Septic arthritis and bacteremia due to Mycoplasma resistant to antimicrobial therapy in a patient with systemic lupus erythematosus.

We report a case of septic arthritis caused by Mycoplasma hominis in a patient with systemic lupus erythematosus. The infection started as monarthritis but spread to at least four joints despite apparently suitable therapy with various antimicrobial agents, including doxycycline, clindamycin, and ciprofloxacin; subsequent bacteremia was documented. Control was ultimately achieved with use of the experimental fluoroquinolone temafloxacin in combination with doxycycline administration, arthroscopic drainage of a persistently infected joint, several intravenous infusions of immunoglobulins (which led to increases in levels of antibodies specific to M. hominis), and discontinuation of corticosteroid therapy. Antimicrobial susceptibility testing of various mycoplasmal isolates showed the presence of the tetM gene, disparity between susceptibility to tetracycline and doxycycline, and increasing resistance to most antimicrobial agents used (including to fluoroquinolones before clinical use), although the patient ultimately had a favorable clinical response to treatment with combined modalities.

Polyarticular versus monoarticular gout: a prospective, comparative analysis of clinical features.

This investigation was undertaken to define prospectively the clinical characteristics of patients with crystal-documented gouty arthritis simultaneously involving multiple joints. Of 106 consecutive patients with gouty arthritis (GA), 42 (40%) had articular inflammation at 2 or more sites. Comparison of these 42 patients with GA with the 64 patients with GA who presented with monoarthritis yielded the following conclusions: 1) Polyarticular gout represents one end of a generally predictable spectrum of GA, reflecting chronicity associated with poor patients understanding, poor patient compliance, and suboptimal physician management. 2) Polyarticular patients with GA tend to develop attacks of more smoldering onset and increasing duration, while joint involvement tends to occur in an ascending but asymmetrical fashion, with upper extremity joints later added to repeatedly active lower extremity sites. 3) There may be a significant discrepancy between the site (or sites) of the GA patient's chief complaint and clinically involved joints on careful physical examination. 4) Recognition of polyarticular joint involvement increases the number of sites for potential joint and/or tophus aspiration, permitting greater ease of establishing a definitive diagnosis. 5) No single laboratory or synovial fluid value meaningfully distinguishes patients with polyarticular from those with monoarticular gout.

Laryngeal involvement in rheumatoid arthritis. A clinical, laryngoscopic, and computerized tomographic study.

Laryngeal involvement was evaluated in 45 patients with moderately severe rheumatoid arthritis (RA). RA duration and severity, prior laryngeal symptoms, and abnormalities detected by concurrent indirect laryngoscopy (IL) and computerized tomography (CT) were noted and correlated with changes of basilar interstitial fibrosis (BPF) found by chest radiograph. Thirty-two percent had abnormalities detected by IL, 54% had abnormalities by CT, and 36% had BPF on chest radiographs. Comparison of these groups revealed: only two symptoms (sore throat and difficulty during inspiration) were predictive of abnormalities detected by IL; no symptoms predicted abnormalities on percentage of RA patients even in the absence of symptoms; IL tends to detect mucosal and gross functional abnormalities while CT detects structural lesions; BPF shown on chest radiographs in RA patients does not appear to be correlated with cricoarytenoid arthritis as defined by IL and CT.

Immunologic abnormalities in hemodialysis patients: improvement after pyridoxine therapy.

8 male patients undergoing maintenance hemodialysis were studied to determine the effect of administering supplements of pyridoxine hydrochloride, 50 mg/day for 3-5 weeks, on tests of immune function. In the 3 patients who initially had abnormal nitroblue tetrazolium reduction tests, the values returned to normal with therapy (p less than 0.05). The generation of chemotactic factors from plasma was defective in all evaluated patients and improved after pyridoxine therapy in 4 of 5 patients (p less than 0.01). The lymphocyte subpopulations changed with a rise in the populations of null cells after supplementation with pyridoxine. In addition, lymphocyte transformation in response to mitogens improved in the 3 patients who initially showed low values in these assays. The improvements occurred with pyridoxine therapy even though some patients who responded had no evidence for vitamin B6 deficiency before therapy, as indicated by a normal erythrocyte glumatic-pyruvic transaminase index. We conclude that several parameters of immune function are improved with pyridoxine supplementation. Studies are necessary to establish the minimum daily intake of pyridoxine which will maintain improved values of these tests of immune function in hemodialysis patients.

Collagen diseases affecting the foot.

This article classifies various forms of arthritis which may affect the foot. Osteoarthritis of the foot usually involves the first metatarsophalangeal joint or the ankle, the latter usually being secondary to prior trauma. Secondary osteoarthritis of the foot is frequently due to Charcot destruction which is usually secondary to diabetic neuropathy. Seronegative spondyloarthropathies include ankylosing spondylitis and Reiter's syndrome. The three variants of psoriatic arthritis of the foot are also discussed.

Plasmapheresis in lupus nephritis with nephrotic syndrome: a long-term followup.

Lupus nephritis with nephrotic syndrome is one of the most serious complications of systemic lupus erythematosus. Six female patients with systemic lupus and nephrotic syndrome, refractory to immunosuppressive drug therapy, received 15-20 exchange plasmaphereses. One patient, treated concurrently with high-dose steroids, showed temporary improvement, and five patients, treated concurrently with steroids and either cyclophosphamide or azathioprine, had long-term remissions. Plasmapheresis is a promising therapeutic modality in cases of refractory lupus nephritis with nephrotic syndrome.