The association of Sweet's syndrome with sarcoidosis.

We report a 43-year-old woman with biopsy proven Sweet's syndrome with massive mediastinal lymphadenopathy. No other clinical signs compatible with sarcoidosis were present. Mediastinoscopy was performed to establish a diagnosis. Histological evaluation revealed non-caseating granulomas compatible with sarcoidosis. We review the association of Sweet's syndrome and (haematological) malignancies, and eight other cases of Sweet's syndrome and sarcoidosis. All but one presented with erythema nodosum, making the diagnosis of acute sarcoidosis (Löfgren's syndrome) more likely than malignancy.

Prevention and treatment of glucocorticoid-induced osteoporosis.

Glucocorticoid-induced osteoporosis is a common clinical problem. This review briefly summarizes the pathogenesis of this disorder. All relevant studies on the prevention and treatment of glucocorticoid-induced osteoporosis are discussed more in detail. As the results of these studies are inconclusive, a proposal for a practical approach of the individual patient is formulated.

Increased bone mass with pamidronate treatment in rheumatoid arthritis. Results of a three-year randomized, double-blind trial.

OBJECTIVES: Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We therefore investigated the effect of oral pamidronate therapy as a specific bone-sparing agent in RA. METHODS: The study design was a 3-year randomized, double-blind trial of 300 mg oral pamidronate/day compared with placebo in 105 RA patients. Bone mineral density (BMD) measured at 12-month intervals was the primary efficacy parameter. RESULTS: In 3 years, lumbar spine and forearm BMD increased significantly in the pamidronate-treated group (by 8.4 +/- 6.9% [mean =/- SEMI] [P < 0.00011 and 5.2 =/- 6.5% [P < 0.005], respectively), compared with nonsignificant changes in the placebo-treated patients (increase of 0.6 =/- 5.2% and decrease of 1.2 =/- 5.8%, respectively). Femoral neck BMD increased in the pamidronate-treated group (by 2.6 =/- 8.6%) and decreased significantly in the placebo-treated group (by 4.0=/- 1.3% [P < 0.005]). The changes in BMD with time at all 3 measurement sites were significantly different between the treatment groups (P < 0.0001). Changes in radiographic signs of joint damage and in disease activity were similar in the 2 groups. CONCLUSION: The present study provides the first evidence that long-term treatment with an orally administered bisphosphonate overcomes bone loss and increases bone mass when compared with placebo. This finding may have significance with regard to the treatment of patients with RA.

Clinical and biochemical response to single infusion of pamidronate in patients with active rheumatoid arthritis: a double blind placebo controlled study.

OBJECTIVE: To assess the effects of 3-amino-1-hydroxypropylidine-1,1-bisphosphonate (pamidronate) in rheumatoid arthritis (RA). METHODS: Thirty patients with active RA were randomly allocated to receive a single intravenous infusion of placebo, 20 mg pamidronate, or 40 mg pamidronate. RESULTS: Pamidronate treatment resulted in a rapid and sustained reduction in urinary calcium and hydroxyproline excretions. A sustained reduction in serum corrected calcium was only noted in the group treated with 40 mg pamidronate. In both groups treated with pamidronate a temporary increase in serum parathyroid hormone was noted. Compared to the placebo group clinical variables of disease activity improved significantly in both groups treated with aminohydroxypropylidine bisphosphonate. The erythrocyte sedimentation rate and serum C-reactive protein levels improved significantly in patients treated with 40 mg pamidronate. No serious side effects were documented. CONCLUSION: A single infusion of pamidronate in patients with RA is safe, suppresses bone resorption, and reduces disease activity. It is suggested that the effect on disease activity is dose dependent.

Sepsis syndrome and death after bronchoalveolar lavage.

Bronchoalveolar lavage is widely used in the management of patients with interstitial lung diseases and is considered a safe procedure. We describe a patient who died with a picture consistent with acute pulmonary edema and septic shock following bronchoalveolar lavage. This potential complication has not been previously reported.

Bone mineral density in ambulant, non-steroid treated female patients with rheumatoid arthritis.

Bone mass measurements were performed in a group of 30 ambulant, non-steroid treated female patients with rheumatoid arthritis (RA) of relatively short duration (mean 4.9 years). The bone mineral density (BMD) of the lumbar spine and femoral neck was assessed by dual-energy x-ray absorptiometry (DEXA), and related to parameters of disease activity and severity. Lumbar BMD was within the range of normal while femoral BMD was decreased compared to age-matched controls. BMD values, expressed as the percentage of age-matched healthy controls (BMD%), were positively related to the body mass index and negatively related to the number of swollen joints, the erythrocyte sedimentation rate and the platelet count. No relation was found between the lumbar and femoral bone mass on the one hand and disease duration, number of disease modifying anti-rheumatic drugs ever used, Ritchie articular index, C-reactive protein, functional ability or radiological scores on the other. It is concluded that in ambulant non-steroid treated female RA patients lumbar bone mass as measured with DEXA is within the range of normal, while femoral bone mass is slightly reduced. Both lumbar and femoral bone mass are related to the body mass index and parameters of disease activity.

