[Involvement of the foot in metabolic diseases].

In the acute stage of gout, the hallux is most commonly involved followed by the mediotarsal joints and the Achilles tendons. Diagnosis of gout is established when typical monosodium urate crystals can be identified. Apart from NSAIDs, colchicine can be used when there is no renal impairment.

[Apatite deposition diseases].

Deposition of apatite crystals can be observed as calcific periarthritis and articular calcifications. Deposition of these crystals in the tendons and bursae of the rotator cuff of the shoulder is found in about 3% of adults; it is most of the time asymptomatic. Calcifications often totally disappear after an acute flare up.

How to keep a wet preparation of synovial fluid.

Identification of crystals in the synovial fluid (SF) is mandatory for the diagnosis of a microcrystal deposition arthropathy. In some cases, this analysis can be troublesome, especially in medical centers where a qualified practitioner is not continually present. Therefore, we investigated a method for preservation of a wet preparation of SF for 24 hours at room temperature.

EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

Objective: To develop evidence based recommendations for the diagnosis of gout.

Methods: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert, representing 13 European countries. Ten key propositions regarding diagnosis were generated using a Delphi consensus approach.

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).

Objective: To develop evidence based recommendations for the management of gout.

Methods: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert representing 13 European countries. Key propositions on management were generated using a Delphi consensus approach.

CPPD crystal deposition disease in patients with rheumatoid arthritis.

The aim of this study was to assess the frequency and the outcome of patients suffering from rheumatoid arthritis in which calcium pyrophosphate dihydrate (CPPD) crystal deposits were found to coexist in synovial fluid analysis. Such association was more frequent than previously believed with CPPD crystals found in 25.8% of 93 patients with rheumatoid arthritis.

Synthesis and structure-activity-relationships of 1H-imidazo[4,5-c]quinolines that induce interferon production.

1H-Imidazo-[4,5-c]quinolines were prepared while investigating novel nucleoside analogues as potential antiviral agents. While these compounds showed no direct antiviral activity when tested in a number of cell culture systems, some demonstrated potent inhibition of virus lesion development in an intravaginal guinea pig herpes simplex virus-2 assay. We have determined that the in vivo antiviral activity can be attributed to the ability of these molecules to induce the production of cytokines, especially interferon (IFN), in this model.

[Reactive arthritis induced by Clostridium difficile enteritis].

This article reports the case of an acute monoarthritis of the ankle occurring in a HLA-B27 positive female patient who presented with diarrhea and fever. We retained the hypothesis of a Clostridium difficile colitis, as she had previously received an antibiotic treatment. The culture of the synovial fluid remained sterile, which postulated that this arthritis was reactive.

[Slow-acting anti-rheumatic agents: recent developments].

Until recently, treatment of osteoarthritis targeted the pain and the disability of the involved joints. It consisted in a mix of analgesics, anti-inflammatory drugs, steroid infiltrations and physical therapies. Usefulness of slow but long acting substances is increasing not only by their action on the symptoms but also because they positively influence the evolution of the disease.

[Chondrocalcinosis: a disease frequently occurring in the second half of life].

Articular chondrocalcinosis (ACC) is a metabolic arthropathy caused by calcium pyrophosphate crystal deposits. It is frequent in the second half of the life (6% of the population aged between 60 and 70 years, 30% of the elderly after 80 years). Both males and females, are involved in the same proportion.

[Bilateral shoulder-hand syndrome revealing hypothyroidism and colon carcinoma].

The autors describe a case of a bilateral shoulder-hand syndrome. A Hashimoto's thyroiditis bound hypothyroidism was retained as promoting factor. Rheumatic manifestations amended slowly with a treatment of corticosteroids associated to thyroid hormones replacement.

[Calcium pyrophosphate dihydrate deposition disease in the transverse ligament of the atlas].

Calcium pyrophosphate dihydrate (CPPD) deposits, answerable for chondrocalcinosis, are frequently observed in elderly people. Involvement of the spine is not rare. We present the case of a woman hospitalised for an acute arthritis of the right knee related to CPPD crystal deposition disease who suffered from acute neck pain.

Return-to-work status 1 year after muscle reconditioning in chronic low back pain patients.

Objective: To evaluate return-to-work status 1 year after a physical deconditioning program in manual laborers with chronic low back pain.

Methods: In this open prospective study, a questionnaire was sent to 125 patients and their physicians (115 men and 10 women, mean age 40 years). Mean sick leave duration at program initiation was 4 months.

The cervical spine in calcium pyrophosphate dihydrate deposition disease. A prevalent case-control study.

Objective: To test the hypothesis that calcium pyrophosphate dihydrate (CPPD) deposition disease is a risk factor for neck pain.

Methods: A prevalent case-control study was conducted to assess cervical calcifications and neck pain between patients with and without known peripheral CPPD deposition disease. CPPD cases were included if diagnosed with CPPD deposition disease of peripheral joints, and excluded if their chief complaint was neck pain.

Good outcomes of Lyme arthritis in 24 patients in an endemic area of Switzerland.

Objective: To describe outcomes of treated Lyme arthritis in an endemic area of western Switzerland, where some of the first cases of Lyme disease outside the United States were reported.

Patients And Methods: We retrospectively studied 24 patients (15 males and nine females, mean age 38.7 years) managed by rheumatologists between 1994 and 1999 for Borrelia burgdorferi arthritis manifesting as monoarthritis (n = 20), oligoarthritis (n = 3), or polyarthritis (n = 1).

Arthritis is linked to local and systemic activation of coagulation and fibrinolysis pathways.

Background: Activation of coagulation and fibrinolysis play a role in the pathophysiology of experimental arthritis.

Objective: To determine the extent of activation of the coagulation and fibrinolytic pathways in different joint diseases in humans and to ascertain the factors that may influence fibrin deposition within the joint.

Methods: Plasma from normal subjects (controls, n= 21) and plasma and synovial fluid samples from patients with rheumatoid arthritis (RA; n = 64), osteoarthritis (OA; n = 29), spondyloarthropathy (SpA; n = 22) and crystal arthritis (CA; n = 25) were analyzed for the levels of TF (tissue factor) and tissue factor pathway inhibitor (TFPI) activities, thrombin-antithrombin III (TAT) complexes, and F1 + 2 (thrombin fragment), fibrin d-dimer and thrombin-activated fibrinolysis inhibitor (TAFI) antigenic levels.

Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial.

Background: With the help of a measurement feedback system, the treatment strategy for individual patients with rheumatoid arthritis (RA) can be adjusted to achieve optimal control of disease activity.

Objective: To study whether a measurement feedback system is effective in reducing disease activity in patients with RA.

Methods: Forty eight rheumatologists and 264 patients participated in a controlled clinical trial.