Résumé
OBJECTIVE: Symptomatic neuropathy is uncommon in rheumatoid arthritis (RA) but, compression neuropathy and vascular neuropathy were reported in longstanding RA. To investigate the occurrence of electrophysiologically evident peripheral nerve involvement in RA patients without a clinical manifestation of peripheral nerve involvement, we studied nerve conduction velocity study (NCV) in RA patients without symptomatic neuropathy. Twenty-five RA patients were evaluated neurological examination and by NCV. We compared clinical parameters between electrophysiologic positive group and negative group. There was no patient who had neurologic symptoms or signs of peripheral involvement. Eleven patients (44%) of all exhibited NCV findings consistent with distal symmetrical sensorimotor polyneuropathy, 5 patients (20%) had entrapment neuropathy, 2 patients (8%) showed distal symmetrical sensory polyneuropathy, 1 patient (4%) had digital neuropathy, and 6 patients (24%) had normal NCV. CONCLUSION: Patients with RA may have electrophysiologic peripheral nerve damage, even in the absence of clinical evidence of peripheral nerve involvement. There was no correlation with any clinical parameters. The inclusion of electrophysiologic examination of the RA patients is recommended in routine diagnostic procedures.
Sujets)
Humains , Polyarthrite rhumatoïde , Conduction nerveuse , Examen neurologique , Manifestations neurologiques , Nerfs périphériques , Neuropathies périphériques , PolyneuropathiesRésumé
No abstract available.
Sujets)
Adulte , Humains , Coagulation intravasculaire disséminée , Défaillance multiviscérale , Maladie de Still débutant à l'âge adulteRésumé
OBJECT: To investigate the characteristics of diffuse idiopathic hyperostosis (DISH) in Koreans. METHODS: The nine patients of DISH were investigated in terms of symptom, involved area in simple X-ray, accompaning disease, serum uric acid level, and serum triglyceride and cholesterol. RESULTS: Eight of nine patients were male, one patient was female, and their mean age was 64. Their symptoms were no symptom(2/9), neck pain(2/9), dorsal pain(2/9), and low back pain(3/9). The involved areas were the cervical vertebrae(1/9), the lower thoracic vertebrae(3/9), or the lower thoracic and upper lumbar vertebrae(5/9). The accompaning diseases were ankylosing spondylitis (1/9), degenerat,ive joint disease (2/9), posterior laminectomy (1/9), diabetes mellitus (1/9), chronic active hepatitis (1/9), cerebrovascular accident (2/9), hypertension(2/9), chronic renal failure(2/9), and gout(2/9). In the cases involving thoracic vertebrae, the ossification was seen dominantly in the right side. Four of nine patients had diabetes mellitus, hyperuricemia (7. 0 mg/dl in male and 6.6 mg/dl in female), or dyslipidemia (194 mg/dl in serum triglycerid level and 275 mg/dl in serum cholesterol level). CONCLUSIONS: In our cases of DISH, it was dominant in male and old age, and the diabetes mellitus or hyperuricemia was more frequently found than in general population.
Sujets)
Femelle , Humains , Mâle , Cholestérol , Diabète , Dyslipidémies , Hépatite chronique , Hyperostose , Hyperostose vertébrale ankylosante , Hyperuricémie , Maladies articulaires , Laminectomie , Cou , Pelvispondylite rhumatismale , Accident vasculaire cérébral , Vertèbres thoraciques , Triglycéride , Acide uriqueRésumé
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Sujets)
Adulte , Femelle , Humains , Mâle , Jeune adulte , Acné juvénile , Syndrome SAPHO , Arthrite , Fesses , Hyperostose , Ostéite , Psoriasis , Pyodermie phadégénique , Peau , Synovite , Paroi thoraciqueRésumé
OBJECTIVES: Human osteoarthritis is a heterogeneous and multifactorial disease characterized by the progressive deterioration of the cartilage of diarthrodial joints. In some instances, there is an identifiable cause, such as trauma or congenital malformation, but, mostly the etiology remains unknown. Since familial aggregation is seen, genetic factors may be important, particularly in osteoarthritis of the hand. METHODS: Blood samples from patients and controls were obtained for DNA analysis. Exon 31 of type II procollagen gene was amplified by polymerase chain reaction, and screening for the mutation was undertaken using a restriction enzyme digestion (Dsa I). RESULTS: The patients phenotype represented typical, but earlyonset and family history, osteoarthritis. No mutation in exon 31 of type II procollagen gene could be identified. CONCLUSION: Screening of the 31 exon did not, however, reveal any mutation. It needs further evaluation in other sites of type II procollagen genes.
