Fabrice Michel

Serum adipokines and adipose tissue distribution in rheumatoid arthritis and ankylosing spondylitis. A comparative study.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are inflammatory rheumatic diseases that may modify body composition. Adipose tissue has the ability to release a wide range of products involved in physiologic functions, but also in various pathological processes, including the inflammatory/immune response. RA and AS are both associated with the development of cardiovascular complications. It is has been established that central/abdominal, and particularly intra-abdominal or visceral adiposity is closely linked to cardiovascular events. Thus, in this study, we aimed to evaluate the body composition of patients with RA or AS compared to healthy controls (HC), with a special emphasis on the visceral region. In parallel, we measured adipose products or adipokines, namely leptin, adiponectin and its high molecular weight (HMW) isoform, resistin, and ghrelin, a gastric peptide that plays a role in energetic balance. The homeostasis model assessment for insulin resistance (HOMA-IR) and atherogenic index were used to evaluate cardiovascular risk. One hundred and twelve subjects were enrolled (30 patients with RA, 31 with AS, and 51 HC). Body composition was measured using dual-energy X-ray absorptiometry to determine total fat mass and lean mass, adiposity, fat in the android and gynoid regions, and visceral fat. Patients and HC did not differ in terms of body mass index. On the contrary, adiposity was increased in RA (p = 0.01) while visceral fat was also increased, but only in women (p = 0.01). Patients with AS tended to have lower total fat mass (p = 0.07) and higher lean mass compared to HC (p = 0.07). Leptin and leptin/fat mass were decreased in male patients with AS (p < 0.01), while total adiponectin and the ratio of HMW to total adiponectin were both increased in RA (p < 0.01). There were no changes in serum resistin and ghrelin in any group of patients. HOMA-IR and the atherogenic index were not modified in RA and AS. These results confirm that body composition was altered in RA and AS, affecting distinct soft tissue compartments. The effect of the increased visceral adipose tissue on cardiovascular risk is presumably attenuated by the favorable cardiometabolic profile in women with RA, as suggested by the normal HOMA-IR and atherogenic index.

Avascular necrosis of the hallucal sesamoids update with reference to two case-reports

We report two cases of nontraumatic metatarsal pain with sclerosis and fragmentation of the lateral sesamoid bone on roentgenographs and computed tomography images. One patient underwent magnetic resonance imaging (MRI), which showed low signal from the sesamoid bone. These imaging findings suggested osteonecrosis. Histology of the sesamoidectomy specimen confirmed this diagnosis in one patient. Avascular necrosis of the metatarsal sesamoid is an uncommon disorder. The suggestive roentgenographic and MRI findings rule out the other painful conditions of the sesamoid bone. The features are reviewed and the treatment options discussed.

Ustekinumab in chronic immune-mediated diseases: a review of long term safety and patient improvement

Ustekinumab is a fully human monoclonal antibody targeting the common p40 subunit shared by interleukin (IL)-12 and IL-23. Ustekinumab prevents the interaction of IL-12 and IL-23 with their cell surface receptors, and thus blocks T helper (Th)-1 IL-12 and Th-17 IL-23 inflammatory pathways. Ustekinumab has been evaluated in the treatment of various chronic immune-mediated diseases including, psoriasis, psoriatic arthritis, Crohn’s disease, and multiple sclerosis. It led to a rapid and durable improvement in psoriasis area and severity index in patients with moderate to severe psoriasis. Ustekinumab also improved joint symptoms of psoriatic arthritis. Results in Crohn’s disease were more mitigated, albeit with a symptomatic improvement in patients refractory to tumor necrosis factor-α inhibitors. Ustekinumab did not reduce the number of magnetic resonance imaging brain lesions in multiple sclerosis. The most common adverse events to have been observed during clinical trials are mild in intensity, and include respiratory tract infections, nasopharyngitis, headaches, and injection site reactions. A pooled analysis of clinical trial data indicated no specific patterns of infection or malignancy under long-term ustekinumab administration. Ustekinumab is easy to use, has a comfortable therapeutic regimen, improves quality of life in patients, and thus appears to be an attractive biological treatment that is adapted and accepted by patients with moderate to severe psoriasis.

Parsonage-Turner syndrome revealing Lyme borreliosis.

Parsonage-Turner syndrome, also known as acute brachial neuritis or neuralgic amyotrophy, can be caused by various infectious agents. We report on four patients who experienced Parsonage-Turner syndrome as the first manifestation of Lyme disease. The clinical picture was typical, with acute shoulder pain followed rapidly by weakness and wasting of the shoulder girdle muscles. Electrophysiological testing showed denervation. A single patient reported erythema chronicum migrans after a tick bite. Examination of the cerebrospinal fluid showed lymphocytosis and protein elevation in 3 patients. Serological tests for Lyme disease were positive in the serum in all 4 patients and in the cerebrospinal fluid in 2 patients. Antibiotic therapy ensured a favorable outcome in all 4 cases. Two patients achieved a full recovery within 6 months. Parsonage-Turner syndrome should be added to the list of manifestations of neuroborreliosis. Serological tests for Lyme disease should be performed routinely in patients with Parsonage-Turner syndrome.

Yellow nail syndrome associated with thiol compound therapy for rheumatoid arthritis : two case reports

Yellow nail syndrome is characterized by ungual dystrophy, lower limb lymphedema, and pleural effusions or bronchiectasis. Rheumatoid arthritis is the autoimmune disorder most often associated with yellow nail syndrome. We report two new cases of yellow nail syndrome in patents receiving thiol compound therapy for rheumatoid arthritis. Eight similar cases have been reported since 1979, suggesting a possible causative effect of this class of drugs.

Spondyloarthropathy and retroperitoneal fibrosis: a case report.

Retroperitoneal fibrosis is an uncommon inflammatory condition in which the retroperitoneal tissue is transformed into a tight sheet of fibrous tissue. It can occur in association with various diseases, including rheumatic conditions. We report a new case in a 66-year-old man with spondyloarthropathy. Nine similar cases have been reported. Axial manifestations predominated, and half the patients carried the HLA-B27 antigen. The relation between retroperitoneal fibrosis and spondyloarthropathy remains controversial.

Polyarthrite aiguë œdemateuse révélant une arthropathie amyloïde

Resume L’amylose articulaire est une amylose primitive de type AL qui s’associe a la presence d’une paraproteine sanguine et/ou urinaire. Le syndrome RS3PE est une polyarthrite benigne aigue œdemateuse du sujet de plus de 60 ans. Nous rapportons un cas d’arthropathie amyloide primitive associee a un syndrome RS3PE. Un homme de 74 ans, est hospitalise pour une polyarthrite aigue benigne qui concerne les quatre extremites. Par ailleurs, il signale une symptomatologie de syndrome du canal carpien predominant a droite. La biopsie synoviale droite identifie des depots avec une affinite tinctoriale pour le rouge Congo persistant apres traitement prealable par du permanganate de potassium (Wright positif). Le diagnostic d’amylose articulaire de type AL est retenu. L’evolution favorable sous corticotherapie seule fait discuter la responsabilite de l’amylose dans la symptomatologie articulaire. Les lesions radiologiques geodiques ne peuvent etre rapportees au RS3PE. L’hypothese d’une nouvelle presentation clinique (type RS3PE) de l’amylose articulaire est envisagee.

Ostéonécrose aseptique des sésamoïdes métatarsiens ou maladie de Renander: aspects actuels à propos de 2 cas

Resume Les auteurs rapportent 2 observations de patients souffrant de metatarsalgies en dehors d’un contexte traumatique, avec radiologiquement un aspect condense et fragmente du sesamoide lateral, des modifications semblables sur l’examen tomodensitometrique et un aspect en hyposignal du sesamoide sur l’IRM dans un cas. Ces modifications de l’imagerie sont evocatrices d’une osteonecrose sesamoidienne, diagnostic confirme sur l’examen histologique de la piece operatoire de sesamoidectomie dans un cas. La maladie de Renander ou necrose aseptique du sesamoide metatarsien est une affection peu frequente qui se distingue des autres causes de douleurs sesamoidiennes par des aspects radiologiques et IRM evocateurs. Les caracteristiques de cette pathologie sont rappelees et les aspects therapeutiques abordes.

Syndrome des ongles jaunes survenant au cours du traitement d'une polyarthrite rhumatoïde par dérivés thiolés : à propos de deux observations et revue de la littérature

Resume Le syndrome des ongles jaunes comporte une dystrophie ungueale, des lymphœdemes des membres inferieurs ainsi que des manifestations pleuropulmonaires a type d’epanchements pleuraux ou de bronchectasies. La polyarthrite rhumatoide est l’affection dysimmunitaire la plus frequemment associee au syndrome des ongles jaunes. Nous rapportons ici deux nouvelles observations de syndrome des ongles jaunes apparus au cours d’une polyarthrite rhumatoide traitee par derives thioles. Depuis 1979, huit cas semblables ont ete rapportes dans la litterature, soulevant l’hypothese de la responsabilite de cette classe moleculaire.