Les tissus hybrides de substitution du tissu osseux sont constitues d'un materiau synthetique et de cellules autologues osteogeniques fixees a leur surface. Depuis l'identification de cellules souches osteogeniques parmi les cellules stromales des cavites medullaires, de nombreux facteurs de croissance, hormones et cytokine ont montre leur activite sur l'osteoblaste en culture. Des ceramiques phosphocalciques poreuses ont ete developpees pour servir de vecteurs a des cellules osteogeniques cultivees et multipliees in vitro. Differentes etudes publiees dans le monde ont permis de mener une etude experimentale etudiant l'implantation de cellules stromales fixees sur des billes d'hydroxyapatite poreuses, dans des defects osseux faits dans des diaphyses de cubitus de chien
L'incapacite fonctionnelle represente un des aspects majeurs de la morbidite des lombalgies qu'il est necessaire de prendre en compte dans l'evaluation et la prise en charge des patients. Cet article decrit les principales etapes de l'adaptation en francais puis de la validation du Disability Questionnaire de Roland et Morris. Ce questionnaire auto-administre s'est revele court, simple, reproductible, valide et sensible au changement. Une large utilisation, dans des contextes aussi differents que la recherche epidemiologique ou clinique, l'expertise mais aussi la pratique clinique, pour l'evaluation individuelle des patients parait donc possible
A propos d'une observation de syndrome de Gougerot-Sjogren chez une patiente presentant une hepatite virale chronique C, les auteurs discutent des rapports entre les hepatopathies auto-immunes, dont on connait maintenant les liens etroits avec l'infection virale chronique C, et le syndrome de Gougerot-Sjogren. L'hypothese d'une cascade auto-immune declenchee directement ou indirectement par le virus C est la plus probable. La prevalence de l'infection par le virus C dans le syndrome de Gougerot-Sjogren et les eventuelles implications therapeutiques d'une telle association restent a determiner
Afin de preciser la valeur de la manoeuvre de Leclercq (cliche de face de l'epaule en abduction active contrariee) pour le diagnostic de rupture de la coiffe des rotateurs, les dossiers de 93 malades ayant eu une arthrographie opaque de l'epaule, des radiographies simples et une manoeuvre de Leclercq ont ete revus retrospectivement
We report the simultaneous occurrence of systemic sclerosis and the relapse of hairy cell leukemia. This is to our knowledge the first published observation of this association and it raises the question of its mechanism.
L'influence reciproque de la grossesse et de la maladie de Still debutant a l'âge adulte est mal connue. Par une enquete retrospective, les auteurs ont recueilli neuf observations entre 1983 et 1991. Il s'agissait de sept femmes d'âge moyen 27,7 ans (extremes: 23-40 ans); cinq femmes ont eu une grossesse, deux femmes ont eu deux grossesses contemporaines ou consecutives a l'installation de la maladie de Still debutant a l'âge adulte. La maladie de Still debutant a l'âge adulte a debute au 5 e et 6 e mois d'une premiere grossesse chez deux patientes; une deuxieme grossesse chez l'une d'entre elles ne s'est pas accompagnee de poussee
Les auteurs rapportent une observation de spondylarthrite ankylosante avec insuffisance aortique et troubles de la conduction cardiaque, associee, apres seize ans d'evolution, a une fibrose retroperitoneale periaortique. Huit autres observations associant pelvispondylite et fibrose retroperitoneale ont ete signalees anterieurement. Les rapports des deux affections sont discutes: le role de l'Indometacine consomme pendant seize ans dans le cas decrit est evoque
Rheumatoid anemia is a typical example of anemia of chronic disease. It differs from other forms of anemia, such as iron deficiency anemia or iatrogenic anemia. Rheumatoid anemia is normochromic, normocytic or, less often, microcytic, aregenerative, and accompanied with thrombocytosis. Serum transferrin levels are normal or low, transferrin saturation is decreased, serum ferritin levels are normal or high, the soluble transferrin receptor (sTfR) is not increased (a distinguishing feature with iron deficiency anemia), and the sTfR/log ferritin ratio is lower than 1. This review discusses the prevalence and impact of rheumatoid anemia based on a review of the literature. Iron metabolism, absorption, diffusion, storage, and use by the bone marrow are described using published data on transferrin, ferritin, and hepcidin. Hepcidin is now recognized as a key factor in rheumatoid anemia, in conjunction with the cytokine interleukin-6 (IL-6). Hepcidin is a hormone that lowers serum iron levels and regulates iron transport across membranes, preventing iron from exiting the enterocytes, macrophages, and hepatocytes. In addition, hepcidin inhibits intestinal iron absorption and iron release from macrophages and hepatocytes. The action of hepcidin is mediated by binding to the iron exporter ferroportin. Hepcidin expression in the liver is dependent on the protein hemojuvelin. Inflammation leads to increased hepcidin production via IL-6, whereas iron deficiency and factors associated with increased erythropoiesis (hypoxia, bleeding, hemolysis, dyserythropoiesis) suppress the production of hepcidin. Data from oncology studies and the effects of recombinant human IL-6 support a causal link between IL-6 production and the development of anemia in patients with chronic disease. IL-6 diminishes the proportion of nucleated erythroid cells in the bone marrow and lowers the serum iron level, and these abnormalities can be corrected by administering an IL-6 antagonist. IL-6 stimulates hepcidin gene transcription, most notably in the hepatocytes. Studies involving human hepatocyte exposure to a panel of cytokines showed that IL-6, but not TNFα or IL-1, induced the production of hepcidin mRNA. Recent data on hepcidin level variations in patients with rheumatoid arthritis are reviewed. Rheumatoid anemia is best corrected by ensuring optimal control of systemic disease activity. The role for iron supplementation (per os or intravenously) and erythropoietin in the treatment of rheumatoid anemia is discussed. Given the cascade of interactions linking IL-6, hepcidin, and anemia, IL-6 antagonists hold considerable promise for the management of rheumatoid anemia.
Antiperinuclear factors (APF) are directed to epithelial cell "kerato-hyaline granules". Standardization of the APF test has been achieved, but the way to express the results is still debatable. APF were found to be present in 76% of rheumatoid arthritis (RA) patients: thus the sensitivity and the specificity for RA were 76 and 97%, respectively. No clinical or serological associations were substantiated in RA. The antigens targetted by these auto-antibodies are extremely variable from one to another donor.
Cytokines are secreted by several cell types in the bone microenvironment. These peptides act on bone cells by a paracrine or autocrine mechanism and play an important role, although not completely clarified, in the regulation of bone remodeling. Postmenopausal osteoporosis could be due to a local overproduction of some osteoclast-stimulating cytokines in response to estrogen deficiency. During chronic inflammatory joint diseases, such as rheumatoid arthritis, synovial cells produce large amounts of cytokines leading to increased local bone resorption and juxta-articular bone destructions. The local action of cytokines is also involved for interactions between tumoral cells and bone cells. These are secreted by the tumoral (metastatic or hemopoietic) cells, bone marrow cells, bone cells, or even could be released from the bone matrix during bone resorption. Recent progress in our knowledge in the field of cytokines have improved the understanding of the pathogenesis of these diseases and let hope future promising developments for more specific treatments.
Thirty seven postmenopausal women aged under 65 with densitometric osteoporosis defined by a bone density value below the 80th percentile of the osteoporotic population but without identifiable crush fractures, were treated and monitored for two years using clinical, laboratory and densitometric parameters. Sixteen of them were given hormonal replacement therapy combining percutaneous or transdermal 17 beta estradiol with a progestogen and the other 21 sodium fluoride at the dose of 50 mg/d combined with calcium and vitamin D. There was a significant increase in vertebral bone density in both groups: 6.3 +/- 0.9 per cent for hormone treatment and 7.1 +/- 1.5% for fluoride after 2 years, while it fell in a control group. The increase was linear with fluoride, while 2/3 of the gain was acquired by the end of the first year of hormonal therapy. Nine of the 16 patients on hormonal therapy and 9 of the 21 taking fluoride showed a significant vertebral gain at 2 years (greater than or equal to 0.043 g/cm2). There was no parameter which enabled the identification of "responders" before treatment. There was no difference in changes in femoral bone density between patients treated with fluoride and controls. From a laboratory standpoint, hormonal therapy caused a significant fall at 12 months in the urinary calcium/urinary creatinine ratio, and a non-significant fall in osteocalcin at 2 years. With fluoride, there was a marked rise in osteocalcin and a more moderate rise in alkaline phosphatase, reflecting stimulation of bone formation without any variation in resorption. In conclusion, this study shows the ability of both these types of treatment of increasing, by different mechanisms, the vertebral bone density of osteoporotic women. However, it does not indicate the extent to which this gain in bone density might have a positive influence on fracture risk.
A new case of simvastatin-induced acute rhabdomyolysis with heart failure after initiation of treatment with fusidic acid is reported. In most reported instances, statin treatment was initially well tolerated with muscle toxicity developing only after addition of another drug. The mechanism of this muscle toxicity is unelucidated but involvement of a decrease in tissue Co enzyme Q is strongly suspected.
A retrospective study of 404 cases of rheumatoid arthritis seen in a department of internal medicine in Casablanca highlights a number of specific features of the disease in Morocco. Onset occurred early and mean age of patients was 34.4 years. Analysis of joint manifestations showed that the disease tended to be mild in the hips and perhaps in the cervical spine. Thirty-five percent of patients were Steinbrocker's class II and 25.5% had carpal bone fusion. Only 20 patients had severely erosive disease, which manifested as giant geodes in 8 cases and as main en lorgnette deformity in one case. Subcutaneous nodules (7.9%) and systemic visceral disorders were fairly infrequent. Only three cases of malignant rheumatoid arthritis were found. Gougerot-Sjögren syndrome was present in 13.6% of patients. Among comorbid conditions, thyroid gland diseases and tuberculosis were fairly common. Serologic tests were positive in 61.14% of cases, often in low titres. Gold salt therapy was well tolerated. No patients in this group had surgical treatment. These data suggest that in Morocco rheumatoid arthritis may be less aggressive than in Europe.
