ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

During a 30-year period, 323 SSc patients were admitted to a tertiary center specialized in connective tissue diseases. Among them 13 (4|X%) developed scleroderma renal crisis (SRC). These 13 SRC patients with respect to the remaining SSc patients were older, were more often affected by diffuse cutaneous systemic sclerosis (dcSSc), and had slightly higher blood pressure and more frequent heart involvement at initial presentation. Among the 13 SRC patients, an older age, a shorter disease duration, and a higher peak serum creatinine correlated with a poor outcome.SRC in Italian patients showed a lower prevalence (4|X%) than in many earlier reports. Mean survival in SRC patients was 6 years. This tended to be less than the 16.5 years for all others, but this trend was not statistically significant at least for those admitted in the post-captopril era.From a clinical point of view, the higher prevalence of later SRC in dcSSc patients presenting with mild arterial hypertension and or heart involvement is worth noting. Many patients were asymptomatic and were detected only on a routine visit. Such patients must be carefully followed to detect any early finding of SRC.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This study evaluated measures of metalloproteinase gene expression in synovial biopsies as a means of differentiating the activities of two antirheumatic therapies: piroxicam and tenidap. Synovial biopsies and quantitative in situ hybridization for stromelysin (STR), collagenase (COL), tissue inhibitor of metalloproteinase-1 (TIMP), and actin mRNA were performed in a subset of patients with rheumatoid arthritis in a larger doubleblind randomized crossover trial comparing 120 mg/day of tenidap for 6 weeks with 20 mg/day of piroxicam for 6 weeks. There were no consistent differences between tenidap and piroxicam on COL or TIMP mRNA expression, but STR mRNA was significantly lower after tenidap compared with piroxicam (p= 0.037). There were no significant associations between measures of local or systemic clinical activity and STR, COL, or TIMP gene expression. However, changes in STR gene expression were significantly correlated with changes in serum C-reactive protein (p= 0.016). Because tenidap and piroxicam are both potent inhibitors of prostaglandin production, the effect of tenidap on STR gene expression may be due to its additional cytokine modulating activity. Clinical trials with data from synovial biopsies may be useful in evaluating the potential for disease-modifying effects of antirheumatic drugs.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The 10-year survival rate of patients with systemic lupus erythematosus (SLE) currently is more than 85|X%; the greater longevity permits late complications to emerge. Recent studies have shown an increased incidence of coronary artery disease (CAD), frequently in young adults. CAD currently is among the most common causes of death in patients with SLE who survive longer than 5 years. Multiple risk factors, some specific to SLE, are implicated in premature development of CAD. These include coronary artery vasculitis, hypertension and hyperlipidemia, corticosteroid therapy, and antiphospholipid antibodies, which may result in coronary thrombotic events. Therefore, risk factors for CAD should be actively sought as part of routine care of patients with SLE, and appropriate modification strategies, including medications if necessary, should be employed. Noninvasive cardiac tests should be used early in the evaluation of any symptoms consistent with myocardial ischemia, heart failure, or cardiac arrhythmias.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Postmenopausal osteoporosis is characterized by an increased frequency of activation of bone remodeling units and by a relative increase in bone resorption. Biochemical markers for bone turnover are simple noninvasive tools for evaluating these changes. Some are enzymes produced by osteoblasts or osteoclasts, whereas others are components of the bone matrix that are released in the bloodstream during bone formation or resorption. The most effective in osteoporosis are serum bone alkaline phosphatase and osteocalcin for bone formation, and urinary pyridinoline and deoxypyridinoline for bone resorption. In addition to being sensitive, these markers have shown evidence in recent experimental studies of contributing usefully to the evaluation of the osteoporosis or fracture risk and to the monitoring of treatments for osteoporosis.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The leukocyte colony stimulating factors (recombinant granulocyte colony stimulating factor and granulocyte macrophage colony stimulating factor) have become widely used in hematology and oncology to raise neutrophil levels in patients with neutropenia. They have been used primarily by rheumatologists to treat neutropenia accompanying infections in patients with Felty's syndrome or systemic lupus erythematosus and in infected patients made neutropenic with drug therapy. These factors have been lifesaving. The drugs generally are well tolerated and adverse effects usually are easily treated. Some of the adverse effects of the agents may mimic de novo rheumatic conditions such as vasculitis and Sweet's syndrome. There may be important future roles for these growth factors in treatment protocols for patients with rheumatic disease using more aggressive chemotherapy regimens.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Stroke, which is unusual in young adults, has been linked to recreational drug use and the antiphospholipid syndrome (aPS). Cocaine use has been related to stroke in this population, and aPS is a known cause of thrombotic neurologic events. We report a patient with positive lupus anticoagulant and anticardiolipin antibodies as well as a history of cocaine use immediately preceding the acute onset of multiple neurologic deficits. The findings in this case suggest a relationship between the use of cocaine, the aPS, and stroke in young adults.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Occipital neuralgia is a commonly encountered presenting feature in patients with giant cell arteritis. However, actual histopathologic confirmation of vasculitis of the occipital arteries is rarely cited. We present the first case of multi-vessel giant cell arteritis diagnosed with simultaneous biopsies of the right occipital and bilateral temporal arteries, along with a discussion concerning a possible role for occipital artery biopsies in the evaluation of giant cell arteritis.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Tuberculosis is a significant cause of morbidity and mortality in immunocompromising diseases such as systemic lupus erythematosus (SLE). It often is difficult to distinguish between central nervous system (CNS) involvement and infectious complications in SLE. We report the case of a 30-year-old woman with active SLE and severe tuberculous meningoencephalitis. The diagnosis of tuberculous meningoencephalitis was confirmed by cerebrospinal fluid culture examination, which revealed mycobacterium tuberculosis and typical findings for tuberculous meningoencephalitis on magnetic resonance imaging. Despite treatment with isoniazid, rifampicin, ethambutol, streptomycin, and prednisone, the patient developed significant neurological deficits. This case is a reminder that febrile episodes in patients with SLE should always lead to aggressive evaluation for infection. The early clinical symptoms of tuberculous meningitis often are nonspecific. Because of the unfavorable prognosis in latetreated and untreated cases, even a suspicion should lead to a trial of antituberculous treatment.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This case report describes an association of chronic diurnal urticaria with the onset of seronegative arthritis in a 38-year-old woman after her first pregnancy. Remission of the urticaria and rheumatoid arthritis occurred with methotrexate therapy. The variety of urticarial lesions that can be seen with arthritis are noted.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID