René-Marc Flipo

Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis.

OBJECTIVE--To assess the usefulness of high resolution computed tomography (HRCT) of the lungs in patients with rheumatoid arthritis (RA) with and without respiratory symptoms. PATIENTS AND METHODS--Eighty eight RA patients with a mean duration of disease 12 (SD 8) years were evaluated. Eleven patients were excluded because of previous exposure to silica. The 77 remaining patients formed two groups according to the absence (group I, n = 38) or the presence (group II, n = 39) of chronic respiratory symptoms. A control group consisted of 51 non-smoking, healthy patients. RESULTS--The most frequent abnormalities observed in the 77 RA patients were bronchiectasis or bronchiolectasis (n = 23, 30%), pulmonary nodules (n = 17, 22%), subpleural micronodules or pseudoplaques (n = 13, 17%), ground glass opacities (n = 11, 14%), and honeycombing (n = 8, 10%). Bronchiectasis or bronchiolectasis (p = 0.012), rounded opacities (p = 0.016), ground glass attenuation (p = 0.004), and honeycombing (p = 0.002) were found more often in RA group II (with respiratory symptoms) than in group I (no respiratory symptoms). Non-linear septal opacities were more frequent in group I than in the control group, but other HRCT findings did not differ statistically significantly between group I and the control group. CONCLUSION--Bronchiectasis may be a characteristic lung change in RA patients. Abnormalities on HRCT are less frequently observed in the absence of respiratory symptoms than in the presence of such symptoms (29% versus 69%).

Pigmented villonodular synovitis of the hip: review of radiographic features in 58 patients

Clinical and radiographic findings were retrospectively reviewed in a multicentric survey of 58 patients with histologically proven pigmented villonodular synovitis (PVNS) of the hip. The most common clinical features were mechanical pain (47 cases) and limitation of joint motion (47 cases). On plain films, a classic form with large and multiple lucencies was found in 36 cases, followed by an osteoarthritis-like form (9 cases), an arthritis-like form (8 cases), normal radiographic appearance (3 cases), osteonecrosis of the femoral head (one case) and joint destruction with acetabular protrusion (one case). Bilateral involvement of the hips was probable in two patients. In contrast to the knee, the hip showed a high prevalence of bony lesions and joint space narrowing. Although an uncommon disease, PVNS of the hip has to be considered when arthritis is associated with uncharacteristic clinical or radiographic findings.

Revisiting comorbidities in gout: a cluster analysis

Objectives The reciprocal links between comorbidities and gout are complex. We used cluster analysis to attempt to identify different phenotypes on the basis of comorbidities in a large cohort of patients with gout. Methods This was a cross-sectional multicentre study of 2763 gout patients conducted from November 2010 to May 2011. Cluster analysis was conducted separately for variables and for observations in patients, measuring proximity between variables and identifying homogeneous subgroups of patients. Variables used in both analyses were hypertension, obesity, diabetes, dyslipidaemia, heart failure, coronary heart disease, renal failure, liver disorders and cancer. Results Comorbidities were common in this large cohort of patients with gout. Abdominal obesity, hypertension, metabolic syndrome and dyslipidaemia increased with gout duration, even after adjustment for age and sex. Five clusters (C1–C5) were found. Cluster C1 (n=332, 12%) consisted of patients with isolated gout and few comorbidities. In C2 (n=483, 17%), all patients were obese, with a high prevalence of hypertension. C3 (n=664, 24%) had the greatest proportion of patients with type 2 diabetes (75%). In C4 (n=782, 28%), almost all patients presented with dyslipidaemia (98%). Finally, C5 (n=502, 18%) consisted of almost all patients with a history of cardiovascular disease and renal failure, with a high rate of patients receiving diuretics. Conclusions Cluster analysis of comorbidities in gout allowed us to identify five different clinical phenotypes, which may reflect different pathophysiological processes in gout.

Diffuse pigmented villonodular synovitis of the shoulder.

