摘要:

Synovial fluid white blood cell counts are considered to be useful in diagnosing infectious arthritis, however, considerable overlap exists between infectious and noninfectious types of inflammatory arthritis. We undertook this review of synovial fluid studies at our institution to better define this degree of overlap and characterize the features of infectious arthritis in relationship to synovial fluid white cell counts. The records of 202 consecutive patients with synovial fluid white blood cell counts >2000/mm3were reviewed. Infectious arthritis was diagnosed in 77% (10/13) of patients with counts >100,000, 47% (8/17) in the 50,000–100,000 range, and 5% (9/172) with counts <50,000. Crystal-induced arthritis and rheumatoid arthritis made up 81% of patients in the 15,000–50,000 range. Overall, 10 of 27 (37%) cases of infectious arthritis had white cell counts >100,000, and 18 of 27 (67%) had counts >50,000. A majority of these infections (14/18) were related toStaphylococcus aureus, while 5 of 7 infections associated with counts <20,000 were associated with atypical organisms.This study confirms that a majority of patients with very high synovial fluid white blood cell counts have infectious arthritis, and that the likelihood of infection is markedly reduced, but certainly not excluded, below this level. The presence of atypical infections in a small percentage of patients with low counts emphasizes the importance of clinical judgment in evaluating all patients with inflammatory arthritis, regardless of synovial fluid white cell counts.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Massage therapy has been observed to be helpful in some patients with fibromyalgia. This study was designed to examine the effects of massage therapy versus relaxation therapy on sleep, substance P, and pain in fibromyalgia patients. Twenty-four adult fibromyalgia patients were assigned randomly to a massage therapy or relaxation therapy group. They received 30-minute treatments twice weekly for 5 weeks. Both groups showed a decrease in anxiety and depressed mood immediately after the first and last therapy sessions. However, across the course of the study, only the massage therapy group reported an increase in the number of sleep hours and a decrease in their sleep movements. In addition, substance P levels decreased, and the patients’ physicians assigned lower disease and pain ratings and rated fewer tender points in the massage therapy group.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Memory decline and mental confusion frequently complicate the clinical presentation of fibromyalgia; however, formal cognitive examination often does not support deterioration. This paradox was examined in the context of dissociation, a condition with many cognitive similarities. Dissociation refers to the separation of parts of experience from the mainstream of consciousness. A common example is highway hypnosis. Eighty-nine fibromyalgia (FM) patients and 64 other rheumatic disease patients were screened for memory decline and mental confusion using a questionnaire format. Pain, dissociation, affective distress, fatigue, sleep difficulty, and mental confusion were also assessed.Cognitive complaints (76.4%–43.8%) and dissociative symptoms (37.1%–1.9%) were overrepresented in patients with FM. Among FM patients with high dissociation, cognitive difficulties were reported by 95%; 100% of these cases reported that both memory and mental clarity were affected, a condition referred to as fibrofog. Dissociation in combination with fibrofog was associated with higher levels of FM symptom intensity and decreased mental well being. These findings suggest that dissociation may play a role in FM symptom amplification and may aid in comprehending the regularity of cognitive symptoms. Separating cases of fibrofog from cognitive conditions with actual brain damage is important. It may be prudent to add a test of dissociation as an adjunct to the evaluation of FM patients in cases of suspected fibrofog. Otherwise, test results may prove normal even in patients with disabling cognitive symptoms.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Myositis of the skeletal muscle is rarely seen as an extraintestinal manifestation of inflammatory bowel disease. We report a case of a 36-year-old man with ulcerative colitis who developed 3 episodes of steroid responsive myositis in a 4-month period. He presented with a blistering rash followed by pain and massive swelling in the right shoulder and lower extremities, with marked elevation in muscle enzymes. Diagnosis of myositis was made after a muscle biopsy, which showed neutrophilic infiltrate in the deep subcutaneous tissue and skeletal muscle. Review of the literature indicates only a few cases of myositis associated with ulcerative colitis, most of them during an acute exacerbation of the disease. However, the present patient had his first episode when the ulcerative colitis was in remission. Myositis in ulcerative colitis may present atypically, in particular mimicking pyomyositis. Clinicians should be aware of this unusual steroid-sensitive complication.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pseudoxanthoma elasticum is an inherited disorder of abnormal calcification of elastic fibers in the skin, retina, and cardiovascular system. Herein, we report a patient who had dry eyes and mouth, keratoconjunctivitis sicca, and a low titer ANA at presentation. A lip biopsy was performed to confirm a clinical suspicion of Sjögren’s syndrome; however, the histologic findings were diagnostic of pseudoxanthoma elasticum. Antibodies to Ro and La were negative. Subsequently, she was found to have skin and eye findings consistent with pseudoxanthoma elasticum. Although a causal relationship between keratoconjunctivitis sicca and pseudoxanthoma elasticum is not proven, salivary gland involvement with pseudoxanthoma elasticum may explain this patient’s symptoms. Physicians should consider the diagnosis of pseudoxanthoma elasticum in patients who present with sicca symptoms without obvious cause, especially if cutaneous or ophthalmologic abnormalities, or both, are present. Careful monitoring for associated problems is needed as soon as pseudoxanthoma elasticum is diagnosed.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This report describes a patient with abdominal pain at presentation, which on angiography was found to be caused by vasculitis limited to the superior mesenteric artery. He was treated with oral glucocorticoids after an initial 5-day course of pulse therapy and obtained excellent relief of symptoms. Steroids were tapered over 8 months. Repeat angiography revealed complete resolution of the vasculitis with a residual aneurysm of a branch of the left gastric artery, which was resected to avoid the risk of rupture. Histologic analysis revealed thickened intima with myxoid degeneration and no evidence of active vasculitis. Extensive laboratory and clinical investigations did not reveal an underlying connective tissue disorder to account for the gastrointestinal vasculitis. This report of an angiographically defined regional vasculitis involving the superior mesenteric artery with complete clinical as well as radiologic resolution on treatment with glucocorticoids alone emphasizes the need to differentiate between an isolated or regional vasculitis, which has an excellent prognosis, to avoid subjecting the patient to cytotoxic therapy with significant toxicities.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Eosinophilic fasciitis is a rare connective tissue disease in children characterized by hardening and thickening of the skin and soft tissues, peripheral eosinophilia, elevated erythrocyte sedimentation rate, and hypergammaglobulinemia. In this study, we report three pediatric patients with eosinophilic fasciitis whose clinical presentation and response to therapy differed from those reported in the literature. All three patients were female. Two of them had Raynaud’s phenomenon as an initial feature, and the third had hepatosplenomegaly. Muscle involvement with weakness was present in two patients, as documented not only by increased aldolase levels at the time of presentation but also by inflammatory changes in the muscle biopsy. Serum immunoglobulin G levels were increased only in the most severely involved patient. Peripheral eosinophilia was present in all three cases. All three patients responded well to prednisone therapy. Two patients had a uniphasic course, and one required further therapy to control a postinfection relapse. In summary, we found that Raynaud’s phenomenon and hepatosplenomegaly can be part of the spectrum of clinical manifestations of childhood eosinophilic fasciitis. Identification as eosinophilic fasciitis and not scleroderma, despite hand involvement and Raynaud’s phenomenon, can suggest that the illness may be steroid responsive.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Two male patients with mechanics hands and concomitant interstitial lung disease, Raynaud’s phenomenon, dermatomyositis-like rash, and arthritis were evaluated with gray-scale ultrasonography (US) and color Doppler US of the hands using a high-resolution hockey stick configuration 10-MHz transducer (ATL3000). Color Doppler US and gray scale US images of the flexor tendons were obtained at the level of the metacarpophalangeal joint. Initial gray-scale US demonstrated subcutaneous tissue and tendon thickening and synovial sheath effusion; color Doppler US demonstrated hyperemia of the subcutaneous tissues and tendons. Flexor tendon dysfunction on physical examination was proportional to hyperemia and thickening of structures shown by US. Follow-up examination, at a time when patients were improved, showed decreased blood flow in tendon sheaths and subcutaneous tissues and resolution of synovial sheath effusion; one patient, however, demonstrated accumulation within the sheath. Relative improvement in functional status mirrored the changes in the US. The color Doppler US finding of increased blood flow in the soft tissues of these two patients with mechanic’s hands represents a physiologic anatomic abnormality amenable to treatment and provides prognostic information for these patients. Mechanic’s hands and tenosynovitis occur in patients like these without muscle weakness.

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:

Peptide antigen recognition by T-cells occurs because of the interaction of the epitope cradled within the peptide-binding groove of the major histocompatibility complex molecule on the surface of an antigen-presenting cell with the T-cell antigen receptor, a heterodimer whose chains belong to the immunoglobulin superfamily. Passage of the message from the receptor to the cell’s nucleus occurs via a complex choreography of kinases, calcium, and chemical combinations consisting of families of proteins described by arcane acronyms, numbers and letters that perplex the casual observer. However, taming the T-cell is crucial in transplantation and in controlling autoimmunity. Behind the jargon is a fascinating, albeit confusing, set of mechanisms that already offer therapeutic promise.

ISSN:1076-1608    

出版商:OVID    

年代:2002

数据来源: OVID