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Introduction Une infection d’origine cutanee a Staphylococcus aureus lors de la periode neo-natale peut se presenter sous diverses manifestations qui sont, pour la majorite d’entre elles, associees a des signes clinico-biologiques d’inflammation. Observations Un nourrisson âge de 10 jours, ne a terme, etait recu aux urgences neonatalogiques devant l’apparition depuis 48 h de quatre lesions nodulaires sous cutanees : une centimetrique axillaire gauche, deux millimetriques inguinales droites, et une millimetrique retro-auriculaire. Il n’existait pas d’autres lesions cutanees mais on notait une conjonctivite gauche non purulente. Le reste de l’examen physique etait normal, et l’enfant etait apyretique. Biologiquement, il n’y avait pas de syndrome inflammatoire. Le bilan immunitaire etait sans particularites. Une echographie des parties molles decrivait des collections sous cutanees, sans adenopathies satellites. Le prelevement vaginal maternel etait positif a Staphylococcus aureus multisensible. Devant une evolution defavorable apres 48 h, l’abces axillaire gauche a ete draine. Le prelevement trouvait un Staphylococcus aureus d’antibiogramme identique a celui du prelevement vaginal maternel, en faveur d’une transmission bacterienne materno-fœtale durant l’accouchement. Apres drainage et antibiotherapie par amoxicilline et acide clavulanique per os, l’evolution etait rapidement favorable avec guerison complete de l’ensemble des localisations. Juste au decours, nous apprenions que le test de Guthrie etait en faveur d’une mucoviscidose, confirmee par le test de la sueur et le test genetique. Discussion L’abces froid des grands plis du nourrisson est une entite de description recente par l’equipe de dermato-pediatrie du CHU de Bordeaux. Elle correspond a une infection neonatale a Staphylococcus aureus. Elle se presente chez un nourrisson en bon etat general par l’existence d’abces peu inflammatoires des grands plis. Ces abces sont decrits comme « froids » devant l’absence de symptomes generaux et de syndrome inflammatoire biologique. Il parait licite de chercher une immunodepression face a cette pathologie en raison de sa survenue precoce dans la vie, bien qu’aucun cas de deficit immunitaire n’ait ete mis en evidence a ce jour dans cette pathologie. Dans cette observation, notre patiente est atteinte de mucoviscidose, ce qui pourrait etre un facteur favorisant. Conclusion Nous rapportons un cas d’abces froids des grands plis du nouveau-ne en contexte de mucoviscidose. Cette entite, bien que debattue, doit pouvoir etre evoquee par le dermatologue. Face a celle-ci, la recherche d’une contamination par transmission materno-fœtale et d’une immunodepression du nouveau-ne s’avere interessante, bien que d’autres observations soient necessaires pour mieux caracteriser la pathologie.

Resume Nous presentons le cas d'une patiente de 51 ans ayant subi un degantage de jambe droite apres un accident de voiture. Le premier geste de repose simple avec parage minimal des lambeaux se solde par un echec et une necrose quasi totale. Apres une avulsion complete des tissus devitalises, il est pose un VAC® circulaire de jambe. Quatre cycles de VAC® et 12 jours plus tard, une greffe de peau mince en filet est realisee. Celle-ci prend parfaitement et permet a la patiente une verticalisation en un mois apres l'accident initial. Cet exemple souligne le role de detersion et probourgeonnant de la therapie negative lors du sauvetage d'un degantage de jambe mal conduit.

The correction of type II sequelae of breast conservative surgery is a difficult problem to solve. The authors present the case of a 39 years old woman, in which the repair has been carried out in two steps. A latissimus dorsi muscular flap is first realised, then a breast implant and a double-opposing Z plasty on the areola finish the reconstruction. The final result is very satisfactory in a cosmetic point of view, with a little cost in terms of scars. This difficult case presents the muscular variant of the latissimus dorsi flap, as a technique of choice in the post-quadrantectomy sequelae.

