J C Gerster's research while affiliated with Lausanne University Hospital and other places
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Publications (167)
Dans la phase aigue la goutte touche le plus souvent l'hallux, plus rarement le mediotarse ou le tendon d'Achille. Le diagnostic de certitude repose sur la mise en evidence de cristaux typiques. Le traitement de la crise aigue ou subaigue avec la colchicine est une bonne alternative aux AINS s'il n'y a pas d'insuffisance renale. Le traitement hypo-...
The aim of this study was to assess the frequency and the outcome of patients suffering from rheumatoid arthritis in which calcium pyrophosphate dihydrate (CPPD) crystal deposits were found to coexist in synovial fluid analysis. Such association was more frequent than previously believed with CPPD crystals found in 25.8% of 93 patients with rheumat...
Calcium pyrophosphate dihydrate (CPPD) deposits, answerable for chondrocalcinosis, are frequently observed in elderly people. Involvement of the spine is not rare. We present the case of a woman hospitalised for an acute arthritis of the right knee related to CPPD crystal deposition disease who suffered from acute neck pain. The computerised tomogr...
Identification of crystals in the synovial fluid (SF) is mandatory for the diagnosis of a microcrystal deposition arthropathy. In some cases, this analysis can be troublesome, especially in medical centers where a qualified practitioner is not continually present. Therefore, we investigated a method for preservation of a wet preparation of SF for 2...
The use of morphinic analgesics for treatment of pain in rheumatic diseases has been clarified. Because of their costs, coxibs should be given in priority to patients having risks of gastrointestinal severe complications due to their old age or previous history of gastric problems. A new anti-TNF-α agent has been introduced in Switzerland for the b...
Activation of coagulation and fibrinolysis play a role in the pathophysiology of experimental arthritis. Objective: To determine the extent of activation of the coagulation and fibrinolytic pathways in different joint diseases in humans and to ascertain the factors that may influence fibrin deposition within the joint.
Plasma from normal subjects (...
La condrocalcinosis articular es una artropatía microcristalina debida al depósito de cristales de pirofosfato de calcio que, por lo general, se forma en los cartílagos y los fibrocartílagos. El diagnóstico se basa en el hallazgo de las típicas calcificaciones de los cartílagos en las radiografías convencionales. Habitualmente, estas lesiones se lo...
New coxibs will soon be marketed. In addition to their anti-inflammatory properties coxibs can also be used as analgesics. Recent studies of large series of patients treated with rofecoxib have failed to show cardio-vascular or thrombotic risks. However, cotherapy with cardio-aspirin could obliterate the gastrointestinal benefits of coxibs. Inhibit...
Treatment with sulfasalazine has been reported to be effective in psoriatic arthritis (PsA).1–3 However, the role of sulfasalazine in cutaneous lesions has been surrounded by controversies. As far as we know its possible beneficial effect on nail lesions has not been reported.
A 25 year old man had presented with nail lesions considered to be psor...
To determine the usefulness of computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US) in providing specific images of gouty tophi.
Four male patients with chronic gout with tophi affecting the knee joints (three cases) or the olecranon processes of the elbows (one case) were assessed. Crystallographic analyses...
Rheumatoid nodules are the most frequent cutaneous signs, affecting about 15% of the patients with rheumatoid arthritis (RA) ; the males with a high seropositivity are most frequently involved. Cutaneous vasculitis can be found especially in the periungueal area and in the skin of the fingers. Rheumatoid nodulosis is the separate entity which occur...
In a 45 years old HIV positive man, a diagnosis of Mycobacterium xenopi spondylodiscitis was made. The patient, who was under tritherapy for HIV infection, complained of severe low back pain and presented inflammatory signs. Lumbar spine MRI showed an intraspongious herniation of vertebra L2 with a riming contrast after gadolinium uptake, an erosio...
A 26 year old Albanian woman presented with intermittent claudication of upper limbs in association with alleviation of radial pulses, reduction of arterial pressures, bilateral axillary bruits and subocclusive lesions of proximal part of both humeral arteries on arteriography and MRI. Takayasu's arteritis was diagnosed according to ACR criteria. A...
The diagnosis of a bone sarcoidosis was made in a 77-year old woman who presented sacral pain with hypercalcemia, increased osteolysis and a low serum parathyroid hormone (PTH) level. The MRI showed multiple lesions scattered on sacrum and pelvis bone. Bone biopsy specimens demonstrated tuberculoid granuloma without necrosis. The thoracoabdominal C...
To report two cases of amyloidosis secondary to ankylosing spondylitis.
Of the 47 ankylosing spondylitis patients who have received follow-up at our department over the last few years, two have developed AA amyloidosis. Both have extremely severe, long-standing joint disease, with virtually complete spinal ankylosis and destructive peripheral arthr...
Celecoxib and rofecoxib, two AINS drugs with specific COX-2 inhibition have been marketed in Switzerland in 1999. Both are devoid of secondary gastroduodenal effects and of action on platelets' aggregation. In the basis therapy of rheumatoid arthritis, leflunomid has been marketed; diarrhoea is the commonest secondary effect. In severe and aggressi...
We describe 2 men with seronegative rheumatoid arthritis who presented non-union of bone after osteotomy of the tibia in one case and of a metatarsal bone in the second. Both patients were still being treated with oral low doses of methotrexate (MTX). After MTX was stopped, a prompt healing of the bone occurred. These observations suggest that MTX...
Propionibacterium acnes, a gram positive anaerobic organism, is a component of normal skin flora. It can exceptionally be a source of osteoarticular infection (osteitis, arthritis, spondylodiscitis). We report a case of Propionibacterium acnes spondylodiscitis following lumbar puncture. This observation should alert the clinician to the fact that P...
Propionibacterium acnes, a gram positive anaerobic organism, is a component of normal skin flora. It can exceptionally be a source of osteoarticular infection (osteitis, arthritis, spondylodiscitis). We report a case of Propionibacterium acnes spondylodiscitis following lumbar puncture. This observation should alert the clinician to the fact that P...
Metalloproteinases (MMP) play an important role in the remodelling of the extracellular matrix. However, evidence that they are responsible for tissue damage in pathological situations remains circumstantial. Stromelysin (MMP-3) production is increased in rheumatoid arthritis (RA), and has been proposed as a marker of joint damage. The relevance of...
Acrodermatitis chronica atrophicans is a delayed manifestation of Lyme disease caused by a Borrelia burgdorferi subspecies, B. afzelii. Although rheumatic manifestations are rare, they can result in deformities of the fingers and toes if they are not treated promptly.
We report four cases of acrodermatitis chronica atrophicans seen over a 15-year p...
Apart from the therapy of autoimmune diseases, corticosteroids have an important position in the treatment of rheumatoid arthritis. Corticosteroids are used after the failure of non-steroidal antiinflammatory agents or of the basis therapies to control the illness. When the rheumatoid arthritis is accompanied by a systemic disease, they will be use...
Recommendations about the practice of epidural steroid injections for low back pain and sciatica are formulated based on an extensive review of the published literature. These infiltrations should be reserved to trained physicians observing strictly aseptic conditions. Their indications are limited to the few special situations where classical trea...
Needle fasciotomy is a non surgical treatment of Dopuytren's contracture. This technique has been developed in the Rheumatology Unit of the Lariboisière hospital in Paris and has been recently introduced in Switzerland. The first results 3 months after the fasciotomy on 73 fingers (44 patients) are similar to those fourdin the literature. They are...
We report a case of large medial meniscal cyst responsible for symptomatic saphenous nerve compression in a 49-year-old male with a history of mild trauma to the affected knee. We are not aware of any similar cases in the literature. The lesion was delineated by ultrasonography and even more clearly by magnetic resonance imaging. At surgery, the sa...
Thromboangiitis obliterans (TAO) or Buerger's disease is an inflammatory disease that affects the small and medium caliber arteries and veins. It affects predominantly young, smoking males. The clinical manifestations are usually ischemic lesions of the extremities or limb claudication. The physiopathology is yet unknown. However, several hypothese...
Pneumococcal arthritis generally presents as non-destructive monoarthritis, although some underlying metabolic disorders such as liver failure and diabetes have been suggested to represent a risk factor for severe joint disease. Here we report a case of destructive pneumococcal arthritis of the left hip joint in a patient suffering from chronic ren...
To establish if computed tomography (CT) imaging, which has proved helpful in detecting intra-articular tophi in gout, can also be used to document gouty enthesopathy and tendinopathy.
Three patients with tophaceous gout and clinical involvement of the Achilles tendon (two cases) or patellar tendon (one case) were assessed with CT examination and p...
To evaluate the utility of computed tomography (CT) of the knee joint for detecting intraarticular tophaceous deposits.
A prospective study of 16 patients with gout affecting the knee was conducted. A condition for inclusion in the study was the presence of needle-shaped crystals with negative birefringence in the knee joint synovial fluid. Convent...
Two old patients with a rapid destructive arthropathy of the hip with osteolysis of the femoral head are presented. X-Rays show chondrocalcinosis. The other common causes of destructive arthropathy have been dismissed. Although the exact mechanism of osteolysis remains unclear, chondrocalcinosis might be involved in the destructive process.
In conclusion the concept of rheumatoid nodulosis illustrates the multiplicity of the nosological pictures wich could be realized in rheumatoid arthritis by various combinations of constitutive clinical, biological and morphological features. The pathogenesis of this special variant provides a useful field of investigation, together with a long ter...
We describe the case of a 5-year-old boy who presented with parvovirus B19 associated arthritis of the left knee lasting for 6 weeks. Other features included flu-like symptoms, a mild "slapped cheek" sign, and a macular, erythematous, lace-like rash over the chest and limbs. The analysis of the synovial fluid showed a high white cell count with a p...
We describe the case of a 40-year-old-woman with an acute arthritis of the left shoulder. Synovial fluid aspirated from the joint cavity appeared purulent but contained few leucocytes and no birefringent crystals. It was, however, rich in apatite crystals. A communication between the subacromial bursa and the gleno-humeral cavity through the rotato...
We present a case of a destructive arthritis of the coxofemoral joint and osteitis of the ilium, in a patient aged thirty five, suffering from palmo-plantar pustulosis and psoriasis for six years. This diagnosis was made when the patient presented a sudden worsening of the pain of the hip joint, due to an inflammatory arthritis. This observation is...
We present two cases of destructive and hypertrophic arthropathy of the atlanto-axial joint in patients with calcium pyrophosphate dihydrate deposition disease. The clinical symptoms were mild and intermittent in spite of severe radiographic changes.
Long term experience with low dose methotrexate (MTX) in 35 patients with rheumatoid arthritis (RA) is presented. Thirty-five cases of RA (one case with Felty's syndrome) were treated with MTX for up to 2 years (mean 6 years; 312 months). Our data demonstrate that: - Two patients (14% of our study) discontinued MTX therapy after a mean period of 36...
Two patients are described who presented with a chronic effusion with calcium containing particles, considered as apatite, in one finger joint. After a followup of several years, these joints presented erosive changes on radiographs, which raises the question of the pathogenic role of apatite crystals.
Edematous benign polyarthritis of the elderly (syndrome of remitting seronegative synovitis with pitting edema) affects Caucasians aged over 60, predominantly males. The symptoms involve constant edema of the hands and often of the feet, with pain and muscular weakness. These symmetric edemas are accompanied by arthritis of the extremities and the...
Acute periarthritis is a typical example of apatite arthropathy related to intratendinous calcifications. The attack may be followed by virtually complete radiological disappearance of the calcification. Within the joint one may exceptionally demonstrate the presence of hydroxyapatite crystals in the synovial fluid during a fluxional flare-up of ar...
A monoarthritis may correspond to a localized inflammatory process or to the onset of rheumatoid disease that may later on spread over few or several of the other joints. In this article the different diagnostic and therapeutic steps to approach monoarthritis are presented. One of the first investigations consists in an analysis of the synovial flu...
The authors report four cases of stress fracture of the distal tibia simulating acute arthritis of the ankle. Two patients had a noninflammatory tibiotarsal joint effusion whose cause is discussed.
An insufficient compliance is regularly observed in 30% of outpatients. In chronic rheumatic diseases such as rheumatoid arthritis a poor compliance is often associated with alleviation of symptoms whereas symptomatic patients tend to take their medication more regularly. Drug abuse, mainly corticosteroids, can often not be avoided. The latter may...
Whipple's disease is a worrying disease because of its protean manifestations. It may sometimes take on the appearance of sarcoidosis with polyvisceral granulomatous dissemination. We describe 2 cases of sarcoid-like Whipple's disease including one with synovial granulomatous involvement. It therefore appears to be essential, in view of the therape...
Metabolic disorders including diabetes mellitus, glucose intolerance, dyslipidemias, hyperuricemia, and hypervitaminosis A have often been mentioned in association with diffuse idiopathic skeletal hyperostosis (DISH). Production of bone under the influence of insulin or retinol has been suggested as a possible mechanism for this disease. We prospec...
The authors report four cases of stress fracture of the distal tibia simulating acute arthritis of the ankle. Two patients had a noninflammatory tibiotarsal joint effusion whose cause is discussed.
Metabolic disorders including diabetes mellitus, glucose intolerance, dyslipidemias, hyperuricemia, and hypervitaminosis A have often been mentioned in association with diffuse idiopathic skeletal hyperostosis (DISH). Production of bone under the influence of insulin or retinol has been suggested as a possible mechanism for this disease. We prospec...
