ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Four patients with Crohn's disease arthritis, who were unresponsive to conventional treatment, improved very rapidly and safely with the use of infliximab, the chimeric antibody directed against tumor necrosis factor alpha. The patients were able to stop or significantly decrease other antirheumatic medications after the infliximab infusions. It is likely that tumor necrosis factor plays a major role in the arthritis as well as the bowel involvement that is seen in Crohn's disease. Suppression of this cytokine may effectively ameliorate Crohn's disease arthritis in some patients.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In cranial electrotherapy stimulation (CES), microcurrent levels of electrical stimulation are passed across the head via electrodes clipped to the ear lobes. After successful clinical use of CES with fibromyalgia patients in our clinic, it was decided to test these results with a double-blind, placebo-controlled study in which 60 randomly assigned patients were given 3 weeks of 1-hour-daily CES treatments, sham CES treatments, or were held as wait-in-line controls for any placebo effect in the sham-treated patients. Treated patients showed a 28% improvement in tender point scores, and a 27% improvement in self-rated scores of general pain level. The number of subjects rating their quality of sleep as poor dropped from 60% at the beginning of the study to 5%. In addition, there were significant gains in the self-rated feelings of well-being and quality of life, plus gains in six stress-related psychological test measures. No placebo effect was found among the sham-treated controls. A theoretical role of CES in affecting the brain's pain message mechanisms and/or neurohormonal control systems is discussed. It is concluded that CES is as effective as the drug therapies in several trials, with no negative side effects, and deserves further consideration as an additional agent for the treatment of fibromyalgia.

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:

A 74-year-old woman presented to her rheumatologist with classic symptoms of giant cell arteritis. The temporal arteries were strikingly swollen, warm, and erythematous. On biopsy of the right temporal artery, a focal dissection was found associated with a pan-arteritis and giant cells. Isolated temporal artery dissection in giant cell arteritis has not been reported previously. We propose that the unusually intense vascular inflammation may have weakened the vessel wall, so that the dissection occurred during the routine physical exam or biopsy. We believe this case illustrates that physicians should take special care in the examination of floridly inflamed vessels, because vigorous palpation might lead to dissection. In the case of patients with giant cell arteritis, dissection may result in an increased risk of ischemic complications, such as scalp necrosis.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Necrotizing fasciitis is an uncommon manifestation ofSalmonellainfection. We report a case ofSalmonellagroup D septic arthritis complicated with necrotizing fasciitis in a 51-year-old man who had noninsulin dependent diabetes mellitus and rheumatoid arthritis. He presented with fever and severe right hip pain complicated with septic shock and disseminated intravascular coagulation. Crepitation was noticed upon physical examination, and plain films showed numerous air bubbles in the soft tissue around the hip joint. Prompt antibiotic therapy and surgical management were performed with a successful response. The causative organism wasSalmonellagroup D. Antibiotic was given in the total course of 3 months, and there was no relapse of salmonellosis after 2 years follow up.The differential diagnosis of causes of nonclostridial crepitant soft tissue and muscle infections must includeSalmonella,especially in patients who have underlying diseases or are taking immunosuppressive drugs. Prompt management is needed to reduce mortality and morbidity. Long-term suppressive therapy may be needed to prevent relapse.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Both rheumatoid vasculitis and amyloidosis in rheumatoid arthritis (RA) are uncommon. We describe a patient in whom they occurred together and were associated with fatal intra-abdominal hemorrhage. A 56-year-old Caucasian woman was referred because of increasing lethargy, edema, and proteinuria. She had suffered from seropositive, erosive, nodular RA for 14 years. Previously, she had undergone numerous joint replacements, a thyroidectomy for amyloid-associated (AA) amyloidosis of the thyroid that caused a large goiter and a renal biopsy that showed renal AA-amyloidosis in the context of nephrotic syndrome. As her condition deteriorated, this patient became increasingly reluctant to go to the hospital and to take drugs beyond analgesics. Thus, her RA was chronically under treated. While in the hospital for evaluation, this patient suddenly developed hypotension, tachycardia, and a severe colicky left-sided abdominal pain radiating from the left upper quadrant/epigastric region to the left iliac fossa. Computed tomography (CT) showed a large amount of echogenic free fluid within the abdomen and marked thickening of the omentum.At laparotomy, 2 liters of free blood was found adjacent to a hematoma of the greater omentum, and it was evacuated without identification of a discrete bleeding point. All solid and hollow organs were normal. The omentum was noted to be very friable. She developed a more disseminated bleeding diathesis and persistent peritoneal hemorrhage via her abdominal drains. She succumbed shortly afterward. Histology revealed extensive omental hemorrhage and one large vessel within the area of hemorrhage showed a severe necrotizing vasculitis. Extensive amyloid deposition was also found within the walls of the smaller omental arterioles.Vasculitis in the context of RA is relatively rare and is associated with under treated, seropositive disease. Skin and nerve involvement are most common, but bowel involvement has been reported, with a highly significant morbidity (partly due to late presentation/recognition). Similarly, AA-amyloidosis is a rare but feared long-term concomitant of under treated RA. Early recognition can permit successful anti-inflammatory therapy to affect a clinical and pathological remission; continued inflammatory stimulation is associated with rapid progression and demise. Chronically under treated patients with RA are more prone to rare but potentially devastating complications. Gastrointestinal catastrophes are a feature of both rheumatoid vasculitis and of amyloidosis, here uniquely co-localized.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Wegener's granulomatosis is an uncommon disease process that causes necrotizing vasculitis predominantly in the lungs, kidneys, and upper air-ways. Subglottic stenosis has been observed in up to 20% of patients with established diagnosis of Wegener's granulomatosis, but it is rarely the initial manifestation of the disease. This case report presents a patient with Wegener's granulomatosis who had subglottic stenosis as predominant initial manifestation, without signs of lung or kidney involvement. The diagnosis was unclear initially due to the absence of damage to these organs and to the nonspecificity of the initial biopsy findings. After stabilizing the patient, an elevated cytoplasmic pattern of antineutrophil cytoplasmic antibodies titer was obtained, which played an important role in the diagnostic process and led to a second biopsy that showed vasculitis. The patient had an excellent response to prednisone, methotrexate, and trimethoprim/sulfamethoxazole, but as with many such cases, she also required tracheolaryngoplasty.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pericarditis, a common feature of adult-onset and juvenile-onset Still's disease, is rarely complicated by cardiac tamponade. We report one patient with juvenile-onset and another with adult-onset Still's disease presenting with pericardial tamponade. On the basis of our experience and analysis of literature, we suggest early identification of pericarditis and the life-threatening complication of tamponade, with institution of aggressive intervention with corticosteroids and, if necessary, pericardiocentesis and pericardial window formation. These cases remind physicians about the need to include Still's disease in the differential diagnosis of pericarditis and tamponade and to not neglect the potential of severe systemic inflammation to lead to fatal complications in this group of patients.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Ticlopidine is a widely used drug for prevention of stroke and other serious vascular events with a multitude of possible side effects. An increasing number of drugs are being recognized as the triggering agents of drug-induced lupus. We describe three patients in whom the etiologic connection between ticlopidine and lupus was supported by the appearance of lupus-like features (fever, rash, arthritis, renal involvement, positive antinuclear and antihistone antibodies), shortly after drug initiation, and their gradual resolution after its discontinuation. If suggested by clinical or/and laboratory findings (fever of unknown cause, musculoskeletal involvement, hematologic abnormalities), the possibility of ticlopidine-induced lupus should be taken into consideration and appropriate investigations should be performed. Patients should resolve slowly but completely after withdrawal of ticlopidine.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID