ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Giant cell arteritis is often considered less common in African Americans. In 1985, we reviewed 34 African American patients with biopsy-proven temporal arteritis. We report on 9 additional biopsy positive patients seen at the Washington Hospital Center (WHO between 1988 and 1996.Clinical presentations were similar to those reported in previous series, with the exception that only one patient had polymyalgia rheumatica. Two patients had visual symptoms, but only one patient had permanent monocular visual loss. In combining our 9 new patients with 41 biopsy-proven, well characterized, published patients and comparing them with a representative Caucasian group, we found statistically significant differences. Male gender, anemia, and visual loss were overall more common in African Americans, whereas constitutional symptoms and polymyalgia rheumatica were less common. The detection rate of temporal artery biopsies at WHC was lower than rates reported in other studies, but they did not differ by race.We conclude that giant cell arteritis should be pursued as a diagnosis in all patients presenting with appropriate clinical features, regardless of race, and that earlier recognition may account for the lower incidence of permanent visual loss.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Kikuchi's disease or histiocytic necrotizing lymphadenitis is a recognized cause of benign lymphadenopathy, although the current clinical literature also supports a link with systemic lupus erythematosus (SLE). Eight patients represent all the cases of Kikuchi's disease admitted to our hospital from 1990 to 1997. They were all young women of median age of 31 years (range 22–43 years). All patients showed cervical lymphadenopathy, and in two cases splenomegaly was present. In one patient, the diagnosis of lupus preceded the onset of Kikuchi's disease by 5 months. In 4 other patients, antinuclear antibodies (ANA) were positive at titers ranging between 1:80 and 1:2560 and were associated with leukopenia ranging from 1190 to 2800 white blood cells/mm3 when the diagnosis of Kikuchi's disease was made. Among these, 3 patients developed SLE after periods ranging from 6 to 25 months. The other ANA positive patient and the 2 remaining ANA negative patients did not develop any autoimmune disease after 2-A years of follow-up.The differential diagnosis between Kikuchi's disease and lupus lymphadenitis cannot always be clarified histologically. We recommend that patients with necrotizing lymphadenitis, leukopenia, and ANA be closely followed. This should ensure an early diagnosis of development of an autoimmune disorder that will require treatment, rather than always considering these patients to be affected by a benign self-limited disorder like Kikuchi's disease.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study was designed to evaluate, by means of a randomized controlled trial, the effects of a physical activity program incorporating aerobic, strength, and stretching exercises in individuals with osteoarthritis of the knee. We randomly assigned 137 volunteers ages ≥50 to an experimental group or a control group. The experimental group participated in three 1-hour sessions of supervised exercises per week over a 3-month period. The control participants were instructed to continue their usual daily activities, and they attended 1-hour education sessions twice a month. The effectiveness of the program was evaluated using repeated measurements of parameters related to self-reported health status, physical capacity, and joint tenderness.After 3 months, significantly greater improvements were observed in the experimental group than the control group in terms of: arthritis pain (p = 0.02), ability to walk and bend (p = 0.03), aerobic capacity (p < 0.0001), hamstring and low back flexibility (p = 0.003), quadriceps and hamstring strength (p <0.01), and the perception of changes relating to osteoarthritis of the knee and general condition (p < 0.0001). However, no significant differences were observed between the groups in isokinetic strength of the quadriceps (all p's ≧ 0.05), joint tenderness (p = 0.18), and health perception (p = 0.7). The overall results suggest that this program is effective for older persons with osteoarthritis of the knee and that it could contribute to maintaining their independence and improving their quality of life.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There were 55 Israeli patients with Behcet's disease (BD) included in a study conducted to determine the correlation between HLA-B5 and clinical manifestations and severity of the disease. The systemic manifestations of BD were analyzed in relation to HLA typing, and a systemic severity score for BD was calculated according to potential morbidity and mortality associated with various clinical features. Of the 55 patients, 42 (76.4%) were sephardic Jews, 2 (3.6%) were ashkenazi Jews, and 11 (20.0%) were Israeli Arabs. There were 39 (70.9%) HLA-B5 positive patients; they had a significantly higher incidence of thrombophlebitis and a lower rate of erythema nodosum. The HLA-B5-positive patients were significantly older at disease onset, and their severity score tended to be higher, although not statistically significant.The results of our study imply that HLA-B5 in Israeli patients is associated with specific clinical features, especially more vascular disease, and may be associated with a more severe course of BD. This is of general interest because American and North European patients also have less HLA-B5 and less severe disease. (J Clin Rheumatol 1999;5:137–140)

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:

A drug interaction that seemed to contribute to sudden worsening of corticosteroid-stabilized vasculitis stimulated this review. A large number of drugs share with corticosteroids critical phase I metabolic steps mediated by hepatic cytochrome P450 (CYP) enzymes, particularly the individual enzyme CYP3A4. In their metabolic interaction with CYP3A4 as substrates, a growing number of these drugs have the potential to induce (upregulate) hepatic CYP3A4 levels, resulting in accelerated clearance (and reduced efficacy) of concomitantly administered glucocorticoids, which are also CYP3A4 substrates. Many other drugs can have the opposite effect, that is, they can inhibit CYP3A4 function by tight binding to its active site. This can result in reduced clearance (and augmented efficacy) of concurrently administered glucocorticoids. Current knowledge of this type of drug interaction, the drugs to watch out for, and multiple clinical reports of altered corticosteroid efficacy, are reviewed after presentation of the case illustrating potential relevance to the management of rheumatic diseases.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies directed against components of neutrophils and monocytes, and are helpful in identifying different forms of vasculitis. Until the discovery of ANCA, there was no specific laboratory method for the investigation of systemic vasculitis. Many issues regarding ANCA, such as their role in the pathogenesis of vasculitis, sensitivity, specificity, predictive value, and antigen specificity are still unclear. The differential diagnosis of the vasculitic syndromes is often difficult because of the variable presentation, but is important because of the variable outcome.Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome are three vasculidities that commonly are associated with a positive ANCA. The “gold standard” for a precise diagnosis of vasculitis depends on both the clinical and pathologic features. ANCA testing is used to support the clinical and pathologic findings. The ANCA pattern, determined by indirect immunofluorescence, can be either cytoplasmic (C-ANCA), perinuclear (P-ANCA), or atypical perinuclear (X-ANCA). Interpretation of the ANCA pattern can be problematic, and a reactive antinuclear antibody can contribute to the confusion, requiring testing for reactivities to specific autoantigens. Proteinase-3 and myeloperoxidase are the most common autoantigens and are commonly associated with C-ANCA and P-ANCA, respectively. ANCA reactivity to other autoantigens is associated with the X-ANCA pattern.

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:

Systemic vasculitis is a rare but devastating problem in patients with human immunodeficiency virus (HIV). The coinfection with hepatitis C virus (HCV) further complicates the clinical management. We report a 46-year-old woman coinfected with HCV and HIV with a CD4 count of 950/mm3who presented with a life-threatening vasculitis of the lungs, kidneys, and skin and who initially responded after use of corticosteroids and then 2 monthly pulses of i.v. cyclophosphamide. Her condition deteriorated when she was switched to azathioprine. Ultimately, the patient died of neutropenic sepsis. On the basis of our experience and an analysis of the literature, we suggest that monthly pulsed i.v. cyclophosphamide and steroids might be used as an induction therapy, followed by antiviral treatment for patients with HIV, HCV, and a life-threatening ischemic vasculitis if the CD4 count is >400/mm3. For patients in this complex condition who are receiving immunosuppressants close surveillance for signs of secondary infection, and prophylactic trimethoprim/sulfamethoxazole, are advised. The use of interferon alpha, ribavirin, i.v. immunoglobulin, and plasmapheresis are alternatives for patients with milder vasculitis.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID