摘要:

In recent years most of the interest in musculoskeletal problems secondary to renal disease has focused on problems occurring in patients with chronic renal failure and specifically in patients on long-term hemodialysis. The musculoskeletal involvement in long-term hemodialysis may involve the joints, soft tissues, or both, and there is presently no good classification to which authors may refer when they report musculoskeletal problems in these patients. There has been intense interest in the past few years in the amyloidosis associated with long-term hemodialysis, and now, apparently, also with peritoneal dialysis. This type of amyloidosis is due to a specific type of amyloid, namely β2-microglobulin amyloid. Debate is ongoing about the role of both aluminum toxicity and iron deposition as cofactors affecting the location and extent of amyloid deposits. Debate is also unresolved about the role of specific dialysis membranes in lessening the incidence of dialysis-related amyloid. I review some of these areas as well as interesting new developments in localization of amyloid deposits in patients with chronic renal failure who are on hemodialysis.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Abnormal exposure to bacterial or dietary antigen across a diseased bowel wall may result in extraintestinal clinical complaints. Persistence of this antigen for years at these extraintestinal sites does occur, resulting in chronic and sometimes autoreactive disease. Treating the bowel disease can “cure” the extraintestinal complaints, but identifying the etiology of the original bowel disorder remains a problem, especially with the inflammatory bowel diseases. In 1992, nonsteroidal anti-inflammatory drugs remain essential in the treatment of various rheumatologic complaints. Although these drugs do work, they also produce gastrointestinal disease that may be far more extensive than was formerly appreciated. This risk is obviously a problem, and those who demand a change in our therapeutic approach to arthritis probably have the right idea.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A spectrum of immune alterations underlies the clinical syndrome of sarcoidosis. There is an increase in the number of helper T lymphocytes at sites of disease activity. Both macrophages and T cells are in a state of activation. Inflammation in sarcoidosis probably attracts specific T lymphocytes, as has been shown by the preferential usage of the Cβ1 elements of the T-cell antigen receptor. Acute sarcoid arthritis is distinctly different in its HLA association and clinical outcome than chronic sarcoid arthritis. Muscle and osseous lesions are well described but are usually asymptomatic. Childhood sarcoidosis may be confused with juvenile rheumatoid arthritis because of the similarity of eye and articular involvement. Nonsteroidal anti-inflammatory drugs and corticosteroids are effective for most patients. Hydroxychloroquine, methotrexate, and cyclosporine have been tried with success in patients with refractory sarcoidosis.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Recent literature on nonneoplastic hematologic disease in the rheumatic disorders has been reviewed, and current concepts on the anemia of rheumatoid arthritis and its treatment have been expanded. The anemia of chronic renal failure and of acquired immunodeficiency syndrome has responded to treatment with recombinant human erythropoietin. Recent studies document that the anemia of rheumatoid disease can also be alleviated with intermittent intravenous or subcutaneous administration of erythropoietin without apparent adverse reaction. However, no improvement is evident in the underlying rheumatoid disease or functional abilities of these patients. Further data are needed to determine the utility of erythropoietin therapy in rheumatoid arthritis and in other rheumatic diseases. Other mechanisms of anemia of rheumatoid disease have been studied, and as the underlying defects become known, other therapies may become available to patients with rheumatoid arthritis and other rheumatic diseases.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The effect of thyroxine replacement therapy on bone mass continues to attract attention. Although the advice of the American Thyroid Association to normalize serum thyroxine and thyroid-stimulating hormone concentrations is recommended, even physiologic doses of thyroxine may have an adverse effect on bone mass. The diagnosis and treatment of osteomyelitis in the diabetic foot is aided by magnetic resonance imaging, and long-term review of cases of diabetic femoral neuropathy emphasizes the good prognosis. Adrenal insufficiency as a complication of antiphospholipid syndrome is reviewed, and a useful physical sign, the acromegalic rosary, rediscovered. The association of sex steroids, oral contraception, and parity with rheumatoid arthritis is discussed. The outcome of pregnancy in women with juvenile rheumatoid arthritis is good, and quiescent disease does not appear to be permanently reactivated. Calcium deficiency, rather than vitamin D deficiency, is a cause of rickets in some Nigerian children.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Neoplasia can be associated with a wide range of rheumatologic manifestations. Literature over the last 12 months has reviewed metastasis of solid tumors to the joint and hypertrophic pulmonary osteoarthropathy. Vasculitis has been reported as a paraneoplastic syndrome associated with both hematologic and solid malignancies. Paraproteinemia occurs in association with rheumatoid arthritis and may progress to lymphoproliferative malignancy. A careful review of 23 rheumatoid arthritis patients with a serum paraprotein has attempted to study the predictive value of monoclonal gammopathy in rheumatoid arthritis for the later development of lymphoproliferative malignancy. Rheumatic manifestations, including cutaneous vasculitis and lupuslike syndromes, are seen in up to 10% of patients with myelodysplastic syndromes. Leukemias sometimes present as synovitis, and immunocytologic analysis of joint fluids can help to establish the diagnosis of leukemic arthritis at an early stage. Several other case reports of arthritis associated either directly or indirectly with neoplasia are presented.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Discovery of the different proteins that constitute the multiple types of amyloid has led to an increasing variety of studies in the literature of diverse medical subspecialties. In fact, in this review, the editors have chosen to review the β2-microglobulin amyloid of long-term hemodialysis in the section on renal disease. The current review focuses on the rapidly advancing basic studies of familial, amyloid A protein amyloid and the relevant clinical studies, although the research on amyloid light-chain protein and other forms of amyloidosis is also noted.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This review discusses miscellaneous diseases with rheumatic manifestations, and out of necessity many rarities are delineated,eg, the Charcot-type joints accompanying congenital sensory neuropathy with anhidrosis or the little-known arthritides that can result from severe acne. Of more general interest is a recent study showing that rheumatic disorders may underlie many neurologic admissions. In cardiology, the main point of interest is a possible resurgence of acute rheumatic fever, occurring first in the United States. Physicians should be alert to this possibility, particularly with the importance of prophylactic antibiotics. Finger clubbing and hypertrophic osteoarthropathy remain unexplained manifestations of pulmonary disease provoking an “International Workshop” devoted to their study. Platelet-derived growth factors may be the favorite candidate. Metabolic disorders with rheumatic complaints include the storage diseases. Some advances in imaging and assessment have been made, and the benefits of liver transplantation are the subject of another report. Other small-print causes of rheumatic complaints include drug abuse, whose protean manifestations include many resembling vasculitic or granulomatous disease.

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1992

数据来源: OVID