Gout and hyperuricemia.

A number of investigators have applied the tools of molecular biology to characterize genes responsible for the control of urate homeostasis and clarify the roles of uric acid precursors in inflammation. Some, using the tools of clinical medicine, continue to provide novel descriptions of gout and to explore better ways for evaluating hyperuricemia and for understanding the pathophysiology of disorders such as familial urate nephropathy. Others link the disciplines of basic research and clinical medicine in approaching the perplexing questions of crystal-induced inflammation.

An antibody that inhibits in vitro bone marrow proliferation in a patient with systemic lupus erythematosus and aplastic anemia.

A non-complement-dependent antibody that inhibits bone marrow proliferation in vitro was detected in the serum of a patient with systemic lupus erythematosus and aplastic anemia. The patient recovered from the aplastic anemia following treatment with corticosteroids and plasmapheresis. The antibody could no longer be detected after this recovery. This case demonstrates that a rare, but potentially lethal, complication of systemic lupus erythematosus is aplastic anemia due to an autoantibody. Results of the experiments suggest a mechanism for, and treatment of, similar cases.

Evaluation of patients with back pain of suspected inflammatory nature.

PURPOSE: Detection of early inflammatory back disease is often difficult. Certain clinical characteristics have been reported to increase the likelihood of its detection in referral patients, but the usefulness of these clinical characteristics has not been evaluated in an open population. In our study, we undertook to evaluate the value of the clinical history as a screening test for inflammatory back disease in a general population. PATIENTS AND METHODS: Twenty-three male patients with back pain of moderate duration and with clinical characteristics suggestive of inflammatory back disease were recruited by advertising and were studied by various means, including computed tomography (CT), scintigraphy, and radiography. RESULTS: One patient had radiographic sacroiliitis. Two had positive results for the B27 antigen, and another had positive results for the cross-reacting HLA antigen B7. Eight patients had abnormal scintiscans of the sacroiliac joints. Twenty-one of 23 patients and 20 of 23 control subjects had abnormalities that were detected by CT. Repeat plain radiographs of the pelvis done 36 months after enrollment into the study did not uncover further evidence of sacroiliitis. CONCLUSIONS: These results indicate plain radiographic evidence of sacroiliitis will often not develop in patients with historical features suggestive of inflammatory back disease even with long-term evaluation, thus vitiating the specificity of these historical findings in men with back pain of relatively brief duration.

Acute renal failure without fibrotic skin changes in progressive systemic sclerosis.

Scleroderma renal crisis (SRC) is defined as sudden development of accelerated hypertension, hyperreninemia, and acute renal failure in a patient with progressive systemic sclerosis (PSS). Although the diagnosis of PSS is generally straightforward because of dermal fibrosis, we report 2 patients who had PSS with SRC without the characteristic fibrotic skin changes of scleroderma. PSS should be considered in the differential diagnosis of unexplained acute renal failure and accelerated hypertension even though the cutaneous fibrotic manifestations of the disease may be absent.

Fatal soft-tissue infection complicating pulmonary arteriovenous fistulae.

A patient with pulmonary arteriovenous (AV) fistulae presented with an ultimately fatal anaerobic soft tissue infection. This represents the first report of such a complication, but the association of intracerebral anaerobic abscess with pulmonary AV fistulae suggests the possibility of a common pathophysiologic mechanism.

Study of HLA antigens in ten multiple-case rheumatoid arthritis families.

We studied the inheritance of HLA haplotypes in 10 families with more than one member affected with adult onset rheumatoid arthritis (RA). The frequency of DR4 was 81% among these patients. Nine families had DR4 bearing haplotypes and homozygosity for DR4 existed in 4 families. In 6 of these families DR4 positive haplotypes were shared among affected members. All but one of the affected sibs shared at least one haplotype with their index case. Ten percent of the unaffected relatives had rheumatoid factor (RF). HLA-DR4 or associated genes appeared to confer susceptibility for RF production and development of RA. However, these haplotypes were inherited also by many sibs who did not develop any manifestations of disease.

Gallium-67 scanning in Sjögren's syndrome: concise communication.

We performed gallium-67 scans in 12 patients with primary or secondary Sjögren's syndrome (SS). Salivary-gland uptake of gallium-67 was noted in four of five patients with primary SS. Pulmonary uptake was observed in ten of 12 patients. Chest radiographs were essentially normal in all patients, although 60% complained of significant dyspnea with exertion. The gallium-67 scan may prove to be a sensitive noninvasive diagnostic test for lung and mediastinal involvement by either primary or secondary SS, and for salivary-gland involvement in primary SS.