摘要:

Abstract:The management of acute gouty arthritis is outlined, with special attention to the use of colchicine, phenylbutazone, oxyphenbutazone, ACTH, indomethacin, the uricosuric drugs (probenecid and sulfinpyrazone) and the xanthine oxidase inhibitor, allopurinol. The prevention as well as the treatment of acute attacks, tophaceous deposits and renal calculi is discussed. Also discussed is the knotty problem of what to do about the incidental finding of hyperuricemia in apparently healthy persons. Since hyperuricemia does not of itself predetermine the occurrence of renal lesions, it would seem best to wait for the first objective evidence of tophaceous deposit (usually a period of ten or fifteen years, if ever) before starting treatment to lower the concentration of uric acid.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02088.x

年代:1968

数据来源: WILEY

摘要:

Abstract:Several associations of mesenchymal disease with gastrointestinal disease are discussed, e.g., scleroderma and its alimentary manifestations, erythema nodosum and pyoderma gangrenosum as complications of chronic ulcerative colitis, and the relationship between arthritis and ulcerative colitis. Most of the article is concerned with the relationship between peptic ulcer and arthritis, and the drugs used in therapy. Several reports in the literature are cited. A principal finding is that patients with rheumatoid disease are particularly prone to peptic ulcer. The pathogenesis of peptic ulcer depends upon the balance between digestive secretions and mucosal resistance in the stomach and duodenum.Several substances can be ulcerogenic, e.g., gastrin, histamine, aspirin, phenylbutazone and cinchophen. Possibly ulcerogenic are (large doses) testosterone and corticosteroids. Since corticosteroids are among the most beneficial drugs for the treatment of some mesenchymal diseases and ulcerative colitis, this point is an important one. We should not conclude that a disease is drug‐induced just because it follows administration of the drug. This is particularly applicable to peptic ulcer, which seems to occur secondarily or in association with a large variety of disorder

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02089.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The relationship between rheumatoid arthritis and lung disease is discussed. A case is presented of a young woman with juvenile rheumatoid arthritis in whom the lung disease progressed from a highly cellular lymphocytic interstitial pneumonitis (biopsy) to dense diffuse fibrosis within five years. A survey of the records of 702 patients with rheumatoid arthritis showed that 8 had diffuse lung fibrosis. The arthritis usually preceded the pulmonary lesion. There was no correlation between the severity of the arthritis and the severity of the lung fibrosis.Rheumatoid lung disease encompasses a wide range of pathologic alterations, varying from insignificant fibrous pleural adhesions to progressive and fatal diffuse fibrosis. The high frequency of lung disease in rheumatoid patients suggests that the rheumatoid process is essential or at least important to its causation, but the lack of correlation between the intensity of the arthritis and the severity of the lung disease suggests that the rheumatoid process alone is not responsible for the lung involvement.The exceptional reactivity of the lung tissue in patients with rheumatoid disease makes it reasonable to propose that ordinary pathogenic stimuli, particularly viral and bacterial infections, may provoke an intense response and, ultimately, severe lesions of the lung in the rheumatoid patient.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02090.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The management of rheumatoid arthritis is outlined in detail since certain basic principles are applicable to the management of other rheumatic disorders discussed much more briefly. Emphasis is laid on the physician‐patient relationship. It is important for the physician to inform the patient of some of the basic facts about the disease and the general objectives of treatment. Also important is the patient's choice of objectives. Therapy with the following nonsteroid drugs is discussed: salicylates, indomethacin, phenylbutazone, aminoquinoline compounds and gold salts.The treatment of rheumatic diseases is largely empiric and is directed toward symptomatic relief and palliation. Knowledge of causes and cure is grossly deficient, and our therapeutic capabilities are limited. Nevertheless, significant advances are being made in the investigative laboratories and in the application to patients of the knowledge and therapy which are availabl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02091.x

年代:1968

数据来源: WILEY

摘要:

Abstract.Fibrositis—muscular or nonarticular rheumatism—is a controversial diagnosis; nevertheless it represents a real entity, whether primary or secondary. The outstanding symptoms are pain and stiffness. Objective findings are “trigger areas” and indurations. The most common sites are the soft tissues of the neck, shoulder, elbow, carpal tunnel, palms (Dupuytren's contracture) and low back, but sometimes the syndrome is generalized.Therapy for each type is outlined. The immediate treatment usually includes the administration of analgesics, immobilization of the affected area, and infiltration of the trigger points with procaine and adrenocortical steroids. Physical therapy (heat, massage and described exercises) is indisp