Sujets)
Humains , Cartilage , Collagène de type II , Digestion , ADN , Exons , Main , Articulations , Dépistage de masse , Arthrose , Phénotype , Réaction de polymérisation en chaîne , ProcollagèneRésumé
OBJECTIVE: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. METHODS: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). RESULTS: Serum CK activity was significantly reduced in RA (mean+SD: 45.7 +24.2 IU/L) compared to controls (81.3+33.9 IU/L) (p < 0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: 0.31, p < 0.01; 0. 45, p < 0.001; 0.42, p < 0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant.
Sujets)
Humains , Hormones corticosurrénaliennes , Polyarthrite rhumatoïde , Sédimentation du sang , Protéine C-réactive , Creatine kinase , Créatine , Numération des plaquettes , Études rétrospectives , Rhumatismes , StéroïdesRésumé
OBJECTIVE: To investigate the clinical characteristics of fibromyalgia syndrome and to determine the usefulness of visual analogue scale (VAS) in global pain as predictor of symptoms and functional disabilities of daily activities and to evaluate the relationship between social environmental factors and fibromyalgia syndrome. METHOD: : Fourth-three patients with fibromyalgia syndrome who have met 1990 ACR criteria and 30 control patients with rheumatoid arthritis were included in the study. Clinical features, functional disabilities, VAS and psychological impact due to life stress by criteria and 30 control patients with rheumatoid arthritis were included in the study. Clinical features, functional disabilities, VAS and psychological impact due to life stress by social environmental factors were studied by direct interviews and questionnaires. RESULT: The mean age of the patients with fibromyalgia syndrome was 48+/-11 years old. The physical findings revealed that tender points were 15.5+/-1.4 and skin fold tenderness presented in 59% of patients. The most frequent symptoms with scores and ratio of symptom presented were fatigue(2.2, 93%), morning stiffness(2.2, 80%), arthralgia(2.1, 90%), lower back pain(2.1, 98%), depression(1.6, 95%). The majority of functional disabilities in fibromyalgia group were less severe than those of rheumatoid arthritis group. The VAS in global pain had correlationship with age, arthralgia, fatigue, hurt all over, morning stiffness, tender points as well as the majority of functional disabilities of daily activities. Although living together mother-in-law was not different significant ly from each other groups, the duration of living together was longer in fibromyalgia group. There were more histories and frequencies of artificial abortions in patients with fibromyalgia syndrome. CONCLUSION: The patients with fibromyaliga showed various symptoms. The visual analogue scale in global pain have had significant correlation with some symptoms and functional disabilities in daily activities. Fibromyalgia patients revealed more social and obstetrical life stress which may suggest more psychological impact.
Sujets)
Humains , Arthralgie , Polyarthrite rhumatoïde , Fatigue , Fibromyalgie , Enquêtes et questionnaires , Peau , Environnement social , Stress psychologiqueRésumé
OBJECTIVES: Polymerase chain reaction (PCR) technology was eamine synovial fluid and peripheral T cells in patients with rheumatoid arthritis(RA) to determine the preferential usage of the T cell receptor(TCR) variable region(V) gene. METHODS: Oligonucleotide primers specific for individual TCR Vfi gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in unselected T cell populations. RESULTS: The result of Vfi utilization was generally heterogenous, similar with previous reports. However, the mean expression of Vfi16 and Vfi18 in RA was more preferentially utilized compared to normal donors. The usage of Vfi in peripheral blood from 3 patients with RA demonstrated restrictions in Vfi16, Vfi 20 and Vfi18 genes, respectively. Analyses of synovial fluid resulted in restriction in Vfi12, Vfi20 and Vfi20, respectively. Although there was no significant pattern of skewed Vfi gene mean usage when comparing the synovial fluids with the peripheral blood T cells from RA patients, there were significant biased Vfi genes, Vfi12, V~I and Vfi20, each 3 patients. As the HLA type is a determining factor in shaping TCR repertoire of peripheral T cells, we compared the Vfi utilization in HLA-DR4 expressing groups that have susceptibility and gene dosage effect in disease progression. It was a little different that comparing the pattern of Vfi usage in peripheral blood and synovial fluid from RA patients between HLA-DR4 positive and negative group. CONCLUSION: The results were consistent with the conclusion that the increased Vfi family T cells infiltrate synovium and are dependent on each patient and may be involved in inducing and maintaining the synovitis that characterizes RA. The different outcome of each patient may be due to the difference in disease duration, genetic background and geographic region. A more important factor may be the stage of disease, because epitope 'induced immune reaction may change over time. Therefore, selecting patients early in the course of disease may be important and may facilitate the need for more in-depth TCR analysis in the future.