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1.
Clin Exp Rheumatol ; 27(2): 329-32, 2009.
Article in English | MEDLINE | ID: mdl-19473577

ABSTRACT

OBJECTIVE: The aim of this study was to assess inflammatory changes within the knee joint of systemic lupus erythematosus (SLE) patients by using ultrasound (US). Rheumatoid arthritis (RA) patients and healthy subjects (HS) were evaluated as controls. US findings were correlated with disease activity parameters. METHODS: Twenty-six SLE patients were enrolled in the study, 25 RA patients and 15 HS were selected as controls. US was performed by two different experienced operators, using an Agilent-HP Image point Hx machine equipped with a 10 MHz linear transducer. Power Doppler (PD) was used to determine local synovial perfusion (PFR 700-1100 Hz; gain 60-65dB; low filter). Knee joints were examined bilaterally. US findings, expressed after consensus of the 2 operators, were correlated to clinical and serological parameters of disease activity. Statistical analysis was performed by the EPISTAT program. RESULTS: In SLE, synovitis was found in 21 knees (40%), joint effusion in 12 (23%), synovial proliferation in 12 (23%), positive PD signal in 5 (10%) and gastrocnemius-semimembranosus bursitis in 5 (10%). No erosions were detected. There was a significant difference respect to RA for synovitis (p<0.003), synovial proliferation (p<0.002) and positive PD signal (p<0.01). No correlation was found between US alterations and SLE disease activity parameters. In the HS group 1 patient showed mild synovial proliferation. CONCLUSION: This is the first study that investigates knee joint involvement in SLE by ultrasonography. US was able to depict inflammatory alterations in the articular tissues of SLE patients, revealing some common characteristics with RA, except for the presence of erosions. We believe that US might be of help in the global evaluation of SLE patients with inflammatory joint involvement, providing relevant information to the clinician.


Subject(s)
Knee Joint/diagnostic imaging , Lupus Erythematosus, Systemic/diagnostic imaging , Synovitis/diagnostic imaging , Adult , Aged , Arthritis, Rheumatoid/diagnostic imaging , Case-Control Studies , Female , Humans , Knee Joint/pathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/pathology , Male , Middle Aged , Synovitis/complications , Synovitis/pathology , Ultrasonography , Young Adult
2.
Clin Exp Rheumatol ; 24(2): 186-90, 2006.
Article in English | MEDLINE | ID: mdl-16762157

ABSTRACT

Systemic lupus erythematosus is a protean disease which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Visceral leishmaniasis is a parasitic infection, endemic in 88 countries, whose hallmarks may mimic a lupus flare. Fever, pancytopenia, splenomegaly, hypergammaglobulinemia, production of autoantibodies and complement consumption are some of the overlapping features between the two diseases. Thus, extra attention must be paid to patients with lupus who present with the mentioned symptoms. Diagnosis of visceral leishmaniasis relies on the detection of leishmania antibodies, on the presence of amastigotes in bone marrow aspirates, biopsies and cultures of the parasite. Treatment is based on the use of i.v. liposomal amphotericin B. The missed recognition of a leishmania infection in a lupus patient may lead to death, since both the omission of a specific anti-parasite treatment and the increase of the immunosuppressive therapy, in the conviction of a lupus flare, accelerate a fatal outcome. In this paper we present a case of visceral leishmaniasis occurring in a lupus patient. The clinical and laboratory features that overlap in the two diseases and the current literature on the topic were discussed.


Subject(s)
Leishmaniasis, Visceral/parasitology , Lupus Erythematosus, Systemic/parasitology , Adult , Amphotericin B/therapeutic use , Animals , Antibodies, Protozoan/blood , Antiprotozoal Agents/therapeutic use , Bone Marrow/parasitology , Bone Marrow/pathology , Diagnosis, Differential , Fluorescent Antibody Technique, Indirect , Humans , Leishmania donovani/isolation & purification , Leishmania donovani/physiology , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/immunology , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Male , Recurrence
3.
Clin Exp Rheumatol ; 22(5): 621-4, 2004.
Article in English | MEDLINE | ID: mdl-15485017

ABSTRACT

OBJECTIVE: To define joint alterations in the wrists of patients with systemic lupus erythematosus (SLE) by ultrasonography (US). METHODS: Fifty-two wrists of 26 SLE patients and 30 wrists of 15 healthy controls were evaluated using US by two different experienced operators, blinded to the clinical data. A 14 MHz linear probe was used. Power Doppler (PD) was applied to evaluate the presence of synovial neoangiogenesis as a parameter of active local synovitis. The findings were correlated to the clinical evaluation, serological systemic disease activity parameters (ESR, C3 levels) and the SLE-disease activity score (SLEDAI). Statistical analysis was performed by the EPISTAT program. RESULTS: Signs of synovitis were found in 22 wrists (42.3%). Synovial proliferation was present in 10 joints (19.2%), PD positivity in 5 (9.6%) and joint effusion in 13 (25%). Erosions were present in both wrists (3.8%) of one patient. Signs of tenosynovitis of one or more tendons were shown in 23 cases (44.2%). Ganglia were found in 2 joints (3.8%). Changes of the median nerve, joint dislocations, tendons' ruptures, cysts and nodules were never detected. In 14 wrists (26.9%) no alterations were found. There was no correlation between sonographic findings and clinical, laboratory and indexes signs of disease activity. In the control group the only alteration found was tenosynovitis in 1 joint (p < 0.0001). CONCLUSION: US proved to be an useful technique to detect wrist joint alterations in SLE. These findings may help the physician to modulate treatment strategies and to perform a low cost monitoring of joint disease activity.


Subject(s)
Lupus Erythematosus, Systemic/diagnostic imaging , Tenosynovitis/diagnostic imaging , Wrist Joint/diagnostic imaging , Adult , Cohort Studies , Female , Humans , Lupus Erythematosus, Systemic/complications , Male , Middle Aged , Neovascularization, Pathologic/diagnostic imaging , Tenosynovitis/etiology , Ultrasonography, Doppler/methods , Wrist Joint/blood supply
4.
Clin Exp Rheumatol ; 20(5): 709-18, 2002.
Article in English | MEDLINE | ID: mdl-12412207

ABSTRACT

Thalidomide is an immunomodulatory agent; although its mechanisms of action are not fully understood, many authors have described its anti-inflammatory and immunosuppressive properties. More interestingly, thalidomide has shown the ability to suppress tumor necrosis factor alpha (TNF alpha) production and to modify the expression of TNF alpha induced adhesion molecules on endothelial cells and on human leukocytes. Thalidomide has been used in several diseases (i.e. dermatological, autoimmune, gastrointestinal). In this review we focus specifically on the use of this drug in disorders with rheumatological features such as lupus erythematosus, rheumatoid arthritis and Still's disease, ankylosing spondylitis, and Behçet's disease. Despite its well known side effects, first of all peripheral nerve involvement and teratogenesis, which can be avoided by following strict guidelines, thalidomide could represent an alternative drug in some rheumatological conditions, particularly in patients who show resistance, contraindication or toxicity with other conventional treatments.


Subject(s)
Arthritis, Rheumatoid/drug therapy , Behcet Syndrome/drug therapy , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Thalidomide/therapeutic use , Abnormalities, Drug-Induced , Clinical Trials as Topic , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/pharmacology , Lupus Erythematosus, Systemic/physiopathology , Thalidomide/adverse effects , Thalidomide/pharmacology , Tumor Necrosis Factor-alpha/drug effects
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