ABSTRACT
Takayasu's arteritis is an uncommon condition with a unique constellation of clinical findings that continues to fascinate clinicians and researchers. Advances in the techniques used for classifying lymphocytes, recognizing markers of cellular activity, and detecting the presence of cytokines has produced more evidence that Takayasu's arteritis is a cell-mediated immune condition. The etiology(ies) or triggering mechanism(s) of the disease remains elusive. Alternatives to standard angiography for vascular imaging, such as digital subtraction angiography, duplex ultrasonography, and magnetic resonance imaging, have improved the facility with which the diagnosis and management of Takayasu's arteritis can be safely accomplished. Percutaneous transluminal angioplasty of the aorta and renal arteries is a safe and effective means to dilate symptomatic stenoses. In the short term, this technique provides relief from claudication, hypertension, and ischemia. Long-term follow-up suggests that restenosis at the angioplasty site occurs in a substantial number of patients. Whether this represents a fibrotic healing process or continued inflammation is unclear. Attempts to control the inflammation with anti-inflammatory and immunosuppressive agents continue to be reported. Prednisone plus methotrexate is a promising combination for use in this life-threatening condition of young people.
Subject(s)
Takayasu Arteritis/diagnosis , Angioplasty, Balloon , Autoimmune Diseases/diagnosis , Autoimmune Diseases/immunology , Autoimmune Diseases/therapy , Diagnostic Imaging , Humans , Immunity, Cellular/immunology , Immunosuppressive Agents/therapeutic use , Takayasu Arteritis/immunology , Takayasu Arteritis/therapyABSTRACT
The sparing effect of neurological damage on the development and progression of several arthritic conditions has been documented. We describe the first 2 cases of unilateral remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in individuals with neurologic disorders. Case 1 suffered from birth trauma resulting in paresis of the right upper extremity and developed RS3PE syndrome in the nonaffected extremities. Case 2 developed RS3PE syndrome on the nonparetic side 7 years after a cerebrovascular accident resulting in hemiparesis.
Subject(s)
Edema/complications , Synovitis/complications , Aged , Aged, 80 and over , Edema/diagnosis , Edema/physiopathology , Humans , Male , Nervous System Diseases/complications , Nervous System Diseases/physiopathology , Serologic Tests , Syndrome , Synovitis/diagnosis , Synovitis/physiopathologySubject(s)
Arthritis, Infectious/microbiology , Borrelia/isolation & purification , Lyme Disease/microbiology , Adult , Antibodies, Bacterial/analysis , Borrelia/immunology , Fluorescent Antibody Technique , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Male , Synovial Fluid/microbiologyABSTRACT
Although indirect evidence suggests that chronic Lyme arthritis is caused by persistent infection with Borrelia burgdorferi, direct visualization has been lacking. We report the demonstration of B. burgdorferi from synovial fluid aspirated from the right knee of a 31-year-old man with Lyme arthritis for more than 1 year. After 6 days, culture medium inoculated with synovial fluid showed one motile and several nonmotile spirochetes. Direct immunofluorescence staining showed reactivity with anti-B. burgdorferi serum. Spirochetes were not seen in subcultured material. The patient's arthritis improved with high-dose intravenous penicillin. Identification of B. burgdorferi from the joint fluid of a patient with long-standing arthritis supports the concept that the arthritis is due to persistent infection.
Subject(s)
Arthritis, Infectious/microbiology , Borrelia/isolation & purification , Lyme Disease/microbiology , Synovial Fluid/microbiology , Adult , Antibodies, Bacterial/analysis , Arthritis, Infectious/drug therapy , Borrelia/immunology , Chronic Disease , Fluorescent Antibody Technique , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Knee Joint , Lyme Disease/drug therapy , Male , Penicillins/therapeutic useABSTRACT
The effect of nifedipine on fingertip hemodynamics was studied in 10 patients with Raynaud's phenomenon. Fingertip blood flow (FBF) was determined in a 20 degrees C environment by venous occlusion air plethysmography and fingertip vascular resistance (FVR) was calculated from the mean blood pressure and the FBF. Nifedipine, administered as a 10 mg sublingual dose, increased FBF in 8 of the 10 patients. FVR for the 10 patients decreased 40% from 40.7 +/- 10.8 to 24.2 +/- 6.1 U (p less than 0.05). Seven of the 10 patients were followed in a crossover placebo-controlled clinical trial. The frequency and severity of Raynaud's phenomenon was less in all seven patients when taking nifedipine as compared to placebo. Nifedipine-induced fingertip vasodilation may contribute to clinical improvement in some patients with Raynaud's phenomenon.
Subject(s)
Fingers/blood supply , Nifedipine/pharmacology , Raynaud Disease/physiopathology , Vasodilation/drug effects , Adult , Blood Pressure/drug effects , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , Nifedipine/therapeutic use , Plethysmography , Raynaud Disease/drug therapy , Vascular Resistance/drug effectsABSTRACT
Eight patients with Raynaud's phenomenon were entered into a double-blind crossover study of nifedipine versus placebo, with 7 patients undergoing finger plethysmography before and after sublingual nifedipine administration. While receiving nifedipine, all patients reported decreased frequency and severity of attacks, and 4 of 5 had digital ulcer healing. Total finger blood flow increased 5 of 6 patients after treatment with sublingual nifedipine. This preliminary study indicates that nifedipine may be a useful agent for treatment of digital vasospasm.
Subject(s)
Nifedipine/administration & dosage , Raynaud Disease/drug therapy , Adult , Blood Pressure/drug effects , Creatinine/blood , Double-Blind Method , Female , Fingers/blood supply , Humans , Male , Middle Aged , Muscle Contraction/drug effects , Muscle, Smooth, Vascular/drug effects , Nifedipine/adverse effects , Raynaud Disease/complications , Raynaud Disease/physiopathology , Scleroderma, Systemic/complications , Scleroderma, Systemic/drug therapy , Skin Ulcer/drug therapy , Skin Ulcer/etiologyABSTRACT
Three generations of a family with hereditary C2 deficiency were studied, Six members heterozygous for C2 deficiency were identified by serum C2 levels that were approximately 50% of normal C2 values and the identity was supported by HLA analysis. All six members with low C2 levels had only a single electrophoretic variant. Two of four children did not have the variant found in the parent from whom they inherited the partial C2 deficiency. It is inferred that the low levels of C2 result from the inheritance of a silent or null gene, C2D allelic with the structural genes controlling the electrophoretic variants.
