ABSTRACT
The need for prevention of venous thromboembolism (VTE) after total hip or knee replacement is obvious. However, the optimal regimen to achieve this remains to be defined. In patients with rheumatoid arthritis (RA) long term coumarins may not be necessary owing to the use of non-steroidal anti-inflammatory drugs (NSAIDs). 103 patients in whom 151 surgical procedures were performed (55 hip and 96 knee prostheses) were treated only with short term subcutaneous heparin. NSAIDs were used daily in 85% of the patients, and they were continued after hospital discharge. Only one patient developed symptomatic deep venous thrombosis during one year follow up. Bleeding complications were seen in 20/151 (13%) of the surgical procedures, all clinically judged as minor, and recovery was not delayed except in one case. Short term (low molecular weight) heparin appears to be an adequate, simple, and safe method for prevention of symptomatic VTE in patients with RA after knee or hip replacement, though further studies are necessary to confirm these preliminary findings.
Subject(s)
Anticoagulants/therapeutic use , Arthritis, Rheumatoid/surgery , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Venous Thrombosis/prevention & control , Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome , Venous Thrombosis/etiologySubject(s)
Acetabulum/surgery , Arthritis, Rheumatoid/surgery , Arthroplasty, Replacement, Hip/methods , Prosthesis Failure , Adult , Aged , Arthritis, Rheumatoid/mortality , Arthroplasty, Replacement, Hip/mortality , Arthroplasty, Replacement, Hip/statistics & numerical data , Bone Transplantation/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Netherlands , Polyethylene/therapeutic use , Prosthesis Design , Prosthesis-Related Infections , Reoperation , Retrospective Studies , Survival AnalysisABSTRACT
We describe a 22-year-old female with systemic lupus erythematosus and lymphopenia, who developed septic arthritis of the right knee with Listeria monocytogenes type 1/2 A, whilst on low-dose methotrexate (MTX). So far, septic arthritis due to this microorganism has been reported in two other patients treated with low-dose MTX, one having rheumatoid arthritis and the other psoriatic arthritis. No reports exist on patients treated with other cytotoxic antirheumatic therapies.
Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Infectious/chemically induced , Knee , Listeriosis/chemically induced , Lupus Erythematosus, Systemic/drug therapy , Methotrexate/adverse effects , Adult , Aged , Female , Humans , Lupus Erythematosus, Systemic/complications , Lymphopenia/complications , Male , Middle AgedABSTRACT
OBJECTIVE: To assess the nutritional status of female elderly nursing home residents and to study the effect of dietary supplementation with a physiological dose of water-soluble vitamins. DESIGN: Single-blind, randomised, placebo-controlled intervention trial. Daily consumed supplement consisted of fortified fruit juice containing 50 g carbohydrate and 50% of the daily dietary recommendations of water-soluble vitamins. Regular fruit juice was used as placebo. Dietary intake assessment at baseline. Fasting blood sample, anthropometric measurements and medical record at baseline and after 4 and 12 weeks of supplementation. SETTING: Three nursing homes within 40 km of the coordination centre (Department of Human Nutrition, Wageningen Agricultural University, the Netherlands). SUBJECTS: Forty-two female nursing home residents aged 60 years and older, in relatively stable health condition, at least 3 months resident at baseline. In each nursing home, 14 subjects were randomly assigned to the supplement or control group. INTERVENTIONS: Twelve weeks of supplementation. RESULTS: Participants had a poor nutritional status. Dietary supplementation significantly improved the concentrations of thiamin pyrophosphate and pyridoxal 5'-phosphate, increased body weight and decreased serum homocysteine concentration in the supplement group. Plasma vitamin C levels were significantly increased in both supplement and control group. CONCLUSIONS: Even in this heterogeneous population of female nursing home elderly it is possible to improve the nutritional status through dietary intervention with a physiological dose of water-soluble vitamins.
Subject(s)
Deficiency Diseases/drug therapy , Food, Fortified , Nutritional Status , Vitamins/therapeutic use , Aged , Aged, 80 and over , Female , Geriatric Assessment , Homes for the Aged , Humans , Nursing Homes , Single-Blind MethodABSTRACT
We present a 45-year-old male patient with chronic obstructive lung disease treated with low-dose corticosteroids, who developed a chronic septic polyarthritis due to Pseudomonas aeruginosa following a surgical wound infection. Due to the mild synovitis and the absence of systemic signs of infection the diagnosis was delayed for nearly 2 years and resulted in severe joint destruction.
Subject(s)
Arthritis/microbiology , Pseudomonas Infections , Chronic Disease , Humans , Lung Diseases, Obstructive/drug therapy , Male , Middle Aged , Prednisone/therapeutic use , Pseudomonas aeruginosa , Surgical Wound Infection/complicationsABSTRACT
Primary antiphospholipid syndrome or PAPS is characterised by antiphospholipid antibodies and arterial and/or venous thromboses. Numerous other clinical features have been shown to be related to this syndrome. Chorea is a well known but rare phenomenon in systemic lupus erythematosus; it has been shown to be strongly related to the presence of antiphospholipid antibodies. We describe two patients with chorea that appeared to be caused by the PAPS.