Three cases of undiagnosed primary hypothyroidism with high thyroid stimulating hormone values presented destructive arthropathy of the proximal interphalangeal joints. None had chondrocalcinosis, neuropathy, myopathy or sicca complex. Quick improvement followed hormonal therapy, which suggests that hormonal imbalance could be responsible for this...
Rapidly destructive spondyloarthropathy occurring in the lumbar spine of 2 chronically hemodialysed patients is reported. These lesions resembled infectious spondylitis. Histological examination revealed deposits of amyloid in the L3-L4 intervertebral space in one patient, which could be a causative factor in the joint destruction. The other favour...
An 83-year-old lady was admitted for bilateral pain and weakness of the shoulder and hip girdles. These symptoms suggested a Polymyalgia rheumatica (PMR) but there was no response to corticosteroids. A pulmonary adenocarcinoma without any metastasis was then diagnosed. The excision of this tumor was followed by prompt and complete recovery. The ery...
The authors report the case of a 63 years old man who presented 13 years after a diagnosis of a tabes dorsalis, stress fractures of the lower limbs and Charcot's joints (knees). 7 years later, he had multiple stress fractures of the sacrum and pelvis and of the ribs following a minor trauma. Laboratory investigations revealed a major osteoporosis p...
Summary Upper lumbar spondylolysis is rare and there are few reports which describe the condition. Three patients with upper lumbar spondylolysis, two of whom underwent surgical treatment, are reviewed. A radiological review of 205 patients with back pain attending a Back Research Clinic revealed three additional patients with symptomatic upper lum...
Six cases of insufficiency fracture of the sacrum were diagnosed in the Rheumatic Diseases Division of the CHUV during 1990. They show that this recently described entity is frequent. Present knowledge of the clinical course, predisposing factors, radiological findings and treatment is reviewed. This diagnosis should be considered in all cases of l...
The osseous metastasis in our patient's first toe has been the initial clinical manifestation of a pulmonary neoplasm and the clinical picture was that of a gout-attack or an other osteoarticular affection. As a rule, primary supradiaphragmatic neoplasia tend to metastasize to the hands whereas primary infradiaphragmatic neoplasia tends to metastas...
The case history of two young men suffering from osteoid osteoma is described as follows. The clinical features, the mechanism of pain, the differential diagnosis, investigations and treatment are discussed in accordance with the recent review of the literature. The OO is a benign bone tumor, with no systemic signs characterized by nightly pain whi...
Coagulation abnormalities are not included in the definition of adult onset Still's disease (AOSD). Nevertheless, eight cases with disseminated intravascular coagulopathy (DIC) sometimes associated with hepatopathy have been reported in the literature. The first patient, a 39-year-old woman, presents an AOSD well stabilized under steroid therapy si...
Coagulation abnormalities are not included in the definition of adult onset Still's disease (AOSD). Nevertheless, eight cases with disseminated intravascular coagulopathy (DIC) sometimes associated with hepatopathy have been reported in the literature. The first patient, a 39-year-old woman, presents an AOSD well stabilized under steroid therapy si...
This article presents the case of a boy who complained of cervical and thoracic spine pain for the first time at the age of nine. Plain films of cervical and thoracic spine showed calcifications of intervertebral disc C4-C5, C5-C6, C6-C7 and D3-D4. The symptoms disappeared after conservative therapy. Plain films taken 16 months later showed spontan...
Three cases of apatite tenosynovitis of the hands are presented. This rare condition has often a dramatic outset with an intense inflammation that could suggest an infectious process. The radiographic feature is characteristic, and the examination of the material removed from synovial sheath or from calcific deposits allows apatite crystals to be i...
We describe avascular necrosis at multiple sites in 2 young adults. This is a condition rarely seen except in hypercortisonism or hemoglobinopathies. In one case, it occurred in the first trimester of pregnancy. No obvious cause of osteonecrosis could be found but both patients were infected by the HIV. The role of the latter in the bone necrosis i...
Thoracic discal hernia is a rare condition which in most cases is associated with radiologic calcifications of the disc, the nature of which remains unclear. However, it is generally accepted that the calcifications consist of apatite. In our observation a calcified discal hernia caused progressive paraparesis. The fact that it occurred in a patien...
Citations
... [1][2][3][4] Percutaneous aponeurotomy is more effective and has fewer complications; its latest modification is needle aponeurotomy, which entails dividing the cords percutaneously with a fine needle. 5,6 Compared to conventional surgery, this out-patient procedure confers shorter recovery times and lower complication rates, and may be repeated for recurrences. We reviewed 8 Chinese patients who underwent needle aponeurotomy for Dupuytren's contracture. ...
... En effet, l'aspect clinique suggère, tantôt une arthropathie de la cheville en raison d'une hydarthrose réactionnelle lorsque le trait de fracture se situe au tiers inférieur de la diaphyse [146] , tantôt une métastase osseuse en l'absence de traumatisme chez un sujet âgé traité quelques années auparavant pour un cancer ostéophile. D'autres tableaux cliniques trompeurs ont été rapportés : pseudocellulite [188] , pseudodermohypodermite bactérienne [27] notamment. L'IRM, facultative dans la forme radioscintigraphique habituelle, est cependant demandée pour confirmation lorsque l'hyperfixation, très étendue et/ou hétérogène, fait redouter une métastase osseuse chez un patient âgé comptant un antécédent de néoplasie, une tumeur primitive maligne des os, voire une ostéomyélite aiguë ou subaiguë [7,71] . ...
Reference: Exploration scintigraphique du squelette
... This severe complication has been reported to occur in AOSD and its diagnosis can be challenging, even for seasoned clinicians [41]. Eight disseminated intravascular coagulopathy (DIC) cases, some associated with hepatopathy have been reported in the literature to date [42]. The clinical presentation of a patient with AOSD complicated by coagulopathy and the patient becoming acutely ill may closely mimic sepsis, leading to treatment with antimicrobials only and delaying management with immunomodulators. ...
... Since in some diseases, it is possible to find erosive changes resembling EHOA, it may be difficult to establish whether these changes are an expression of the same disease or are due to an association with EHOA. These cases are more numerous than might be expected and may be essentially included in many diseases: endocrine diseases such as hypothyroidism and hyperparathyroidism [18,19]; microcrystal induced arthtritis, such as CPP crystals, apatite crystals and calcific periarthritis associated with hypophosphatasia [20], chronic renal diseases [21,22], autoimmune diseases such as scleroderma [23], Sj gren's syndrome [24] and autoimmune thyroiditis [25]. Some of these combinations are probably only anecdotal; however, they may be useful in better understanding the differential diagnosis of EHOA by other diseases and their likely associations. ...
... L'ostéoarthropathie hypertrophiante de Pierre-Marie-Bamberger est dans 90 % des cas une manifestation paranéoplasique d'un cancer bronchique. Parmi les autres syndromes paranéoplasiques du cancer bronchique, des cas rapportant une pseudopolyarthrite rhizomélique (PPR) paranéoplasique ont été décrits [3][4][5]. ...
... In this case, a biopsy revealed a florid septal panniculitis with infiltration of the septa by foamy macrophages containing intracellular granules that were strongly stained with PAS reagent [9]. Cutaneous granulomatosis related to WD is also a rare clinical feature previously reported in some cases [10,11]. Erythema nodosum-like lesions can be described in WD treated with antibiotics as features of immune reconstitution inflammatory syndrome [12,13]. ...
... The presence of calcific deposits in calcified tendinopathy worsens the clinical manifestations of tendinopathy [1] with an increase in rupture rate [2], slower recovery times [3] and a higher frequency of post-operative complications [4]. It has a similar pattern of occurrence and features in common with other tendinopathies such as that in patella [5,6], Achilles rotator cuff [5] and supraspinatus tendons [7,8]. ...
... Lumbar spondylolysis is common at the fourth and fifth lumbar vertebrae. The frequency of spondylolysis in the upper lumbar vertebrae has been estimated by various authors to be between 0.2% and 1.5%6. Two factors play a determinant role in the pathogenesis of spondylolysis: the genetic factor and the mechanical factor of the lumbar spine. ...
... However, certain risk factors and genetic predisposition may increase the risk of vascular disruption, increasing the risk for osteonecrosis through increased intraosseous pressure and compromised blood supply [6,[29][30][31][32]. Although cases can be idiopathic, several risk factors, both direct and indirect, have been proposed, most notably corticosteroid use [33], sickle cell anemia [31,34,35], systemic lupus erythematosus [36], alcohol consumption [37,38], human immunodeficiency virus (HIV) [39][40][41], and dysbaric osteonecrosis [42,43]. ...
... [4][5][6] This can lead to delayed presentation and diagnosis, especially with lack of symptoms of the primary tumor. 7 Similar pitfalls have been reported in the rare appearance of tuberculosis in the foot. 8 Only 8% of all primary metastatic tumors originate from the lung. ...
