ABSTRACT
OBJECTIVE: To identify the frequency of serologic activity in the face of clinical quiescence in a large cohort of patients with systemic lupus erythematosus (SLE) followed prospectively in a single center. METHODS: In a prospective cohort study, patients serologically active but clinically quiescent (SACQ) in 3 consecutive clinic visits were analyzed for the development of a clinical flare over the subsequent year and were evaluated for predictive factors for flare before and during their SACQ period. RESULTS: Forty-six episodes of SACQ went on to clinical flare within one year while 60 did not. No predictive factors for flare were found either during or before the SACQ period. CONCLUSIONS: A significant population of patients with SLE are SACQ and must be followed over time and treated only on the basis of clinical criteria.
Subject(s)
Antibodies, Antinuclear/blood , Complement System Proteins/analysis , Lupus Erythematosus, Systemic/physiopathology , Adult , Cohort Studies , Female , Humans , Lupus Erythematosus, Systemic/immunology , Male , Prognosis , Prospective StudiesABSTRACT
We describe a patient with biopsy proven polyarteritis nodosa who presented with headache, scalp tenderness and lymphadenopathy. This case illustrates the need to be wary of conditions mimicking temporal arteritis.
Subject(s)
Giant Cell Arteritis/complications , Lymphatic Diseases/etiology , Polyarteritis Nodosa/complications , Aged , Diagnosis, Differential , Humans , MaleABSTRACT
OBJECTIVE: Methotrexate (MTX) has been used successfully in the treatment of rheumatoid arthritis, psoriatic arthritis, polymyositis, and Reiter's syndrome. Our objective was to determine the effectiveness of MTX in the treatment of systemic lupus erythematosus (SLE). METHODS: We reviewed retrospectively MTX therapy in 5 patients with SLE, 3 with renal disease and 2 with arthritis. RESULTS: MTX therapy was well tolerated and effective in all 5 patients. CONCLUSION: MTX appears to be both effective and well tolerated in patients with SLE.
Subject(s)
Lupus Erythematosus, Systemic/drug therapy , Methotrexate/therapeutic use , Adolescent , Adult , Arthritis/drug therapy , Arthritis/etiology , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/drug therapy , Lupus Nephritis/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
A 35-year-old woman had a 13-year history of systemic lupus erythematosus (SLE) with recurrent flares since 1972 responding to corticosteroid therapy. In August, 1990 she presented with a 2-month history of dyspnea at rest, 4-pillow orthopnea and paroxysmal nocturnal dyspnea. Respiratory rate was 32-36/min, chest expansion 2 cm and crackles were present at the lung bases. On chest radiograph diaphragms were elevated. Pulmonary function tests (PFT) showed further reduction in lung volumes, maximum inspiratory pressures, maximum expiratory pressures and arterial blood gases. Ventilation/perfusion and gallium lung scans were normal. A diagnosis of "shrinking lungs syndrome" was made. Treatment with 40 mg of prednisone resulted in resolution of the patient's shortness of breath. PFT showed improvement in all variables. Corticosteroid therapy for acute "shrinking lungs syndrome" in active SLE can improve symptoms and pulmonary function.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Lung Diseases/complications , Lung Diseases/drug therapy , Lupus Erythematosus, Systemic/complications , Adult , Blood Gas Analysis , Dyspnea/complications , Dyspnea/drug therapy , Dyspnea/physiopathology , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/physiology , Lung Diseases/physiopathology , Lung Volume Measurements , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/physiopathology , Radiography , Respiratory Function Tests , SyndromeABSTRACT
Sensitivity to allopurinol, which occurs in 10-15% of patients, can seriously limit the drug's use in chronic tophaceous gout. Oral allopurinol desensitization has been advocated for sensitive patients in whom use of the drug is warranted. We report the successful use of intravenous allopurinol desensitization in a patient with chronic tophaceous gout in whom oral desensitization had previously failed.
Subject(s)
Allopurinol/administration & dosage , Desensitization, Immunologic/methods , Drug Hypersensitivity/therapy , Gout/drug therapy , Administration, Oral , Allopurinol/adverse effects , Chronic Disease , Drug Hypersensitivity/immunology , Humans , Injections, Intravenous , Male , Middle AgedABSTRACT
Upper limb claudication and pulselessness is an uncommon presentation of giant cell arteritis (GCA), often resulting in delayed diagnosis. We describe such a case diagnosed by angiography, in which a temporal artery biopsy showed classic GCA, despite the absence of local signs or symptoms. A review of 26 similar cases revealed that in 81% of patients where the only manifestation of GCA was upper limb findings, temporal artery biopsy yielded positive findings. Steroid therapy clinically improved 24/26 patients. These findings suggest that a consideration of temporal artery biopsy early in the investigation will hasten diagnosis and appropriate therapy.