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Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to digestive tract involvement. Pancreatic involvement is a rare and benign complication. The authors report two cases of acute pancreatitis as a complication of HSP. Pancreatitis was confirmed in both cases by clinical presentation and increase of serum amylase levels. Abdominal echography has demonstrated ascites or alithiasic cholecystitis without pancreatic abnormality. The prognosis was favourable in each case. Pathophysiologic mechanism is presumably a vasculitis of the small vessels specially within the pancreas leading to inflammation. Abdominal pain can be explained by a digestive tract involvement but also by an acute pancreatitis. This later occurrence is not as exceptional as reported in the literature. Thus, serum amylase levels should be evaluated in patients with HSP who have intense epigastric or abdominal pain, in order to recognize a pancreatic involvement.

Chronic hepatitis is infrequently reported in the course of RA (1.9%). We report 6 cases with such an association. The six patients were all female (mean age: 59.5 years) with typical RA (ACR criteria), and sicca syndrome in 5 cases. Chronic hepatitis always developed after the onset of RA (delay: 1 to 47 years). Laboratory findings revealed a mild increase of transaminases. Alkaline phosphatase were increased in 3 cases. Liver insufficiency was present in 4 cases and polyclonal hypergammaglobulinemia in 6 cases. Rheumatoid factors were detected in 5 cases; antinuclear antibodies and anti-smooth muscle antibodies were also detected in 5 cases. Histological examination of liver biopsy disclosed active chronic hepatitis in 5 cases (with cirrhosis in 3 cases) and persistent chronic hepatitis in 1 case. Steroid therapy was administered in 4 cases of active chronic hepatitis with clinical and biological improvement (18 months to 6 years follow-up). One patient died of gastric bleeding.

Antibody-dependent cell-mediated cytotoxicity mediated by peripheral blood lymphocytes was studied in patients with systemic lupus erythematosus, polyarteritis nodosa. Sjogren's syndrome, and rheumatoid arthritis. The target cells were chicken erythrocytes coated with rabbit anti-chicken erythrocyte antibody. Antibody-dependent cell-mediated cytotoxic activity was normal in Sjogren's syndrome and rheumatoid arthritis but significantly decreased (P is less than 0.001) in active systemic lupus erythematosus and in two patients with polyarteritis nodosa. A partial regeneration of antibody-dependent cell-mediated cytotoxic activity was obtained by treatment with pronase and DNase followed by overnight incubation. Sera from patients with systemic lupus erythematosus inhibited antibody-dependent cell-mediated cytotoxic activity of normal lymphocytes. The inhibitory activity was studied by specific immunoadsorption and sucrose density geadient ultracentrifugation. Removal of IgG but not IgM greatly reduced inhibition. Inhibitory factors were present in 7S and heavier fractions containing IgG. Five systemic lupus erythematosus patients were studied serially to determine if improvement in clinical status could be correlated with a decrease in serum inhibitory factors as studied by inhibition of normal antibody-dependent cell-mediated cytotoxicity. Indeed, a greater serum inhibitory capacity was found in each patient during periods of greater disease activity.

Out of 214 cases of infective sacro-ileitis observed on Rheumatology Units, 65% were due to common bacteria, 25% were tuberculous and 10% due to brucellosis. Post-partum infections were early, severe and often due to streptococci. Sacrocoxalgia was accompanied in 50% of cases by another focus of active tuberculosis. Two clinical presentations are possible, either that of acute sacro-ileitis with a sudden onset, severe pain, frank infection and major impotence which is common in infections due to current bacteria; or the presentation may be that of subacute sacro-ileitis with progressive onset with little or no fever, pain and moderate impotence which may be due to any bacteria. Identification of the responsible organism depends on blood culture, bacterial sampling at the point of entry of the infection but, above all, direct swab or preferably needle biopsy. Bone scan may demonstrate early hyperfixation in the absence of any radiological signs. Prolonged antibiotic treatment is sufficient in most cases.

