ABSTRACT
A case of hypereosinophilic syndrome (HES) with a rare complication of Buerger's disease-like large arterial occlusion (AO) was successfully treated with emergent percutaneous transluminal angioplasty and anticoagulants plus corticosteroid. By reviewing 15 reported cases of HES with AO including the present case, we found man predominance but no other consistent characteristics in HES with AO, such as age, smoking history, eosinophil counts or previous treatments, thus, predicting AO in HES patients appears to be difficult. Vessel intervention should be considered as a treatment option, since treatment delay in some patients has resulted in the amputation of extremities.
Subject(s)
Angioplasty, Balloon , Arterial Occlusive Diseases/therapy , Femoral Artery , Hypereosinophilic Syndrome/complications , Adult , Angiography , Anticoagulants/therapeutic use , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Femoral Artery/diagnostic imaging , Humans , MaleABSTRACT
It is commonly believed that infliximab-induced anticardiolipin antibody belongs to the IgM subclass but not the IgG subclass and that the IgM subclass could not produce clinical symptoms. However, we had a patient with scleroderma overlap/rheumatoid arthritis who developed thrombocytopenia associated with the appearance of IgM anticardiolipin antibody after treatment with infliximab. This is a report of a rare case that should make us aware of the possibility of the development of thrombocytopenia with the appearance of IgM anticardiolipin antibody induced by infliximab.
Subject(s)
Antibodies, Anticardiolipin/immunology , Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Scleroderma, Systemic/drug therapy , Thrombocytopenia/chemically induced , Adult , Antibodies, Anticardiolipin/blood , Antibodies, Monoclonal/immunology , Antirheumatic Agents/immunology , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/immunology , Female , Humans , Immunoglobulin M/immunology , Infliximab , Scleroderma, Systemic/complications , Scleroderma, Systemic/immunology , Thrombocytopenia/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Tetrathiomolybdate (TM), a drug developed for Wilson's disease, produces an anti-angiogenic and anti-inflammatory effect by reducing systemic copper levels. TM therapy has proved effective in inhibiting the growth of tumors in animal tumor models and in cancer patients. We have hypothesized that TM may be used for the therapy of rheumatoid arthritis and have examined the efficacy of TM on adjuvant-induced arthritis in the rat, which is a model of acute inflammatory arthritis and inflammatory cachexia. TM delayed the onset of and suppressed the severity of clinical arthritis on both paw volume and the arthritis score. Histological examination demonstrated that TM significantly reduces the synovial hyperplasia and inflammatory cell invasion in joint tissues. Interestingly, TM can inhibit the expression of vascular endothelial growth factor in serum synovial tissues, especially in endothelial cells and macrophages. Moreover, the extent of pannus formation, which leads to bone destruction, is correlated with the content of vascular endothelial growth factor in the serum. There was no mortality in TM-treated rat abnormalities. TM also suppressed inflammatory cachexia. We suggest that copper deficiency induced by TM is a potent approach both to inhibit the progression of rheumatoid arthritis with minimal adverse effects and to improve the well-being of rheumatoid arthritis patients.
Subject(s)
Arthritis, Experimental/drug therapy , Cachexia/drug therapy , Chelating Agents/therapeutic use , Chelation Therapy , Copper/metabolism , Molybdenum/therapeutic use , Administration, Oral , Animals , Arthritis, Experimental/complications , Arthritis, Experimental/pathology , Biomarkers/metabolism , Cachexia/complications , Cachexia/pathology , Disease Models, Animal , Female , Hindlimb/pathology , Immunoenzyme Techniques , Joints/drug effects , Joints/metabolism , Joints/pathology , Rats , Rats, Inbred Lew , Synovial Membrane/drug effects , Synovial Membrane/metabolism , Synovial Membrane/pathology , Vascular Endothelial Growth Factor A/bloodABSTRACT
Decreased serum dehydroepiandrosterone (DHEA) concentrations may be associated with an increased risk of cardiovascular disease (CVD) in men. We evaluated relationships between serum DHEA sulfate (DHEA-S) concentration and carotid atherosclerosis, as well as major cardiovascular risk factors, in men with type 2 diabetes. Serum DHEA-S concentrations were measured in 206 consecutive men with type 2 diabetes. Relationships were analyzed between serum DHEA-S concentration and carotid atherosclerosis, determined by ultrasonographically evaluated intima-media thickness (IMT) and plaque score (PS), as well as major cardiovascular risk factors, including age, blood pressure, and lipid concentrations. Negative correlations were found between DHEA-S concentration and IMT (r = -0.298, P < 0.0001) and between DHEA-S concentration and PS (r = -0.308, P < 0.0001). IMT and PS were significantly greater in patients with lower concentrations of DHEA-S (<1000 ng/ml) than in patients with higher concentrations of DHEA-S (1.07+/-0.30 mm versus 0.91+/-0.19 mm, P < 0.0001, and 5.5+/-4.2 versus 3.1+/-3.4, P < 0.0001, respectively). A negative correlation was found between serum DHEA-S concentration and age (r = -0.488, P < 0.0001). Multiple regression analysis demonstrated that serum DHEA-S concentration was an independent determinant of IMT (beta = -0.289, P < 0.0001) and of PS (beta = -0.301, P < 0.0001). In conclusion, serum DHEA-S concentration is negatively associated with carotid atherosclerosis determined by ultrasonographically evaluated IMT and PS in men with type 2 diabetes.
