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ID PMID Title PublicationDate abstract
11237573 Hypothesis: gonadal hormones act as confounders in epidemiological studies of the associat 2001 Mar 7 There are grounds for suspecting that, to varying degrees, smoking, alcohol consumption, oral contraceptive use, vasectomy and induced abortion are markers for high steroid hormone levels. So in epidemiological studies, false inferences may be drawn that these markers (treated as risk factors) have causal or exacerbating effects on diseases which are truly partially caused by high levels of hormones (e.g. probably prostatic cancer and breast cancer). Analogously, such studies of conditions which are truly partially caused by low levels of hormones (e.g. bone fractures, poor sperm quality, and perhaps testicular cancer and rheumatoid arthritis) may yield spurious suggestions of an ameliorative effect. The results of epidemiological studies of the above five "risk factors" for the above six pathologies are-in many cases-in striking disarray. I suggest that this is, at least partially, because of this form of confounding. The point may be tested by contrasting the hormone levels of people who self-select for smoking, vasectomy, etc., at the time that self-selection is made with those of appropriately selected control subjects.
9987954 [Scientific bases of medical examinations of patients with rheumatic diseases]. 1998 The 40-year experience of the Institute of Rheumatology has shown that follow-up in rheumatic diseases is the necessary method of management of patients with rheumatic diseases since it is the method that makes it possible to control the progression of disease and provide long-term safe treatment with glucocorticoids, cytotoxics, and other antirheumatic drugs which are now widely used in rheumatological care. Medical examination mainly made in rheumatism caused a substantial reduction in the number of relapses. Since the 1960s, intensive and scientifically grounded studies in medical examinations for other rheumatic diseases have promoted more prolonged longevity and better working fitness in the vast majority of patients. Thus, a long-term follow-up of over 600 patients with exanthematous lupus erythematosus made it possible to detail its clinical picture and to develop the therapeutical programmes that control the progression of the disease in 93% of the patients who had been incurable before. In rheumatoid arthritis, the follow-up of large groups of patients by using the computer database has enabled the researchers to develop a mathematically accurate method for prediction of the progression of disease by employing the integral parameter--the index of severity, as well as to reveal a number of important regularities of treatment. A follow-up of patients with reactive arthritis, Bekhterev's disease, systemic scleroderma, and other rheumatic diseases is shown to be of great importance.
9588275 Oral tolerance: mechanisms and therapy of autoimmune diseases. 1998 Jan Oral tolerance is a state of immune hyporesponsiveness induced by the oral or mucosal exposure to antigens. This state is dependent on the dose of the oral antigen administered, with a low dose stimulating regulatory T cell development leading to an active immune suppression that is transferable via T cells. The active mechanism appears to be a cytokine mediated immune deviation with a predominant Th2 and Th3 response (TGF-beta). In contrast, high dose oral antigens lead to clonal deletion and anergy. The active suppression of low dose oral tolerance can also suppress an unrelated immune response (bystander suppression) paving the way for therapy of autoimmune diseases like rheumatoid arthritis. Oral tolerance has been effective in the treatment of autoimmune diseases like experimental autoimmune encephalomyelitis (EAE), collagen-induced arthritis (CIA) and insulin-dependent diabetes in animals. However, recent studies in human autoimmune diseases have not been as effective but the results are encouraging and more work is required to understand the mechanisms involved and other factors that may modulate the response.
9575116 [Parvovirus B19 as infectious agent in infants]. 1997 Dec OBJECTIVE: Since its casual discovery and implication as a human pathogen that provokes transitory aplastic crises and infectious erythema, the B19 parvovirus has been related to a wide spectrum of diseases. To better understand this clinical diversity, we reviewed the cases of a serology positive infants admitted to the hospital. PATIENTS AND METHODS: From January 1992 to June 1995, all clinical charts were reviewed and we obtained 15 patients that had positive IgM antibodies by immunoenzyme assay. RESULTS: The mean age was 12.2 months. No sex differences were seen. The incidence was higher in winter months. Over 50% of the patients belong to the last year studied. Clinical findings included 5 cases of arthritis (one juvenile rheumatoid arthritis, one polyarticular syndrome and 3 nonspecific forms), hematology disturbances in 5 cases (1 case of erythrophagocytosis, 1 of thrombocytopenic purpura, 2 of anemia and 1 chronic neutropenia), 3 cases of febrile syndrome, 1 liver dysfunction, and 1 neuromyelitis. Complementary exams were not significant and follow-up in all infants was satisfactory. CONCLUSIONS: The B19 parvovirus, a poorly understood virus, is related to many clinical situations where is true significance remains unknown.
