ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Hydroxychloroquine has been suggested to exert lipid lowering effects. The purpose of this study was to determine the effect of hydroxychloroquine on total cholesterol and on other lipoproteins in a controlled trial involving patients with systemic lupus erythematosus (SLE). Seventeen female patients with SLE were enrolled in a double-blind, randomized, placebo-controlled, multiple-dose pilot study comparing placebo with hydroxychloroquine at daily doses of 400 and 800 mg. The primary endpoint was alteration in total cholesterol. Patients were evaluated at two screening visits pretreatment and at three monthly follow-up visits. At all visits, a fasting panel of lipoproteins, disease activity, and adverse drug effects were assessed. There were no significant alterations in lipoproteins in patients receiving placebo. Treatment with 400 mg/day of hydroxychloroquine resulted in a significant decrease in total cholesterol (mean decrease of 11.6 mg/dL). Treatment with 800 mg/day of hydroxychloroquine resulted in a significant decreases in total cholesterol (mean decrease of 13.4 mg/dL), triglycerides, very low density lipoproteins, cholesterol, and the ratios of total cholesterol/high density lipoprotein cholesterol and low density lipoprotein/high density lipoprotein cholesterol. More adverse effects were noted among patients receiving the high dose (800 mg/day). Hydroxychloroquine affects a significant reduction in total cholesterol in patients with SLE. The findings of this double-blind, placebo-controlled, pilot trial support the conclusions of earlier open trials. This lipid-lowering effect may be an added benefit of hydroxychloroquine treatment in these patients with a high prevalence of atherosclerotic cardiovascular disease.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Sacroiliac joint disease is an under-considered cause of sciatica-like pain. One hundred thirty-three patients studied over 14 years, with sciatica-like pain, had their sacroiliac joints instilled with a combination of lidocaine/triamcinolone acetonide under fluoroscopy. Each patient had a normal myelogram or magnetic resonance imaging (or both) of their lumbar spine before entering the series. We described a reproducible fluoroscopic technique that other rheumatologists can use, if appropriate, to instill medication into the joint. Patients with pseudosciatica arising from their sacroiliac joints found relief with correctly placed instillations. The duration of relief varied considerably. Sciatic-like pain may indeed arise in the sacroiliac joints.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Musculoskeletal complaints are a common reason for outpatient visits to internists, and little training time is devoted to this in the majority of internal medicine residency programs. The objectives of this study were to determine whether rheumatology training improves accuracy in diagnosing common musculoskeletal syndromes and whether this results in decreased cost of diagnosis.Internal medicine residents (n = 43), staff internists (n = 27), and rheumatologists (n = 8) were given 15 written vignettes of common musculoskeletal syndromes. Participants' choices of laboratory tests, radiographs, and consultations were used to calculate cost of evaluation. Diagnostic accuracy for each physician group was compared with the physicians' rheumatology and orthopedic training and with their clinical experience. Cost for evaluation was also compared with diagnostic accuracy and physician experience.Rheumatologists accurately diagnosed 91% of the vignettes, staff internists 75%, and residents 68%. Rheumatologists tended to spend less for evaluation. Those who made correct diagnoses incurred significantly less cost for several vignettes. Rheumatology training for greater than 14 days correlated with improved diagnostic accuracy (p= 0.0001), whereas orthopedic training did not. Staff internists with greater than 6 years of experience had at least 80% diagnostic accuracy (p= 0.02). Internists trained in rheumatology had improved accuracy in diagnosing common musculoskeletal syndromes and tended to incur fewer costs.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Wide variability exists in the treatment of gout. We compared the treatment practices of rheumatologists with those of primary care physicians (PCPs) in the management of gout. Pharmacy records were reviewed to identify patients treated with colchicine, allopurinol, probenecid, or sulfinpyrazone. Forty PCP patients were compared with 33 patients followed by rheumatologists. Rheumatologists were three times more likely to confirm the diagnosis with joint aspiration and guide therapy with 24-h urine uric acid collections than were PCPs. Rheumatologists were more likely to use prophylaxis in acute gout before initiating uric acid-lowering therapy than were PCPs. All PCP patients were treated with allopurinol compared with 65% of rheumatology patients. Mean posttreatment uric acid levels were lower for rheumatology patients (5.0 mg/dL) compared with PCP patients (6.0 mg/dL). Previous studies have reported poor symptom control and increased toxicity in gouty patients with suboptimal treatment. With the vast majority of patients being treated by PCPs in a man-aged care setting, further studies will be necessary to determine whether treatment variability affects outcome between the two groups.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

After tissue injury, homeostatic mechanisms attempt to repair the damage. Local changes in the vasculature allow inflammatory cells to exit to deal with pathogens and take part in healing. Cytokines produced locally can cause systemic changes: fever, leukocytosis, transfer of amino acids from muscles to the liver, and increased glucocorticoid levels. A complicated blend of cytokines, including interleukins 1 and 6 and tumor necrosis factor, modulate patterns of hepatic protein synthesis. Changes in the production of metabolism-related enzymes occur, serving to provide fuel for the body and increase protein glycosylation. Also, there is an increase in synthesis of certain proteins exported from the liver, including components of the coagulation, complement, kinin, and fibrinolytic systems, all involved in the inflammatory response. Different inflammatory conditions elicit different responses; the types of proteins and the pattern of glycosylation may vary. Serum levels of heavy metals, including iron, copper, and zinc, change during inflammation because of altered levels of relevant transport or storage proteins.It is not clear what purpose is served by some of these changes. Many of the proteins are immunomodulatory, but some “functions” may be merely in vitro artifacts. What is clear, however, is that measurement of the protein known as C-reactive protein and of the erythrocyte sedimentation rate may provide markers of inflammation and measures of the response of certain inflammatory diseases to therapy.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The management of acute gout, and other acute microcrystalline arthritides, can be difficult in aged patients, and in those with multiple medical illnesses contraindicating therapy with either nonsteroidal anti-inflammatory drugs or colchicine. Intra-articular corticosteroid therapy is particularly useful for the treatment of acute mono-or oligo-articular micro-crystalline synovitis in these patients. Oral corticosteroids (e.g., prednisone), and both parenteral corticotrophin (adrenocorticotrophic hormone) (ACTH) and corticosteroids (e.g., triamcinolone acetonide, methylprednisolone acetate), are useful alternate treatment modalities in those patients with acute polyarticular attacks. Although ACTH has demonstrated comparable clinical efficacy to corticosteroids in the treatment of acute micro-crystalline events, corticosteroids are preferred by many physicians for many reasons: administration can be oral, dose can be regulated precisely, effectiveness does not depend on adrenocortical responsiveness, and incidence of certain side effects, such as hypertension and fluid overload, is lower.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

An easy office technique is described for measuring tophi or rheumatoid nodules. Quantitative measurements obtained can provide objective evidence for early reduction in size of tophi under therapy and can document increases or decreases in rheumatoid nodules.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We describe a case of isolated Candida albicans arthritis in a non-intravenous drug-abusing, human immunodeficiency virus positive patient. This presentation is extremely unusual without other systemic features or risk factors for candidemia, asCandidaseptic arthritis normally reflects disseminated infection. In terms of diagnosis, this case also highlights the potential utility of magnetic resonance imaging for early detection of osteomyelitis.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID