ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Central nervous system (CNS) involvement represents a common complication in systemic lupus erythematosus (SLE). Diagnosis and therapy of severe neuropsychiatric disease remain a challenge to the clinician. The clinical data of 171 inpatients with CNS-SLE in Peking Union Medical College Hospital from January 1980 to June 1998 were retrospectively reviewed for understanding and better management of this challenging complication. The incidence of CNS involvement in SLE was 14.2%. The mean SLE duration at onset of CNS-SLE was 2.21 ± 1.87 years, with 132 (77.2%) occurring within 2 years. A cerebral spinal fluid abnormality was seen in 91.4% (138 of 151) of CNS-SLE, with protein elevation in 113 (74.8%), pressure elevation in 69 (45.7%), and white cell elevation in 51 (33.8%, 42 cases were <100X106/L), glucose reduction 6 (4.0%). The positive reates of anti-P in diffuse CNS-SLE and SLE with epilepsy were significantly higher than in non-CNS-SLE (p< 0.05). Although not reaching a significant level, they were also tending to be higher than in focal CNS-SLE. On the contrary, the positive rate of ACL in focal CNS-SLE was significantly higher than in the diffuse type or non-CNS-SLE (p< 0.01). The total mortality rate in 171 patients with CNS-SLE was 18.7% (32 cases); however, the mortality rate since 1993 (4.0%, 3 of 75) was much lower than before (30.2%, 29 of 96,p< 0.01). Of 24 CNS-SLE patients who received intrathecal injections with dexamethasone plus methotrexate, 22 (91.7%) improved considerably. To improve the outcome of CNS-SLE, early diagnosis and aggressive therapy are essential. Cerebral spinal fluid analysis is proposed as the most fundamental test. Intrathecal injection might be a useful alternative for those patients with CNS-SLE refractory to conventional therapy.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Temporomandibular joint (TMJ) arthropathy is common in juvenile rehumatoid arthritis (JRA) patients and can cause functional and esthetic problems. The purpose of this pilot study was to begin to evaluate whether methotrexate (MTX) therapy can reduce TMJ arthropathy in patients with polyarticular JRA.There were 27 patients with polyarticular JRA studied. Of these, 18 were receiving MTX and non-steroidal anti-inflammatory drugs and 9 were receiving just non-steroidal anti-inflammatory drugs. A routine physical examination, including a detailed joint evaluation, was performed by their rheumatologist. A craniofacial examination was performed by the orthodontist and included a radiographic TMJ evaluation (panoral and corrected axial tomograms).Radiographic evidence of condylar degeneration was apparent in 83% of all polyarticular JRA patients. The patients receiving MTX showed less severe TMJ involvement than those not receiving MTX.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The human foot pad is essential in buffering stress and strain during ambulation. Foot pad atrophy has been associated with foot pain, limping gait, callous formation, and foot ulcers. We report a method to measure foot pad thickness and have investigated its measurement reliability. Two podiatrists independently and bilaterally measured fore and rear foot pads on lateral view radiographs of weight bearing for 78 patients with rheumatoid arthritis. The intrarater coefficient on the fore and rear foot pads was 0.90 or higher, whereas the interrater reliability ranged from 0.73 to 0.92. These results suggest foot pad measurement is simple, practical, and reproducible for measuring foot pad atrophy. This measurement will help identify patients at risk for foot pain and/or ulceration so that appropriate orthotics and soft tissue supplements may be recommended.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Some overlap between features of fibromyalgia and systemic lupus erythematous (SLE) is well-recognized. Our objective is to describe eight patients with an original diagnosis of SLE, in whom, after re-evaluation, the multi-system symptoms could be explained on the basis of the dysautonomia that occurs in fibromyalgia.Seven of the eight patients were females. Their mean age was 31 years. All of them fulfilled the American College of Rheumatology criteria for fibromyalgia. Their lupus-like features that could later be explained by dysautonomia were the following: diffuse arthralgias with subjective feeling of swelling, malar erythema, syncopal episodes, profound fatigue, and distal vasospastic changes. Six patients had low titer ANA. None of the patients had signs of organic damage. Autonomic dysfunction was demonstrated by means of circadian studies of heart rate variability (6 patients) and/or tilt table testing (3 patients). We conclude that autonomic dysfunction may be an explanation for the lupus-like symptoms present in some patients with FM.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Spinal gout has been reported only rarely. We describe a 59-year-old man with a history of gout, who was receiving chronic immunosuppressive therapy after a renal transplant and who presented with fever and back pain. After an extensive work-up and biopsy, the diagnosis was thoracic tophaceous gout. The pain and fever responded to prednisone and allopurinol. Tophaceous gout is a rare cause of fever and back pain but should be considered in the differential diagnosis in the appropriate clinical setting.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Kava-kava is an herbal medication, most commonly used to treat anxiety. It is derived from the roots of the pepper plant, Piper methysticum. A 47-year-old white woman presented with a rash and proximal muscle weakness 2 weeks after ingestion of kava-kava. Her creatine kinase level was elevated at 8654 U/L, and an electromyogram showed a myopathic pattern. Skin biopsy and muscle biopsy samples showed changes consistent with dermatomyositis. The patient improved with prednisone and discontinuation of the kava-kava. No similar association between kava-kava ingestion and dermatomyositis has been reported previously.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The syndrome non-familial acro-osteolysis features bone reabsorption of the digits in association with short stature. Osteoporosis is common in this disorder, but no successful treatment has been previously reported. We report a case of non-familial acro-osteolysis complicated by multiple fractures in which treatment with antiresorptive therapy improved both biochemical markers of bone turnover and bone mineral density but had no effect on the acro-osteolysis.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Guillain-Barre syndrome (GBS) has been rarely reported as a presenting manifestation of systemic lupus erythematosus (SLE). We describe a 23-year-old patient with SLE who presented with GBS. He developed progressive ascending motor paralysis but also had pulmonary disease, proteinuria, and hypoalbuminemia. Serologic studies revealed ANA and antibodies to double stranded-DNA. Electromyographic and nerve conduction studies were suggestive of acute inflammatory demyelinating polyneuropathy, and a kidney biopsy specimen showed membranous glomerulonephritis. Treatment with corticosteroids and plasmapheresis resulted in clinical improvement of the neurological illness. The renal disease progressed despite prednisone and was eventually treated with hemodialysis. The neurologic disease did not recur.Auto-antibodies reactive with neural tissue and immunological crossreactivity between auto-antibodies in SLE and neural tissue antigens may occur. Complement fixing antibodies to nerve and kidney in patients with GBS and membranous glomerulonephritis, point to a common pathogenic relationship. Such antibodies may be seen in patients with SLE. The increased susceptibility to infection caused by immunosuppression may make patients with SLE susceptible to GBS. Plasmapheresis and corticosteroids, as in our patient, plus i.v. immunoglobulins and cyclophosphamide has brought good results in patients who have SLE with GBS.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID