Comparison of clinical and psychologic features of fibromyalgia and masticatory myofascial pain.

The aim of this study was to investigate common symptoms and divergent features in fibromyalgia (FS) and masticatory myofascial pain (MFP) in patients affected by craniomandibular disorders. Twenty-three women with MFP and 23 women with FS were studied. All patients were examined by a dentist and by a rheumatologist. Craniomandibular disorders were assessed with a subjective symptoms questionnaire, detailed history interview, joint function examination, and manual palpation of masticatory and cervical muscles. The Middlesex Hospital Questionnaire was used to obtain personality profiles of the patients. The craniomandibular disorders questionnaire revealed various similarities in the two groups, the most striking of which were pain during mandibular function, articular noises, and headache. Both groups had muscle pain upon palpation; the mean scores (on a 0 to 4 scale) did not differ significantly between the two groups and ranged between 1.39 (SD 1.2) and 2.86 (SD 0.75). The mean value of active mouth opening was 40.9 mm (SD 9.1) in MFP patients and 44.6 mm (SD 7.2) in FS patients, while the mean value of passive opening was 49.6 mm (SD 6.0) in MFP patients and 49.8 mm (SD 3.5) in FS patients. These values did not differ significantly between the two groups, but did differ from the normal population, similar to the trend of the psychologic profile. The authors conclude that the physician should be alert to the need to conduct interdisciplinary evaluations in the diagnosis and management of FS and of MFP.

[A case of Reiter syndrome in HIV infection]. / Su un caso di sindrome di Reiter in corso di infezione da HIV.

The onset of Acquired Immunodeficiency Syndrome (AIDS) is often characterized by a variety of symptoms, with the involvement of several tissues and organs. In the present case a polyarthritic syndrome was the symptomatology at the onset. Clinical onset. A 26 year old man, drug abuser, anti HIV positive, with a CD4/CD8 ratio = 0.8, was observed in January 1990. He presented polyarthritic involvement of the ankles and right knee, conjunctivitis and successfully keratodermia. The diagnosis of Reiter syndrome was made on the basis of the clinical features and laboratory findings (Chlamydia in his urethral secretion). The patient did not denote any symptom of immunodeficiency, except small lymphonodal painless swelling in axillary and latero-cervical region. A significant clinical improvement was obtained with chlortetracycline at a dosage of 100 mg daily and 6 methylprednisolone 12 mg daily. Comment. This experience suggests the importance and the usefulness of the anti HIV test in patients affected by a reactive arthritis, as the Reiter's syndrome, since the progressive diffusion of the HIV infection.

The lack of correlation between the positivity of anti-platelet antibodies and the presence of thrombocytopenia in course of HIV infection.

The presence of anti-platelet autoantibodies has been reported in many cases of HIV infection, but there is no accordance about their pathogenic role in the onset of thrombocytopenia in the patients studied. In the present study surface anti-platelet antibodies (PAIgG) and serum anti-platelet antibodies (sPAIgG) were assayed in a group of 135 HIV-infected patients (109 men, 26 women), in different clinical stages by using an immunofluorescence test (PSIFT). In order to investigate the possible correlation of the positivity of these autoantibodies and the onset of thrombocytopenia, some of these patients were controlled in a follow-up study, with two successful controls: 10 months (II control: 89 patients) and 20 months (III control: 59 patients) after the first time. In the I control PAIgG were positive in 68 subjects (50.4%) and sPAIgG in 34 (25.2%); both PAIgG and sPAIgG were present in 23 patients (17%). 56 patients did not present anti-plt antibodies (41.5%). No significantly different distribution of these autoantibodies in each stage of disease was observed. The mean value of platelet count resulted in the normal range both in the anti-plt antibody positive and in the anti-plt antibody negative patients, but the value found in the anti-plt antibody positive patients was significantly lower than the one found in the anti-plt antibody negative group (p < 0.01). This difference was more marked between the group with PAIgG and anti-plt antibody negative patients than between the group with sPAIgG and the anti-plt antibody negative patients (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Responses to nifedipine by patients with Raynaud's disease and Raynaud's phenomenon secondary to another disease.

Thirteen patients with Raynaud's phenomenon were studied; six patients had the primary disorder and in the other seven progressive systemic sclerosis was diagnosed. Each patient received 10 mg of nifedipine; telethermographic evaluation of the hands was performed in basal conditions and 30 minutes after the administration of the drug. A more marked increase of hand tissue temperature was observed in the patients with progressive systemic sclerosis than in those with the primary disorder.

Cyclophosphamide treatment in polyarteritis nodosa.

Five male patients with polyarteritis nodosa were treated with cyclophosphamide as follows: 3 mg/Kg/die i.v. up to maximum of 3 g.; subsequently, 200 mg/die per os for two weeks, then 100 mg per os every other day for three months; finally, 100 mg every fourth day until the 18th month. One patient, who also had fever, received 25 mg/die of prednisone for the initial three weeks of treatment. Before treatment ESR, WBC, and circulating immune-complexes were increased, while C3a, C3c and C4 serum complement components levels were normal. Skin ulcers healed within 4 months. A progressive marked improvement of visceral damages in the first months of therapy have been noted (e.g. blood pressure values in normal range after suspension of concomitant antihypertensive treatment, regression of peripheral neuropathy, etc. etc.). No further ischemic lesions occurred during treatment. Significant decreases of ESR and serum immune-complexes levels were detected. No untoward effects due to cyclophosphamide were observed. These findings support the effectiveness of this drug in polyarteritis. The possibility of association with glucocorticoids during the acute phase of disease is also discussed.

Plasma free aminoacids pattern in progressive systemic sclerosis.

20 free aminoacids levels have been measured with a chromatographic method (Beckman 118 BL Aminoacid analyzer) in 9 patients affected by progressive systemic sclerosis and in 15 healthy subjects (control group). Both patients and control group were females, mean daily protein intake was between 1,2-1,5 gr/Kg in the two groups. No other pathological condition was found in each patient, none of them was receiving drug therapy at least from 2 months. No significant age different existed between the patients and the control group. Analysis of variance of the results showed significant decreases of proline, histidine, valine and methionine levels and significant increase of aspartic acid concentration in the plasma of PSS patients.