Soft tissue and subcutaneous calcification in connective tissue diseases.

PURPOSE OF REVIEW: Calcinosis is a recognized manifestation of many connective-tissue diseases, especially juvenile dermatomyositis (JDM) and systemic sclerosis; however, little is known about the pathogenesis and the treatment of this condition. The purpose of this review is to discuss the most recently published data about calcinosis in connective-tissue diseases with emphasis on the pathogenesis and its treatment. RECENT FINDINGS: Calcinosis is more common in patients with sustained disease-activity and longer disease duration. JDM patients with anti-p140 antibodies and tumour necrosis factor (TNF) α-308AA allele are at an increased risk. Low levels of the calcium-regulating proteins, fetuin-A and osteopontin, have been found in the serum of patients with JDM. Macrophages and cytokines interleukin (IL) 6, IL-1ß and TNFα isolated from the calcific tissues in JDM have also been implicated in the pathologic process. Raised tissue expression of advanced glycation end products and their receptor has been noted in patients with systemic sclerosis and systemic lupus erythematosus with calcinosis. SUMMARY: Many agents have been used for treatment of calcinosis but none has been accepted as a standard therapy. Case studies have shown that aggressive treatment of the underling inflammatory condition with intravenous immunoglobulin, anti TNF agents, thalidomide and haematopoietic stem cell transplantation has also led to improvement of the calcinosis. Aggressive management of the underlying inflammatory condition should help in treating as well as decreasing the incidence of calcinosis. Some case studies have focused on agents such as warfarin, bisphosphonates, diltiazem and others, which are primarily aimed at treating the process of calcinosis with varying success.

What's New in the Management of Bacterial Septic Arthritis?

Septic arthritis is a common rheumatological emergency requiring prompt diagnosis and treatment, since delays in management can lead to high morbidity and mortality. In this review article, we discuss the epidemiology and recent advances in knowledge of the pathogenesis of septic arthritis, with a special emphasis on various bacterial and host factors involved in mediating the inflammatory process and the potential for targeted therapy to modulate the immune response. Recent advances in laboratory and imaging techniques are reviewed along with treatment and potential new therapies.

Effect of mechanical coronary reperfusion on QT dispersion in acute coronary syndrome.

BACKGROUND: The time for cardiac repolarization and homogeneity of repolarization on surface electrocardiogram is denoted by QT interval and QT dispersion, respectively. Numerous studies suggest an association between an increased dispersion of the QT interval obtained from the 12-lead electrocardiogram and increased risk for serious cardiac events. METHODS AND RESULTS: We evaluated the effect of thrombolysis and percutaneous transluminal coronary angioplasty on QT dispersion in acute coronary syndrome in 45 patients (age: 55 +/- 6 years). QT dispersion was calculated on admission and immediately after the procedure (thrombolysis and percutaneous transluminal coronary angioplasty). There was a significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty (75 +/- 21 ms to 38 +/- 20 ms, p < 0.0001). In a subset of these patients with acute myocardial infarction (n = 29) who underwent thrombolysis, QT dispersion decreased only marginally (78 +/- 19 ms to 67 +/- 22 ms, p < 0.05). Even in this subgroup, there was a significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty (to 37 +/- 22 ms, p < 0.0001). In patients with unstable angina (n = 16), there were similar significant changes after percutaneous transluminal coronary angioplasty (p < 0.0001). CONCLUSIONS: These results suggest a highly significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty compared to a less significant decrease after thrombolysis, which may have clinical implications.