Introduction Le recours aux medecines non conventionnelles (MNC) semble augmenter, surtout chez les patients ayant une maladie chronique. L’objectif de notre etude etait d’estimer la frequence du recours aux MNC au cours des maladies inflammatoires du tube digestif (MICI) pediatriques. Les objectifs secondaires etaient de preciser les MNC les plus utilisees, etudier les facteurs favorisants et les raisons de leur utilisation ainsi que les benefices ressentis par les enfants et leurs parents. Methodes Notre etude etait une enquete, par auto-questionnaire nominatif, multicentrique menee dans les centres hospitaliers du Nord-Pas-de-Calais. Les enfants, âges de moins de 18 ans revolus, suivis pour une MICI etaient inclus de maniere prospective, de septembre a decembre 2013. Une etude dans les dossiers medicaux permettait de completer le recueil de donnees. Resultats Cent dix questionnaires ont ete distribues. Le taux de reponse etait de 74 % ; 69 % des patients avaient une maladie de Crohn, 27 % une rectocolite hemorragique et 4 % une colite inclassee ; 32 % (IC : 22 %–42 %) des patients avaient eu recours aux MNC pour leur MICI et 39 % (IC : 29–50 %) pour une autre maladie. Au total, 53 % (IC : 41–63 %) des enfants avaient deja eu recours a une MNC. Les MNC les plus utilisees etaient l’homeopathie (58 %), l’osteopathie (27 %), la naturopathie et la kinesiologie (15 % chacun) ; 42 % des parents avaient discute des MNC avec le pediatre gastro-enterologue referent (56 % avant leur utilisation) ; 53 % des parents auraient aime que le pediatre leur parle de lui-meme des MNC. Les principales raisons d’utilisation d’une MNC etaient : la volonte que l’enfant se sente mieux (88 %) ; la peur des effets secondaires des traitements (42 %) ; et l’impression que les MNC sont plus naturelles et moins dangereuses (42 %). En analyse multivariee, les facteurs favorisant l’utilisation des MNC etaient : âge du patient plus eleve ( p = 0,03) ; categorie socioprofessionnelle de la mere elevee ( p = 0,04) ; utilisation des MNC par les parents ( p = 0,0002) ; traitement actuel par immunomodulateur ( p = 0,03) ; insatisfaction de la medecine conventionnelle ( p = 0,02). Parmi les patients ayant utilise une MNC, 63 % ont ressenti un effet benefique et aucun un effet deletere. Conclusion Le recours aux MNC est frequent chez les enfants suivis pour une MICI. Les pediatres gastro-enterologues doivent s’informer sur ces pratiques et ouvrir le dialogue avec les familles, afin de pouvoir les guider dans leur choix, prevenir les effets potentiellement deleteres des MNC et determiner les sources d’insatisfaction motivant les familles a se tourner vers d’autres alternatives therapeutiques.

Bellamy N, Bell MJ, Carette S, Fam AG, Haraoui BW, McCain GA, Reynolds WJ, Wells GA, Campbell J. Estimation of observer reliability and sample size calculation parameters for outcome measures in fibromyalgia clinical trials. Inflammopharmacology. 1994;2:345-360.

Fibromyalgia (fibrositis) is one of the most common rheumatologic conditions. This paper reviews the clinical presentation and pathophysiology of the syndrome and presents a global approach to the management of the disease.

Primary or nonobstructive, endogenous lipoid pneumonia is a rare clinical entity usually associated with an underlying systemic disease. The present report describes a case involving a 21-year-old man with systemic-onset juvenile rheumatoid arthritis who developed primary endogenous lipoid pneumonia. Multiple treatment regimens were attempted; however, definitive management was only achieved through double-lung transplantation.

144 patients with severe rheumatoid arthritis from six centres were randomised to receive oral cyclosporin or placebo for 6 months. The initial daily dose of cyclosporin was 2·5 mg/kg, which was increased cautiously with monitoring of serum cyclosporin levels and creatinine; the mean stabilisation dose was 3·8 mg/kg. There were significant improvements in the cyclosporin-treated patients compared with the controls in the major outcomes of reduction of active joints (23% improvement), pain (24%), and functional status (16%); global improvement was 27%. In the cyclosporin group serum creatinine increased by a mean of 15·6 μmol/l and mean arterial blood pressure by 6·27 mm Hg; these increases were controlled in all but 2 patients by dose adjustment without withdrawal from the study.

We present the case of a 51-year-old woman who suffered an avulsion injury of the right leg in a car accident. In a first time, the simple suture with tiny debridement of the flaps is a failure and lead to a nearly complete necrosis. In a second time, a total avulsion of the devitalized skin is realised and a circumferential VAC system is placed on the wound. Four cycles of vacuum therapy and twelve days later, a split-thickness skin mesh-graft is applied on the leg. This one has a very good take and allows the patient to stand up one month after the initial accident. This example underlines the role of cleaning and pro-budding of the negative therapy after the salvage of a leg avulsion.

Introduction: Methotrexate is one of treatment options for Crohns disease (CD) in children. However, actual evidence of its efficacy in scientific literature is scarce. Aim: The aim of this study was to evaluate the efficacy of methotrexate in maintaining remission in pediatric CD resistant to azathioprine. Methods: This retrospective study included children with CD who were treated in our hospital since January 2004 and who received methotrexate for at least 12 months. Results: During the observed period 25 children were treated with methotrexate for at least 12 months [8 girls (32%); median age at diagnosis 13.4 years (range 1 17.3 years)]. Methotrexate was started in average of 1.8 years after the diagnosis (median: 1.3 years; range 0.6 6.9 years). The mean duration of follow-up was 4.6 years (median 4.7 years; range 1.7 9.6 years). During the treatment with methotrexate 6 (24%) children had a relapse during the first year, 8 (32%) children after the first year and 11 (44%) children remained in remission till the end of follow-up period. The mean duration of remission was 1.7 years (median 1.1 years; range 1 3.5 years). The overall remission duration was longer after methotrexate was introduced comparing to remission duration on previous therapy (azathioprine) (0.9 vs 1.7 years; p = 0.022). Survival analysis (Cox proportional hazard regression model) failed to reveal the relapse risk factors (disease location, treatment for remission induction, age at diagnosis, duration of disease and disease location). Conclusion: Methotrexate is an effective treatment option for children with CD who did not respond to azathioprine.

Early diffuse scleroderma (systemic sclerosis; SSc) has no proven treatment. This study was undertaken to examine the efficacy of methotrexate (MTX) in improving the skin and other disease parameters in early diffuse SSc.Seventy-one patients with diffuse SSc of3 years' duration were enrolled in a multicenter, randomized, placebo-controlled, double-blind trial. Thirty-five patients were treated with MTX and 36 with placebo. Treatment was administered for 12 months. The primary outcome measures were skin score (as determined with 2 different indices) and physician global assessment.At baseline, there were no statistically significant differences in skin scores, carbon monoxide diffusing capacity (DLco), physician global assessment, or other secondary outcome measurements between the 2 treatment groups. At study completion, results slightly favored the MTX group (mean +/- SEM modified Rodnan skin score 21.4+/-2.8 in the MTX group versus 26.3+/-2.1 in the placebo group [P0.17]; UCLA skin score 8.8+/-1.2 in the MTX group versus 11.0+/-0.9 in the placebo group [P0.15]; DLco in the MTX group 75.7+/-4.6 versus 61.8+/-3.4 in the placebo group [P0.2]). In addition, physician global assessment results favored MTX (P0.035), whereas patient global assessment did not differ significantly between groups. When between-group differences for changes in scores from baseline to 12 months were examined using intent-to-treat methodology, MTX appeared to have a favorable effect on skin scores (modified Rodnan score -4.3 in the MTX group versus 1.8 in the placebo group [P0.009]; UCLA score -1.2 in the MTX group versus 1.2 in the placebo group [P0.02]), but differences in the degree of change in the DLco and physician global assessment were not significant. For the UCLA skin score, these differences in results were not statistically significant after adjustment for baseline differences in sex distribution and steroid use. Dropout rates were similar in the 2 groups.Although results of this trial demonstrated a trend in favor of MTX versus placebo in the treatment of early diffuse SSc, the between-group differences were small and the power to rule out false-negative results was only 50%. Our findings do not provide evidence that MTX is significantly effective in the treatment of early diffuse SSc.

