ABSTRACT
OBJECTIVE: To determine the incidence, time trends, risk factors, and severity of herpes zoster in a population-based cohort of patients with newly diagnosed rheumatoid arthritis (RA) compared to a group of individuals without RA from the same population. METHODS: All residents of Olmsted County, Minnesota fulfilling for the first time the 1987 American College of Rheumatology criteria for RA between January 1, 1980 and December 31, 2007 and a cohort of similar residents without RA were assembled and followed by retrospective chart review until death, migration, or December 31, 2008. RESULTS: There was no difference in the presence of herpes zoster prior to the RA incidence/index date between the cohorts (P = 0.85). During followup, 84 patients with RA (rate 12.1 cases per 1,000 person-years) and 44 subjects without RA (rate 5.4 cases per 1,000 person-years) developed herpes zoster. Patients with RA were more likely to develop herpes zoster than those without RA (hazard ratio [HR] 2.4 [95% confidence interval (95% CI) 1.7-3.5]). Herpes zoster occurred more frequently in patients diagnosed with RA more recently (HR 1.06 per year [95% CI 1.02-1.10]). Erosive disease, previous joint surgery, and use of hydroxychloroquine and corticosteroids were significantly associated with the development of herpes zoster in RA. There was no apparent association of herpes zoster with the use of methotrexate or biologic agents. Complications of herpes zoster occurred at a similar rate in both cohorts. CONCLUSION: The incidence of herpes zoster is increased in RA and has risen in recent years. There also has been an increasing incidence of herpes zoster in more recent years in the general population. RA disease severity is associated with the development of herpes zoster.
Subject(s)
Arthritis, Rheumatoid/epidemiology , Herpes Zoster/epidemiology , Population Groups , Severity of Illness Index , Adult , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Minnesota/epidemiology , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. It is usually self-limiting and is characterized by an immune complex-mediated vasculitis associated with IgA deposition. We present an unusual case of HSP with mucosal lesions and coronary artery thickening.
Subject(s)
Coronary Artery Disease/diagnosis , IgA Vasculitis/diagnosis , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Child, Preschool , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/etiology , Humans , IgA Vasculitis/diagnostic imaging , IgA Vasculitis/etiology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Male , Prednisone/therapeutic use , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcal Infections/diagnostic imaging , Streptococcal Infections/drug therapy , Treatment Outcome , UltrasonographySubject(s)
Dermatomyositis/diagnosis , Dermatomyositis/pathology , Hand , Skin/pathology , Adrenal Cortex Hormones/therapeutic use , Dermatomyositis/drug therapy , Drug Therapy, Combination , Female , Humans , Immunoglobulins, Intravenous , Immunosuppressive Agents/therapeutic use , Middle Aged , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , Necrosis , Treatment OutcomeABSTRACT
Elevated levels of complement components, C3 and C4, are often seen in inflammatory diseases. They are generally not thought to be responsible for organ injury but simply reflect stimulation of the immune system. Extremely high elevations of these components are rarely seen. Such values are usually reported in patients with hematopoietic malignancies. We report here a case of C3 elevation to 9.22 g/L (5 times the upper limit of normal) and C4 elevation to 2.48 g/L (6 times the upper limit of normal). To our knowledge, no prior elevations of this magnitude have been reported previously from our institution or in the published medical literature (+/- MEDLINE search, using keywords hypercomplementemia, C3, C4, and lymphoplasmacytic lymphoma). In this case, there appeared to be no adverse end-organ damage from the excessive complement components or their activation.
