ABSTRACT
The prevalence of tonsillectomy and appendectomy was higher in 196 patients with rheumatoid arthritis (RA), prior to the onset of articular disease, than in their spouses and siblings. The estimated increased risk of developing RA with tonsillectomy was 1.5 and 3.5 times, with appendectomy 1.7 and 6.6 times, and with both surgical procedures 2.3 and 6.7 times, using patient-spouse and patient-sibling matched-pair data, respectively. However, only with patient-sibling data did the lower limits of the 95% confidence interval for the risk ratio exceed 1.0. Several hypotheses are offered to explain the possible association between these surgical procedures and RA.
Subject(s)
Appendectomy/adverse effects , Arthritis, Rheumatoid/etiology , Tonsillectomy/adverse effects , Adult , Arthritis, Rheumatoid/genetics , Female , Humans , Male , Risk , Time FactorsABSTRACT
Flexor tenosynovitis (FT) is a common manifestation of rheumatoid arthritis (RA), contributing to hand deformity and manual dysfunction. The efficacy of intratendon sheath corticosteroids was assessed by reviewing the results of such treatment in 173 episodes of FT documented in 46 patients with definite or classic RA. Ninety-three percent of initial episodes resolved completely for 3 or more months (median: 25 months); tenosynovitis did not recur in 59%. The likelihood of a favorable response did not diminish with treatment of recurrent FT in a given digit. Comparable results were found in 52 FT episodes observed in 38 non-RA patients. No tendon sheath or soft tissue infection or tendon rupture ensued in either treatment group. The response was influenced by the specific corticosteroid preparation selected. Based on this experience, a trial of intratendon sheath corticosteroid injections prior to surgical intervention is recommended for RA patients with FT.
Subject(s)
Glucocorticoids/therapeutic use , Tenosynovitis/drug therapy , Arthritis, Rheumatoid/complications , Betamethasone/therapeutic use , Glucocorticoids/administration & dosage , Humans , Injections , Prednisolone/therapeutic use , Recurrence , Tenosynovitis/etiology , Triamcinolone Acetonide/analogs & derivatives , Triamcinolone Acetonide/therapeutic useABSTRACT
Serum protein and immunoglobulin concentrations, rheumatoid factor (RF) titers, and erythrocyte sedimentation rates (ESR) from 18 patients with active rheumatoid arthritis (RA) who were being treated with gold sodium thiomalate (Myochrysine) and monitored clinically were measured serially. Serum antiepithelial antibody (AEA) titers from 10 patients with pemphigus who were similarly treated were measured at frequent intervals. Statistically significant reductions of alpha2, gamma, and total globulins, IgG, IgA, and IgM, ESR, and RF, and AEA titers were found after 3 to 6 months of gold treatment. Serum albumin levels rose significantly, but alpha1, beta-globulin, and total protein did not change. A temporal relationship between the alteration of these serological tests and the clinical response to treatment was noted, but the magnitude of protein change did not correlate with the degree of clinical improvement within a given patient. These findings indicate that gold treatment influences serum protein and antibody concentrations in two diseases having diverse target organs and different etiologies. The question of whether gold compounds exert an immunosuppressive action, or whether the serologic changes are a secondary phenomenon reflecting amelioration of disease activity, is unresolved.
