ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Several recent open studies suggest that the response rates of lupus nephritis to intravenous (IV) cyclophosphamide are lower than those observed in clinical trials. One explanation could be ethnic differences; for example, black patients more frequently have treatment-resistant lupus nephritis. Another could be the inclusion of patients who are noncompliant with therapy. From our register of 268 systemic lupus erythematosus (SLE) patients examined between 1973 and 1996, 61 patients were treated for proliferative lupus nephritis (17 had World Health Organization [WHO] type III and 43 had WHO type IV) and were followed through to 2001. Exclusion criteria included a serum creatinine level >3 mg/dL. In this retrospective study, we assessed renal outcome and survival with an endpoint of end-stage renal disease (ESRD) or death (Kaplan-Meier). In the univariate analysis, worse prognostic factors for survival were serum creatinine >1.3 mg/dL (p< 0.001), age <30 years (p< 0.001), class 2 renal function stage (p< 0.03), and renal biopsy activity index >7 (p< 0.02). In the subgroup of 26 patients treated with IV cyclophosphamide, survival at 5 and 10 years was 82% and 73%, respectively. The dosage of IV cyclophosphamide was slightly lower than usual and used for a shorter period (median = 23 months) than what is usually recommended because of the high frequency of complications. Renal outcome of the IV cyclophosphamide–treated patients was poorer than that reported in the National Institutes of Health series (ESRD: 15% versus 3%). This low survival rate could reflect the short course and lower doses of IV cyclophosphamide used or ethnic differences. These data emphasize the need for continuous research for better-tolerated drug schemes for treatment of our lupus nephritis patients.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Practitioners of rheumatology in the 21st century are increasingly recognizing the benefits of computer technology as they relate to point-of-service care delivered in the hospital or in the outpatient setting. Electronic medical records and other computer-driven aids are resources emerging as affordable tools that can greatly enhance the rheumatologist's ability to provide stellar care, reduce professional and administrative burdens and improve lifestyle measures. Herein, we provide a practical nontechnical introduction to the world of electronic medical records, personal digital assistants, and other computer-dependent tools, with an emphasis placed on how these instruments can be used by the clinical rheumatologist to achieve excellence in medical care.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study was designed to explore the impact of a managed care system on the morbidity and mortality rates in a systemic lupus erythematosus (SLE) cohort in Puerto Rico. The clinical manifestations and outcome measures of public SLE patients, before and after implementation of the managed care system, were compared with those of SLE patients treated in a private fee-for-service system. Of the cohort of 171 patients, 103 (60%) were treated in the public system and 68 (40%) in the private sector. Except for higher prevalence of hematuria, renal insufficiency, and serositis in the public group, both groups had a similar prevalence of clinical manifestations, Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage score, and mortality rate before introduction of the managed care system. Six years after implementation of the managed care system, medically indigent patients were more likely to have photosensitivity (90% vs. 75%), malar rash (85% vs. 65%), hematuria (43% vs. 24%), nephrotic syndrome (17% vs. 6%), and end-stage renal disease (8% vs. 0%). They also had a higher mortality rate (10% vs. 2%) and SLICC/ACR damage index score (1.5 vs. 0.8). In summary, SLE patients treated in the public system of Puerto Rico demonstrated higher morbidity and mortality after being treated in a managed care system compared with patients managed in a private fee-for-service system. Different from the fee-for-service system, the managed care system seeks medical care cost reductions that could affect the management and outcome of SLE patients. These differences could also be related to the higher disease severity before implementation of the managed care system and lower socioeconomic status of the public group. Nevertheless, the public managed care system in Puerto Rico requires continuous evaluation to ensure SLE patients better access to specialty and subspecialty healthcare and optimal pharmacologic treatments.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Fasciitis, one of the presentations of chronic skin graft-versus-host disease (GVHD), is characterized by symmetrical inflammatory swelling of extremities with or without eosinophilia, but it is rarely reported. This article describes a patient with the clinical and histologic features of fasciitis, as the only form of chronic GVHD that developed 20 months after HLA-matched allogeneic peripheral hematopoietic stem cell transplantation (HSCT) for chronic myelogenous leukemia (CML). She reported tightness of the skin and pain in both wrists and elbows on motion, with edema of the limbs. A deep cutaneous biopsy showed thickening of the subcutaneous fascia with inflammatory infiltrates. The patient was treated with cyclosporine and prednisone, which resulted in much improvement of her symptoms and signs related to the fasciitis. The authors recommend that clinicians maintain a high index of suspicion for fasciitis because fasciitis is a distinct entity among the chronic GVHD that may lead to a functional disability.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Thromboangiitis obliterans (TAO) is an uncommon to rare vasculitis of small and medium arteries and veins typically affecting young male smokers. Inflammatory arthritis has only been rarely reported in association with TAO. We describe the case of a young male smoker presenting with inflammatory arthritis as the initial manifestation of his TAO. His arthritis resolved with a course of corticosteroid therapy. The vascular disease improved with hyperbaric oxygen therapy, although he continued to smoke. Similar cases have been described, suggesting that rheumatologists should keep Buerger's disease in mind in patients with arthritis and vascular disease.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We present a case of gout that presented initially as a bullous lesion. The patient had no history of gout, and the lesion was diagnosed initially as a simple pressure sore. Examination revealed a large blister over the right medial first metatarsophalangeal joint. Aspiration of the blister yielded cloudy fluid, with many monosodium urate crystals present on microscopic examination. There is scant literature on bullous lesions in gout. Such lesions can occur in patients known to have gout or can lead to the diagnosis of gout in previously undiagnosed patients. Gouty blisters likely form at sites of trauma, as has been proposed for gouty tophi. This case also emphasizes the importance of careful clinical and microscopic examination of aspirated fluid for crystals in the diagnosis of gout.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Respiratory failure from causes exclusive of intrinsic lung disease is rare in systemic sclerosis. We report an unusual case of a young woman with diffuse systemic sclerosis who presented with proximal muscle weakness, dyspnea, weight loss, and nasal regurgitation. On physical examination, she had normal breath sounds but severe limitation of chest wall expansion. Pulmonary function tests (PFTs) were consistent with restrictive lung disease. Pulmonary pressures were normal on right heart catheterization and chest radiography and high-resolution computed tomography showed no evidence of intrinsic lung disease. Quadriceps muscle biopsy was consistent with type II atrophy, without any element of inflammatory myositis. After a meal, the patient aspirated, developed severe persistent hypercapnia, and required ventilatory support. Therapy with corticosteroids and intravenous gamma globulin failed to improve her condition, and the patient subsequently expired. Hypercapnic respiratory failure on the basis of chest wall involvement from systemic sclerosis may occur in the absence of intrinsic lung disease, and the prognosis, as in this case, may be grave.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A splenectomized patient with systemic lupus erythematosus, who had previously been treated with high doses of corticosteroids, presented with headaches and symptoms of a respiratory tract infection. A magnetic resonance imaging scan of the brain revealed a ring-enhancing lesion, andNocardia asteroideswas isolated from a stereotactic biopsy specimen. After adverse reactions to a number of antibiotics, infection control was finally achieved by the new oxazolidinone drug, linezolid. Nocardiosis should be considered as a differential diagnosis in all immunocompromised patients who develop an obscure infection; delay in diagnosis and subsequent initiation of appropriate treatment often results in a fatal outcome. Linezolid is a new option for the treatment of nocardiosis and is effective when given orally.

ISSN:1076-1608    

出版商:OVID    

年代:2003

数据来源: OVID