Drug-induced lupus erythematosus presenting with cardiac tamponade: a case report and literature review.

The presentation of drug-induced lupus erythematosus (DILE) is typically mild, with a significantly lower incidence of life-threatening end-organ dysfunction relative to idiopathic systemic lupus erythematosus. DILE is an uncommon cause of cardiac tamponade but has been reported in patients treated with procainamide, isoniazid, hydralazine, sulfasalazine, and carbamazepine. We present a case of DILE presenting with cardiac tamponade associated with infliximab use that resolved with discontinuation of the medication and administration of high-dose steroids. In conclusion, DILE should be considered in the differential diagnosis in cases of pericarditis with cardiac tamponade without a clear cause.

The effect of ingestion of ferrous sulfate on the absorption of oral methotrexate in patients with rheumatoid arthritis.

OBJECTIVE: To investigate if ingestion of ferrous sulfate, 300 mg twice daily, will reduce the urinary excretion of unmetabolized methotrexate (MTX) in patients with rheumatoid arthritis (RA) who ingest 2 drugs concurrently, and determine if ferrous sulfate interferes with the absorption of oral MTX. METHODS: In this randomized double-blind placebo controlled crossover study, we compared the urinary excretion of unmetabolized MTX in 10 patients with RA who ingested 7.5 mg MTX as their weekly dose and took either ferrous sulfate 300 mg twice daily or placebo. RESULTS: Ten patients with RA taking 7.5 mg MTX orally once weekly had an average 24 h urine excretion of MTX (while taking 300 mg ferrous sulfate twice daily for one week) of 8.44 micromoles compared to 7.65 micromoles for patients taking placebo. The difference was not statistically significant (p = 0.50). CONCLUSION: Our results showed no less absorption of MTX for the placebo group compared to the group that took ferrous sulfate. These results do not support the hypothesis that ferrous sulfate interferes with the absorption of oral MTX.

Elevated serum nitric oxide levels in patients with inflammatory arthritis associated with co-expression of inducible nitric oxide synthase and protein kinase C-eta in peripheral blood monocyte-derived macrophages.

OBJECTIVE: To quantify circulating nitric oxide (NO) levels and inducible NO synthase (iNOS) expression in peripheral blood monocyte-derived macrophages (PB-MDM) from patients with inflammatory arthritis (IA) as a measure of disease activity, and to determine if there is a correlation between expression of iNOS and protein kinase C-eta (PKC-eta). METHODS: PB-MDM were isolated from whole blood of 20 patients with IA (14 rheumatoid arthritis and 6 peripheral spondyloarthropathies). Thirteen patients with osteoarthritis (OA) and 9 healthy individuals were controls. Serum NO levels were measured by indirect determination of nitrite and nitrate. Expression of PKC-eta and iNOS was investigated by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. RESULTS: Serum NO (189.9 +/- 49.7 microM) was significantly higher (p < 0.0028) in IA patients than in controls (131.1 +/- 18.5 microM) or patients with OA (126.9 +/- 37.1 microM). IA patients with severe inflammation had highest levels of NO, while those with mild inflammation had normal levels of NO. RT-PCR showed that PB-MDM from IA patients with active disease co-expressed iNOS and PKC-eta. This was observed in 15 out of 16 cases. All other groups with normal plasma NO expressed neither gene. CONCLUSION: Our findings show that elevated plasma NO levels were only present in IA patients with severe disease activity. We show for the first time a positive correlation between PKC-eta and iNOS expression in arthritis, supporting our earlier in vitro findings that PKC-eta expression was essential for lipopolysaccharide-mediated iNOS induction and NO production in human monocytes. PKC-eta may be important for the development of IA-induced iNOS positive phenotype in human PB-MDM.