ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Minidose aspirin (60–325 mg/day) has been widely used in the prevention and treatment of cardiovascular and cerebrovascular diseases. However, studies on the effects of minidose aspirin on renal handling of uric acid and renal function are limited. We studied the effect of aspirin at 60 mg/day (n = 18) and 300 mg/day (n = 14) on uric acid handling and renal function in healthy subjects. The subjects were evaluated weekly during 2 weeks of aspirin therapy, and again 1 week after aspirin was discontinued. Aspirin at both dosages decreased the fractional excretion of uric acid. However, aspirin at 300 mg/day, but not 60 mg/day, significantly decreased uric acid clearance and creatinine clearance by the end of the second week of aspirin therapy. Despite these changes, serum uric acid and serum creatinine remained constant. The uric acid clearance, but not the creatinine clearance, returned to baseline value 1 week after aspirin therapy was discontinued. As aspirin at 60 mg/day showed no suppressive effect on renal function, it may be better for long-term use.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The goal of this study was to obtain data for prescription habits, tolerability for patients at high risk, and clinical effectiveness of meloxicam administered at 7.5 mg and 15 mg for various rheumatic diseases under real world prescribing conditions.This was a 3-month large-scale prospective observational cohort study in 4000 medical practices throughout Germany shortly after the introduction of meloxicam. To be eligible, patients had to have a diagnosis of acute or chronic active rheumatic disease for which nonsteroidal antiinflammatory drug (NSAID) therapy was required according to the prescribing information.In this study, 13,307 patients receiving meloxicam prescriptions (7.5 mg in 65% and 15 mg in 33%) were observed. The diagnoses of these patients included osteoarthritis (61%), rheumatoid arthritis (24%), ankylosing spondylitis (1.6%), and other rheumatic conditions (28%). A substantial proportion of high risk patients were enrolled: 12% with a previous history of a perforation, ulceration, and bleeding (PUB), 24% with at least one concomitant cardiovascular disorder, and 26% receiving concomitant antihypertensive medication. Many of the patients (58%) had received NSAIDs before meloxicam, including patients with insufficient prior treatment effectiveness (43%) and those with NSAID-related adverse drug reactions (21%). In 85% and 94% of the patients, respectively, effectiveness and tolerability were rated as good or very good. Quality of life and daily functions improved in 64% to 84% of the patients. Only 0.8% of the patients reported gastrointestinal (GI) adverse drug reactions. Four uncomplicated cases of gastric ulceration, one serious perforated gastric ulcer, and one serious ileus complication were reported after incorrect use or overdosing of meloxicam.Treatment with the selective cyclooxygenase-2 (COX-2) inhibitor meloxicam in doses of 7.5 mg and 15 mg resulted in meaningful treatment responses under real life conditions, despite inclusion of a substantial number of patients with insufficient effectiveness of previous use of non–COX-2 selective NSAIDs. All major GI toxicity (PUB) observed was owing to the fact that prescribing conditions were not respected appropriately. Despite a selection of high risk patients overall, GI, cardiovascular, and renal tolerability was favorable.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Cardiovascular and cerebrovascular events, the third leading cause of death in patients with systemic lupus erythematosus (SLE), are disproportionately common by age and gender. Risk factors for atherosclerotic cardiovascular disease (ASCVD) cannot reliably predict subsets of patients at risk for events. Coronary electron beam computed tomography (EBCT), a noninvasive imaging technique that quantifies ASCVD by measuring calcium deposition in the walls of coronary arteries, has been demonstrated to be a marker of ASCVD in traditional populations. A pilot group of 13 SLE patients (ages, 33–48 years) with two or more traditional risk factors for cardiovascular disease were studied by EBCT. Five of these SLE patients had calcification scores in the 70th percentile or higher, as compared with age-matched women without known coronary artery disease, and three had scores in the 90th percentile. Four of these five patients had antiphospholipid antibodies currently or in the past. These data suggest that EBCT may be able to detect premature ASCVD in SLE patients and may be a useful noninvasive tool as more attention is directed to ASCVD as a major complication of SLE.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Genetic, immune, hormonal, and environmental factors are associated with the multifactorial origin of autoimmunity. When one or more of these factors are altered, a “switch” from one autoimmune condition to another can occur, developing the so called “kaleidoscope phenomenon” of autoimmunity. We present the case of a 30-year-old woman with myasthenia gravis and hypothyroidism probably resulting from autoimmune thyroiditis. A thymectomy was performed, and 1 year later, rheumatoid arthritis was diagnosed based on clinical, radiological, and serological features. Nine years after thymectomy, systemic lupus erythematosus was diagnosed based on skin, renal, hematologic, and immunologic manifestations. We suggest that the immune system function was modified when thymectomy was performed, playing an important role in the development of the new autoimmune conditions. Thymectomy increases the risk of developing a new autoimmune disease because it modifies, by mechanisms not well defined, the equilibrium and normal function of the immune system. This patient presents the infrequent association of four autoimmune conditions. When a patient has one autoimmune disease, she is at risk for another.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We describe four patients with widespread cutaneous necrosis as a manifestation of the antiphospholipid antibody syndrome. In three of the patients, the lesions were the first manifestation of the syndrome, and they were located in upper and lower extremities. Vascular thrombosis was present in the skin biopsy in all of the patients. Patients were effectively treated with anticoagulants, and healing occurred within 60 days. Such widespread cutaneous necrosis is a rare manifestation of the syndrome, and it must be regarded as major thrombotic event. Long-term treatment with anticoagulants must be considered. The recognition of these lesions is important, because they may be the onset of the syndrome, allowing its early diagnosis and treatment.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Antiphospholipid antibodies are associated with a variety of neurologic manifestations, both in patients with and without concomitant systemic lupus erythematosus. We report a patient in whom chorea and rapidly progressive subcortical dementia developed in the setting of persistently high titers of antiphospholipid antibodies. While some manifestations of antiphospholipid syndrome can be clearly linked to vascular thrombosis, it is not known whether this is also true for patients affected with chorea, dementia, or both. In our patient, serial magnetic resonance imaging showed the progressive development of deep white matter lesions but no cortical infarcts. The development of widespread pulmonary arterial thrombosis and acute cerebral ischemia, evidenced clinically and on diffusion-weighted magnetic resonance imaging of the brain, provided indirect evidence for a thrombotic pathogenesis for this patient’s neurologic disease. Anticoagulation should be considered as an adjunct to the treatment of patients with antiphospholipid antibodies and chorea or subcortical dementia.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID