Revue du rhumatisme (English ed.)
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IgG antibodies to cardiolipin and beta 2-glycoprotein I were looked for using an enzyme-linked immunosorbent assay (ELISA) in 19 patients with giant cell arteritis (meeting 1990 American College of Rheumatology criteria), including 16 with concomitant polymyalgia rheumatica (meeting Bird's criteria) and in three patients with isolated polymyalgia rheumatica. IgG anti-cardiolipin antibodies were demonstrated in eight patients (36%) and IgG anti-beta 2-glycoprotein I antibodies in two patients (9%) including one without anti-cardiolipin antibodies. Titers of anti-cardiolipin antibodies ranged from 27 to 190 units of IgG antiphospholipid antibodies (UGPL) (mean 71 UGPL). ⋯ These data, as well as findings from serial measurements, suggest that anti-cardiolipin antibodies are present early in the course of giant cell arteritis and disappear within a few weeks of initiation of corticosteroid therapy in a dose of more than 25 mg prednisone per day. In this study, only one patient without anticardiolipin antibodies developed a cerebrovascular accident. Positive tests for anti-cardiolipin antibody or anti-beta 2 glycoprotein I antibody in a patient with polymyalgia rheumatica suggest a diagnosis of concomitant giant cell arteritis, which is usually symptomatic.
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Review Case Reports
Epidural lipomatosis not induced by corticosteroid therapy. Three cases including one in a patient with primary Cushing's disease (review of the literature).
We report three cases of epidural lipomatosis including one in a patient with primary Cushing's disease. Our literature review found 16 additional cases of symptomatic epidural lipomatosis in patients who were not receiving corticosteroids. The presenting symptoms were nonspecific. ⋯ In patients without neurologic compromise, surgery should be considered only if symptoms fail to respond to weight reduction. The rate of occurrence of epidural lipomatosis in patients with Cushing's disease is probably underestimated. Routine investigation by magnetic resonance imaging of Cushing's disease patients who have manifestations known to occur in epidural lipomatosis would allow to evaluate the role of increased production of endogenous corticosteroids in the occurrence of epidural lipomatosis.
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Review Case Reports
Reactive arthritis induced by Strongyloides stercoralis.
Reactive arthritis induced by Strongyloides is exceedingly rare. A case in a 53-year-old man from the Guadeloupe (French Antilles) is reported. ⋯ The cycle of Strongyloides is reviewed, and the contribution of parasites to reactive arthritis in patients with genetic risk factors is discussed. Establishing the correct diagnosis is sometimes difficult but is essential in order to avoid inappropriate administration of corticosteroids that can lead to fatal, multivisceral dissemination of the parasite, particularly in patients with strongyloidiasis.
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Letter Case Reports
Acute monoarthritis in a patient under isotretinoin.
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Review Clinical Trial
When is spinal fusion warranted in degenerative lumbar spinal stenosis?
This study, conducted by a group of neurosurgeons who devote a large portion of their professional time to the treatment of degenerative lumbar spine lesions, was prompted by the dramatic increase in the number of lumbar spinal fusion procedures performed over the last few years in a broad spectrum of disorders ranging from chronic incapacitating low back pain to lumbar spinal stenosis. In the authors' experience, lumbar spinal fusion is rarely warranted and often of dubious efficacy. ⋯ Findings demonstrate that spinal fusion is a technique of unproven benefit that should be used only in carefully selected patients until results of reliable, prospective, comparative clinical trials become available. In the authors' opinion lumbar spinal fusion should be used as the first-line treatment only in young patients with clinical manifestations directly related to lumbar instability as defined in this study, when decompression requires removal of both facet joints and of the disk (which is rarely the case) or when simple decompression is followed by a recurrence of symptoms ascribable to worsening vertebral slippage.