Skeletal muscle pathology in systemic sclerosis.

OBJECTIVE: Systemic sclerosis (SSc) is characterized by abnormal deposition of collagen in the skin and by visceral involvement. Muscle weakness is a relatively frequent complication of SSc, although severity varies. We studied muscle pathology in patients with SSc with progressive muscle involvement. METHODS: We performed histochemical and immunohistochemical investigations to detect neural cell adhesion molecule (NCAM). RESULTS: Five of the 6 cases of SSc expressed NCAM in atrophic angulated fibers (some fibers stained heavily with oxidative enzymes). CONCLUSION: Neurogenic involvement in SSc is more frequent than reported.

[Tropical myositis]. / Miosite tropical.

The authors describe six cases of tropical myositis or pyomyositis treated in the Department of Internal Medicine of the University of São Paulo between 1985 and 1992. Staphylococcus aureus was the causative agent. It was isolated from the muscular abscess in four cases and blood cultures in two cases. The treatment with appropriate antibiotics and drainage of the abscess(es) determined satisfactory evolution without mortality or residual deformity.

[Radiological staging index of osteoarthrosis]. / Indice de estadiamento radiológico na osteoarthrose.

The association of joint pain with radiological changes (such as osteophytes, joint space narrowing, and sometimes, bone cysts and erosion) is the most commonly criteria used in daily medical practice for the diagnosis of osteoarthrosis. However, these findings do not allow objective quantification of the intensity of the joint involvement. In an attempt to measure quantitatively the radiological lesions encountered in osteoarthrosis the authors elaborated a radiological index based on the following parameters: I. severity of radiological changes, II. area of the affected joint and III. number of affected joints. The application of this index in the medical practice allows a simple way of quantification of radiological lesions of osteoarthrosis and thus, a better clinical monitorization of the disease.

[Minipulses of cyclophosphamide in the treatment of dermatopolymyositis with lung involvement]. / Mini-pulsos de ciclofosfamida no tratamento da dermatopolimiosite com envolvimento pulmonar.

A new scheme for the treatment of dermatopolymyositis with pulmonary fibrosis not responding to corticosteroid therapy is presented. Monthly endovenous administration of a small dose of cyclophosphamide is advocated. Two patients with dermatopolymyositis not responding to prednisone were treated for two years with small doses of cyclophosphamide given monthly after which recovered from muscular and pulmonary involvement showing at present normal clinical parameters.

[Systemic lupus erythematosus in the aged: clinical and laboratory characteristics]. / Lúpus eritematoso sistêmico no idoso: características clínicas e laboratoriais.

The clinical and serologic characteristics of 199 systemic lupus erythematosus patients with early and late onset of disease were compared to determine if the disease in the older age group defines a specific subset of SLE. This study demonstrated that SLE in the elderly patients exhibits peculiar clinical features with a high frequency of muscular involvement (p < 0.05) and low frequency of cutaneous manifestations (p < 0.001) and alopecia (p < 0.02). Moreover, the most frequent clinical manifestation was muscular pain and stiffness, arthritis and weight loss (over 10 kg). This condition is often hard to distinguish from polymyalgia rheumatica or underlying malignancy. The frequency of autoantibodies was similar in both groups. The absence of anti-La was surprising, however it was confirmed by "Western blotting". The symptoms of late onset SLE are not very prominent however the diagnosis should be considered in order to avoid delays in treatment.