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02092.x

年代:1968

数据来源: WILEY

摘要:

Abstract:Scintillation scans of the joints were obtained after intravenous injection of radioiodine in patients with rheumatoid arthritis, lupus, scleroderma, gout and osteoarthritis. Distinct radioactivity (correlated with the severity of the disorder) was observed in the first four diseases, but not in osteoarthritis.In a 72‐year‐old man with prostatic carcinoma and back pain, x‐ray examination of the lumbar region failed to reveal metastases, whereas they were indicated by strontium85scanning of that area and confirmed at autopsy.Thus scintillation scanning after the injection of a suitable isotope can be of value in differential diagnosis and in estimating the severity of disease. However, the scan must always be interpreted in the light of the clinical situ

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02093.x

年代:1968

数据来源: WILEY

摘要:

Abstract:The functions of synovial membrane and synovial fluid are described, as well as the changes that occur during inflammation, particularly in gout and rheumatoid arthritis. Methods for examination of the synovial fluid are given in detail, involving the gross appearance of the fluid, the collection of the specimen, the cytology, fibrin clot formation, mucin clot formation, viscosity, detection of crystals, and simultaneous determination of blood and synovial fluid glucose. Interpretations are discussed.A fairly complete examination of synovial fluid is possible with a minimum of equipment and within a reasonable time. The significance of the findings outweighs the effort of the analysis. Proper interpretation of synovianalysis will greatly aid in diagnosis, offer some insight concerning prognosis, provide a measure of the therapeutic response and add to understanding of the pathogenesis of synovial‐tissue inflammatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02094.x

年代:1968

数据来源: WILEY

摘要:

Abstract:Osteoarthritis and rheumatoid arthritis of the hip are each discussed with regard to clinical considerations, radiographic findings, and available operative procedures.While search continues for an entirely satisfactory hip arthroplasty operation, the careful selection of the appropriate available procedure can be of great benefit to the arthritic patient. Osteotomy, arthroplasty and arthrodesis have fully proved their worth.For patients with rheumatoid arthritis, selection is the more important and difficulties arise from a lack of the same extensive background of clinical experience against which to review a particular patient's clinical state. Increasing interest in this field is manifest, however, and more patients are being helped by surgery than heretofore.It is worth emphasizing again, the importance of a team approach to the arthritic patient, with participation in the team by a rheumatologist or internist, orthopedic surgeon, physical therapist, occupational therapist, social service worker and vocational rehabilitation counsellor. That there is a pressing need for specialized teams of this sort in modern American medicine is obvious to any who have become involved in the field to anything more than a superficial degree.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02095.x

年代:1968

数据来源: WILEY

摘要:

Abstract:Some of the ocular lesions associated with rheumatic diseases are described—uveitis, scleritis and scleromalacia, retinitis, and keratoconjunctivitis sicca. Also discussed are the ocular complications associated with treatment of rheumatic disease. These complications include steroid cataracts, steroid glaucoma, and chloroquine changes.A plea is made for clinicians to be aware of the possible cata‐ractogenic influence of corticosteroid therapy, and also the possibility of steroid‐induced glaucoma, particularly in a patient with incipient glaucoma or with a family history of the disease. The possible retinotoxic effects of long‐term chloroquine or hydroxychloroquine therapy should be kept in mind. To avoid these dangers, patients receiving steroids or chloroquine for prolonged periods should undergo regular eye exami

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02096.x

年代:1968

数据来源: WILEY

摘要:

Abstract.Several otorhinolaryngologic aspects of rheumatoid diseases are pointed out. With regard to rheumatic fever and rheumatoid arthritis, the removal of tonsils or other foci of infection will not alter the course of the disease or prevent recurrence. Arthritis of the cricoarytenoid joint may progress to the point of acute respiratory distress and even death. Such antirheumatic drugs as salicylates, phenylbutazone and gold salts have certain otologic and oral toxic effects. Salicylate‐induced hearing loss is usually reversible. Salicylate hypersensitivity should be kept in mind. Other diseases that produce symptoms referable to the head and neck are discusse

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02097.x

年代:1968

数据来源: WILEY