Efficacy, safety and therapeutic benefit of etodolac (Lodine 200) in rheumatological practice. An open clinical trial performed by 974 rheumatologists enabled an evaluation of efficacy, safety and therapeutic benefit of etodolac (Lodine 200) on 4,947 patients with rheumatoid arthritis, ankylosing spondylitis and osteoarthritis of the lower limbs; the initial dosage was 600 mg/d (for 2 weeks), then 400 to 600 mg/d (for 2 to 4 weeks, according to the indication). Efficacy, assessed by classical items for NSAID's, was shown to be excellent to good by 61-77 p. 100 of patients, according to the indication. 7.7 p. 100 of patients only dropped out for lack of efficacy. 20.4 p. 100 of patients developed adverse effect(s) (AE), but the relationship between etodolac and AE was assessed "possible" or "probable" only for 9.6 p. 100 of patients; this figure should be compared to the 7.6 p. 100 of patients who dropped out for AE and to the 92 p. 100 of patients who assessed the global safety as "excellent or good". The therapeutic benefit was estimated very favorable: 75 p. 100 of patients felt better than at the beginning of the study, 64.5 p. 100 of patients wished to continue the treatment and the (mean) benefit-risk ratio assessed with a logarithm scale (-1 to +1), ranged from 0.45 to 0.6 according to the indication. Therefore, this trial confirmed the good efficacy and safety profile of etodolac on a large scale in normal clinical practice in France, following assessments during controlled trials. It also permitted to perfect new items of evaluation for NSAID's, in particular for therapeutic benefit.

Pericarditis is common in juvenile polyarthritis, but tamponade is a very rare complication and usually needs pericardiocentesis, pericardiotomy or pericardiectomy. We report an exceptionally rare recurrent tamponade after an 8 years interval in a patient with juvenile polyarthritis: the first tamponade was treated by pericardiotomy; the second episode of adiastole regressed after high dose steroid therapy.

The authors studied HLA tissue groups for 28 specificities in 70 patients with psoriatic arthropathy (44 with pure peripheral arthropathy and 26 with axial involvement, 19 of whom also had peripheral lesions). Four antigens of this system were found with a significantly increased frequency in 70 patients in comparison with a control group of 152 normal subjects. For antigen HLA-B27, the frequency seemed very significantly increased in patients with axial involvement as compared with those without axial troubles (pc less than or equal to 0.0001) and with the controls (pc less than or equal to 0.0001). For antigen HLA-B13, the frequency was significantly increased in patients with axial involvement as compared with the controls (pc less than 0.05). Antigen HLA-Bw17 was present with significantly increased frequency as compared with the controls in the patients with peripheral involvement (pc less than 0.001). For antigen HLA-Bw38 (W16.1), the frequency in patients with or without axial involvement was significantly increased in comparison with the controls (pc less than 0.001). The interpretation of these results is discussed and the association of antigen HLA-B27 with sacro-iliac involvement once again stressed.

The authors present 46 cases studies of herniated lumbar discs treated by chemonucleolysis in the previous 2 to 9 months. One patient suffered from recurrent acute lumbago; the other 45 patients suffered from lumbar root pain. The diagnosis of herniated disc was confirmed by radiography of the lumbar roots. Chemonucleolysis was performed under neuroleptanalgesia in the majority of cases, after failure of medical treatment and as an alternative to surgery. The patient treated for recurrent lumbago obtained a good result. After one month, 20 patients no longer suffered from sciatica and two had only a mild and intermittent sciatic pain. The results are lasting. Overall, chemonucleolysis is successful in 69% of cases. The success rate decreases with the age of the patient and the age of the symptoms. The results appear to be unchanged by the number of discs treated, their level or their discographic features. The results appear to be unchanged by the number of discs treated, their level or their discographic features. The results seem to be better when the disc being treated has not collapsed and when the hernia is not too large. Seven failed cases went to operation when, in each case, a non ruptured herniated disc was found. In 4 cases there was minimal tissue and in 2 cases the hernia was soft. The tolerance was excellent. Chemonucleolysis is effective in the treatment of herniated lumbar discs, but should be reserved for selected patients. Used with care, the treatment is safe. In cases where the treatment fails, the surgical procedure is not interefered with.

