G H Fallet's research while affiliated with Hôpital Universitaire Necker and other places
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Publications (61)
A case of sternocostoclavicular hyperostosis was reported in a 63-year-old woman who had been followed for 15 years. Radiographic changes in the claviculo-sternal area were typical of this condition, and biopsy revealed abnormalities in the right clavicle and in the sternum compatible with infection. Radiographic changes in the thoracic and lumbar...
A method of synovial fluid preparation giving optimal hydroxyapatite detection as well as definitions of the threshold masses of hydroxyapatite in viscous synovial fluid detectable by x ray diffraction and scanning electron microscopy with energy dispersive analysis is reported. Use of an equal volume of 100% hydrazine with the synovial fluid optim...
A case of rapidly evolving osteoarthrosis of the right hip in a 65 year-old woman, as the presenting feature of ochronosis is described and literature reviewed. This unusual presentation may have been precipitated by an acute mechanical overload.
Since the second publication by some of the present authors in which 10 patients with coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were described, 7 new cases have been found. For accuracy, all cases of the original study still available were reexamined. Of the total of 17 cases, 13 were male and 4 female. All had positive t...
Four cases of periarticular calcifications chronologically related to deposteroid injections of small joints of the hands are presented. The calcifications were excised and documented to contain hydroxyapatite by x-ray diffraction analysis.
Three cases of sternocostoclavicular hyperostosis (SCCHO) or pustulotic arthro-osteitis (PAO) associated with plantar pustulosis are presented. Two of them were associated with psoriasis vulgaris although the pustulosis was of a different histological type in each case. Anatomo-pathological study of two of these three cases shows that this hyperost...
Anatomico-radiological study of a sternocostoclavicular mass taken post-mortem from a man whose clinical history had shown bilateral sternocostoclavicular hyperostosis (SCCH) with plantar pustulosis for 27 years. The clavicle showed an ununited fracture attributable to a trauma sustained five years earlier. Both clavicular segments showed active re...
Low back pain is a very frequent complaint and its treatment remains difficult. Etiological diagnosis has improved since introduction of the CT scanner, which is as effective as myelography. 33 adults with chronic low back pain (without neurological signs) had been followed for a mean of 18 months. 26% had a herniated disc, usually at a paramedian...
The hand x-rays of group of patients with generalised osteoarthrosis alone were compared with those patients with generalised osteoarthrosis and chondrocalcinosis (CC). An arthropathy seemingly specific for CC could be identified in the metacarpophalangeal (MCP) and carpal joints. In the MCP joints it was characterised by subchondral rarefactions,...
Chondrocalcinosis is an arthropathy caused by deposits of calcium pyrophosphate-dihydrate microcrystals (CPPD) in the joints and occasionally in the tendons and ligaments. In our region it is almost always seen in its sporadic form in elderly subjects. The patients can be without symptoms or present four different clinical entities: an acute arthri...
Soluble pyrophosphate was measured in the plasma and synovial fluid of various groups of patients and in the plasma of two control groups. The two control groups consisted of 13 healthy subjects and 19 patients suffering from benign lumbar back pain. The other group of patients had rheumatoid arthritis (RA) (14 plasma and 19 synovial fluid examinat...
Seven patients with chronic dorsolumbar pain, stiffness and some restriction of spinal movements are described. Multiple lesions of the vertebral bodies were present. The lesions occurred at various levels and all had similar radiological characteristics, often returning to normal after several years. Vertebral changes of this type may be seen in p...
Articular chondrocalcinosis results from the deposits of calcium pyrophosphate microcrystals in the articular hyalin and fibrocartilages, the synovium and at times the tendons. In our area it is seen most frequently as isolated cases in the elderly and may be asymptomatic. When the affected joints present clinical manifestations, they vary from acu...
A double-blind study was made on the effectiveness of erbium169 synoviorthesis in the digital joints of 7 patients with erosive, seropositive rheumatoid arthritis. The study involved 70 joints observed over a 12-month period: 20 pairs of metacarpophalangeal joints (MCP) and 15 pairs of proximal interphalangeal joints (PIP) were injected with erbium...
Seronegative spondyloarthritides (Reiter's syndrome, ankylosing spondylitis, or psoriatic arthritis) was diagnosed in 24 of 30 patients with severe heel pain. Most of the patients were carriers of the antigen HLA B27. Talalgia was frequently the first symptom of disease. Heel surgery is contra-indicated during the inflammation phase, since it may c...
It is still the opinion of the authors that the cytotoxics, in particular certain antimetabolites and the alkylating agents, are indicated in the treatment of rheumatoid arthritis. These substances are administered essentially in 2 circumstances: when the functional capacity of the patient responds badly to the classical antiphlogistics and to the...
Synoviorthesis of the finger joint with erbium-169 is a beneficial therapeutic procedure which produces reduction of articular pain and swelling in 2/3 of cases. The effect is lasting and shows only slight regression during the first 24 months. However, if the rheumatoid disease is very active, or if the articular lesions are primarily erosive, the...
This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondyl...
Synoviorthesis of the knee joint with OsO4 is a simple procedure with few short or long term side effects. The substance used is inexpensive and easy to handle. All studies published so far have confirmed its suitability in the treatment of synovitis of the knee and various other joints. The initial good results deteriorate steadily, primarily in t...
Fine linear extraarticular calcium deposits were found in X-rays of 7 of 52 patients with articular chondrocalcinosis (ACC). Seven Achilles tendons, seven quadriceps tendons, and one plantar fascia were affected. In a control group of comparable age and sex, without ACC but with generalized osteoarthritis, no calcifications were found in the tendon...
Six patients (five men and one woman) are described, who consulted rheumatologists with varied rheumatic complaints: four had subacute synovitis with effusion, frequently associated with vague arthralgias; and five of the patients had back pain which was more severe at rest. Most of the patients had some clinical signs of secondary syphilis, such a...
The distinction between rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has hitherto relied on supporting evidence of characteristic radiological changes in the sacroiliac joints, together with the Rose-Waaler and Latex tests for rheumatoid factor (RF). This distinction has remained incomplete since some 30 per cent of patients with RA ma...
Three cases of familial pseudo-pseudohypoparathyroidism (PPH) are described. Two patients presented the essential features of this rare syndrome, while the third had the signs of PPH associated with those of tricho-rhino-phalangeal dysplasia (GIEDION). All of our patients had spondylolisthesis of L5 as well as arthrosis of the hips (secondary to co...
Transitory demineralization of the hip, a special form of reflex sympathetic dystrophy, is a rare condition. It should however be distinguished from more severe conditions such as tuberculosis or neoplastic bone disease. The typical symptoms are illustrated from 3 personally observed cases. The patients, usually men between the ages of 30 and 50 ye...
Rheumatoid arthritis and ankylosing spondylitis are often difficult to differentiate, though it is important to do so as the natural history and treatment of the two conditions differ. Nine patients have recently been seen, each of whom fulfilled the criteria for both rheumatoid arthritis and ankylosing spondylitis. In eight of the nine patients th...
A study of 113 knees of 72 patients treated with intra-articular injection of osmic acid for chronic exudative synovitis caused by various rheumatic diseases is reported. Certain cases presented abnormal radiological opacities, statistically more frequent after the injection of 200 mg than after 100 mg of osmic acid (33.9% and 15.7%). These images...
Sixteen cases of severe destructive arthropathy in elderly persons (13 females and 3 males) suffering from articular chondrocalcinosis are described. The knee is the most commonly affected joint, followed by the hips, shoulders, wrists, elbows and feet. One joint is destroyed in seven patients, 2 joints in five, 3 joints in one and 4 joints in thre...
One hundred mg of osmic acid (with corticosteroid and lidocaine) was injected for therapeutic purposes into the knee in 10 patients suffering from various types of recalcitrant synovitis (mostly rheumatoid arthritis). The effects of this injection were followed by examination of synovial fluid, blood, and urine of these patients, collected at vario...
Unusual radiological opacities have been observed in 29 cases after intraarticular injection of osmic acid in 113 knees of 72 patients under treatment for a chronic exudative synovitis in different types of rheumatic diseases. They are statistically more frequent after the injection of 200 mg than after 100 mg (33.9 and 15.7% respectively). Most of...
Amongst 66 pagetic patients, whose average age (median) was 76 years, 9 cases of ACC were found. This represents an incidence of 13.6% of the whole group. Of 72 control subjects, whose average age (median) was 73 years, 7 were found to have ACC. This represents an overall incidence of 9.7% of the control group, but the difference is not statistical...
Both generalised osteoarthrosis (GOA) and articular chondrocalcinosis (ACC) become more frequent with increasing age. Destructive changes, especially of the finger, knee, or hip joints, may be a complication of osteoarthrosis. 72 consecutive patients with the diagnosis of GOA as described were evaluated. Articular chondrocalcinosis was diagnosed on...
Ten patients with inflammatory disease (rheumatoid arthritis, ankylosing spondylitis, Reiter's disease) or metabolic disease (gout, pseudogout, tendinous xanthomatosis) affecting the Achilles tendons are presented and discussed. Radiological lateral views of heel were obtained with xeroradiographic techniques, which permitted the recording on the s...
A destructive arthropathy is much more common when generalized osteoarthritis (GOA) and articular chondrocalcinosis (ACC) coexist than in GOA alone. Fifty-two patients with GOA and ACC were compared to a matched control group with GOA alone. A marked increase in the frequency of a destructive arthropathy was found in the group with both GOA and ACC...
A case is described of an elderly woman with primary hyperparathyroidism who was initially thought to be suffering from polymyalgia rheumatica, as myalgia, low grade fever and an elevated sedimentation rate were the only symptoms. Hyperparathyroidism was suggested by the fact that 2 of 10 serum calcium determinations were too high, and the diagnosi...
The synovial fluid beta1a (C3) and beta1e (C4) expressed by their ratio to corresponding serum concentrations) were studied in 31 cases of seropositive rheumatoid arthritis (RA+), 5 cases of seronegative rheumatoid arthritis (RA-1), and 15 cases of osteoarthrosis (OA) before osmic acid synoviorthesis on knees. This was repeated after synoviorthesis...
