ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The current study was initiated to estimate the use of oral contraceptives and estrogen replacement therapy in women with systemic lupus erythematosus (SLE). Four hundred and four patients were surveyed from five medical centers. Two hundred and twenty four (55%) had ever used oral contraceptives, however, only 51 (13%) were taking oral contraceptives at the time SLE was diagnosed. Fifty five (14%) used oral contraceptives after their disease was diagnosed. Only seven (13%) reported an exacerbation of disease activity, mostly confined to the musculoskeletal system. In one substudy, there were no significant differences observed between women with or without SLE with regard to the frequency of ever-use of oral contraceptives. In contrast, significantly fewer women with established SLE were taking oral contraceptives at the time of interview compared with healthy women,p< 0.02. In a second substudy, information on past and present usage of estrogen replacement therapy was obtained in women followed at two of the sites included in the main study. Fifty-five (59%) of the 94 postmenopausal patients at these centers had ever taken estrogen therapy, 23 (24%) at the time of diagnosis. Forty-eight women (51%) began or remained on estrogen therapy after the diagnosis of SLE, four (8%) of whom reported exacerbations of disease activity. A significantly higher percentage of Caucasian women had taken or were taking estrogen replacement compared with other ethnic groups. This study suggests that exogenous hormones were generally well tolerated by women with SLE; this preliminary observation is based on patient recall. The low frequency of current oral contraceptive use in lupus patients of reproductive age may reflect, in part, bias of the managing rheumatologists and obstetricians/gynecologists. Given the health needs of and potential benefits for women with SLE, these observations suggest that larger prospective studies are critical and are likely to change prescribing practices for exogenous estrogen.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Second-line drugs may have different effects on nodules than on synovitis. In this study, we have begun to evaluate the effects of these agents on rheumatoid nodules. The appearance, progression, or regression of rheumatoid nodules were studied in an open series of 119 patients with rheumatoid arthritis (RA) seen at an academic center over the last 20 years. Fifty-six of these patients had nodules during a mean period of observation of 5.4 years. During this time, 1–5 second-line drugs were taken. Our population had a higher prevalence of nodules (47%) than did patients in most previously reported series. New nodule formation and nodule progression were most often associated with methotrexate (n = 21, 68%) but were also noted during use of gold salts (n = 6, 18%) and hydroxychloroquine (n = 3, 8%). Nodule regression and even complete resolution of nodules was most often observed with hydroxycholoroquine (n = 14, 36%) and with sulfasazine (n = 6, 32%) and injectable gold (n = 5, 14%). Changes in nodules occurred without consistent relation to synovitis. Second-line drugs that may modify the articular aspects of RA may exert varying effects on nodules. These very different effects, if confirmed, suggest important differences in drug mechanisms of action on this basic manifestation of RA.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A review of the results of the second 100 cases of office-based arthroscopy is presented. The major difference between the first 100 cases and the present group has been the change from a diagnostic mode to an interventional mode. This transition has been facilitated by the use of a 2.7-mm, 30-degree oblique arthroscope along with a computerized fluid management system. The indications included knee pain refractory to conservative measures that included rest, exercise, physical therapy, anti-inflammatory medication, monoarticular arthritis of uncertain etiology, and the abrupt onset of locking suggestive of an acute mechanical problem. The pathology found at the time of arthroscopy for the most part confirmed the clinical impression; however, there were several instances in which the diagnosis was changed and the subsequent medical therapy was changed accordingly. The clinical response to arthroscopic intervention generally paralleled what has been reported by others, with important and prolonged relief of pain in most cases. Three major complications (septic joint, cellulitis, and thrombophlebitis) were seen. Strategies are suggested to avoid these. Arthroscopy is valuable in establishing, confirming, or possibly negating previous diagnostic impressions. More importantly, the ability to perform arthroscopic intervention in the office in patients with arthritis adds another therapeutic weapon to the armamentarium of clinical rheumatologists.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We sought to assess the impact of recent observations and recommendations on the treatment of rheumatoid arthritis in a university-based rheumatology practice over a recent 6-year period. Data was collected from information recorded in a database by physicians treating patients in outpatient rheumatology clinics. The treatment regimens of all patients with rheumatoid arthritis seen during the first half of 1987 and 1993 were compared. The populations were similar in age, race, and sex distribution, disease duration, and seropositivity. Nonsteroidal anti-inflammatory drug use decreased from 85% to 74%, while corticosteroid use increased from 31% to 44% of patients. Second-line agent use increased from 46% to 65% of patients, all of which could be accounted for by the increase in methotrexate use from 11% to 32%. The use of other second-line agents remained stable (hydroxychloroquine, auranofin, azathioprine), declined (intramuscular gold, penicillamine), or increased slightly (sulfasalazine). An increase in combination second-line drug therapy from 2% to 6% was noted. This study shows that between 1987 and 1993, our drug therapy for rheumatoid arthritis has become more aggressive: we have increased steroid use, decreased nonsteroidal use, and more frequently used second-line agents, particularly methotrexate.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

VariousCandidaspecies have emerged as clinically important pathogens, as documented by increasing incidence of localizedCandidainfections, candidemia, and systemic candidiasis. Septic bursitis caused by fungi has been described infrequently. We describe a case of septic olecranon bursitis caused byCandida parapsilosis. The patient responded well to antifungal therapy and bursal aspirations.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We describe a 10½-year-old black female who had severe angioedema, possibly triggered by penicillin, with respiratory distress as the initial presentation of systemic lupus erythematosus. In this patient, the Cl esterase inhibitor quantitative and functional serum levels were normal. Although there are several case reports with similar presentations in adults, this is the first case report in the pediatric age group.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We describe four patients who presented with seronegative inflammatory peripheral polyarthritis with pitting edema. All of these patients had spontaneous resolution of their disease over 9–18 months. None of them developed erosions or relapse after prolonged follow-up. Recognition of the features described may allow for conservative therapy with less toxic drugs.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although monarticular erosive osteoarthritis is uncommon, it is not rare. In our example, there was a monarticular presentation of cartilage destruction, soft tissue swelling, and linear periosteal bone apposition. Such bone apposition adjacent to affected joints is not uncommon in erosive osteoarthritis. However, when observed in the context of monarticular disease, particularly when accompanied by soft tissue swelling, it could easily be mistaken for an infectious arthritis.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID