[Serum amyloid A as a useful index of disease activity in polymyalgia rheumatica].

PURPOSE: To clarify the usefulness of measuring serum amyloid A (SAA) levels in patients with polymyalgia rheumatica (PMR), we compared this parameter to C-reactive protein (CRP). SUBJECTS AND METHODS: The study included 10 patients with PMR, who could be prospectively followed up from the start of prednisolone (PSL) treatment until the CRP level decreased to 1 mg/dl or less. When the CRP level decreased, the subjects were divided into the group in which the symptom persisted (n = 6) and those in which the symptom disappeared (n = 4). RESULTS: In the group in which the symptom persisted, both CRP and SAA levels were significantly higher. When the CRP level decreased, there was no significant difference in the CRP level between the two groups. However, the mean SAA level in the group in which the symptom persisted (137.8 micrograms/ml) was significantly higher than that in the group in which the symptom disappeared (21.8 micrograms/ml). On the initial consultation, there was a positive correlation between CRP and SAA (R = 0.77). The SAA level was more sensitive than the CRP level (y = 94.899 x -51.22). When the CRP level decreased, SAA was much more sensitive (y = 222.92 x +6.9121), suggesting the usefulness of SAA after the start of PSL treatment. CONCLUSION: SAA may be a useful parameter of PMR activity.

[A case of septic pulmonary embolism accompanied with tricuspid valve endocarditis and pyogenic spondylitis].

A 54-year-old man was admitted with complaints of high fever and lumbago. A chest radiograph on admission showed bilateral multiple patchy infiltrations. Chest CT showed multiple nodules of various sizes, some with necrotic centers and feeding vessels in the peripheral areas. Some nodules had wedge-shaped consolidations aboutting the pleura. Echocardiography showed vegetation about 12 x 7 mm in size attached to the tricuspid valve. MR imaging of the lumbar vertebrae showed increased signal intensity in the vertebral bodies in L1-4 in T2-weighted images and a further increase of signal intensity by gadolinium enhancement in T1-weighted images. These findings led to a diagnosis of septic pulmonary embolism accompanied with tricuspid valve endocarditis and pyogenic spondylitis irrespective of a negative blood culture. The fever was reduced and the inflammatory findings and chest radiographs were improved by antibiotic therapy, and then tricuspid valvuloplasty was performed. The characteristic CT features of septic pulmonary embolism, mentioned above, can contribute to an accurate and early diagnosis and proper treatment.

[A patient with polymyalgia rheumatica who exhibited fever as the main symptom for a long period].

We encountered a patient with polymyalgia rheumatica (PMR) who exhibited fever as the main symptom for a long period without muscular pain. As an etiological factor, the condition may have been associated with nonsteroidal anti-inflammatory drugs (NSAIDs). A 71-year-old man consulted our Department of Orthopedics for fever and lumbar pain, which initially developed in early September 2000. Administration of NSAIDs resulted in the disappearance of lumbar pain. However, fever persisted. The C-reactive protein (CRP) level was persistently high. Therefore, on October 5, 2000, the patient was referred to our department. At the outpatient clinic, a detailed examination was performed. However, the etiology could not be determined. Repeated administration of NSAIDs resulted in pyretolysis, and the dose of NSAIDs was decreased from January 31, 2001. Severe fever appeared again, and inflammatory reaction also exacerbated. On March 11, 2001, muscular pain involving the bilateral shoulders and forearms suddenly developed. For diagnostic treatment, administration of prednisolone (PSL) at 10 mg/day was started. Muscular pain rapidly disappeared. According to Bird's criteria, PMR was diagnosed. After the dose of PSL was decreased to 7.5 mg/day, the course is good. PMR should be considered as the etiology of idiopathic fever in elderly patients.