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Rheumatoid rosette formation was investigated in 236 tests, using lymphocytes from 190 subjects. Filtration of the blood to produce the lymphocyte suspension eliminated a high proportion of rosette forming cells. That the eliminated cells were B lymphocytes is supported by the demonstration that, using unfiltered lymphocytes, only two of 54 rheumat...
Osmic acid synovectomy was performed on 59 knees in 31 patients all suffering from chronic synovitis with recurrent effusions resistant to systemic and local treatment. The injection consisted of 100 mg of osmic acid, 5 ml of 2% 'Xylocaine' and 80 mg of 'Codelcortone TBA'. The effects of the synovectomy were checked at regular intervals using vario...
The concentration of inorganic pyrophosphate (I.P.P.) has been determined in the plasma, urine, and synovial fluid of patients with pyrophosphate arthropathy (chondrocalcinosis articularis or pseudogout). The concentrations of I.P.P. in plasma and urine were normal in patients with pyrophosphate arthropathy. In contrast, the concentrations in synov...
Citations
... Another study in finger joints was also published in 1979 by Boussina et al.. 23 33 all included ra and non-ra patients had previously failed to respond to gc injection only. after 6 months 69% of the [ 169 er]erbium or [ 186 re]rhenium rSo + gc treated group showed good response (74% of the ra patients versus 56% of the non-ra patients) versus 29% of the saline + gc treated group (18% of the ra patients versus 56% of the non-ra patients), P=0.001. ...
... SpA is distinct from RA, and it is important to recognize and manage early in their presentation to improve health outcomes [29]. The coexistence of RA and AS in the same patient has rarely been reported [11,27,[30][31][32][33][34][35]. ...
... Severe refractory heel pain should prompt investigations for severe spondyloarthropathy or a bone abnormality such as a calcaneal stress fracture or a bone infection [6,7]. Mechanical heel pain results from excessive stress, which is often related in part to misalignment of the foot, a feature found in 64% of our patients. ...
... The complement system constitutes a crucial effector mechanism in the immune system to clear the pathogens and immune complexes and consists of a cascade of very tightly regulated array of proteins, improper regulation of which may lead to self tissue damage. The deposition and activation of complement factors in OA cartilage have been documented in several early studies in OA patients as well as in animal models of OA [19][20][21][22]. Tarkowski et al. observed expression of decay accelerating factor (DAF) in the synovial lining cell layer both in rheumatoid arthritis (RA) and in osteoarthritis (OA) along with C5b-9 terminal complement complex suggesting an activation of complement-mediated response [23]. ...
Reference: Immunopathogenesis of Osteoarthritis
... research questions (34), including 16 patients with a definite CPPD diagnosis and 27 with a suspected diagnosis, using CR as either an index or a reference test. The imaging technique used to detect the calcific deposits was CR alone in 10 articles (19,29,(31)(32)(33)(34)(35)(36)(37)(38) and US in four articles (23, [25][26][27], while eight papers evaluated both CR and US (18, 20-22, 24, 28, 30, 39). The reference standards were the McCarty Criteria in 12 articles (19-26, 29, 35, 36, 39), and SFA and CR alone in two (30,38) and six (27,(31)(32)(33)(34)37) (31,35,92,94). ...
... Calcaneal spurs are the characteristic feature of Reiter's disease. The type of pain in Reiter's disease was more severe as compared to the other conditions [21]. Another study showed the association between spondylarthritis {SpA} and Achille's tendon enthesitis and bone erosion being separate processes, and SpA is related to the normal mechanic only. ...
... The metabolic conditions that definitely predispose to CPDD are hyperparathyroidism, hemachromatosis, gout, hypophosphatasia, and hypomagnesemia. 11 Probable association is present with hypothyroidism, ochronosis, Wilson's disease, and senile amyloidosis. 12 ...
... These acute attacks can be associated with fever, malaise, and radiating pain that persist for weeks [7][8]. While most acute CPPD attacks are selflimited, intervention may prevent serious chronic complications such as joint degeneration, spinal stenosis, and crowded dens after repetitive attacks [9][10]. ...
... A recent study suggested chondrocalcinosis to be associated with increased pain but not MRI-assessed synovitis in knee OA (41). While some studies suggest that CPP crystal deposits do not accelerate knee OA progression (42), others suggest that chondrocalcinosis produces greater radiographic attrition, a distinct pattern of joint involvement, and rapid progression of structural knee arthropathy (43)(44)(45)(46). Clearly, the field is held back by enigmatic lines and shadings between CPPD and various forms of degenerative joint disease, such as OA, including OA and mixed CPPD and BCP crystal deposition (11). ...
... This may lead to quadriceps muscle rupture. 10 In chronic gout, tophaceous deposits may occur in the Achilles tendons-the result being nodular tendonitis and, in some cases, erosive changes ("rat bite" erosions caused by pressure from the tophi or from pre-Achillis bursa 11 in the upper part of the calcaneum can be observed 12 ) (Figure 7). Again, this may predispose to rupture of the Achilles tendon. ...
