Use of alternative therapies by patients with rheumatic disease in Guadalajara, Mexico: prevalence, beliefs, and expectations.

OBJECTIVE: To assess the prevalence, practices, beliefs, and expectations of patients with rheumatic diseases in relation to the use of alternative therapies. METHODS: We conducted a cross-sectional survey of 300 consecutive patients with rheumatic diseases at 3 outpatient rheumatic disease clinics in Guadalajara, Mexico to evaluate the use of alternative therapies. A face-to-face structured interview was administered by a trained assistant to evaluate the prevalence of use and patient beliefs, perceptions, and expectations in relation to alternative therapies. RESULTS: Two hundred fifty patients (83%) had used a total of 1,386 alternative therapies (range 1-19); 203 (68%) patients had used alternative therapy in the previous 12 months. Sixty-one percent received at least one alternative treatment before the first rheumatology consultation, but an additional 18% initiated these therapies after their initial contact with a rheumatologist at our clinics. Only 66 (26%) of the patients using alternative therapy notified their rheumatologist about their use. Thirty-six patients (14%) discontinued formal treatment at least on one occasion in order to receive alternative therapies, and only 8 (22%) notified their rheumatologist. Alternative therapy practitioners recommended discontinuation of conventional therapy on 57% of the occasions when formal treatments were discontinued. Mean expenditures per patient for fees to alternative therapy providers were equivalent to 28 days of the official minimum daily wage, and per patient costs for the remedies themselves were equivalent to 13 days of the official minimum daily wage. Patients who used alternative therapy in the past 12 months had lower education (7 versus 10 years, P < 0.001) and were slightly more disabled (1.7 versus 1.5, modified Health Assessment Questionnaire, P < 0.01). CONCLUSIONS: In this survey most patients used alternative therapies for the treatment of their rheumatic disease. Alternative therapies were costly and appeared to decrease adherence to conventional therapy. Health care providers should openly discuss the use of alternative therapy in patients with rheumatic diseases.

Intravenous cyclophosphamide pulses in pyoderma gangrenosum: an open trial.

OBJECTIVE: To evaluate the potential efficacy of intravenous bolus cyclophosphamide (IVCY) in patients with pyoderma gangrenosum. METHODS: Consecutive patients with a diagnosis of pyoderma gangrenosum seen in a period of 3 years in tertiary care referral center were included. Patients received IVCY 500 mg/m2 of body surface area, every month until reaching a maximum of 6 doses, or healing of their ulcers or a lack of response after 3 doses. Patients were assessed every month during the time they received IVCY and every 3 months thereafter. The assessments included number and size of ulcers, and a safety profile of the study drug. Complete remission was defined as 100% ulcer healing, partial remission as a decrease > or = 50% but less than 100%, and therapeutical failure if the size of the ulcer increased or decreased < 50%. RESULTS: Nine patients were included, 6 were men, the mean age was 46 yrs (range 24-76). The mean disease duration was 3.3 yrs (range 1 week to 9 yrs). Four patients had idiopathic pyoderma gangrenosum, 3 had associated rheumatoid arthritis, and 2 had associated systemic lupus erythematosus. Complete remission was observed in 7 patients, partial in one, and failure in one. Relapses were observed, 3 months after the last IVCY (2 cases) and 12 months after the last IVCY (one case). Transitory thrombocytopenia and leukopenia developed in one patient and nausea and vomiting in another. CONCLUSION: IVCY appears effective in controlling the lesions of pyoderma gangrenosum and inducing remission for a substantial period in many individuals.

Endocrine disorders and musculoskeletal diseases.

Some clinical features observed in diabetes mellitus suggest secondary Sjögren's syndrome, and the effect of autonomic neuropathy on tear production is analyzed. Limited joint mobility in diabetes mellitus continues to attract attention, and a number of suggestions for further studies are discussed. Neurophysiologic assessment of the median nerve distinguishes diabetic polyneuropathy from carpal tunnel syndrome; however, Martin-Gruber anastomosis may modify nerve conduction measurements. Fracture rate does not appear to be increased in diabetes mellitus. The role of confounding variables and a dose-dependent effect of thyroxine therapy on bone mass is discussed. The possible association of hypothyroidism with gout is debated. Autoimmune thyroid diseases may be added to the list of conditions that produce anticardiolipin antibodies without the clinical manifestations of antiphospholipid syndrome.

[Antibodies against human immunodeficiency virus in generalized lupus erythematosus]. / Anticuerpos contra el virus de la immunodeficiencia humana en lupus eritematoso generalizado.

After studying a bisexual male with a clinical picture suggestive of AIDS a positive ELISA test for antibodies against the Human Immunodeficiency Virus (HIV), but negative results on indirect immunofluorescence testing, as well, as absence of core and envelope HIV antibodies by ELISA, and who later turned out to have Systemic Lupus Erythematosus (SLE) which become asymptomatic on corticosteroid therapy, we decided to test 70 patients with SLE for HIV antibodies. Four of them (5.6%) were positive by ELISA, but on a repeated test only 2 (2.8%) remained positive, and their sera was tested by indirect immunofluorescence. They were negative, as was the ELISA test for core and envelope HIV antibodies. We conclude that the possibility of more such cases, of SLE mimicking AIDS, should be kept in mind, including the occurrence of false positive ELISA tests in such patients.