The authors studied the tissue groups in a first series of patients with properly diagnosed rheumatic disorders. They found HL-A W27 antigen in 84 percent of 50 cases of primitive ankylosing spondylarthritis in adults, in 33 percent of the 50 cases of Fiessinger-Leroy-Reiter syndrome, in 20 percent of the 40 cases of psoriatic polyarthritis (50 percent of the 12 cases with radiological sacroiliac involvement) and in 66 percent of the 6 cases of spondylarthritis associated with haemorrhagic rectocolitis. In a second series of 45 patients with unclassifiable inflammatory rheumatism, only the W27 antigen tested for and it was found in 33 percent of the patients. On the basis of these observations, which were compared with those in other publications, the authors confirm the absence of a clear correlation between the pathological picture and the presence of the W27 antigen. They discuss the significance of the association between the W27 antigen and the disease, and underline the diagnostic and sometimes the prognostic value of the W27 test in rheumatology.

Chronic articular involvement is rare in sarcoidosis (approximately 0,2 p. 100). The authors report seven cases and describe the special features of chronic sarcoid polyarthritis: incidence of synovitis, possibility of destructive forms resembling rheumatoid arthritis, sensibility to steroids, relatively good functional prognosis. The diagnosis is essentially histological; it should be suspected in any chronic polyarthritis of obscure origin and confirmed by synovial biopsy. The physiopathology of sarcoid synovitis has not yet been determined.

The authors report on 4 cases of aseptic osteonecrosis of the vertebral matter in adult. The relatively rare localisation is the lot of elderly patients. It may follow cobalt therapy or corticotherapy and seems to be brought about by osteoporosis, hypertriglyceridemia and, perhaps, malignant lymphoidal proliferation. Histological confirmation of osteonecrosis was available in one case. The radiological aspect is characterised by settling, with heterogenic osteo-condensation and gaseous dissection of the vertebral matter. A double vertebral localisation is possible, and scintigraphical hyperfixation is common. The course is slowly favourable, with a symptomatic treatment.

Ankylosing spondylitis (AS) with juvenile onset (under 17 years of age) is not infrequent. Thirty-six cases were studied, amounting to 18% of patients hospitalized between 1977 and 1981. The following criteria were used for diagnosis: radiologic sacroiliitis (typical AS), presence of HLA B27 and/or pelvic or vertebral clinical manifestations (possible AS). 31 patients (85%) were boys. Mean age at onset was 12.3 +/- 2.8 years. In three cases, AS was found in a member of the family of the propositus and in one case there was cutaneous psoriasis. Usually (29 cases) onset was in the lower limbs: arthritis of the knee (14 cases), hip (9 cases), ankle (7 cases) or painful heel (4 cases). During the course (with a mean follow-up of 11.2 +/- 7 years), 35 patients exhibited peripheral joint diseases and 25 had axial involvement. Ocular involvement was present in 5 cases. 10 patients had a modification of respiratory function. Radiologic sacroiliitis was found in 31 patients but with a delay of 5.3 +/- 2.6 years. Vertebral radiologic lesions were only seen in 11 patients. Radiologic hip involvement was frequent (20 cases) with complete destruction in 6 patients. Erosion and ossification of the calcaneum were observed in 15 cases. The ESR was above 20 mm/first hour in 26 cases (72%). 81% of these patients were HLA B27 positive. Functional prognosis was good: 16 patients (51.6%) led an almost normal life, 6 were bedridden (Steinbrocker's grade IV), 3 had severe impairment (grade III) and 6 had slight impairment (grade II).(ABSTRACT TRUNCATED AT 250 WORDS)

After a double-blind trial of 4 months, 40 patients with RA were treated with 100 mg Levamisole. Clinical results were good or excellent in 50%. The immunological status is not a valuable criterion for the selection of patients apt to respond to Levamisole. A good correlation was found between clinical improvement, reduction of ESR, percentage of immunoblasts, rheumatoid factor titre and the enhancement of lymphoblastic response to polyclonal mitogens. The treatment maintenance rate for efficacy was much lower for Levamisole than for D-penicillamine.

The authors report 18 cases of Felty's syndrome followed, in an average, for 5 years (1 to 12 years). There were 3 deaths, 9 patients are in complete remission, 6 others still show signs of the disease: splenomegaly (4 cases), leucopenia (1 case) and only one complete Felty's syndrome. Steroid therapy has proved to be effective regardless of the mechanism of the neutropenia specified in 9 cases by an isotopic study. Prognosis and infectious risk are difficult to determine but the overall course was rather favorable.

The authors report on a case of erythema elevatum diutinum developing at the same time as a seropositive rheumatoid polyarthritis. Disulone, moderately active on skin lesions, has little influence on the development of arthritis that have reacted well to treatment with D-penicillamine. A review of the literature makes it possible to identify the type of rheumatismal manifestations and immunological disorders accompanying the dermatosis. Three etiological circumstances must be looked for : focal infection, malignant lymphopathy, connectivitis.

The authors report 11 cases of solitary plasmocytoma of the spine. This tumour mainly affects men (9 cases) before the age of myeloma (average age 56 years). The back pain is associated with radicular irradiation (9 cases) and objective neurological signs (5 cases). The site was dorsal (5 cases), lumbar (5 cases) and rarely sacral (1 case). The vertebral lesion was either lysis (5 cases), a very characteristic polycystic appearance (5 cases) or common vertebral collapse (1 case). A lesion of the posterior arch was common (9 cases). A monoclonal immunoglobulin was demonstrated in the serum of 7 patients. Radiochemotherapy resulted in a reduction (2 cases) or complete regression (3 cases) of the monoclonal component. Radiotherapy alone did not prevent an increase of the monoclonal peak in 2 cases, nor the later occurrence of a monoclonal immunoglobulin in 2 other cases. An increase in polyclonal Ig. was an early sign of remission and their fall heralded myelomatous dissemination. The patients were followed up for an average of 6 years (range 1-16 years). The solitary course varied from 3 months to 16 years. Four patients developed metastatic plasmocytoma; 3 had medullary invasion after 1, 4, and 10 years.

Erosions of vertebral bodies and intervertebral discs are usually considered as late manifestations of ankylosing spondylitis. Yet they may occur early and indeed constitute the first sign of the disease. This is illustrated by the case reported here, where a 19-year-old woman with an 18-months diagnosis of ankylosing spondylitis was found to have severe destructive lesions of the 6th cervical vertebra without discal lesion nor cervical ankylosis. Surgical biopsy excluded a tumoral or infectious process. Spinal fusion (C4-C7) was performed, and cervical pain was completely relieved with non-steroidal anti-inflammatory drugs.

The age-related variation in antibody-dependent cell-mediated cytotoxicity (ADCC) in spleen was examined in four different mouse strains (DBA/2, Balb/c, NZB and NZB/NZW). The ADCC effector activity against antibody-coated chicken red blood cells in untreated spleen from all four strains was roughly comparable. An initial rise in activity with increasing age until two to three months was followed by a sharp decline in effector activity. Treatment of the spleen cells with poly-l-lysine-coated carbonyl iron to remove phagocytes resulted in a decrease in ADCC activity in NZB, NZB/NZW and DBA/2 strains at all ages examined. The same general pattern of age-dependent decline was still seen in these depleted spleens. However, the same treatment essentially abolished ADCC in Balb/c spleen at all ages studied.