripheral involvement clinical sign evoking an enterocolopathy. This double-blind study compared the activity of SI at a dose of 2 g/day with a placebo, for 6 months. Thirteen patients had to discontinue the treatment: 6 in the placebo group (inefficacy: 3 cases, anemia: 1 case, epigastric pain: 1 case, rash: 1 case) and 7 cases in the SI group (inefficacy: 2 cases, nauseous: 3 cases, abdominal pain: 1 case, moderate elevation of transaminases: 1 case). These 13 patients were kept for the global analysis and considered as therapeutic failures. The treatment was considered effective in 15 out of 30 patients of group SI and in 30 patients on placebo (p less than 0.02). In addition, in group SI, a statistically significant decrease of the daily dose of non-steroid anti-inflammatory drugs was observed (-6.5 +/- 7.2 versus -2.4 +/- 6.4 in the placebo group, p less than 0.05); also was observed a decrease of the functional index (-5.9 +/- 6.6 versus -1.9 +/- 5.7 in the group placebo, p less than 0.05) and of the serum level of immunoglobulin G (-1.8 +/- 3.6 g/l versus +0.8 +/- 2.9 in the placebo group, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

[Ankylosing spondylarthritid and Berger's disease. A fortuitous association?]

Fifteen cases of ankylosing spondylarthritis, associated to an IgA nephropathy have been reported in the literature. This association may be fortuitous, or on the contrary suggest a common pathogenic link between the two diseases and the authors have compared the incidence of radiological abnormalities of the sacro-iliac joints as well as the incidence of rheumatoid clinical signs in 186 patients suffering from an IgA nephropathy to those observed in 192 reference patients. This study could not demonstrate any difference between the two groups and, therefore, suggests that the cases reported in the literature are secondary to a simple fortuitous association.

[Multicentric reticulohistiocytosis. A case with unusual clinical, radiologic and ultrastructural aspects]

We are reporting a case of multicentric reticulo-histiocytosis which is exceptional because of its gravity and the diversity of the clinical lesions: huge subcutaneous nodules, bone destruction in the spine responsible for spondylolisthesis, pulmonary fibrosis, acute pericarditis, laryngeal compression requiring a permanent tracheostomy. From ultrastructural observations, various hypotheses to explain the intra-macrophagic accumulation of membrane granules and lipids are discussed.

[Arthritis of the wrist disclosing osteoid osteoma of the capitate bone]

A 22-year-old woman with an osteoid osteoma of capitate bone presented initially with arthritis of wrist. Bone scan imaging and digital subtraction angiography allowed diagnosis of a nidus. This case draws attention to articular manifestations of osteoid osteoma.

Cyclosporin A in rheumatoid arthritis: preliminary clinical results of an open trial

Twelve patients with refractory rheumatoid arthritis were included in a 1-year open trial of cyclosporin A (CsA), 5 mg/kg/day. Clinical efficacy was observed 1 month after beginning treatment, was well established after 4 months of therapy, and remained stable for the remainder of the 1-year treatment period. Among the numerous side effects observed, renal toxicity and hypertension occurred suddenly during the trial and required constant monitoring, adequate therapy, and modulation of CsA dosage. Cyclosporin A seems to be an effective treatment for active rheumatoid arthritis, but it requires close monitoring for toxicity.

Defective IL2 production in active rheumatoid arthritis. Regulation by radiosensitive suppressor cells

The production of interleukin 1 (IL1) and interleukin 2 (IL2) by mononuclear cells (MNC) from untreated rheumatoid arthritis (RA) patients or healthy subjects were examined. After PHA stimulation, patient MNC or T cells produced varying amounts of IL2 that were related to the disease activity: patients suffering from active disease showed a scant production of IL2 while those who had a quiescent disease were high producers. The prior irradiation of unfractionated MNC induced a marked increase of the PHA-stimulated IL2 production in both active and quiescent patients compared to the moderate augmentation observed for controls. On the other hand, irradiation of enriched T cells had an enhancing effect only in the active RA patient group. Concurrently, we found that non T cells from active or quiescent RA patients were fully competent to produce IL1 upon LPS activation. Taken together, these findings suggest that the suppressive activity evidenced by irradiation could be mediated by non T cells in quiescent disease or in absence of illness. On the other hand, both radiosensitive suppressor T and non T cells may interfere in IL2 production by active RA patient lymphocytes.