摘要:

&NA;Current Opinion in Rheumatology 1993,5:405‐407

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The clinical features and management of ankylosing spondylitis are reviewed here. Important descriptions of the paleopathology of ankylosing spondylitis are discussed, and articles are reviewed in which the characteristics of some extra‐articular complications are described. Controversy persists on the bone mineral content of patients with ankylosing spondylitis and its relationship with disease duration and outcome, as well as on the role of sulfasalazine in the management of ankylosing spondylitis.Current Opinion in Rheumatology 1993,5:408‐413

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;It is now clear that the deposition and persistence of bacterial antigens in the joint are significant features of reactive arthritis. It is possible that in some instances this represents persistence of live bacteria, and several studies point to the potential value of antimicrobial therapy. Searches for bacterial DNA and RNA have yielded conflicting data, however, so further developments in this area will be of great importance. It is likely that bacterial antigens interact in some way with class I major histocompatibility complex (MHC) antigens in the pathogenesis of reactive arthritis. However, with the increasing understanding of the structure and function of HLA molecules, some evidence of a classic antigen‐class I MHC‐CD8 T‐lymphocyte interaction is now emerging. Thus far, the mechanisms that link HLA‐B27 and bacterial antigens with reactive arthritis remain unclear.Current Opinion in Rheumatology 1993,5:414‐419

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Enteropathic arthritides, uveitis, and Whipple's disease all belong to the category of spondyloarthropathies. The exact mechanism of relationships among joint, tendon, and axial involvement in the spondyloarthropathies, and gut and eye involvement, is unsolved. Different hypotheses have been proposed to explain the role of enterogenic bacteria in interfering with the HLA system and causing inflammatory reactions in these organs. The microorganism responsible for Whipple's disease (Tropheryma whippelii) has been identified by sequencing the largest part of a bacterial 16S ribosomal RNA, followed by polymerase chain reaction amplification. Late‐onset pauciarticular juvenile chronic arthritis should be included in the category of the spondyloarthropathies. New cases of ankylosing spondylitis associated with diffuse idiopathic skeletal hyperostosis have been reported.Current Opinion in Rheumatology 1993,5:420‐427

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis, and its clinical presentation varies from case to case. Distal interphalangeal involvement is characteristic but not seen in all patients. Enthesopathy, including that of the spine, is common and contributes to the classification of psoriatic arthritis as a seronegative spondyloarthropathy. The etiopathogenesis of psoriatic arthritis is not well understood, and evolution as measured by follow‐up is variable. Treatment includes nonsteroidal anti‐inflammatory drugs and some of the drugs used in the treatment of rheumatoid arthritis. Sulfasalazine and, in the more severe cases, cyclosporine, are being studied for efficacy and tolerance. Some cases of psoriatic arthritis are associated with an inflammatory bone disease, frequently seen on the anterior chest wall, which is part of the newly described SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. SAPHO syndrome is characterized by this bone involvement, which can affect the spine and peripheral bones. Various skin conditions are associated with this syndrome, but they do not necessarily occur in all cases. Chronic recurrent multifocal osteomyelitis, which is seen mostly in children, may be a presentation of SAPHO syndrome. Associations with sacroiliitis, bowel disease, and psoriasis link SAPHO syndrome with the spondyloarthropathies.Current Opinion in Rheumatology 1993,5:428‐435

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;In this review, recent data relevant to better understanding of the immunogenetics of the spondyloarthropathies are discussed or, in a somewhat broader sense, the HLA‐B27 disease associations. Although in 1993 much more is known about the B27 molecule than was known in 1992, its contribution to the pathogenesis of disease is unclear. Peptide presentation to the T‐cell receptor is still the basic, if not the only, function of HLA class I molecules. Nothing special was found for the B27 gene, molecule assembly, protein sequence, and crystal and peptide‐binding motif, nor for the function dependent on these physical properties. Nevertheless, the theory regarding an “arthritogenic peptide” seemed to promise an explanation. However, this theory is rather an assembly of older views modified by the new data and is missing any detail or perspective that would answer the specific question: why B27 and not other HLA molecule(s)? If the solution is simple, and B27 is qualified to bind certain (bacterial) peptides that are not bound by any other class I molecule, or the unique complex, B27 + x, has special properties resulting in a “dysfunction,” there is still no answer to the question: which peptide and why does its binding with B27 result in disease?Current Opinion in Rheumatology 1993,5:436‐445

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The 1992 literature on septic arthritis reiterated the factors that portend a poor outcome in septic arthritis. However, we still know very little about how to improve the outcome for such patients. Infections of the musculoskeletal system may be more common among patients with HIV than the reported cases indicate. Bacterial endocarditis is frequently associated with musculoskeletal complaints. Low back pain may be a presenting manifestation. Acute gout and septic arthritis can cause peripheral arthritis in some patients with bacterial endocarditis. Septic arthritis can present unusual manifestations and can occur as a complication of arthroscopic surgery; the risk factors for its development after arthroscopy have been identified. Arthroscopy as a therapeutic procedure to drain an infected joint is discussed.Current Opinion in Rheumatology 1993,5:449‐453

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;In 1992, reported Lyme disease cases increased, but the majority remained clustered in the northeast and midwest, and in California. The clinical syndromes associated with infection are better understood, and this information can calm public anxiety. The concept of fibromyalgia occurring after infection withBorrelia burgdorferiallows more appropriate treatment in late Lyme disease. The polymerase chain reaction is being applied to gain insights into the pathogenic mechanisms of Lyme disease. Progress has been made toward developing a vaccine through the use of animal models. Together, these advances provide clinicians with more confidence in the diagnosis and treatment of Lyme disease.Current Opinion in Rheumatology 1993,5:454‐460

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The principles underlying the diagnosis and management of infection in the orthopedic patient are well established. Despite this, the patient with an infected implant still presents the orthopedic surgeon with a challenging problem. In this review, I consider the recent developments in the diagnosis and management of the infected arthroplasty, infected tibial nonunions, spinal infections, and disease transmission by bone allografts.Current Opinion in Rheumatology 1993,5:461‐467

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID