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Biomedical subjects

A M Prieur

Publications and source records attributed to A M Prieur.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Uveitis in juvenile chronic arthritis].

The authors report the follow-up of thirty patients and 49 eyes, with uveitis associated to juvenile chronic arthritis. Clinical characteristics and risk factors of uveitis are: female gender (90%), bilateral involvement (63%), chronicity (91%), relapses (94%), oligoarticular arthritis (73%), antinuclear antibodies (83%). The intraocular inflammation was most frequently asymptomatic. It is extremely important to screen the patients systematically at regular intervals in order to early diagnose the uveitis to improve the visual prognosis. Risk factors for significant visual loss are still cataract (26.5%) and secondary glaucoma (10%). The most devastating complication is secondary glaucoma.

Arthritis↗
PubMed1993

Occurrence of antiperinuclear, antikeratin, and anti-RA 33 antibodies in juvenile chronic arthritis.

OBJECTIVES: Antiperinuclear factor (APF), antikeratin antibodies (AKA), and anti-RA 33 antibodies are currently considered to be good markers for the diagnosis of adult rheumatoid arthritis with or without rheumatoid factor (RF). The prevalence of these markers was retrospectively reviewed in children with juvenile chronic arthritis (JCA) to determine whether they were associated with specific features. METHODS: One hundred and twenty-four patients with JCA participated in this study. Controls included 28 patients with juvenile systemic lupus erythematosus and 21 healthy children. Antiperinuclear factor and AKA were determined by indirect immunofluorescence on buccal mucosal cells and oesophagus sections respectively. Anti-RA 33 antibodies were detected using a Western blot technique on HeLa cell nuclear extract. RESULTS: Antiperinuclear factor was virtually absent in all the tested subgroups and anti-RA 33 antibodies were detected only in a subset of patients with RF positive polyarticular onset. Antikeratin antibodies were found in 27% of all children with JCA and in 42% of those with RF negative polyarticular onset. These results were statistically significant compared with healthy controls, but the presence of AKA was not specific to any patient subgroup. Moreover, in contrast with previous studies in adult RA, no relation was found between the presence of AKA and disease severity or activity. CONCLUSION: These data suggest that APF, AKA, and anti-RA 33 antibodies are not useful for the diagnosis or classification of JCA.

Antibodies, Antinuclear↗
PubMed1993

[Non-traumatic myositis ossificans in a child. Review of the literature apropos of a case mimicking malignant tumor].

A ten year nine month-old girl was admitted to hospital for a painful inflammatory tumour of the right popliteal area. There was a calcification on X-ray and computerised angiography showed a tumour. MRI showed a heterogenous irregular mass. This looked like a malignant tumour. At surgical biopsy: it was a circonscripta myositis ossificans. This benign tumour of soft tissues, rare in children (25 cases in the literature), had a spontaneous favourable evolution. Differential diagnosis with malignant tumour is well known, but is still difficult. Biopsy is necessary in doubtful cases. We had to remove the mass because of acute pain.

Child↗
PubMed1993

[Criteria for classification of spondylarthropathies in children].

BACKGROUND: The term spondylarthropathy is used for several different entities including undifferentiated forms. The latter are particularly frequent in children and often not recognized. Two sets of criteria, the Amor and the European Spondylarthropathy Study Group (ESSG) criteria, primarily devised for adults, were evaluated in a pediatric population. METHODS: Three hundred and ten consecutive patients referred to one pediatric rheumatology center over 6 months were prospectively assessed, whatever the rheumatic complaint. Twenty two items were analysed for each patient and compared with the criteria proposed by Amor (17 items) and the ESSG (12 items). RESULTS: The Amor criteria performed better than the ESSG criteria. The sensitivity was 84 and 69.7%, and the specificity 96.1 and 92.2% for the Amor and the ESSG criteria, respectively. The sensitivity for pauci-arthritis was much higher in children, but the specificity was lower than in adults. The sensitivity of spinal involvement was very low in children. The undifferentiated type accounted for 81% of all definite spondylarthropathies. Definite and possible spondylarthropathies were 17% of the total referral over the 6 months, i.e. one patient in 6. CONCLUSIONS: These two sets of criteria, particularly the Amor criteria, can help pediatricians to recognize the undifferentiated type of spondylarthropathy, in the absence of spinal or any other characteristic manifestation.

