Dapsone and rheumatoid vasculitis leg ulcerations.
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Biomedical subjects
Publications and source records attributed to R Treves.
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Spinal radiologic lesions suggestive of destructive spondylarthropathy were found in 10 patients on long-term hemodialysis. These lesions were characterized by severe narrowing of the intervertebral disc, associated with erosions and geodes of the adjacent vertebral plates without osteophytosis. In 9 of the 10 patients the lesions were located in the cervical spine, and in 1 patient, in the lumbar spine. Microbial spondylitis, degenerative disc disease, and destructive spondylarthropathy of calcium pyrophosphate dihydrate deposition disease were each, in turn, ruled out. The finding of apatite crystals by transmission electron microscopy in 1 disc specimen suggests that these crystals may be associated with destructive vertebral disc lesions in dialysis patients.
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Antinuclear antibodies (ANA) were demonstrated in four patients (2 male, 2 female) with reactive arthritis (RA) due to Yersinia enterocolitica (YE) and Yersinia pseudotuberculosis (YPT). Changes in ANA titres and serologic tests were not correlated. The two patients are HLA B27 positive. Polysaccharides could be partly responsible for Yersinia antigenicity. The presence of ANA in chronic forms of RA due to Yersinia warrants discussion.
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Treatment of giant-cell arteritis rests on corticosteroids. Three observations of Horton arteritis with initial resistance to cortisone are reported. Diagnosis was substantiated by the examination of biopsy specimens. Resistance to therapy was overcome by changing to another corticosteroid. Observations such as those reported here are very uncommon.