Bone metabolism in rheumatoid arthritis; relation to disease activity.

Biochemical parameters of bone metabolism were investigated in 105 ambulant, non-steroid treated patients with RA and compared with parameters of disease activity. Urinary calcium (Ca) and hydroxyproline (OHP) excretions, as parameters of bone resorption and serum alkaline phosphatase (AP), as a parameter of bone formation, were positively related to parameters of disease activity. Serum osteocalcin, another parameter of bone formation, was not related to parameters of disease activity. Patients with active disease (ESR > or = 28 mm and Ritchie articular index > or = 8) had a significant higher urinary Ca and OHP excretion (62 and 42% higher, respectively) than patients with inactive disease. Serum AP and OC were slightly higher (19 and 16%, respectively) in patients with active disease. These results suggest that in RA patients bone metabolism is related to disease activity. In active disease bone resorption seems to be increased more than bone formation, suggesting that prolonged disease activity may contribute to generalized and/or localized osteopenia.

Polyarthritis as the presenting symptom of the occurrence and recurrence of a laryngeal carcinoma.

A 50 year old male smoker presented with an identical seronegative polyarthritis before both the occurrence and recurrence of a laryngeal tumour. The interval between the joint symptoms and discovery of the tumour was 11 and 13 months respectively. Treatment of the tumour resulted in complete disappearance of the arthritis on both occasions.

Tenosynovitis due to Mycobacterium avium-intracellulare: case report and a review of the literature.

A 57-year-old female patient presented with a tenosynovitis due to Mycobacterium avium-intracellulare (MAI). A relapse occurred following surgical treatment, after which she was successfully treated with ansamycin and ethambutol. Previously reported cases of tenosynovitis due to MAI are reviewed and the treatment modalities are discussed.

Total knee arthroplasty infection due to Gemella haemolysans.

Gemella haemolysans, a relatively unknown commensal of the upper respiratory tract, rarely causes clinically important infections. This report deals with an infection of a total knee arthroplasty due to Gemella haemolysans in a patient with rheumatoid arthritis. The microbiology of this bacterium is discussed and the clinical features of previously reported cases of Gemella infections are briefly reviewed.

An unusual presentation of sarcoidosis.

We describe a 35-year-old woman with arthralgias and skin lesions suggesting sarcoidosis. No pulmonary lesions were present. The diagnosis was established by histological examination of a swollen and discolored scar. We review the literature of "scar sarcoidosis" and discuss the similarities between this entity and silica granuloma.

Alizarin red S staining of synovial fluid in inflammatory joint disorders.

In 153 patients with mainly inflammatory joint disorders alizarin red S staining was used to detect calcium-containing crystals in synovial fluid (SF). The reproducibility of the results of this staining technique in 207 SF samples proved to be fairly good (65% concordant results after two observations). Electron-microscope studies confirmed the presence of apatite or calcium pyrophosphate dihydrate (CPPD) crystals in 92% of the alizarin red S positive samples, and in 27% of the weakly positive samples. Based on these figures it can be estimated that approximately 16% of SF samples obtained from patients with inflammatory joint disorders contain apatite and/or CPPD crystals. In contrast with other studies, mainly involving patients with degenerative joint disorders, no correlation was found between alizarin red S staining results and either radiological joint destruction (n = 130) or age.

Significance of rheumatoid factor isotypes in seronegative rheumatoid arthritis.

In a cross-sectional study of 124 patients with definite or classical rheumatoid arthritis (RA) and negative agglutination assays, rheumatoid factor (RF) isotypes were measured using an ELISA technique. Elevated levels of IgA-RF were found in 55 patients (44%), IgG-RF in 99 (80%), and IgM-RF in 20 (16%). The levels of IgA- and IgM-RF correlated with each other (P less than 0.001). Elevated levels of IgM-RF were associated with a more severe disease course. Elevated levels of IgA-RF correlated with the occurrence of bone erosions. The results of this study suggest that in patients with RA and negative agglutination assays, both IgM- and IgA-RF are markers of disease severity.

Melkersson-Rosenthal syndrome in a patient with sero-negative oligoarthritis.

The Melkersson-Rosenthal syndrome is a rare disease consisting of orofacial swellings, facial nerve palsy and plicated tongue. The etiology is unknown. On histopathological examination a characteristic granulomatous inflammation is found. A case of this syndrome in a young white female with seronegative oligoarthritis is described and the possible relationship between the two diseases is discussed on the basis of the literature.