Adolescent↗
PubMed1993

Prospects in pediatric rheumatology.

Although pediatric rheumatology became a specialty during the mid 1970s, a number of clinical, research and therapeutic issues still need to be addressed. New entities need to be clearly defined and definite diagnostic criteria established. Research has identified the involvement of cytokines and genetic factors in juvenile chronic arthritis (JCA), while synthetic histone peptides will allow more thorough research into antinuclear antibodies. No satisfactory drug therapy exists for the treatment of chronic rheumatic disease, though the use of local injections of triamcinolone hexacetonide has modified the prognosis of pauciarticular JCA. Joint replacement requires special consideration, as prostheses need to be constructed according to individual requirement. Finally, the psychological impact of JCA must not be underestimated.

Arthritis, Juvenile↗
PubMed1993

The place of corticosteroid therapy in juvenile chronic arthritis in 1992.

Juvenile chronic arthritis (JCA) is a heterogeneous disease, treated with systemic or local corticosteroid therapy. Systemic corticosteroids are indicated in systemic JCA only when nonsteroidal antiinflammatory drugs have failed or cause side effects or if there is evidence of severe pericarditis. Intravenous pulses of methylprednisolone produce little benefit. Corticosteroid therapy must be tapered slowly, and it may take a long time to reach an alternate day regimen. Side effects are the most worrying problem with daily therapy, particularly growth arrest. Some cases of polyarticular JCA with severe functional impairment and unresponsive to other therapies may benefit from systemic corticosteroids. The most powerful drug for the treatment of joints is triamcinolone hexacetonide, which produces excellent responses in two-thirds of knee joint cases treated. Local corticosteroid therapy is also indicated for chronic iridocyclitis.

Adrenal Cortex Hormones↗
PubMed1992

Juvenile rheumatoid arthritis of the knee: MR evaluation with Gd-DOTA.

Synovial hypertrophy, effusion, and articular cartilage status were evaluated with gadolinium tetraazacyclododecanetetraacetic acid (DOTA)-enhanced magnetic resonance (MR) imaging in 24 knees in 24 pediatric patients (17 female, seven male; mean age, 10 years; range, 3-18 years) with juvenile rheumatoid arthritis (JRA). T1-weighted spin-echo sequences were performed with a 0.5-T unit before and immediately after injection of Gd-DOTA (0.1 mmol/kg). Substantial enhancement of synovial proliferation was seen in 23 of 24 knees, allowing precise assessment of pannus extension (n = 23), joint effusion (n = 21), cartilage loss (n = 21), and meniscal hypotrophy (n = 23). On T1-weighted images without contrast enhancement, cartilage thickness, loculation of joint effusion, and pannus extension were underestimated. Thus, Gd-DOTA-enhanced MR imaging is mandatory in the assessment of knee involvement in children with JRA and may prove to be useful in the evaluation of response to therapy.

Arthritis, Juvenile↗
PubMed1991

[Spondyloarthropathies in children].

The diagnosis of spondylarthropathy is more difficult in children than in adults because there are no uniform diagnostic criteria. In a study involving 65 children (20 girls and 45 boys) with chronic arthritis and HLA B27 antigen, the clinical symptoms, localization and type of joint involvement, the extraarticular manifestations and radiology results are analyzed. In 73% of cases the joints affected were located in the lower extremities. In 30% of the patients an enthesopathy was present. Four patients had psoriasis and 9 intestinal symptoms. In no patient were autoantibodies detected. In one half of the cases there was evidence of a familial disposition. With the help of two different systems of classification an attempt is made to evaluate the individual criteria and propose guidelines for diagnosis. The results so far have shown that both systems are applicable to children.