To evaluate the role of stressful life events, including negative childhood experiences on the development of rheumatoid arthritis (RA).Retrospective, community based, case-control study founded upon 116 cases, aged 45 to 74 years, registered with the Norfolk Arthritis Register (NOAR), who were also participants in the Norfolk European Prospective Investigation of Cancer study (EPIC). Three controls, matched for age and sex, were selected for each of the cases from among EPIC participants not suffering from arthritis. Data on adverse experiences during childhood and adulthood were available from a self-report questionnaire. The 1987 American Rheumatism Association (ARA) criteria for RA were met by 55 NOAR cases and this subset provided the primary focus for analysis.The number and timing of occurrence of stressful life events, as well as their subjective immediate impact, did not differ between participants who developed RA and their matched controls. Termination of pregnancy was the only specific event individually associated with a higher risk of developing RA (OR 3.74; 95% CI 1.4-9.9). Negative childhood experiences were not associated with the risk of RA. However, RA cases reported significantly slower adaptation to the effects of adverse events than controls.The results of this study do not support the hypothesis that the rate of exposure or reported impact of stressful life events and of adverse childhood experiences play an etiologic role in the development of RA.

To assess risk factors for adult Still's disease (ASD).A matched case-control study of 60 patients with ASD and 60 same sex siblings closest in age was conducted. Subjects were recruited from cohorts in Eastern Canada, Pittsburgh, and the Arthritis, Rheumatism, and Aging, Medical Information Systems (ARAMIS). A questionnaire was used to obtain data on demographic characteristics, education, income, occupation, exposure to toxic substances, stress, and medical history.116 patients with ASD were identified, of which 104 participated. 86 identified same sex siblings, of which 60 replied. When compared to same sex siblings, ASD patients were similar with respect to education and occupation but had a trend to higher median income. There were no significant associations of ASD with smoking, alcohol consumption, individual toxic substances, vaccination, blood transfusion, minor or major surgery, pregnancy, or diet in the year preceding disease onset. There were no significant associations with tonsillectomy or adenoidectomy, appendectomy, asthma, hay fever, allergy shots, or pregnancy at any time preceding the onset of disease. There was a statistically nonsignificant increase in a history of exposure to coal dust [odds ratio (OR) 3.0; 95% confidence interval (CI) 0.30 to 28.84], in allergy preceding the onset of disease (OR 2.67; 95% CI 0.71 to 10.05), and in oral contraceptive use in the year preceding onset (OR 2.00; 95% CI 0.18 to 22.06). Stressful life events (OR 2.56; 95% CI 1.18 to 5.52) in the year preceding onset was significantly associated with increased risk for ASD. This positive association should be treated with caution unless confirmed by a separate study.This exploratory study of risk factors for ASD draws attention to stress as a potentially important risk factor, while likely excluding a considerable number of others.

To determine the variability of several clinical outcome measurements commonly used in scleroderma clinical trials.Ten researchers, members of a multicenter placebo controlled trial of methotrexate in early diffuse scleroderma, studied the intraobserver and interobserver variability of variables used to assess efficacy in scleroderma trials.For most measures, the variability within an observer was less than that found between observers, and therefore the intraobserver reliability was better than the interobserver reliability. The reliability of the modified Rodnan skin score exceeded the Rodnan skin score. Measures with inherent interpretation such as global assessments and skin scores had more variability than easily performed measurements such as grip strength and oral opening.Some of our variability was higher than variability previously reported; this could be due to the large number of examiners and patients in our study.

To compare the relative efficacy and tolerability of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia, and to identify predictors of response to amitriptyline and cyclobenzaprine.Two hundred eight patients who fulfilled the American College of Rheumatology criteria for the classification of fibromyalgia were entered into a 6-month prospective, double-blind, multicenter trial and were randomized to 1 of 3 treatment groups: amitriptyline, cyclobenzaprine, or placebo.After 1 month, 21%, 12%, and 0% of the amitriptyline, cyclobenzaprine, and placebo patients, respectively, had significant clinical improvement (amitriptyline versus placebo P = 0.002, cyclobenzaprine versus placebo P = 0.02, amitriptyline versus cyclobenzaprine P not significant). These percentages increased to 36%, 33%, and 19%, respectively, at the 6-month assessment (P not significant). The nature and frequency of side effects reported by patients treated with amitriptyline and those reported by patients treated with cyclobenzaprine were similar. A normal Minnesota Multiphasic Personality Inventory (MMPI) profile at baseline was predictive of clinical improvement at the 1-month evaluation (odds ratio 3.3, 95% confidence interval 1.2-9.0). However, neither the MMPI profile nor any of the demographic, clinical, or functional parameters evaluated at baseline predicted long-term response.Our data confirm the short-term efficacy of amitriptyline and cyclobenzaprine in a small percentage of patients with fibromyalgia. Long-term efficacy could not be demonstrated because of a higher-than-expected placebo response. Predictors of response to these drugs could not be determined.

The calculation of sample size for clinical trials requires knowledge of the standard deviation (SD) of index variables. There are no published lists of SD and it is difficult to locate variance estimates based on relevant populations. In this study we used standardized procedures to determine in 60 patients with osteoarthritis (OA) of the knee the standard deviation of key outcome measures recommended in current Food and Drug Administration and European League Against Rheumatism guidelines for OA clinical trials. These tables will be useful to clinical researchers in selecting outcome measures as well as for calculating sample size requirements for future clinical studies in OA.

Defining the minimum clinically important difference or delta to be detected in a clinical trial depends on a number of factors including the research hypothesis, patient characteristics, the nature of the intervention and the trial design. In 2 studies, we have developed standardized procedures for conducting outcome measurement based on current Food and Drug Administration and European League Against Rheumatism guidelines for osteoarthritis clinical trials, and determined the standard deviation for these outcome measures. In the final component of this series of studies, we have used a Delphi technique to establish estimates for delta, and calculated the sample size requirements under 2 different conditions of Type I and Type II error probabilities.

We designed a study to assess the effects of standardization procedures on reducing interobserver variability for outcome measures given in the current Food and Drug Administration and European League Against Rheumatism guidelines and others selected from the rheumatology literature. Over 2 days, 6 rheumatologists independently examined 6 patients with osteoarthritis (OA) in predetermined order before and after standardizing their examination techniques. An important and beneficial effect of the standardization procedure was observed on the majority of outcome variables. Such reductions in observer variability have the potential to diminish sample size requirements for OA antirheumatic drug studies.

A 65-year-old woman with rheumatoid arthritis (RA) developed symptomatic compression of the femoral nerve secondary to an iliopsoas bursitis. Her adjacent hip joint was not severely affected by arthritis. This entity should be included among the entrapment neuropathies complicating RA.

Clinical and laboratory manifestations, disease course, outcome, and HLA associations were studied in an inception cohort of 62 subjects with adult Still's disease (ASD) from 5 Canadian universities. Twenty-eight patients (45%) were female and the median age at disease onset was 24 years. In general, the clinical features observed in our patients were identical to those in other published series. However, significantly higher frequencies of sore throat (92%), weight loss (76%), lymphadenopathy (74%), pleuritis (53%), pneumonitis (27%), and abdominal pain (48%) were noted in our patients compared to those in a recent literature review. Liver involvement with hepatomegaly (44%) or abnormal liver function tests (LFTs) (76%) was common and was responsible for the 2 deaths attributed to Still's disease in our series. Severe liver failure always occurred in conjunction with aspirin or NSAID therapy. Therefore, whether or not aspirin or other NSAIDs are used, we recommend close monitoring of LFTs in patients with ASD, especially early in the disease course. Laboratory manifestations were similar to those already reported. Leukocytosis (greater than or equal to 15,000/mm3) was present in 50 patients (81%), a normochromic, normocytic anemia (hemoglobin less than or equal to 10 g/dl) in 42 (68%), and an elevated ESR in all. The mean follow-up of the 62 patients was 70 months (range, 2-163). Twenty-one patients (34%) had a self-limited disease course, 15 (24%) an intermittent course, and 22 (36%) a chronic disease course. Four patients (6%) died, and 2 of these deaths were attributed to Still's disease. For those patients who experienced a recurrence of ASD, the flares were usually of shorter duration and milder in severity than the initial episode. No initiating factor for disease exacerbation was identified in our patients. Although 22 of 62 patients (36%) had a chronic disease course, 52 (90%) were in ARA Functional Class I, and only 4 and 2 patients were in ARA Functional Class II and III, respectively. Patients with Still's disease had higher scores than the controls on the Pain (P less than 0.01) and Physical Disability (P less than 0.05) subscales of Arthritis Impact Measurement Scales health status questionnaire. Joint radiographs performed at the follow-up evaluation disclosed typical carpometacarpal and intercarpal involvement in 16 of 39 patients. In our series, HLA-B17, B18, B35, and DR2 were significantly associated with ASD. Three significant predictors of an unfavorable outcome, either a chronic disease course or a longer time to clinical remission, were identified.(ABSTRACT TRUNCATED AT 400 WORDS)