A 52-year-old man presented with an 8-month history of progressive pain and swelling of his right upper arm. His past medical history was unremarkable. Physical examination showed a soft doughy mass around the right shoulder, but no heat or redness was noted. Shoulder range of motion was significantly limited. The patient was free of systemic symptoms. Laboratory evaluation was within normal limits. Radiographs demonstrated two lucent defects in the head of the right humerus and a soft tissue mass without any calcification (Fig. 1). Magnetic resonance (MR) imaging of the shoulder including axial and coronal planes revealed a lobulated mass in the subcapsular bursa, the axillary and posterior recesses, and around the long head of the biceps. On spin echo (SE) Tl-weighted images, the signal of the mass was slightly higher than that of the surrounding muscle and showed a homogeneous enhancement after gadolinium injection (Figs. 2, 3). Small low-signal areas were seen inside the mass around the bicipital tendon before contrast injection; they did not enhance. On SE T2-weighted images, the mass had a slightly hyperintense signal compared with the muscles and

Two Roman and medieval cases of symmetrical erosive polyarthropathy from Normandy: anatomico-pathological and radiological evidence for rheumatoid arthritis

With continued archaeological discoveries of skeletal remains in the USA and Europe, discussion of the possible aetiology for recognized cases of symmetrical erosive polyarthropathy include the spondylarthropathies and rheumatoid arthritis. One skeleton from the fourth century site of Lisieux and a second from the eleventh century site of Rouen are characterized by numerous symmetrical marginal erosions, primarily involving the metacarpophalangeal and proximal interphalangeal joints. Results of maroscopic, microscopic and radiological examination are highly suggestive of a modern-day diagnosis of rheumatoid arthritis. These data are consistent with the presence of rheumatoid arthritis before the onset of the fourteenth century.

Natural course of erosive arthropathy of the hand in patients undergoing hemodialysis

Abstract Objective. To assess the radiographic features of erosive arthropathy of the hands occurring in patients undergoing hemodialysis, and its relationship with metabolic abnormalities. Patients and design. A retrospective study of hand radiographs of 80 patients on maintenance hemodialysis was performed with the aim of detecting erosive arthropathy. Results and conclusions. Ten patients showed erosive arthropathy of the hands with a predilection for distal interphalangeal joints. The first joint abnormality was joint space narrowing with or without erosion. The mean duration of hemodialysis was 5 years (range 1–15 years). The development of arthropathy could not be related to a metabolic factor. The pathogenesis of arthropathy of the hands is possibly multifactorial, accounting for the disparate descriptions of the radiographic features in the literature.

Biotherapy and rheumatoid arthritis: a medico-economic evaluation from 2008 French Hospital Database.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 3 aout 2011

Changes in the incidence and management of spinal tuberculosis in a French University Hospital Rheumatology Department from 1966 to 2010

INTRODUCTION Two previous single-center studies in a university hospital rheumatology department suggested an increase in the incidence of spinal tuberculosis in France in the 1990s. Our objective in this study was to obtain incidence data on spinal tuberculosis since 1995 in the same department and to describe changes over the entire study period from 1966 to 2010. We also compared patients seen between 1966 and 1995 to those seen between 1995 and 2010. METHODS We conducted a retrospective review of all cases of spinal tuberculosis seen in our rheumatology department between 1966 and June 1995 and between July 1995 and 2010. We collected the annual incidence, clinical and radiological features, and diagnostic and therapeutic strategies. RESULTS One hundred and thirty patients were managed between 1966 and 2010. The number of cases declined in the 1970s and 1980s then increased over the next two decades. None of the patients had HIV infection. Over 70% of patients were from continental France. Compared to patients seen during the earlier period, those seen after June 1995 were older (62.8±17.2 vs. 53±14.3 years, P=0.0006), had more comorbidities, and more often exhibited severe radiological findings (including multilevel involvement, epidural involvement, and abscesses). No changes occurred in time to diagnosis or management strategies. CONCLUSION The incidence of spinal tuberculosis in a university hospital rheumatology department has increased over the last two decades, chiefly as a result of reactivation of past tuberculosis, as opposed to origin from endemic countries or HIV infection.

Giant cell arteritis occurring during psoriatic arthritis treated by adalimumab

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 14 fevrier 2015

La goutte: présentations cliniques et diagnostic

Resume La goutte est une pathologie dont la presentation clinique, avec ses differentes phases bien identifiees, prend une part predominante dans le diagnostic. C’est a partir de ce constat qu’historiquement les differentes classifications diagnostiques, et en premier lieu celles de l’American College of Rheumatology de 1977 et plus recemment de l’EULAR en 2006 ont ete elaborees. Dans cette meme logique, a partir de la confrontation de ces classifications historiques a une pratique quotidienne et la mise en lumiere de leurs limites, de nouvelles classifications comme celle de la Chronic Gout Diagnosis (CGD) ont permis d’affiner les criteres diagnostiques notamment cliniques de la pathologie goutteuse. Parallelement sont apparus des examens morphologiques, au premier rang desquels l’echographie, qui viennent progressivement etayer l’arsenal paraclinique dans l’etablissement du diagnostic de goutte, aux cotes de la recherche de microcristaux et de la radiologie conventionnelle.