ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The safety and efficacy of the sequential addition of sulfasalazine to baseline methotrexate was assessed in patients with active rheumatoid arthritis inadequately controlled by methotrexate alone. Nineteen patients were recruited in a pilot, prospective, open label, uncontrolled clinical trial. One patient was lost to follow-up, four dropped out due to toxicity, one dropped out due to inefficacy, and five violated the protocol. A modified intent-to-treat analysis was performed by carrying forward the clinical data before drop-out or protocol violation to the final visit for the 18 evaluable patients. Swollen and tender joint counts, physicians's and patient's global scores were significantly improved (p< 0.021 to 0.001). Forty-two percent of patients (8/19) demonstrated ≥ 20% improvement and 26% (5/19) showed ≥ 50% improvement in 4 or more clinical parameters at 6 month's follow-up. Rheumatoid factor negative patients were more likely (p< 0.025) to complete the trial. A controlled clinical trial will be necessary to determine the effectiveness of this combination and the value of sequential addition chemotherapy in patients with recalcitrant rheumatoid arthritis.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Alfred Nobel never spoke publicly about his problems of ill health, but a detailed, subjective record has recently been published in the form of 216 letters written to his mistress during an 18-year period. His descriptions of constant pain, debilitating migraine, and “paralyzing” fatigue permit a hypothesis that he might have had a long struggle with fibromyalgia. This does not preclude his having suffered other illnesses as well. He thought he had heart disease, which his physicians denied until his final years, when he was diagnosed with angina pectoris. He died of a cerebral hemorrhage in 1896 at the age of 63. His letters describe a 30-year search for diagnosis from the best physicians in Europe. He was ridiculed by many people as a hypochondriac, and he never received a diagnosis for “the pain that will not go away.” This may well have contributed to the bitterness and depression of his final years. Increasing worldwide interest and research in this elusive syndrome will hopefully prevent a repetition of the Nobel story of a century ago.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The influence of silicone breast implants on patients who develop systemic lupus erythematosus (SLE) and scleroderma are not known. Thirty SLE and 15 scleroderma patients who developed their diseases after under-going augmentation mammoplasty with silicone breast implants were studied. Clinical, laboratory, and treatment features for SLE were compared with age-, sex-, and race-matched controls from our 570-patient cohort. Comparisons were also made with a 75-patient university medical center scleroderma cohort. The SLE implant patients had milder disease but greater frequencies of cutaneous findings, cognitive impairment, and fibromyalgia than SLE patients without implants (p< 0.05). The scleroderma implant group also tended to have milder disease. Of the 45 patients, 26 had their implants removed. Subjective, clinical, and serologic remission after explantation occurred in two of the patients (both with SLE). Twenty-four additional patients had transient subjective improvement or no improvement after explantation; one patient developed malignant hypertension and a scleroderma kidney weeks after explantation.In conclusion, most lupus and scleroderma patients with implants experienced milder, although apparently classical, disease. Dramatic changes in disease course occurred in 3 of the 26 patients immediately after explantation. Because idiopathic disease patients have a 2–10% spontaneous remission rate, more time will be needed to evaluate the natural disease course in the remaining explanted patients.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This survey was performed to review medication usage by pediatric rheumatologists in the care of patients with juvenile rheumatoid arthritis (JRA). Prospective data from 50 patients per physician with JRA were recorded by six pediatric rheumatologists in the Fall of 1993. Naproxen was used most frequently-in 48% of all patients. Next in order of frequency were methotrexate (39%), prednisone (15%), tolmetin (12%), indomethacin (11%) and folic acid (10%). Salicylates (acetylsalicylic acid, trisalicylate and salsalate) were used in 7%, and myochrysine was used in 2% of patients. Overall, nonsteroidal anti-inflammatory drugs were used in 93% of all patients, slower-acting antirheumatic drugs (SAARDs) were used in 54% and prednisone in 15%.Medication usage varied by disease type in predictable ways but also varied by physician in ways that could not be accounted for by population differences. Methotrexate was the most-often used of all SAARDs and supplanted myochrysine in JRA. Naproxen was the most often used NSAID in the treatment of JRA and had largely supplanted salicylates. With the arrival of practice guidelines, reasons for and impact of these changes (as well as the interesting variations between physicians) will need to be examined.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

When patients with rheumatic or other immune-mediated diseases develop acute or chronic neurologic problems, several etiologic possibilities need to be considered. Many of the anti-inflammatory or immunosuppressive medications used to treat these disorders have direct adverse effects on the nervous system, including effects that overlap with neurologic complications of the patient's underlying disorder. Neuromuscular syndromes (peripheral neuropathy, myasthenia gravis, or myopathy) can complicate therapy with corticosteroids, antimalarials, gold, D-penicillamine, colchicine, cyclosporine, and FK506. A large number of anti-inflammatory and immunosuppressive medications can produce altered mental status and other central nervous system manifestations. Such drugs include corticosteroids, nonsteroidal anti-inflammatory drugs, methotrexate, antimalarials, gold, intravenous immunoglobulin, chlorambucil, cyclosporine, FK506, OKT3, and type I interferons. Aseptic meningitis is associated with use of nonsteroidal anti-inflammatory drugs, intravenous immunoglobulin, and OKT3. These and other neurologic adverse effects are the focus of this review.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We report a case of Felty's syndrome in a 65-year-old woman with chronic nonhealing perianal ulcers caused by persistent granulocytopenia. She was successfully treated with low dose recombinant human granulocyte-colony stimulating factor (G-CSF) 300 μg twice weekly. G-CSF contributed to an increase in neutrophil counts and gradual healing of the ulcers. There was no evidence of exacerbation of the rheumatoid arthritis during the 3-month treatment period. Discontinuation of the G-CSF resulted in a return to the baseline neutropenic state without recurrence of ulceration. Intermittent use of G-CSF may be useful therapy for patients who have Felty's Syndrome and develop complications from their neutropenia. A literature review of treatment modalities for these complications suggests that G-CSF appears to be reliable and efficacious, with few reported adverse events in this group of patients.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID