摘要:

Conflicting data have been published about osteoporosis and bone turnover markers in patients with ankylosing spondylitis (AS). The aim of this study was to determine bone mineral density (BMD) of the lateral lumbar spine in a group of male patients with AS and to investigate the relationship between clinical parameters and markers of bone turnover.Thirty-two consecutive AS patients with a mean disease duration of 14.8 years and 32 control subjects were included. Demographic and clinical characteristics were recorded. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to determine the activity of disease. BMD was determined for the lateral lumbar spine in both patients and control groups. Serum osteocalcin and urinary N-telopeptide were measured as bone turnover markers in patient and control groups.Although the mean values of lumbar BMD in AS patients tended to be lower than in the control group, the difference was not statistically significant. Osteoporosis was observed in 11 (34.3%) of AS patients and in 2 (6.2%) of the control group. Osteocalcin levels were significantly higher in AS patients in comparison with control subjects (p< 0.05). In the subgroup analysis according to the activity of the disease, erythrocyte sedimentation rate and N-telopeptide levels were significantly higher in the severely active group when compared with that in mild or moderate disease groups. Active AS patients compared with the control group had significantly lower BMD and significantly higher N-Telopeptide levels (p< 0.05). The levels of BASDAI scores and N-telopeptide values correlated significantly with each other.The incidence of osteoporosis is high in AS patients, and patients with active disease are especially at risk for developing osteoporosis. The monitoring of bone turnover markers and disease activity indices may help to predict patients at risk. Prophylactic and therapeutic strategies are needed to struggle against bone loss in patients with this disabling condition.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a relatively common condition primarily affecting the elderly. Various clinical presentations ranging from an acute arthritis resembling gout (pseudogout) to fever of unknown origin have been reported.We describe four elderly patients with fever and altered mental status. Each patient underwent an extensive unrevealing work-up. An acute arthritis missed by the health-care team in their initial evaluation was later identified, leading to rheumatologic consultation and subsequent diagnosis of CPPD disease after joint aspiration and synovial fluid analysis. Defervescence and resolution of mental status changes occurred after improvement of the arthritis.Awareness that CPPD disease may present with systemic symptoms, including fever and altered mental status, may assure careful examination of joints and can prevent unnecessary testing and diagnostic delay.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Acute motor-sensory axonal neuropathy (AMSAN) is an axonal variant of Guillian-Barré syndrome (GBS) that presents with acute ascending quadriparesis. This has generally been described in association withCampylobacter jejuniinfections or with antiganglioside antibodies. Known cases have shown a slow recovery and a poor prognosis. We report a case with clinical and electrophysiological evidence of AMSAN in association with active systemic lupus erythematosus (SLE) and anticardiolipin antibodies but not the other associations, with a rapid response to combination immunosuppressant and intravenous immunoglobulin (IVIg) therapy. The association between AMSAN and SLE has not been previously described. This case illustrates that early recognition and the utilization of electrophysiologic techniques may be beneficial in the diagnosis and management of GBS associated with SLE. Fulminant or rapidly progressive cases should be managed in specialized intensive care units. Combination therapy of immunosuppressants and IVIg may be beneficial in nonvasculitic axonal radiculoneuropathies associated with SLE, resulting in good outcomes.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are commonly used for treatment of hyperlipidemia and its deleterious effects. Myotoxicity has been associated with use of these agents. We report two cases of inflammatory myopathy in patients receiving these agents that did not respond to drug withdrawal and required immunosuppressive treatment. One of these patients developed an antibody to histidyl tRNA synthetase or Jo-1, an autoantibody associated with idiopathic inflammatory myopathies. We suggest that HMG-CoA reductase inhibitor-associated myotoxicity may trigger an immune-mediated inflammatory myopathy. Patients whose muscle abnormalities do not resolve with drug withdrawal should be considered for muscle biopsy.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The antiphospholipid syndrome (APS) occurs as a primary entity or in association with autoimmune diseases, malignancies, or medications. Conventional treatment for APS-associated thrombosis involves the use of anticoagulants such as aspirin, heparin, and warfarin. Alternative treatment options are limited. We report on a patient with APS who failed conventional therapy but had clinical improvement and a decline in anticardiolipin (aCL) antibody titers during treatment with monthly intravenous immunoglobulin (IVIg). Anticardiolipin antibodies IgG, IgA, and IgM were measured before initiating IVIg and before each subsequent infusion of IVIg. The patient was also evaluated for the presence of thromboses during the treatment period. IgG and IgA aCL levels were elevated initially, and there was a significant decrease in anticardiolipin IgG and IgA levels during treatment without further episodes of thrombosis. IVIg may be an alternative therapy for recurrent thrombosis in the antiphospholipid antibody syndrome.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Muscle toxicity is one adverse reaction reported with the use of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins). This toxicity may include asymptomatic elevations of muscle enzymes, weakness, myalgia, and myositis. High doses of statins, or the combination of statins with other anticholesterol medications, increase the risk of toxicity. In addition, case reports of systemic and autoimmune reactions such as lupus, nephritis, vasculitis, and myositis, suspected to be associated with statins, have been reported.Our 76-year-old patient demonstrates a case of serologically and biopsy-proven inflammatory polymyositis, combined with a statin toxic myopathy. His symptoms and enzyme abnormalities resolved with both the removal of the statin medication and the institution of immunosuppressive therapy. Investigation of muscle enzyme elevation and weakness that do not resolve with statin removal is warranted. Certain muscle biopsy findings, including mononuclear cell infiltrate, distinguish the etiology asinflammatory/possibly autoimmune and do not suggest statin myopathy.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We describe a 65-year-old female who presented with arthritis involving the small joints of her hand, wrists, and knee, fever, rash, and leukocytosis. During the course of her illness, she developed elevated transaminases, myositis, bilateral pleural effusions, a large pericardial effusion compressing the right atrium, and cardiomyopathy with impaired left ventricular function. The patient had evidence of acute parvovirus B19 infection by serology, although parvovirus specific DNA sequences from peripheral white blood cells were negative by polymerase chain reaction.This illness raised concern about possible collagen vascular disease. Low titers of antinuclear antibodies were present transiently, and other autoantibodies were undetected. Treatment with intravenous immunoglobulin resulted in dramatic resolution of her disease manifestations. Pericardial effusion and cardiomyopathy may be rare sequelae of parvovirus B19 infection. The apparent improvement with intravenous immunoglobulin could have been related to clearance of infection or down regulation of host immune response.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID