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We describe a case of a 50-year-old woman presenting articular manifestations of rheumatoid arthritis associated with severe interstitial lung involvement related to multiple pulmonary nodules. Diagnosis of diffuse pulmonary rheumatoid nodulitis was made only after video assisted thoracoscopic lung biopsies.

Objective: To identify risk factors associated with disease activity, in a group of patients with spondyloarthropathy (SpA) living in France., Methods: Patients fulfilling the ESSG or Amor criteria for SpA were enrolled in a cross sectional multicenter study. Disease activity was assessed using a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Univariate and multivariate analyses were used to identify a link between BASDAI and disease characteristics, genetic factors, and environmental factors such as infectious events, mental stress, working conditions, and dietary factors., Results: We studied 293 patients. On multivariate analysis, BASDAI appeared to be mainly linked to disease duration (negative correlation), the absence of sacroiliitis, and the "frequency of meals taken out of home" (negative correlation)., Conclusion: Disease activity in a French population of patients with SpA appeared to be linked mainly to a shorter disease duration and a peripheral pattern of arthritis, as well as to dietary habits. The underlying links between this last environmental factor and disease activity remained hypothetical and could only reflect a nontested social factor.

We report two cases of discitis due to Propionibacterium acnes and review previously published cases of bone and joint infections in which this organism was recovered as a pure culture. P. acnes is an anaerobic organism usually considered a normal inhabitant of the skin but capable of producing a variety of infections including discitis, osteitis, arthritis, and chest wall osteitis. Most patients were immunocompetent. A few infections occurred spontaneously, whereas others were secondary to a break in the skin or to implantation of foreign material into the body for instance during internal fixation of a fracture or arthroplasty. Cases of P. acnes chest wall infection have been reported in patients with palmoplantar pustulosis or chronic or multifocal osteitis, supporting a role for P. acnes in SAPHO syndrome.

Objective: To develop a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and to determine its metric properties in patients with all forms of spondyloarthropathies (SpA)., Methods: A French version of BASDAI was obtained after a translation and back-translation process. Patients fulfilling the European Spondylarthropathy Study Group or Amor criteria for SpA were included. BASDAI of Day 0, Day 1, and, when treatment was changed, Day 8, and other clinical and biological disease activity variables were recorded, along with assessment of disease activity by the physician or the patient. Scalability, reproducibility, sensitivity to change, internal consistency and redundancy, and construct validity of the index were assessed., Results: We studied 293 patients. Good scalability, reproducibility, construct, and internal validity were observed for BASDAI. Sensitivity to change could not be assessed., Conclusion: The French version of BASDAI exhibited good metric properties in patients with all forms of SpA, confirming its utility in further clinical research in SpA. However, sensitivity to changes due to drug therapy remains to be assessed.

Objective: To study the characteristics of radiographs in diagnosis of hydroxyapatite deposits in sites other than the shoulders and hips., Methods: We reviewed the records of patients hospitalized during the last 3 years whose final diagnosis was apatite deposits in sites other than the shoulders and hips., Results: Ten women and 5 men were studied. The initial presentation mimicked septic arthritis or periarticular soft tissue abscess in 12 patients, corresponding to calcifications in the fingers (6), toes (2), wrists (2), elbow (1), and ankle (1). One patient presented with a spontaneous coccygeal pain (precoccygeal deposit), one with a pseudotumoral process of the thigh (paradiaphyseal calcification), and one with acute cervical pain and dysphagia (longus coli muscle calcification). Complete clinical healing was observed after an average of 4.9 days; 11 patients used nonsteroidal antiinflammatory drugs (NSAID), 2 used colchicine, one used oral steroids, and one had brief antibiotic therapy and used NSAID., Conclusion: Initial clinical aspects of apatite deposits in sites other than the shoulders and hips can often be misleading, especially by mimicking an infectious process. Careful analysis of immediate radiographic films can help to rapidly ascertain the diagnosis and thus avoid useless investigations or treatment.

Rheumatologic presentations of factitious illness such as Münchausen's syndrome are rare. We describe a case of alternate edema of the hands in a 25-year-old man, diagnosed as reflex sympathetic dystrophy. This patient eventually presented all clinical characteristics of Münchausen's syndrome.

Objective: Polymorphonuclear leukocyte (PMN) elastase is able to degrade the extra-cellular matrix components of cartilage. However, in vitro several proteinases can degrade elastin. The purpose of this study was to evaluate the role of the serine proteinases and metalloproteinases in the elastase activity measured in cartilage extracts from patients with osteoarthritis (OA), as well as in synovial fluid (SF) from patients with rheumatoid arthritis (RA) and OA., Methods: Elastase activity was determined using synthetic low molecular weight substrates and radiolabelled insoluble elastin. Aminophenyl mercuric acetate was used to activate the prometalloproteinases., Results: Elastase activity, measured using synthetic substrates, was higher in BA SF (0.76 + 0.03 microU/ml, n = 12) than in OA SF (0.14 + 0.04 microU/ml, n = 12) (p < 0.001). This activity was inhibited by metal chelating agents: 86% inhibition in OA and 75% inhibition in RA. However, in RA SF the inhibitor of serine proteinase (PMSF) also induced a 40% inhibition. Elastase activity, measured using radiolabelled elastin, in OA SF and RA SF samples and in OA cartilage extract was very low, but increased following activation by mercurial agents. Again this activity was inhibited by metal chelating agents., Conclusions: Taken together these results indicate that elastase activity (measured by standard methods) in OA and RA SF is mainly due to metalloenzymes.

We report three cases of iatrogenically induced vertebral osteomyelitis due to Pseudomonas aeruginosa. One case was a post-nucleotomy and post-operative complication of herniated disk treatment, one was related to infection of an epidural catheter in a patient suffering from rheumatoid arthritis and the third followed urinary investigation in a patient with prostate cancer. Infection was cured in all patients with antibiotic treatment. These case reports shed light on the possibility of infections with pseudomonas aeruginosa, in addition to the more common infections such as by staphylococci, especially following iatrogenic maneuvers.

The prognosis of large granular lymphocyte proliferation with rheumatoid arthritis (pseudo-Felty's syndrome) remains uncertain. We report a case with a 15-year follow-up. To date, the patient has not developed lymphadenopathy, splenomegaly, abnormalities in erythrocyte or platelet counts, neutropenia or severe or unexplained infections. This favorable course is not ascribable to an unusual lymphocyte phenotype (CD3+, CD8+, CD57+). A beneficial effect of methotrexate therapy is possible.

A case of polyarthritis following intravesical administration of bacillus Calmette-Guérin (BCG) for bladder carcinoma is reported in a patient with long-standing ankylosing spondylitis. Possible links between BCG-therapy and joint manifestations are discussed in the light of data from the literature. Patients who develop joint manifestations after BCG-therapy are often HLA B27-positive.

Objective: To determine whether tenascin is present in normal and diseased human cartilage., Methods: Immunohistochemical and biochemical assays with a monoclonal antibody against all tenascin isoforms (BC-4) were used., Results: Cartilage samples from osteoarthritis and rheumatoid arthritis patients contained increased amounts of tenascin compared with the levels in normal cartilage. Human fetal cartilage was also found to contain tenascin. In normal cartilage explants treated with interleukin-1 beta, tenascin was present in pericellular areas of all layers. Immunolocalization studies revealed that tenascin was most abundant in the superficial layers of osteoarthritic cartilage. Western blot analysis performed from dissociative extracts of diseased cartilage confirmed the presence of subunits of the native molecule., Conclusion: Tenascin is increased in arthritic cartilage and is weakly expressed in normal cartilage.

The serum binding of methotrexate was determined by equilibrium dialysis using radiolabelled methotrexate. Methotrexate was only albumin-bound in serum. The binding was 46% in controls versus 42% in rheumatoid arthritis and 44% in cancer. Serum binding was significantly decreased by salicylate and high concentration of naproxen. Hypoalbuminemia and concomitant administration of salicylate or naproxen may influence methotrexate toxicity.

Extrahematologic manifestations, such as symptoms of rheumatic disease, have been recorded in association with myelodysplastic syndromes, including chronic myelomonocytic leukemia (CMML). We report the case of a 51-year-old woman with tumoral infiltration of the Achilles tendons bilaterally, indicating CMML. This diagnosis was confirmed at postmortem examination.

Plasma levels of cholesterol, triglyceride, HDL-cholesterol, and apolipoproteins A1 and B were assayed in ninety patients (sixty-four male and twenty-six female) with reflex sympathetic dystrophy and in ninety controls matched for age, sex, and body mass index (BMI). No significant differences were found between the two groups for the proportions of patients with increased plasma cholesterol levels (6.6% versus 4.4%) or increased plasma triglyceride levels (40% versus 30%), as defined by Turpin's age and sex-specific criteria, or for mean values of these parameters. In the 38 patients with reflex sympathetic dystrophy of less than 3.5 months duration, plasma triglyceride levels were significantly higher than in the 38 matched controls (1.24 + 0.57 g/l versus 1.02 +/- 0.91; p = 0.04). In patients (n = 52) with disease of more than four months duration (range 4-39), plasma triglyceride levels were similar in the two groups. Lipidemia was similar in patients and controls regardless of age, sex, topography of the disease, clinical manifestations, and whether or not the disease was due to an injury. This study, in contrast to previous reports, failed to disclose an association between reflex sympathetic dystrophy and hyperlipidemia. Transient hypertriglyceridemia may occur during the first 3 1/2 months of the disease as a result of initial immobilization.

Only 3 cases of isolated septic arthritis of a lumbar facet joint have been reported, all due to Staphylococcus aureus. We describe a case of Klebsiella pneumoniae septic arthritis of a lumbar facet joint in an HLA-B27 positive patient.

Joint and muscle pain have been reported with quinolones; however, arthropathies induced by quinolones do not result in erosive changes in humans, although such changes have occurred in animal studies. We report an unusual case of destructive polyarthropathy in a 17-year-old boy after treatment with pefloxacin 800 mg/day for 3 months. Pefloxacin may have accentuated the cartilage damage in this case, even if an underlying joint disease could not be excluded.

The authors report 6 cases of posterior articular cysts responsible for nerve root pain, generally in the form of sciatica. Cysts of the posterior intervertebral joints are a rare cause of nerve root compression. Plain x-rays demonstrate posterior inter-apophyseal osteoarthritis. Demonstration of the posterior articular cyst requires the use of computed tomography with contrast injection and/or MRI. Arthrography of the posterior inter-apophyseal joint allows the cyst to be opacified and treated by infiltration of a corticosteroid.

Pasteurella multocida is frequently responsible for infections in man due to wounds inflicted by animals (generally cats or dogs). However, the development of septic arthritis is a rare complication. We report 4 cases of Pasteurella multocida septic arthritis with demonstration of the organism in the joint in each case. Two cases presented with monoarthritis (sternoclavicular joint and wrist) and 2 cases had polyarticular involvement from the outset.