Does hormone replacement therapy discontinuation cause musculoskeletal pain?
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Estrogen Replacement Therapy↗
Biomedical subjects
Marcel-Francis Kahn
Publications and source records attributed to Marcel-Francis Kahn.
Rheumatoid nodulosis. Two cases with destructive polyarthritis after 20 years.
The term "rheumatoid nodulosis" was coined by Ginsberg in 1975 to designate a rare and distinctive form of rheumatoid disease. Anecdotal case reports suggest a benign nondestructive course, although prolonged follow-up data are usually unavailable. We describe two cases of typical rheumatoid nodulosis with follow-ups exceeding 25 years. Onset occurred at 14 and 22 years of age, respectively. Both patients presented with palindromic rheumatism, positive tests for rheumatoid factors, negative tests for other biological markers, and normal radiographs. Multiple subcutaneous nodules developed after 4 and 6 years with palindromic flares, respectively. Functional impairments and disfigurement required several surgical procedures to remove nodules. Histology was typical for rheumatoid nodules. Neither patient responded to disease-modifying anti-rheumatic drugs (gold, antimalarials, and D-penicillamine). Treatment consisted of nonsteroidal anti-inflammatory drugs combined with prednisone as needed. After 20 and 22 years of follow-up, respectively, both patients had typical rheumatoid arthritis with deformities and radiological joint destruction. In conclusion, these two cases establish that rheumatoid nodulosis can occur as a presentation of rheumatoid arthritis with a potential for severe joint damage after many years.
Anti-Inflammatory Agents, Non-Steroidal↗
Can we estimate the incidence, prevalence, and outcomes of rheumatoid arthritis in France?
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Adult↗
[Current trends in fibromyalgia].
Even if associating in single entity polyalgic symptoms remains a matter of discussion, fibromyalgia concept has gained a large acceptance among medical communities and international instances. Its physiopathological background is still in discussion. Its presentation mostly in middle aged women is a chronic, widespread painful syndrome, mostly appendicular of long duration and resistant to any treatment, associated with multiple tender points. Frequently associated are a poor sleep, local and general fatigue and mood disorders. Clinical, biological and radiological search for a definite condition remains negative, at least for primitive presentation. Concomitant forms are accepted by the American College of Rheumatology criteria, position which can be challenged. It seems more accurate to study such cases as differential diagnosis. Physiopathology involves anomalies of perception transmission and integration of painful signals at different levels of nervous system, either peripheral or central. Medical intervention requires first a good deal of empathy and a multidisciplinary approach combining some drugs, insufficient if used alone and different physical cognitive and comportemental measures. Fibromyalgia, which raises difficult social problems, is an evolving concept.
Age Factors↗
Nicolau's syndrome after local glucocorticoid injection.
We report three cases of Nicolau's syndrome induced by intraarticular glucocorticoid injections. Nicolau's syndrome is defined as livedo-like dermatitis secondary to acute arterial thrombosis occurring immediately after intravascular injection of an insoluble drug substance. The cases described by Nicolau occurred in association with injections of oily bismuth suspensions. In 1970s and 1980s, cases occurred with delayed-action penicillin suspensions injected intramuscularly. Typically, the injection is followed immediately by excruciating pain in the buttock, sometimes with syncope. Cyanotic patches and a livedoid pattern develop. Rapid resolution of the pain and slower clearing of the skin changes occur in most patients. We report three typical cases with both severe pain and skin changes. In addition, two other patients had incomplete variants without skin abnormalities. Each of these five patients had received an injection in or about a joint of a glucocorticoid in a crystalline suspension. The pathophysiology of this syndrome probably involves acute vascular spasm related to penetration of microcrystals into a blood vessel.
Adult↗
Monoarthritis secondary to joint metastasis. Two case reports and literature review.
Synovial metastases from neoplasms are uncommon. We report two cases of knee monoarthritis due to joint metastasis. Joint fluid cytology established the diagnosis. In one patient, an epidermoid carcinoma of the ureter metastasized to the left knee. The other patient had chronic monoarthritis of the left knee unresponsive to conventional treatment and was found to have distal femoral metastases from a lung adenocarcinoma. Only 28 cases of synovial metastases from solid tumors have been reported in the literature. The knee is the most common target, the lung the most common site of the primary (12 cases), and adenocarcinoma the most common histological type (12 cases). Joint metastasis carries a poor prognosis with a mean survival of less than 5 months.
Adenocarcinoma↗
Hip involvement in patients with familial Mediterranean fever. A review of ten cases.
Hip involvement is uncommon in familial Mediterranean fever (FMF) and can result either from a process specific to this disease or from a coexisting chronic inflammatory joint disease, usually suggestive of ankylosing spondylitis (AS). We report ten cases of FMF with radiologically-documented inflammatory hip disease. Five patients had AS and one had juvenile idiopathic arthritis. There were six men and four women, with a mean age of 34.4 years +/- 17.6 (range, 15-70 years). Onset of the inflammatory hip disease occurred after bouts of acute hip symptoms in one of the patients with isolated FMF and after protracted hip arthritis in another; the two other patients had no history of hip symptoms. The HLA-B27 antigen was looked for in two of the five patients with FMF and AS, with negative results in both; another patient in this subgroup had severe ulcerative colitis. Total hip replacement or replacement of the acetabulum was required in six patients, including two with isolated FMF. Chronic joint disease has been estimated to contribute fewer than 5% of the joint manifestations in FMF. In previous studies, the hips and knees were affected in 75% of patients with chronic joint disease related to FMF. The association of FMF and AS (usually without the HLA-B27 antigen) has been well documented, although the pathogenic mechanisms that link these two conditions remain unknown.
Adolescent↗