ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Certain health care reform proposals emphasize “primary” rather than specialty care, so it is important to document whether these changes might affect patients with rheumatic diseases. We therefore assessed outcome and costs of patients who were hospitalized with acute arthritis, comparing management by rheumatologists with nonrheumatologists. We reviewed charts retrospectively from 1991 to 1993 at our community medical center. Twenty patients with acute arthritis were managed by rheumatologists and 35 were managed by nonrheumatologists. Demographic, clinical, and rheumatologic features of patients were comparable.Rheumatologists ordered joint radiographs (65%) and performed diagnostic arthrocentesis (75%) significantly more often than nonrheumatologists (31 and 34%, respectively;p< 0.05). Rheumatologists' initial recorded diagnostic impressions were usually confirmed at discharge, whereas nonrheumatologists' more often were not (p< 0.05). Rheumatologists established definite diagnoses by American College of Rheumatology criteria significantly more often (75%) than nonrheumatologists (34%;p< 0.05). Nonrheumatologists selected antibiotics, systemic corticosteroids, nonsteroidal anti-inflammatory drugs, and allopurinol more often and intra-articular steroids (p< 0.05) and adrenocorticotropic hormone less often for a similar case mix than rheumatologists. Rheumatologists' clinical evaluations (p< 0.001), selection of diagnostic studies (p< 0.001), and therapeutic decisions (p< 0.005) were significantly more complete. Trends strongly favored rheumatologists' patients improving more rapidly (3.5 vs. 6.6 days;p= 0.06) and being hospitalized for shorter stays (7.4 vs. 14.7 days;p= 0.08) and favored rheumatologists' patients as managed at considerably less hospital cost ($8756 vs. $14,750).These limited observations suggest caution about equating nonspecialty with rheumatologic care and are consistent with suggestions that, at least for certain patients and as defined by our criteria above, rheumatologists offer more complete evaluation, more accurate diagnosis, more rational therapy, and better clinical outcome at lower cost than do nonrheumatologists.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this study was to evaluate the character and evolution of bone lesions attributable to amyloid deposition in patients on long-term dialysis. Thirty-five patients who were treated with hemodialysis for 5 to 22 years were studied by a review of medical records and hand radiographs. The frequency, distribution, character, and evolution of skeletal cyst-like lesions believed to be secondary to amyloid deposition were evaluated in relation to dialysis duration. The number and size of these lesions increased with dialysis duration, present in 28% of the patients after 5 through 9 years of hemodialysis and in 91% after 15 through 22 years. In contrast, the changes of hyperparathyroidism decreased. Of patients with skeletal wrist lesions, radiographs of symptomatic large joints were available in 15; five had bone abnormalities. Skeletal amyloid deposition was verified pathologically in nine sites (five patients). It is concluded that skeletal lesions believed to be due to amyloid deposition increase with dialysis duration and most commonly affect the wrists. They have a distinctive character, distribution, and evolution and are often associated with carpal tunnel syndrome.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Juvenile dermato/polymyositis is an inflammatory myopathy that usually presents with symmetrical hip and shoulder girdle muscle weakness, with or without a skin rash. In our series of 78 patients with dermato/polymyositis, we found eight children whose initial complaint was back pain, a rare symptom at the onset of other pediatric rheumatic diseases. This unusual presentation significantly delayed the correct diagnosis in most of our cases.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In rheumatoid synovium, interleukin-6 (IL-6) is the most abundantly expressed cytokine. Therefore, we investigated whether serum IL-6 levels could be clinically useful parameters of disease activity in rheumatoid arthritis (RA). The serum IL-6 levels were measured by enzyme-linked immunosorbent assay. The IL-6 levels were significantly higher in sera from patients with RA (n= 108, 13.3 ± 14.0 pg/mL) than in those from the normal controls (n= 10, < 3.13 pg/mL). The IL-6 levels significantly correlated with conventional parameters, such as the Lansbury index, joint score, erythrocyte sedimentation rates, and C-reactive protein. In addition, the serum IL-6 level was useful to determine clinical remission. Advantages of serial measurement of IL-6 were observed in two cases. These findings suggested that the serum IL-6 level may be clinically useful as a sensitive parameter of disease activity in RA.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The objective of this study was to evaluate the efficacy of low-dose oral methotrexate (MTX) in improving muscle strength and reducing the corticosteroid requirement of patients with polymyositis (PM) and dermatomyositis (DM). The method used was a retrospective chart review of our clinic's PM/DM cohort, Between September 1989 and May 1993, 12 of 53 patients with PM/DM received low-dose oral MTX (mean maximum dose 14.4 ± 1.2 mg/wk, range 7.5–20 mg/wk). A significant increase in strength coupled with a fall in prednisone requirement (42.5 ± 5.8 mg/d to 13.0 ± 5.4 mg/d) was seen during the mean follow-up time of 24.0 ± 4.3 months of MTX therapy. The number of flares per year fell from 1.00 ± 0.35 before oral MTX institution to 0.07 ± 0.05 during oral MTX therapy. Toxicity was minimal. Three patients were able to stop corticosteroids altogether. Low-dose oral MTX therapy should be considered early in the treatment course of patients with PM/DM to improve strength and lower the required dose of corticosteroids.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

During a 30-month period, 51 needle-arthroscopic procedures using a small diameter (1.9 mm) flexible fiberoptic arthroscope were performed to obtain synovial tissue from knee joints. This procedure was performed in an outpatient setting using only a local anesthetic. Twenty-eight procedures were conducted involving 23 rheumatoid arthritis patients and 1 osteoarthritis patient as part of research protocols. In addition, arthroscopy and synovial biopsy were performed on 23 patients to obtain tissue for diagnostic purposes. Large samples of synovial tissue (over 10 g) were easily obtained in most patients. No complications were observed.The easy accessibility to large quantities of synovial tissue provided by needle arthroscopy should enable investigators to better define the pathogenic mechanisms operative in early rheumatoid arthritis. In addition, this technique will afford opportunities for determining the influence of current treatments as well as experimental treatments on molecular events in the synovium of patients. We conclude that outpatient needle arthroscopy using a small fiberoptic arthroscope can be used safely by rheumatologists trained in arthroscopy to obtain synovial biopsies for research and diagnostic purposes.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Chronic fatigue and nonrestorative sleep are prominent features of fibromyalgia (FM). It has been reported that these patients have alpha-wave intrusion during nonrapid eye movement (NREM) sleep (stages 2,3,4). Although alpha-NREM sleep has been noted in patients with other rheumatic disorders, a paucity of controlled data limits the interpretation of these reports. To determine the specificity of alphaNREM sleep, FM patients were compared with pain-free controls and with patients with generalized musculoskeletal pain without evidence of FM. There were no statistically significant differences in alpha-NREM percentages among the three groups. However, nearly half of all “pain” subjects (FM and generalized pain controls) had alpha-NREM percentages above the maximum value found in the painfree control group, and the mean percentage of alpha-NREM approached significance when pain-free controls were compared with all pain patients (FM plus generalized pain controls). These results provide additional evidence that alpha-NREM sleep may be a more generalized marker for chronic pain rather than a specific anomaly in patients with FM. Therefore, at present, sleep studies, although possibly of value in identifying factors associated with FM, should not be used in an attempt to either confirm or exclude a diagnosis ofFM in patients with generalized nonarticular pain.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Despite a lack of governmental legislation, health care reform in the United States will continue secondary to market (insurer) forces. Various motives underlie the forces driving this reform, with patient care issues (sadly) being absent from the top of most lists. One can strengthen a rheumatology practice in concert with these reforms through various means. Continuous quality improvement, expanding your patient base, improving efficiency, decreasing overhead, increasing knowledge of your worth, and expanding your roles are key points discussed in this article. Rheumatologists have the tools needed to be successful and to make important contributions in the present health care era.Musculoskeletal diseases will continue to increase in prevalence, and the need for ongoing care, education, and research will expand. Rheumatologists can not only strengthen their practice but are also well positioned to be leaders in delivering costeffective, quality care to patients with musculoskeletal diseases in the United States and other countries.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID