A Longitudinal Study of the 28 Joints of Disease Activity Score by Ultrasonographical Examination in Rheumatoid Arthritis Patients.

BACKGROUND: The damaging effect of rheumatoid arthritis (RA) on cartilage, bone, ligaments, and tendons has raised the importance of the disease activity and severity assessment to enable therapeutic decisions and to evaluate disease outcome. AIM: The aim is to compare the clinical examination of the Disease Activity Score (DAS)-28 with the musculoskeletal ultrasonography (US) examination in RA patients. Moreover, finding if we can use ultrasonographical results as a tool for predicting subsequent radiological damage. PATIENTS AND METHODS: It is a longitudinal study included 60 adult RA patients. Patients were under assessment at baseline, 6 months, and 12 months from the recruitment time. Twenty-eight joints of DAS were assessed for tenderness and swelling. US gray scale (GS) and US power Doppler (PD) score also was done at each visit. RESULTS: DAS-28, with its parameters, is positively and highly significantly correlated to synovitis severity both by US GS and US-PD score along the study follow-up visits. There was highly significant difference between the number of 28 swollen and tender joints by clinical examination with both US GS and US-PD. Linear regression analysis to predict the number of swollen and tender joints after 12 months showed significance between US PD with swollen and tender joints' numbers. The correlation was positive and significant between Larsen score at 12 months with GS US and PD US assessment, but linear regression analysis was only significant for Larsen score with only GS US. CONCLUSION: GS US and PD is a sensitive and reliable noninvasive method complementary to standard clinical assessment and could be a tool for predicting subsequent joints' damage.

Gemcitabine-induced hemolytic uremic syndrome in ovarian carcinoma.

Multiple chemotherapeutic agents, either alone or in combination, have been implicated in causing hemolytic uremic syndrome (HUS). Gemcitabine has been reported to cause this condition rarely. A 48-year-old Caucasian woman, gravida 3, para 3 (G3P3), was diagnosed with stage III C ovarian carcinoma and after completing numerous chemotherapeutic regimens, she was started on gemcitabine. During her fourth cycle of gemcitabine, she developed generalized anasarca and presented to hospital with hemolytic anemia, thrombocytopenia, and renal failure. A diagnosis of HUS was made, which was confirmed by renal biopsy, and the patient was started on hemodialysis and plasmapheresis. We conclude if a patient has advanced-stage disease and has been heavily treated with chemotherapy before, there is a high risk that, on gemcitabine monotherapy, the patient can develop HUS earlier than expected.

Secondary hyperparathyroidism in chronic hemodialysis patients: prevalence and race.

Secondary hyperparathyroidism is a common complication of renal failure. The exact prevalence in chronic hemodialysis patients in not known. We evaluated 122 patients who were receiving maintenance hemodialysis for at least 12 months in 2 dialysis centers in mid Michigan. Seventy-eight percent of the patients had iPTH above 200 pg/mL (mean 481 pg/mL), 19% had iPTH within the accepted normal range (mean 155 pg/mL), while 3% had level below 100 (mean 53 pg/mL). Phosphate, calcium, calcium phosphate product, age and time on dialysis are the important factors correlating with elevated iPTH. There was no significant difference in iPTH between diabetic and nondiabetic patients with mean iPTH of 403 pg/mL and 407 pg/mL respectively. Black patients had a statistically significant elevated iPTH compared with white patients with a mean iPTH of 438 pg/mL and 283 pg/mL respectively (p < or = 0.004). Factors that predict the response to vitamin D therapy need to be evaluated to help reduce the high prevalence of secondary hyperparathyroidism. The patterns of bone disease in black patients need to be evaluated to further define the accepted normal iPTH range for this population.