摘要:

Hallux valgus deformity is the most commonly observed forefoot deformity in patients with rheumatoid arthritis. This 5-year, double-blind, randomized clinical trial compared treatment orthoses with placebo orthoses for the prevention of hallux valgus deformity in the rheumatoid arthritic foot.One hundred and two subjects with active rheumatoid arthritis and with foot pain and minimal radiographic changes of the feet participated in the study. They were recruited from five arthritis clinics in the Chicago metropolitan area that are affiliated with or are teaching clinics of area medical schools. Patients were followed for 3 years.Eighty-one subjects completed the study. In a logistic regression analysis, the treatment group was 73% less likely to develop hallux valgus deformity compared with the control group (adjusted odds ratio 0.27, 95% confidence interval 0.078, 0.916p= .04). These findings suggest that foot orthoses can prevent or slow the progression of hallux valgus deformity.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Spinal pain is a characteristic of ankylosing spondylitis (AS) that can persist indefinitely, even when laboratory indices of inflammation are normal. We used single photon emission computed tomography to study 28 symptomatic patients with established disease, half of whom had complete ankylosis of sacroiliac and one-third of whom had complete ankylosis of intervertebral joints. Pain in the lumbar region was associated with increased uptake of isotope in the facetal joints. There was no relationship of pain with impaired lumbar flexion, erythrocyte sedimentation rate, serum immunoglobulin A nor with radiologic change in the sacroiliac, intervertebral and facetal joints. We suggest that persistent lumbar pain with AS might be associated with facetal joint inflammation and that treatment directed at these sites may be rewarding.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Patients treated with cyclosporine after organ transplantation are at particular risk for the development of hyperuricemia and tophaceous gout. The appearance of tophi or clinical gout can occur within a short time of initiation of cyclosporine therapy. Treatment decisions for the often accelerated and severe gouty arthritis must take into consideration numerous drug interactions as well as the degree of allograft dysfunction, or renal insufficiency due to the effects of disease or medication.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Fibromyalgia is a common condition that affects 2–4% of the population and is characterized by widespread pain, fatigue, and a number of other symptoms. There is evidence to suggest that fibromyalgia occurs much more frequently than expected in individuals with inflammatory rheumatic disorders. At present, it is not clear whether the inflammatory disorder leads to fibromyalgia or vice versa, but plausible mechanisms exist for either scenario. The coexistence of fibromyalgia and inflammatory disorders can lead to considerable difficulty in both diagnosis and treatment. In this article, the reasons that these two types of disorders can coexist are reviewed, and an approach to the diagnosis and management of individuals with components of both fibromyalgia and an inflammatory disorder is suggested.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

By the time a patient with generalized rheumatism (fibromyalgia) is referred to a rheumatologist, usually he or she has already seen a number of other physicians who have diagnosed various conditions, at least one of which is that the condition is psychiatric. Commonly, these patients, who have been contending with chronic discomfort and fatigue, have also become confused, angry and depressed. Thus, it is important not only for the rheumatologist to correctly diagnose the condition, but to gain the patient's confidence as well. The only way to do this takes time, but it is time well spent.The history must be taken in detail: the patient must be encouraged to tell his or her entire story. The patient must be convinced that the physician has appreciated the extent and significance of each symptom. A thorough physical examination should follow, with evident attention to each symptomatic area. The discussion that follows must be complete and compassionate. It is the hardest but the most important part of the consultation, and therefore an example is provided in detail.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Case reports of Henoch-Schönlein syndrome invariably note the presence of purpura at the time of the vasculitic syndrome. We document an unusual recurrence of Henoch-Schönlein syndrome in the absence of purpura. A 29-year-old man with a history of Henoch-Schönlein vasculitis with several typical purpuric recurrences was admitted with hemoptysis, pulmonary hemorrhage and no cutaneous lesions. Because he had not had purpura in 3 years, a broad differential diagnosis of hemoptysis was considered. A random skin biopsy showing intravascular immunoglobulin A and C3 deposition helped to confirm an apurpuric recurrence of Henoch-Schönlein vasculitis.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pulmonary hemorrhage in a patient with Henoch-Schönlein purpura was shown at autopsy to be caused most likely by Goodpasture's syndrome. The diagnosis was missed in part because of repeated negative assays for glomerular basement membrane antibodies. Linear fluorescence for immunoglobulin G was found in lung and glomeruli at postmortem. Development of Goodpasture's syndrome might be a result of release of glomerular basement membrane antigen by vasculitis.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Erythema induratum, previously uncommon, is appearing more frequently coincident with the recrudescence of tuberculosis. It is a type of panniculitis often confused clinically with erythema nodosum. We report two patients who were both initially believed to have erythema nodosum and a multisystem disorder. However, in each case, the lesions appeared atypical due to suppuration or distribution of the lesions. This led to skin biopsies, which showed the presence of erythema induratum and excluded the panniculitis of erythema nodosum or leukocytoclastic vasculitis. This lesion heightened our suspicion of the presence of tuberculosis, which was subsequently confirmed by culture and/or clinical response.This experience suggests that patients with an atypical presentation of erythema nodosum should have a skin biopsy to exclude a diagnosis of erythema induratum.

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

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID