ABSTRACT
OBJECTIVE: To assess the benefit of the first infliximab infusion on sleep disturbances in patients with RA Material and methods: Evaluation of RA activity, sleepiness (Epworth scale and multiple sleep latency test), alertness (steer clear test), and sleep structure (polysomnography) were conducted before and after the first infusion of infliximab in six female patients with RA. RESULTS: The day after the first infliximab infusion, the mean (SD) number of tender (20 (2.4)) or swollen (15.3 (2)) joints and the morning stiffness (140 (61.9) min) had not changed. There were significant improvements in the median number of total sleep stage transitions per hour (median (IR) before v after infusion: 20.5 (43) v 7.5 (6); Wilcoxon paired test, p = 0.014), median percentage of phase I+II (83.5 (8) v 54.5 (24); p = 0.023), percentage of REM stages (2 (10) v 11.5 (8); p = 0.014), median percentage sleep efficiency (44 (22) v 75 (18); p = 0.014), median sleep latency (77.5 (150) v 25.5 (23) min; p = 0.023), and median number of hits in the steer clear test (48.5 (86) v 6 (45); p = 0.023). Neither objective nor subjective daytime sleepiness was noted. One obese patient had obstructive sleep apnoea syndrome. CONCLUSIONS: Sleep and the alertness disturbances in RA improve with infliximab treatment. Improvement appears unrelated to joint discomfort amelioration but suggests a central effect through inhibition of circulating TNFalpha levels.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Sleep Wake Disorders/drug therapy , Adult , Aged , Arousal/drug effects , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/psychology , Female , Humans , Infliximab , Middle Aged , Neuropsychological Tests , Polysomnography , Prospective Studies , Severity of Illness Index , Sleep Wake Disorders/etiology , Sleep Wake Disorders/psychologyABSTRACT
Kikuchi-Fujimoto disease (KFD) is a histiocytic necrotizing lymphadenitis found mainly in young women. Patients typically present with cervical lymphadenopathy and fever and follow almost always a benign course with excellent outcomes. The etiology of KFD remains unknown and controversial although several viruses have been associated with this disease. One theory proposes that KFD may be a self-limiting form of systemic lupus erythematosus (SLE). This theory is strongly supported by the fact that microscopic features of KFD can be very similar to those found in lupus lymphadenitis. Despite its usually benign course, several cases with fatal outcomes have been reported. We report here a case of clinically aggressive KFD, which featured several autoimmune-related events and resulted in a fatal outcome. Autopsy studies showed characteristic findings of SLE, which suggests a remarkable link between SLE and KFD. Early and intensive immunosuppressive treatment may be the only option for patients who develop very aggressive forms of KFD in order to avoid a fatal outcome.
Subject(s)
Histiocytic Necrotizing Lymphadenitis/diagnosis , Lupus Erythematosus, Systemic , Adult , Autoimmunity , Axilla , B-Lymphocytes/pathology , Biopsy , Fatal Outcome , Female , Histiocytic Necrotizing Lymphadenitis/immunology , Histiocytic Necrotizing Lymphadenitis/pathology , Humans , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/pathology , Lymph Nodes/pathology , Spleen/pathology , T-Lymphocytes/pathologyABSTRACT
Carcinosarcoma of the bladder is a rare neoplasm composed of a mixture of malignant epithelial and mesenchymal components. The presentation and clinical course of an infiltrating carcinosarcoma located in a bladder diverticulum coexisting with prostatic adenocarcinoma in a 69-year-old man are described. We believe this to be the fifth report of true carcinosarcoma appearing in a bladder diverticulum.