The Arthritis Impact Measurement Scales (AIMS) questionnaire was administered to 57 patients with adult Still's disease (ASD) and 104 controls. Six of the 9 scales were consistent for both groups (Cronbach's alpha greater than or equal to 0.70). Two scales, Mobility and Dexterity, were consistent for ASD only (alpha greater than or equal to 0.70). The reliability of a French version of the AIMS was similar to the standard AIMS. Of the 13 associations evaluating criterion related validity of the AIMS in ASD, 11 were statistically significant. We conclude that the French and standard AIMS are comparable and that this questionnaire is reliable and valid for assessing outcome in ASD.

This case-control study assessed whether postmenopausal use of hormones reduces the incidence of rheumatoid arthritis (RA). Cases had classical or definite RA. Controls were patients with primary osteoarthritis or soft tissue rheumatism. Information on exposure was obtained by telephone interview. Compared to women who had never used postmenopausal hormones before onset of rheumatologic symptoms, adjusted relative risk (95% confidence limits) for past and current users were 0.95 (0.56-1.60) and 0.89 (0.49-1.63), respectively. Among current users, the association was not related to the duration of use. Our results provide little support for the hypothesis that use of postmenopausal hormones has a protective effect on the development of RA.

SummaryA two-part multi-centre study was carried out to assess the efficacy and tolerability of a new controlled-release (CR) naproxen tablet in the treatment of osteoarthritis and rheumatoid arthritis. Patients already receiving naproxen on a regular basis were first enrolled in a 6-week randomized double-blind trial comparing the controlled-release tablet (750 mg or 1000 mg once-a-day) to the standard marketed tablet (375 mg or 500 mg twice-a-day). At the end of this phase, patients in both treatment groups were eligible to enter the long-term phase involving 28 weeks of open-label treatment with controlled-release naproxen at the previously established dose level (750 mg or 1000 mg once-a-day). A total of 404 patients entered the initial double-blind phase, 320 of whom continued into the open-label phase. Twenty-nine (14%) naproxen patients and 23 (11%) naproxen CR patients were withdrawn prematurely from the double-blind phase, 87 (27%) patients from the open-label phase. Parameters of efficacy and to...

Behçet's disease is reported in a newborn infant of a mother with the disease. The mother had recurrent orogenital ulcers, pustulonecrotic skin lesions, arthritis, thrombophlebitis, and colonic ulcers. Shortly after birth the infant presented with transient orogenital ulcerations and pustular cutaneous lesions. On healing, depressed scars developed which were very similar to those of the mother. The finding of circulating immune complexes in the mother's serum gives some support to the hypothesis that the infant's transient illness was caused by transplacental passage of maternal antibodies.

The prevalence of fibrositis was determined in 100 patients with subclinical or biochemical primary hypothyroidism. Nineteen patients reported symptoms of joint and/or muscle pain with stiffness. Five of these patients presented 7 or more tender points on examination, thus allowing a diagnosis of fibrositis to be made in only 5% of the total group. Symptomatic improvement after thyroid hormone replacement occurred in 10 of the 19 patients, including 3 of those with fibrositis. There were no significant changes in tender points. Our data indicate that fibrositis is uncommon in patients with primary hypothyroidism despite the frequent occurrence of symptoms suggestive of this syndrome.

A 22-year-old woman with progressive systemic sclerosis developed severe myositis and life threatening myocarditis. Her myocarditis responded to intravenous pulse methylprednisolone therapy. We stress the usefulness of echocardiography in establishing the diagnosis and following the course of myocarditis.