Adolescent↗
PubMed1991

[Surgery of juvenile chronic arthritis].

A number of surgical procedures can be proposed in juvenile chronic arthritis (JCA). These are particularly useful in two circumstances: 1), during the early stages of the disease, as local treatment for hyperplasic synovium (intra-articular injection or synovectomy) in order to avoid further articular destruction; 2) in the late stages of the disease with the aim of restoring function to as near normal as possible (osteotomy, arthrodesis, arthroplasty, tendon repair). However, in all circumstances, such surgery must be decided upon by a team consisting of paediatrician and orthopaedic surgeon. Procedures are often multiple and require careful preparation including psychological support, nutritional, medical and orthopaedic care. And should be followed by intensive and specific physiotherapy. When these conditions are fulfilled, the operative procedures may restore nearly normal joint function in severe forms of JCA, thus allowing children and adolescents to maintain good physical, intellectual and psychological development through independent mobility.

Adolescent↗
PubMed1990

[Management of children with chronic rheumatism. Similarities and differences with rheumatoid polyarthritis].

In France, about 3,000 children under 16 years of age suffer from juvenile chronic arthritis (JCA), whose management presents a problem. JCA covers several nosological entities. In 20% of the cases, a systemic form affecting the articulations in an inconstant way, and starting in the very young child, is observed. In 30% of the cases, a form with a polyarticular start is observed. This group is very heterogeneous and includes in particular early seropositive rheumatoid arthritis (RA), the little girls' polyarthritis with presence of antinuclear antibodies, and the little boys' rheumatisms HLA B27. Finally, in 50% of the cases, an oligoarticular form is observed, also expressed in greatly varying ways. In all cases, the evolution is unpredictable and the management of these children is different from that of adults. It must be noted that the treatments used in adults are rarely applied to children as JCA is a pathology which is quite different from RA. Several types of treatment can be administered by general route: non-steroidal antiinflammatory drugs (NSAIDs) and mainly aspirin, since few NSAIDs have a paediatric licence in France. However, the risks of intolerance at doses reaching up to 100 mg/kg are not negligible. Some NSAIDs can be used in older children. The slow acting drugs are dangerous in the systemic form of JCA. Their indication seem to be more appropriate in the polyarticular forms. In the oligoarticular forms, slow acting drugs are rarely proposed. Corticosteroids are prescribed in aspirin-resistant systemic forms only. Besides the complications observed in adults, the growth is stopped in a constant way.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Renal amyloidosis in juvenile chronic arthritis: evolution after chlorambucil treatment.

Over a 22-year period, eight patients affected with severe systemic or polyarticular juvenile chronic arthritis (JCA) developed systemic amyloidosis with nephrotic syndrome. They were treated with chlorambucil over 5-192 months (mean = 44 months). With treatment, an abrupt decrease in the severity of JCA was observed in six patients but two patients were chlorambucil resistant. After a mean follow-up period of 10 years from onset of renal symptoms, one chlorambucil-resistant patient died of end-stage renal failure; two patients have a persistent nephrotic syndrome; and five patients are free from proteinuria, of whom one has developed hypertension. A good correlation was observed between the response of the rheumatic disease to chlorambucil treatment and the clinical course of renal symptoms. Fourteen renal biopsies were performed in these eight patients. In all, amyloid deposits were of the AA type, which persisted on repeat biopsies. In addition, 15%-60% of glomeruli had become globally sclerotic by the second or third biopsies. At the ultrastructural level, modifications in the structure of amyloid deposits and reparative changes of the glomeruli, characterized by partial restoration of glomerular architecture, were observed in three patients with a favourable clinical course.

Amyloidosis↗