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ID PMID Title PublicationDate abstract
7676020 [Synovial lesions of the upper ankle joint]. 1995 Jul The ankle is a typical synovial joint. It is affected by systemic as well as locally limited synovial processes. Looking at oligo- and polyarticular diseases it is affected by Reiter's Syndrome and Rheumatoid Arthritis in young patients. In middle aged people Crystal Synovitides dominate the picture and in old age Gout and tumorous lesions are seen. Looking at monarticular inflammatory processes one has to think of tuberculosis first. Crystal-induced monarthropathies such as hemochromatosis can also start at the ankle. In this review we describe the possible inflammatory diseases of the talocrural joint and present a diagnostic algorithm.
8336301 Binding of human monoclonal IgG rheumatoid factors to Fc is influenced by carbohydrate. 1993 May OBJECTIVE: The precise nature of the epitope on the Fc portion of the IgG molecule to which IgG rheumatoid factors (RF) bind has not been identified. As patients with rheumatoid arthritis (RA) have abnormal glycosylation of the Fc portion of IgG, we investigated the impact of the sugar present in the Fc on the binding of IgG RF. METHODS: Binding of monoclonal IgG RF to Fc fragments with varying oligosaccharide chains was detected using an immunoblot assay. RESULTS: We demonstrated that the binding of human hybridoma derived monoclonal IgG RF was strongly influenced by the presence of carbohydrate and was maximal when the carbohydrate molecule was intact. The RF did not bind directly to the carbohydrate moiety itself. CONCLUSION: This suggests that conformational changes in the polypeptide chain induced by the carbohydrate are responsible for the observed binding patterns.
27911625 Care of a patient with rheumatoid arthritis and a vasculitic ulcer. 1993 Mar 2 The treatment of an elderly woman's vasculitic leg ulcer and gross oedema of the legs is described.
8835299 Diagnostic value of synovial fluid analysis in children with reactive arthritis. 1995 We report on three children with pauciarticular arthritis in whom the clinical picture and serology were compatible with both arthritis reactive to infection with Yersinia or Salmonella and with Lyme arthritis. Results of analysis of synovial fluid by polymerase chain reaction for enterobacterial or borrelial sequences were negative. Immunofluorescence with specific antibodies revealed the presence of amorphous enterobacterial antigens in synovial fluid cells. Since this staining did not reveal enterobacterial morphology, we infected synovial fluid cells of two children with juvenile rheumatoid arthritis in vitro with Yersinia or Salmonella. After 24 h typical rods were observed, but after about 1 week amorphous antigen similar to what had been found in the three patients was seen. In cases of reactive arthritis with ambiguous results of serological testing the diagnosis may be confirmed by demonstration of enterobacterial antigens in synovial fluid.
1377772 [Therapy of juvenile rheumatoid arthritis]. 1992 May The correct drug treatment of JRA must consider the course and the subtype of the disease. Nonsteroidal antiinflammatory drugs are the first choice treatment, especially the recent ones which are more active and less toxic. The slow-acting antirheumatic drugs are the second choice treatment and must be employed in the chronically active stages of the disease; good results have been obtained with sulphasalazine and methotrexate both on clinical features and on blood biochemistry with relatively scarce side effects. Thymic hormones, cyclosporin A and intravenous immunoglobulins, though not yet widely experienced, can represent a worthwhile alternative to standard treatment in carefully selected cases. Steroids must be used only in special cases (particularly aggressive systemic JRA, carditis, severe anemia and those patients who fail to respond to usual treatments) and must be withdrawn as soon as possible to avoid adverse effects and steroid-addiction. Intraarticular long-acting steroids are the first choice treatment for rheumatoid monoarthritis.
7632094 Association between human parvovirus B19 infection and arthritis. 1995 Jun OBJECTIVE: To gain information concerning the association between parvovirus B19 infection and arthritis. METHODS: Blood or synovial fluid, or both, from a total of 77 adult patients with various arthropathies (rheumatoid arthritis 13; mechanical arthropathies 11; crystal induced arthritis 13; idiopathic mono/oligoarthritis 25; suspicion of viral arthritis 15) were tested for the presence of the viral genome and anti-B19 antibodies. B19 DNA in blood and synovial fluid was investigated by nested polymerase chain reaction, and anti-B19 IgM and IgG antibodies were detected in blood by enzyme immunoassay. RESULTS: A recent parvovirus infection was documented by the presence of anti-B19 IgM antibodies in the blood of 13 patients. B19 DNA, together with anti-B19 IgM and IgG antibodies, were detected in the blood of seven patients who had an acute transient arthritis, putatively of viral origin. Viral DNA was detected in a synovial fluid sample and in the blood of one patient with monoarthritis who had an anti-B19 IgG response only. CONCLUSIONS: The prevalence of anti-B19 IgG antibody in these patients with various forms of arthritis (63%) was within the same range as that in the general population (blood donors). However, for the patients with clinical suspicion of viral arthritis, the increased seroprevalence of anti-B19 IgM and the presence of the B19 genome point to an association between human parvovirus infections and acute forms of arthritis.
8719553 Inappropriate secretion of antidiuretic hormone (SIADH) in a patient with pleurisy related 1995 Dec The syndrome of inappropriate secretion of antidiuretic hormone (ADH) or SIADH has been so far reported in various disorders. However, to our knowledge, no case of SIADH associated with adult onset Still's disease (AOSD) has been described in the literature. We report on a patient who developed inappropriate secretion of antidiuretic hormone (SIADH) during the course of adult onset Still's disease (AOSD). The patient developed SIADH associated with pleuritis and improved when pleuritis subsided during the course of steroid therapy. Thus, it seems suggest that SIADH was induced by AOSD which is considered to be related with vasculitis.
1523525 [A case of Sjögren syndrome associated with sarcoidosis]. 1992 Jun A 70 year-old female with a 6-year history of primary Sjögren syndrome was admitted with fever and loss of weight. Examinations such as the lip biopsy reconfirmed the diagnosis of primary Sjögren syndrome. Abdominal CT and gallium scan showed lymphadenopathy in the abdominal cavity, and an exploratory biopsy was done. Lymph nodes and liver biopsy specimens revealed multiple noncaseating granulomata with some Langhans' giant cells, consistent with sarcoidosis. It has been previously proposed that connective tissue disease and sarcoidosis are related in terms of pathogenesis because both diseases share common immunological features and abnormalities in regard to cellular and humoral immunity. Indeed some data in the literature show a striking similarity between the lymphocyte subpopulation in the parotid gland of Sjögren syndrome and the bronchoalveolar lavage fluid of sarcoidosis. However, it is difficult to assume the same pathogenesis for both diseases, because this aspect of the diseases has not been completely clarified. Despite the fact that the two share common immunological features and abnormalities, the coexistence of primary Sjögren syndrome and sarcoidosis has rarely reported.
1409096 Quantitative immunohistologic study of lip biopsies. Evaluation of diagnostic and prognost 1992 Jun In a group of 45 patients with Sjögren's syndrome (SS) and 80 controls the high specificity (95%) and sensitivity (100%) of a recently proposed bivariate quantitative immunohistologic (QIH) criterion for SS, based on percentages of IgA and IgG-containing plasma cells in labial salivary gland (LSG) tissue, was confirmed. The best univariate QIH criterion for discrimination between LSG biopsies of SS patients and controls appeared to be based on the percentage of IgA containing plasma cells, and had a specificity of 99% and a sensitivity of 96%. A criterion based only on the percentages of IgM-containing plasma cells, proposed in another recent study, resulted in a high number (31%) of false negatives. Interobserver reproducibility of QIH diagnoses was excellent. Moreover it was demonstrated that accuracy, precision and the interobserver reproducibility of plasma cell counting depends on the choice of tissue fixation and immunohistologic staining procedure. The combination of formol sublimate fixation and peroxidase anti-peroxidase procedure appeared to be the best combination for QIH examination. Furthermore, in 2 SS patients systemic monoclonal IgM/kappa gammopathy was preceded by high predominance of IgM and kappa containing plasma cells in the plasma cellular infiltrate of the LSG tissue.
1392371 Recurrent parotid swelling in children: clinical features useful for differential diagnosi 1992 Jun Immunological evaluations were performed in 59 children with at least five episodes of parotid swelling. Autoantibody(ies) was transiently or persistently detected in 12 (20%) of 59 patients with recurrent parotitis. Three of the 12 children with autoantibodies were diagnosed as having Sjögren's syndrome. The mean age at onset of parotid swelling in Sjögren's syndrome was significantly higher than that of recurrent parotitis of unknown etiology. The present study and the review of the literature suggest that patients with the onset of parotid swelling at age five years or over deserve screening for underlying systemic immune disorders.
1519433 Felty's syndrome: favorable response to granulocyte-macrophage colony-stimulating factor i 1992 We report a case of Felty's syndrome in which infectious complications due to severe neutropenia could be overcome by short-term treatment with recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF, 7 micrograms/kg/day s.c.). Leukocyte counts rose from 1,050/mm3 at presentation to 4,470/mm3 after 15 days of treatment. A flare-up of arthritis was not noted. Defects in granulocyte function and clinical improvement prior to leukocyte rise suggest that the beneficial effect of GM-CSF is mainly due to an improvement of granulocyte function.
8202421 Acute polyarthritis. Fifth disease passed from child to adult. 1994 Jun Physicians are familiar with the "slapped cheek" rash seen in childhood cases of erythema infectiosum. Less well known is that infection with its pathogen, parvovirus B19, often becomes manifest in adults as acute viral arthropathy. In evaluation of suspected cases, a complete blood cell count and blood chemistry profile are useful additions to thorough history taking and physical examination. Differential diagnosis includes Lyme disease, other viral infections, acute rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Treatment is symptomatic with nonsteroidal anti-inflammatory drugs.
9063938 [RS3PE syndrome: presentation of two cases]. 1996 Dec Recently, the syndrome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE), has been proposed. The RS3PE syndrome has an acute onset, does not produce bony erosions, with a predilection for elderly patients and an excellent prognosis. This condition distinguishing if from rheumatoid arthritis and polymyalgia rheumatica. The purpose is to call attention to a benign forms of arthritis in aging patients. We report two cases of RS3PE syndrome.
8742392 [Acute paraparesis associated with dorsal diastematomyelia in an adult]. 1996 Mar Diastematomelia presenting in adult life has long been considered a rare occurrence. With the development of modern imagining techniques, cases of adult are being discovered with increasing frequency, but their exact number remains unclear. It occurs most often in the lumbar region, is rarely located above the level of T3 and it present clinical features such as deformity of the food, peculiar posture, or gait disturbance. The symptoms and signs of diastematomelia usually are recognized in children. We are reporting the case of an adult patient who had a forme frustre of Sjögren's syndrome and thoracic diastematomelia presenting as a acute myelopathy. Although in most of patients, the pathogenesis of the neurological deficits could be attributed to lesions such as spondylosis, herniation of a disc, traction injury or the tethering effect derived from an osseous septum or a fibrous band, in our patients was absent. We suggested as contributory cause to damage of the spinal cord a vascular ischemic mechanism during flexion and extension of the spine, and we postulated the role that anti-Ro (SS-A) antibodies play in the immunopathogenesis (mediating or potentiating) vascular injury by altering vascular endothelial function or proliferation.
8531372 [Cutaneous manifestations of primary Sjögren's syndrome]. 1995 Oct Cutaneous manifestations including purpura, annular erythema and pernio-like erythema are one of the extraglandular findings of primary Sjögren's syndrome (SS). Histopathologically, inflammatory vascular lesions are frequently detected. Two types of annular erythema, edematous and atrophic types, can be seen. Histopathologically, atrophic annular erythema is hardly distinguished from SCLE. Skin lesions of primary SS, especially purpura and edematous annular erythema, are related with anti-SS-A/Ro and SS-B/La antibodies. Some of the cutaneous manifestations develop both in primary SS and lupus erythematosus and anti-SS-A/Ro and SS-B/La antibodies may play an important role in the development of these cutaneous lesions.
7837169 Partial splenic embolization for Felty's syndrome: a 10-year followup. 1994 Oct Partial splenic embolization was performed in a case of Felty's syndrome in 1980. The granulocyte count has since remained normal without serious infections for the 10 years after the procedure. This is the first report of partial splenic embolization in this syndrome. This treatment may have an advantage over splenectomy because the defense mechanisms of the spleen are preserved and overwhelming infections may occur less frequently.
8235881 One-stage "front" and "back" correction for rigid cervical kyphosis. A safer technique of 1993 Oct 1 This report describes a new safe technique for surgical correction of rigid cervical kyphosis, in a very rare case of adult-onset Still's disease. It differs from all the previously mentioned reports of similar corrective osteotomies, the essential difference being a combined anterior (front) and posterior (back) approach performed at one stage (under a single anesthesia). The "front" is a release procedure of an open-wedge variety, and the "back" is a closed-wedge type of osteotomy. Such a double procedure ensures a slow and controlled correction at the preoperatively determined level, rather than a snapshot, rapid, and often a violent correction, which may occur at an undesired level. This osteotomy is performed under general anesthesia after an endotracheal intubation by a special "guided" maneuver. This new technique, the authors believe, is only a more comfortable option for the surgeon, but also a safer alternative for the patient.
7738274 Clinical analysis of recurrent hypergammaglobulinemic purpura associated with Sjögren syn 1995 Mar Recurrent purpuric lesions are occasionally seen in patients with Sjögren syndrome. Hypergammaglobulinemia is one of the underlying precipitating factors of this condition. Clinical and histopathological analyses were performed on 5 cases of hypergammaglobulinemic purpura associated with Sjögren's syndrome, and the effects of immunomodulatory therapy were evaluated with regards to these conditions. Three out of 5 cases were successfully treated with oral gold compound (Auranofin) and one case with a low dose of cyclophosphamide. Episodic purpura subsided two months after initiation of therapy with improved serum IgG levels. Salivary flow and serum amylase levels also improved in some cases. Immunomodulatory therapy may be useful in managing recurrent purpura based on hypergammaglobulinemia associated with Sjögren syndrome.
7979594 Obstetric and gynaecological profile in patients with primary Sjögren's syndrome. 1994 Sep OBJECTIVE: To describe the effects of Sjögren's syndrome (SS) on the fertility, parity and sexual activity as well as investigating the aetiopathology of dyspareunia in female patients. METHODS: Fifty one female patients with primary SS (pSS) and 57 healthy controls were interviewed concerning their past gynaecological, obstetric and sexual history and underwent a complete gynaecological examination. Punch biopsy of the vagina was performed in six patients and one healthy individual. In addition, the vaginal tissue was evaluated following hysterectomy in two patients with pSS. RESULTS: No differences were observed in fertility, parity or reproductive success rate between patients and controls. Atrophy of the external genitalia and production of cervical mucus in both patients and controls correlated with age and menopause, but not with other clinical or serological pSS manifestations. Dyspareunia was observed in 40% of the patients during the premenopause period compared with 3% observed in controls. Half of the patients, however, had an obvious aetiology for dyspareunia (trauma or inflammation) not related to pSS. The histological picture of the patients' vaginal tissue revealed perivascular infiltration. Finally, pSS patients appeared to have a similar intercourse frequency with the controls. However, unlike that observed in controls, the intercourse frequency did not diminish with age nor with the presence of dyspareunia. CONCLUSION: The fertility, parity and sexual activity of pSS patients does not appear to differ from that of the healthy population. Dyspareunia is a frequent symptom in these patients and local perivascular in these patients and local perivascular inflammation may contribute to the expression of this manifestation.
7621008 Quantitative assessment of dysphagia in patients with primary and secondary Sjögren's syn 1995 Mar Dysphagia is a common complaint from patients with salivary gland dysfunction. The purpose of this study was to assess and compare dysphagia in two patient groups with salivary gland dysfunction (primary Sjörgen's syndrome and secondary Sjögren's syndrome with systemic lupus erythematosus, and a matched control group. Subjects diagnosed with primary Sjögren's syndrome (n = 13) and secondary Sjögren's syndrome with systemic lupus erythematosus (n = 15) were selected for the study. An age- and sex-matched group of control subjects (n = 14) was selected for comparison. Dysphagia assessments, including videofluoroscopy were performed. Dysphagia was quantified clinically and videofluoroscopically by measurement of 10 seconds of basal or dry swallows as compared with 10-second 10-ml water bolus swallows in all subjects. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significant difference in the dry swallows as compared with the water bolus swallows for both salivary gland dysfunction groups and for both dry swallows and water bolus swallows as compared to controls. Videofluoroscopy yielded significantly prolonged pharyngeal transit times in both salivary gland dysfunction groups as compared with control. Subjective results indicated a greater degree of dysphagia symptoms in both the salivary gland dysfunction groups (p < 0.001). Conclusions from this study indicate clinically significant dysphagia in patients with salivary gland dysfunction associated with Sjögren's syndrome compared with a control population.