ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Leflunomide was recently approved for the treatment of rheumatoid arthritis. Its role in the treatment of psoriasis and psoriatic arthritis is unclear. Twelve consecutive psoriatic arthritis patients who had not responded to at least one disease modifying anti-rheumatic drug (DMARD) were started on leflunomide alone or in addition to another DMARD. Global assessment of improvement in psoriasis and psoriatic arthritis by the treating rheumatologist was scored on a 0–3 scale. After 2–3 months of treatment, 8 patients had moderate to marked improvement in both psoriasis and psoriatic arthritis. The improvement in modified tender joint counts, patient’s global assessments, and grip strengths was statistically significant. However, physicians’ global assessments and the modified swollen joint counts did not reach a significant difference. Three patients whose toxicity necessitated the temporary discontinuation of the drug were able to resume the drug at lower dosage with clinical benefit. Leflunomide may prove to be a useful agent for the treatment of recalcitrant cases of psoriasis and psoriatic arthritis.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Autoantibodies to the insulin receptor have been demonstrated to antagonize the physiologic actions of insulin, most often resulting in hyperglycemia unresponsive to massive doses of insulin (type B insulin resistance). Patients with these anti-insulin receptor antibodies typically have a coexistent autoimmune disorder, most commonly systemic lupus erythematosus (SLE) or undifferentiated autoimmune syndromes. Attempting to determine the prevalence and significance of anti-insulin receptor antibodies, sera from consecutive patients with SLE and early undifferentiated connective tissue disease (UCTD) were tested for the presence of anti-insulin receptor antibodies by radio-immuno assay. Thirty-eight patients participated in the study. Twenty-six had SLE and 12 had UCTD. One patient with SLE (2.6%) was positive for anti-insulin receptor antibodies. None of the patients demonstrated evidence of insulin resistance, hypoglycemia, ovarian hyperandrogenism, or acanthosis nigricans, findings commonly linked with the presence of anti-insulin receptor antibodies.The results presented here indicate that the incidence of anti-insulin receptor antibodies in patients with SLE or UCTD, without associated history of altered glucose metabolism, is quite low. Because in most cases the disturbance of glucose metabolism dominates the clinical picture at presentation and the associated systemic autoimmune syndrome presents either simultaneously with or subsequent to the diagnosis of diabetes, the measurement of anti-insulin receptor antibodies should be reserved for patients with indications of disordered glucose homeostasis.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A 69-year-old male on colchicine 0.6 mg twice a day for more than a year developed subacute onset of painless proximal muscle weakness with significant elevation of creatine phosphokinase (CPK) levels. He also experienced numbness and tingling in the extremities. Nerve conduction studies revealed a mild axonal neuropathy affecting the arms and legs while needle electromyography was unremarkable. He refused a muscle biopsy. After withdrawal of colchicine, muscle strength and serum CPK levels returned to normal over a period of 4 months. Neuromyopathy is a well documented side effect of colchicine, and impaired renal function has been the major risk factor in previously reported cases. In our patient, neurological toxicity occurred in the presence of normal renal function. The neuromyopathy is generally reversible on withdrawal of the drug. Colchicine is to be used with caution in patients with impaired renal function, and even if kidney function is normal, muscle strength must be monitored and serum CPK levels checked if myopathy is suspected.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Aplastic anemia is a rare but serious complication of systemic lupus erythematosus (SLE) with an often dramatic and unanticipated onset. The peripheral destruction of formed blood elements, which frequently accompanies the syndrome, may obscure or delay the diagnosis of bone marrow suppression, and the number of published cases may be an underestimate of the actual incidence of the disease. Furthermore, the disease course may differ significantly from other forms of acquired aplastic anemia and seems to carry a more favorable prognosis once effectively diagnosed and treated. In addition, aplastic anemia may precede other manifestations of SLE. Therefore, the possibility of bone marrow aplasia should be excluded in all SLE patients with severe pancytopenia, and conversely, the diagnosis of SLE should be explored in cases of aplastic anemia.Two patients with aplastic anemia in SLE, one with aplastic anemia preceding the onset of SLE, are described along with 15 cases reviewed from the English language literature. The presentation, prognosis, treatment, and pathogenesis of aplastic anemia complicating SLE are discussed. Recognition that cytopenias, especially pancytopenia, may occur on the basis of inhibited myelopoesis rather than peripheral destruction as either a harbinger of SLE or as a manifestation of disease flare is important. This knowledge will prompt the astute clinician to obtain screening antinuclear antibodies in the setting of otherwise unexplained bone marrow acellularity or, given the prognosis of SLE associated aplastic anemia, give early consideration to more aggressive immunosuppression.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We report the case of a 51-year-old woman with a connective tissue disease of 8 years duration. She had been taking corticosteroids at a dose of 1 mg/kg/day and azathioprine at a dose of 3 mg/kg/day for 1 month. Given the clinical suspicion of systemic sclerosis (limited form of scleroderma), she was studied according to a protocol including endoscopy to assess the degree to which the underlying disease had affected the gastrointestinal tract. Endoscopy revealed a asymptomatic severe esophagitis and a subsequent biopsy disclosed the presence of cytomegalovirus.Cytomegalovirus pneumoniawas also detected. Both processes were successfully managed with intravenous ganciclovir (5 mg/kg/12 hr) for 21 days.This report is a case of cytomegalovirus involving the esophagus in association with systemic sclerosis in a patient immunosuppressed because of drugs that she had been taking. This complication can be asymptomatic and is amenable to treatment.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pulmonary involvement may sometimes be the initial presentation of Takayasu’s arteritis (TA). Since the signs and symptoms of pulmonary TA may be subtle and may not be easily distinguishable from other pulmonary diseases, one has to maintain a high index of suspicion. Cases of pulmonary TA mimicking chronic thromboembolism have been reported. We describe a patient with TA whose initial presentation mimicked acute pulmonary embolism. The patient presented with a 3-day history of cough and shortness of breath and had multiple bilateral perfusion defects on ventilation-perfusion scan, typical of acute pulmonary embolism. However, the constellation of clinical features, elevated erythrocyte sedimentation rate and the angiographic appearance helped us establish the correct diagnosis of pulmonary Takayasu’s arteritis. At a 6-year follow-up, the patient had no worsening of pulmonary symptoms but presented with postural dizziness with angiographic evidence of carotid and innominate artery stenosis; she underwent arterial bypass grafting. In young women presenting with a clinical picture of acute pulmonary embolism without the previous history (or risk factors) of thromboembolism, pulmonary TA must be considered in the differential diagnosis.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We report the extremely uncommon case of a 77-year-old woman in whom a tumor found to be a melanotic schwannoma, arising from the right rectus abdominis muscle, was detected during investigation for a rheumatic disorder, finally identified as polymyalgia rheumatica (PMR). Tumors of this type most commonly occur in spinal nerve roots, and their clinical behavior is very difficult to predict. As far as we are aware, this is the first reported case affecting the aforementioned site. The challenging issue in this case concerns the possible link between the 2 clinical conditions, in particular the development of PMR as a paraneoplastic syndrome. Although such an association has not been reported, PMR is included among the rheumatic disorders reported to be associated with malignancies and occasionally with benign tumors. However, given that tumor resection did not result in remission of PMR and symptoms improved rapidly with prednisone, it seems likely that the above disorders might simply coexist.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Incisional biopsy of labial salivary glands has been a valuable technique for diagnosis of Sjögren’s syndrome. This report describes a new technique using punch biopsies that requires fewer resources and appears to be equally effective. Fifty patients evaluated by punch biopsy all yielded adequate pieces averaging 6 glands per specimen. Two patients had transient numbness of the lip. There were no other complications. Classical findings of Sjögren’s histopathology were demonstrable with these specimens. This technique is safe, less expensive, and is proposed as a reliable alternative to incisional biopsy.

ISSN:1076-1608    

出版商:OVID    

年代:2001

数据来源: OVID