摘要:

To determine the treatments used by patients with ankylosing spondylitis (AS), and to compare these treatments with those recommended by rheumatologists, we surveyed 226 patients with AS, and also surveyed 123 American rheumatologists about their judgments of the effectiveness of different treatments for AS. One hundred eighty-eight patients (83.2%) used nonsteroidal anti-inflammatory drugs (NSAIDs), 62 patients (27.4%) used analgesics, 38 patients (16.8%) used second-line medications, and 22 patients (9.7%) used no medications. Fifty-seven patients (25.2%) were using indomethacin, 8 (3.5%) were using phenylbutazone, 26 (11.5%) were using sulfasalazine, 12 (5.3%) were using methotrexate, and 28 (12.4%) were receiving physical therapy. Results were similar in the subgroup of patients (N = 112) who rated their AS moderately or very active. In contrast, 81% of rheumatologists rated indomethacin either extremely effective or very effective in treating active AS, as did 90% for phenylbutazone. Eighty-two percent of rheumatologists recommended indomethacin for most patients with active AS; 64% recommended sulfasalazine, and 20% recommended methotrexate for most patients who had inadequate responses to NSAIDs. Many patients who report active AS, including many of those treated by rheumatologists, are not using treatments, including drugs and physical therapy, commonly recommended by rheumatologists for patients with active AS. Understanding the reasons for this discordance may suggest ways to improve the health of these patients. Clinicians should review and discuss the treatments received by their patients with AS to ensure that appropriate treatment is being provided.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The concurrent presence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) (“rhupus” or “rufus”) has been described in the literature. However, it has not been clear to what extent and under what circumstances clinical disease expresssion can undergo transitions from one disease to the other. We postulated that major hormonal events might have an influence on disease expression in such patients and conducted a retrospective study of 1507 patients with RA and 893 with SLE. In this population, 13 patients were identified as having convincing clinical diagnoses of both RA and SLE. Although 6 of these 13 patients had symptoms and signs of RA and SLE concurrently during their entire illness, 7 patients had clearly identifiable transitions from SLE to RA, and in one of these patients the reverse occurred as well. Of the 7 transitions from SLE to RA, 5 were associated with menopause (3 of these patients were receiving hormone replacement therapy) and the other 2 occurred in the postpartum period. The one change from RA to SLE in this series occurred during pregnancy. Thus, pregnancy, the postpartum period, and menopause can modulate disease expression in patients with both SLE and RA. It is speculated that, in patients with an autoimmune predilection, a high-estrogen environment (premenopause, pregnancy) favors the clinical expression of SLE, whereas a low-estrogen environment favors more RA-like disease, possibly because of the immunomodulatory effects of sex-steroids. The clinical implication is that in the management of patients with autoimmune diseases such as SLE and RA, hormonal alterations could result in changes in disease expression that might necessitate changes in treatment.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Several studies have reported that the emergence of mycobacterium tuberculosis (TB) is increasing, and that it may be a critical complication of rheumatoid arthritis (RA). Thus, we assessed the clinical and immune status of RA patients with TB to look for features that might favor infection. Seven RA patients with a history of TB and 62 RA patients without TB were compared in terms of background, RA disease activity, and the concentrations of serum soluble cell surface markers (sCD4, sCD8 and sCD23). There were no differences in RA activity between the two groups. It is noteworthy that the RA patients with TB had not been treated with immunosuppressives. Counts of lymphocytes, but not neutrophils, were significantly less in the RA patients with previous TB than in those without TB. The serum concentration of sCD23, a marker of B cell activation, was significantly higher in the RA with TB group. There was also a nonsignificant but considerable difference in the mean sCD8 concentration between the two groups. These results suggest that B cell and possibly also T cell activation is prominent in the RA patients with a history of TB, and that lymphocyte activation might explain in part the high susceptibility of RA patients to TB.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Infectious arthritis of a lumbar facet joint is exceptional; only nine cases have been reported previously. We describe an additional case caused byStaphylococcus aureus.The standard radiographs of the lumbar spine were considered normal. The infection was ultimately detected with bone scintigraphy and precisely localized with computed tomography scan. Because of difficulties of imaging facet joints, infections at this site may be under diagnosed. This patient's severe lumbar pain responded fully to oral antibiotic therapy.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 61-year-old man with palmoplantar pustulosis had pain and swelling persisting in his left knee for more than 3 years. The rheumatoid factor and HLA B 27 antigen were absent. Plain radiographs of the knee revealed no abnormalities despite the persistent synovitis. The bone scintigraphy showed increased uptake in the manubriosternal joint as well as in the knee. Eventually, the patient underwent arthroscopic synovectomy assisted with a holmium: YAG laser. No postoperative complications such as hemarthrosis were noted. The patient was pain free with full range of motion of the knee 22 months after surgery. Peripheral arthritis associated with palmoplantar pustulosis is usually transient. This unique case suggests that laser-assisted arthroscopic synovectomy would be a useful therapeutic option for persistent severe synovitis resistant to conservative treatment in pustulotic arthro-osteitis.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hidradenitis suppurativa is a chronic suppurative and cicatricial disease of the apocrine glands of the skin. We present a 44-year-old African-American male patient with a history of hidradenitis suppurativa who developed recurrent bilateral peripheral ulcerative keratitis and erosive arthritis of the wrists. These are rare complications of hidradenitis suppurativa. The peripheral ulcerative keratitis responded well to prednisone; immunosuppression with cyclophosphamide was added to attempt to prevent further recurrences. Peripheral ulcerative keratitis probably has an immune mechanism similar to that of the arthritis that may complicate hidradenitis suppurativa and may require aggressive immunosuppressive therapy.

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1999

数据来源: OVID