ABSTRACT
We treated 5 patients diagnosed with rheumatoid arthritis (RA) with nitrogen mustard (HN2) and monitored clinical and immunologic variables. HN2, 0.3 mg/kg ideal body weight was given over 7 days. Disease activity and immune function were monitored during and after treatment. Duration of morning stiffness (p = 0.0044), joint count (p = 0.0140), and assessment of pain (p = 0.0264) and function (p = 0.0057) improved by Day 6. T lymphocytes (p = 0.0060), especially T memory cells (CD4CD29; p = 0.0017) fell dramatically. HN2 is effective for rapidly gaining control of active RA. This effect is T cell specific.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/immunology , Nitrogen Mustard Compounds/therapeutic use , Aged , Arthritis, Rheumatoid/physiopathology , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Nitrogen Mustard Compounds/administration & dosage , Pain/physiopathology , Severity of Illness Index , T-Lymphocytes/pathology , Time FactorsABSTRACT
Fatigue is one of the most common complaints among patients seen in the primary care setting. Chronic fatigue syndrome, which has recently been called chronic fatigue immune dysfunction syndrome, is distinctive, with an abrupt onset of symptoms that wax and wane for at least six months. Usually there is low-grade fever, pharyngitis and tender, but not enlarged, lymph nodes. The fatigue can be disabling and is often made worse by physical activity. Some patients with this disorder have also been found to have highly characteristic immunologic abnormalities. Treatment can be rewarding and is based on patient education and support, exercise and symptomatic therapies for abnormal sleep patterns, musculoskeletal pain and other symptoms.
Subject(s)
Fatigue Syndrome, Chronic , Adolescent , Depression/diagnosis , Diagnosis, Differential , Fatigue Syndrome, Chronic/diagnosis , Fatigue Syndrome, Chronic/etiology , Fatigue Syndrome, Chronic/therapy , Female , Fibromyalgia/diagnosis , HumansABSTRACT
We report a retrospective study of 17 patients with systemic lupus erythematosus who were treated with oral methotrexate given as a mean weekly dose of 8.47 +/- 1.72 mg. Methotrexate treatment resulted in symptomatic improvement in 57% of patients and allowed the reduction of the mean daily dose of prednisone from 16.66 mg initially to 8.99 mg at one year follow-up. Twelve of 17 patients (70.6%) experienced at least one episode of toxicity. Factors which might be associated with toxicity are analyzed. Because of its potential as a corticosteroid-sparing agent, controlled studies of methotrexate for the treatment of systemic lupus erythematosus are indicated.
Subject(s)
Lupus Erythematosus, Systemic/drug therapy , Methotrexate/therapeutic use , Adult , Dose-Response Relationship, Drug , Female , Humans , Lupus Erythematosus, Systemic/epidemiology , Male , Methotrexate/adverse effects , Middle Aged , Retrospective StudiesABSTRACT
We tested sera from 94 patients with systemic lupus erythematosus (SLE) by Western immunoblot. Using the criteria established by the Public Health Service Working Group, 11 (12%) sera were reactive, 29 (31%) indeterminate and 54 (57%) unreactive. When the reactive sera were immunoblotted against an extract from an uninfected control lymphoblastoid cell line, identical bands were obtained. HTLVI antigenemia could not be detected in any of the reactive sera. This suggests that previously described "antibodies to HTLVI" in SLE represent artifactual reaction with cellular components in the antigenic extract.
Subject(s)
HTLV-I Antibodies/blood , Lupus Erythematosus, Systemic/microbiology , Blotting, Western , Cross Reactions , False Positive Reactions , HTLV-I Antigens/isolation & purification , Humans , Lupus Erythematosus, Systemic/immunologyABSTRACT
Persistent polyarticular rheumatoid arthritis (RA) and aggressive disease flares resistant to conventional therapy can effectively be controlled by intravenous pulse methylprednisolone (IVMP) or nitrogen mustard (HN2). The efficacy, toxicity and immunologic effects of each agent are reviewed. Clinical response is evident within days of the start of therapy for both; persisting up to 6 weeks for IVMP and at least 59 days for HN2. Morbidity from both agents is minimal when appropriate precautions are taken. No mortalities directly related to either modality have been reported in RA.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Humans , Injections, Intravenous , Mechlorethamine/administration & dosage , Mechlorethamine/adverse effects , Mechlorethamine/therapeutic use , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effects , Methylprednisolone/therapeutic useABSTRACT
Anticardiolipin antibodies delineate a recently defined syndrome characterized by venous and arterial thrombosis, thrombocytopenia and recurrent fetal loss, usually in the setting of autoimmune disease. A recently standardized enzyme immunoassay for this antibody is becoming widely available. Treatment is controversial and includes prednisone and aspirin in pregnant patients. Anticoagulation therapy has been recommended for thrombosis. The roles of plasmapheresis and cytotoxic agents have not yet been defined.
Subject(s)
Autoimmune Diseases/immunology , Cardiolipins/immunology , Abortion, Spontaneous/immunology , Autoantibodies/immunology , Chorea/immunology , Female , Humans , Pregnancy , Syndrome , Thrombocytopenia/immunology , Thrombosis/immunologyABSTRACT
The central nervous system (CNS) and the immune system, communicating through the neuroendocrine system, are closely involved in the individual's adaptation to the environment. The data from basic science research and clinical observations are overviewed, and more recent studies are summarized. As changes in immune function may mediate the effects of psychosocial factors in psychosomatic disorders, it is important for all biopsychosocially oriented physicians to understand the network that connects the central nervous and immune systems.