Twelve patients with active central nervous system systemic lupus erythematosus (CNS SLE) and 11 patients without CNS involvement, all taking corticosteroids, were studied by computerized tomography (CT). Thirty CT scans on 23 individuals were performed and read blindly and independently by 2 neuroradiologists with an 86% correlation. Minimal to moderate atrophy was the most frequent finding, both in CNS SLE and controls, severe atrophy seen in 1 patient only, and no atrophy in 3 patients and a single control. Of the 6 patients who had repeated scans, 4 showed no change in the degree of atrophy, 1 had more and 1 less atrophy. Three patients had evidence of multiple brain infarcts on scan with or without associated cerebral atrophy. Sequential scans in 1 of these patients showed total resolution of the infarcts after 30 months. Thus, there was no correlation between the presence of cerebral atrophy on CT scan and CNS SLE. Rather our findings suggest that steroids may be the cause of atrophy.

Twenty-three patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal manometry. Twenty-two patients had abnormal manometry ranging from lower esophageal sphincter incompetence to aperistaltism. Of these 22 patients, twenty (91%) had abnormal RT with prolongation of transit time. A characteristic RT pattern showing stagnation of the radionuclide in the distal and middle segments of the esophagus was demonstrated in 82% of the patients with advanced sclerodermatous involvement of the esophagus. Fifteen of the 19 controls (79%) studied had a normal RT. Four showed prolongation of transit time without stagnation. We conclude that RT is a safe, noninvasive, highly sensitive method which might be used as an alternative to esophageal manometry. However, it may lack specificity.

This experiment was designed to test the feasibility of reducing interobserver variability of the joint examination by agreement on a standard examination. Six rheumatologists independently examined 6 patients with rheumatoid arthritis (RA) in predetermined order, before and after a standardization of examination techniques. Results of an analysis of variance showed a reduction of the percent of variability due to observers from 13.8%, before standardization, to 3.2% after standardization, and an improvement in the percent variability related to patient differences from 70.7%, before standardization, to 86.3% after standardization. Such a reduction in observer variability has a potential for allowing a reduction in sample sizes required for RA clinical trials.

This case-control study assessed whether postmenopausal use of hormones reduces the incidence of rheumatoid arthritis (RA). Cases had classical or definite RA. Controls were patients with primary osteoarthritis or soft tissue rheumatism. Information on exposure was obtained by telephone interview. Compared to women who had never used postmenopausal hormones before onset of rheumatologic symptoms, adjusted relative risk (95% confidence limits) for past and current users were 0.95 (0.56-1.60) and 0.89 (0.49-1.63), respectively. Among current users, the association was not related to the duration of use. Our results provide little support for the hypothesis that use of postmenopausal hormones has a protective effect on the development of RA.

The cardiac and pulmonary manifestations of SLE are numerous. While the pleura and pericardium are most commonly affected, the myocardium and lung parenchyma can be the targets of life-threatening complications. Secondary processes (in particular, infection) must always be ruled out before attributing a cardiopulmonary manifestation to lupus.

A patient with seropositive nodular rheumatoid arthritis taking large doses of corticosteroids developed multiple tendon ruptures around weight bearing joints. The mechanisms underlying this rare complication are discussed.

The relationship between serum acid-labile alpha interferon and tubuloreticular inclusions within the cytoplasm of circulating lymphocytes was studied in 46 patients with systemic lupus erythematosus. Elevated levels of interferon (greater than or equal to 8 IU/ml) were found in 17 patients and lymphocyte inclusions in 35. The mean serum interferon concentration in patients with lymphocyte inclusions was significantly higher than in patients without inclusions (17.2 versus 2.4 IU/ml, p less than 0.01). Inclusions were found in 16 of 17 patients with elevated interferon and also in 19 of 29 patients without interferon (p = 0.026). In lupus, serum interferon appears to be a sufficient though not an essential marker for the presence of lymphocyte inclusions.

A 34 year old man with a past history of deep vein thrombosis, positive lupus serology, and high titres of anticardiolipin antibodies developed acute adrenal insufficiency. Association of anticardiolipin antibodies with adrenal insufficiency has not been previously reported.