Assuntos
Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Psoriásica/diagnóstico , Artrite Reativa/diagnóstico , Artrite Reumatoide/diagnóstico , Condrocalcinose/diagnóstico , Gota/diagnóstico , Espondilite Anquilosante/diagnóstico , Artralgia , Artrite/diagnóstico , Humanos , Inflamação , Anamnese , Exame Físico , Espondiloartropatias/diagnósticoRESUMO
Patients with multi-system rheumatic conditions may have disease affecting the central and peripheral nervous systems. Early assessment is often helpful in averting the development of serious complications, which in some conditions can be prevented by the prompt institution of treatment. We review the spectrum of neurological disease in patients with a rheumatological diagnosis. The wide variety of associated neurological complications is discussed in the context of specific rheumatic conditions, varying from spinal cord involvement in rheumatoid arthritis, to neuropsychiatric involvement in systemic lupus erythematosus and neurological sequelae in vasculitic disorders. We discuss diagnostic criteria and recommended management options (where available), and describe the role of new tools such as functional brain imaging in the diagnosis and monitoring of disease. We also discuss the potential for development of neurological complications from the use of anti-rheumatic drugs.
Assuntos
Doenças do Tecido Conjuntivo , Doenças Musculoesqueléticas , Sarcoidose , Vasculite , Antirreumáticos/efeitos adversos , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/tratamento farmacológico , Humanos , Imunossupressores/administração & dosagem , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/tratamento farmacológico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Vasculite/complicações , Vasculite/diagnóstico , Vasculite/tratamento farmacológicoRESUMO
BACKGROUND: Gut involvement in inflammatory myositis is rare but causes significant morbidity and mortality. CASE REPORT: A case of eosinophilic gastroenteritis and polymyositis occurring in the same patient is described. The interface of visceral and striated muscle involvement is discussed. The pathophysiology of eosinophilic gastroenteritis and the spectrum of gastrointestinal involvement in inflammatory myositis are also discussed. RESULTS: Both gastrointestinal and skeletal muscle symptoms improved with immunosuppression, suggesting a possible common underlying mechanism.
Assuntos
Eosinofilia/complicações , Gastroenterite/complicações , Polimiosite/complicações , alfa-Globulinas/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Eosinofilia/tratamento farmacológico , Feminino , Gastroenterite/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Polimiosite/tratamento farmacológico , Prednisolona/uso terapêutico , Resultado do TratamentoAssuntos
Antirreumáticos/efeitos adversos , Azatioprina/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Doenças do Pé/induzido quimicamente , Isquemia/induzido quimicamente , Adulto , Hipersensibilidade a Drogas/patologia , Quimioterapia Combinada , Feminino , Doenças do Pé/patologia , Humanos , Imunossupressores/uso terapêutico , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Prednisolona/uso terapêuticoAssuntos
Nefrite Lúpica/diagnóstico , Adulto , Proteínas do Sistema Complemento/metabolismo , Ciclofosfamida/uso terapêutico , Feminino , Taxa de Filtração Glomerular , Humanos , Imunossupressores/uso terapêutico , Consentimento Livre e Esclarecido , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/metabolismo , Proteinúria/diagnóstico , Manejo de Espécimes/métodosAssuntos
Deslocamento do Disco Intervertebral/complicações , Compressão da Medula Espinal/etiologia , Adulto , Vértebras Cervicais , Humanos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgiaAssuntos
Antirreumáticos/administração & dosagem , Metotrexato/administração & dosagem , Comprimidos , Administração Oral , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Cooperação do PacienteRESUMO
The first British case of fibroblastic rheumatism is reported. Treatment with apha-interferon in combination with a reducing course of steroids resulted in some regression of the cutaneous nodules, and initial improvement in the skin fibrosis and digital contractures.
Assuntos
Doenças Reumáticas/patologia , Adulto , Terapia Combinada , Fibroblastos/patologia , Humanos , Interferon-alfa/uso terapêutico , Masculino , Prednisolona/uso terapêutico , Doenças Reumáticas/terapiaAssuntos
Meios de Contraste/farmacocinética , Coração/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico , Angiografia , Imagem Ecoplanar/instrumentação , Rejeição de Enxerto/diagnóstico , Neoplasias Cardíacas/diagnóstico , Transplante de Coração , Humanos , Aumento da Imagem/instrumentação , Aumento da Imagem/métodosRESUMO
Fifteen patients with clinical gout occurring after long term treatment with diuretics were studied retrospectively. In all 15 patients one or more additional factors were present which might have contributed to the hyperuricaemia and gout. The most common of these was the impairment of the glomerular filtration rate. Twenty five other patients receiving long term treatment with diuretics who did not have gout were also studied. The concentrations of uric acid, urea, and creatinine were, in general, markedly lower in these patients than in those who had developed gout. It is concluded that diuretic induced gout occurs in patients in whom there is an additional cause of hyperuricaemia, usually impaired renal function.
Assuntos
Diuréticos/efeitos adversos , Gota/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Gota/sangue , Gota/fisiopatologia , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ureia/sangue , Ácido Úrico/sangueRESUMO
In this case report, 30 sera from a 25-year-old heroin abuser with intervertebral candidosis were treated for the presence of anti-Candida albicans antibodies by agglutination, counterimmunoelectrophoresis, and indirect immunofluorescent assay. Sera were also adsorbed with heat-killed blastospores to remove antibodies against yeast-phase cells and tested by indirect immunofluorescent assay for anti-C. albicans germ tube antibodies (CAGTAs). Humoral responses to candidal 47-kD antigen were studied by immunoblotting in 23 unadsorbed sera. Anti-C. albicans antibodies were found in high titers by the three procedures but correlated poorly with the clinical evolution of the disease. CAGTAs were present from the beginning of the infection: Titers decreased in association with antifungal treatment and the patient's improvement, eventually becoming negative. Only class IgG antibodies to the 47-kD antigen were detected. These were present during the full course of the infection, failing to disappear at the end of the study. In this case, detection of CAGTAs appeared to be an important aid to diagnosis of the bony candidal infection, as they are detected early during the illness and seemed to have a prognostic significance.
Assuntos
Anticorpos Antifúngicos/análise , Candida albicans/imunologia , Candidíase/diagnóstico , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Adulto , Testes de Aglutinação , Candidíase/complicações , Contraimunoeletroforese , Feminino , Imunofluorescência , Heroína , Humanos , Imunoglobulina G/análise , Cinética , Osteomielite/complicações , Doenças da Coluna Vertebral/complicações , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
A 25 year old woman who had received intravenous heroin over one year previously developed an intervertebral abscess due to infection with Candida albicans. Immunological investigation of this patient showed no evidence of a specific defect in the host response to candida.
Assuntos
Abscesso/etiologia , Candidíase/etiologia , Heroína , Doenças da Coluna Vertebral/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Feminino , HumanosRESUMO
Flurbiprofen has been compared with phenylbutazone in a double-blind study involving 33 patients with acute gout. Patients received either flurbiprofen 400 mg daily for 48 h followed by 200 mg daily, or phenylbutazone 800 mg daily for 48 h followed by 400 mg daily. The drugs were of comparable efficacy, while side-effects were uncommon and relatively mild. Flurbiprofen appears to be a satisfactory alternative to phenylbutazone in the management of acute gouty arthritis.
Assuntos
Flurbiprofeno/uso terapêutico , Gota/tratamento farmacológico , Fenilbutazona/uso terapêutico , Propionatos/uso terapêutico , Adulto , Idoso , Artrite/tratamento farmacológico , Ensaios Clínicos como Assunto , Método Duplo-Cego , Flurbiprofeno/efeitos adversos , Humanos , Pessoa de Meia-Idade , Fenilbutazona/efeitos adversos , Distribuição AleatóriaAssuntos
Aspirina/intoxicação , Diurese , Feminino , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-IdadeRESUMO
Azapropazone is an anti-inflammatory agent with reported uricosuric properties. The aim of the present study was to extend these observations, by examining the dose-response and to compare the uricosuric effect of azapropazone with that of probenecid. Patients were given varying doses of azapropazone from 900-2400 mg daily for 4-day periods at separated intervals. Plasma uric acid levels were measured before and at the end of each treatment period. Three other patients maintained on low purine diets were given a 4-day course of 1200 mg azapropazone daily followed at an interval by a 4-day period of probenecid 1 g daily. Plasma uric acid levels and 24 h urinary uric acid excretion were compared. The mean fall in plasma uric acid level after four days of 900 mg azapropazone daily was 31.4% (n = 9) compared with 33.9% (n = 12) on 1200 mg daily; 42.3% (n = 10) on 1800 mg daily; and 46% (n = 6) on 2400 mg daily, indicating a graded dosage response. In the three patients on low purine diets the falls in plasma uric acid levels on probenecid 1 g daily were 50.5%, 46% and 29% compared with 33.5%, 32% and 20% respectively on azapropazone 1200 mg daily. Similarly the total amount of uric acid excreted in the urine by each patient during the 4-day period on probenecid 1 g daily was 14.01; 13.03 and 8.97 mmol compared with 23.53, 10.9 and 7.69 mmol on azapropazone 1200 mg daily.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Apazona/farmacologia , Probenecid/farmacologia , Triazinas/farmacologia , Uricosúricos , Creatinina/sangue , Dieta , Relação Dose-Resposta a Droga , Humanos , Purinas/administração & dosagem , Ácido Úrico/sangueRESUMO
Crystal deposition in asymptomatic knee and first metatarsophalangeal (MTP) joints has been studied in 31 patients with previously proven gout. All had had clinical gout in their MTP joints but their knee joints had never been the site of acute gout. Knee arthroscopy was performed permitting synovial membrane inspection, photography and biopsy. Crystalline material was seen in 9 knees (28%) and confirmed histologically as monosodium urate (MSU) in 4 (12.5%). Synovial fluid analysis on 26 samples using a polarizing light microscope demonstrated MSU crystals in 4 (12.5%) and calcium pyrophosphate dihydrate (CPPD) in 2 (6%). Fluid aspirated from 27 of the metatarsophalangeal joints revealed MSU crystals in 14 (52%) and no CPPD crystals.