9433402 Sociodemographic characteristics and gynecological disease in 40-42 year old women reporti 1997 The study, which was part of a cardiovascular screening programme of 40-42 year old women organised by the National Health Screening Service, wanted to assess the prevalence of locomotor complaints in Middle-Norway. Forty-nine percent of the respondents reported the occurrence of musculoskeletal disorders. Low back pain and myalgia was the most and chronic inflammatory joint diseases the least frequent. Between healthy women and some groups of women reporting musculoskeletal disorders, significant differences in sociodemographic background, workload, working ability, and health care utilisation emerged. Among lifestyle factors, smoking was significantly more frequent for women reporting fibromyalgia. Analysing the occurrence of symptoms and diseases in the genital tract revealed that a significantly higher proportion of women reporting musculoskeletal disease answered positively. Differences between healthy women and women reporting pelvic joint syndrome, fibromyalgia, whiplash, or arthritis were significant in bleeding disorders chronic pelvic pain and inflammatory pelvic disease. Patients with rheumatoid arthritis reported oophorectomy significantly more often than healthy women. In conclusion, a high rate of musculoskeletal symptoms and disorders was reported by middle-aged women. A strong association between musculoskeletal disorders and gynecological disease was found.
11293366 Developing interventions for chronically ill patients: is coping a helpful concept? 2001 Mar In this review, the role of coping in the development of psychosocial interventions for chronically ill patients is discussed. After summarizing the theoretical issues involved in the translation of the coping concept into an intervention, a review is undertaken of 35 studies concerned with the impact of interventions aimed at improving coping on patients' quality of life. These studies concern seven different chronic disease types (AIDS, asthma, cancer, cardiovascular diseases, chronic pain, diabetes, and rheumatoid arthritis) and show explicit consideration of attempts to manage illness in terms of coping to be rare. Many studies nevertheless address the equivalent of coping, namely behaviors and/or cognitions intended to deal with an illness situation appraised as stressful. The results of these studies are encouraging, although largely limited to the improvement of one or two particular coping strategies and problem-focused strategies in particular. It is argued that in order to expand on these initially positive findings, greater and more explicit consideration should be given to the potential of the coping concept for intervention with the chronically ill. The appraisal of stressful situations, the use of coping resources, and the strategic application of particular coping strategies should, for example, be given more careful consideration.
10691927 Autoantibodies to DEK oncoprotein in systemic lupus erythematosus (SLE). 2000 Mar Autoantibodies against the transcriptional DEK protein have been considered characteristic of the pauciarticular onset subtype of juvenile rheumatoid arthritis (JRA) associated with iridocyclitis in young girls. In this study we investigated the presence of anti-DEK autoantibodies in the sera of 288 patients with SLE using a recombinant DEK protein as autoantigenic target. Thirty sera (10.4%) were positive against DEK protein by immunoblotting. Patients with anti-DEK autoantibodies show a lower frequency of cutaneous manifestation, exhibit more frequently certain markers of a chronic inflammatory status like anaemia and positivity for C-reactive protein, as well as a higher frequency of anti-double-stranded DNA autoantibodies. In contrast to JRA patients positive for anti-DEK autoantibodies, no association with erosive arthritis nor iridocyclitis were found in SLE. In conclusion, our results show that 10.4% of SLE patients from our area show antibodies against DEK protein, although this feature did not clearly establish a clinical subset of the disease.
11832039 [Clinical analysis of 13 infected total knee replacements]. 2000 Apr OBJECTIVE: To investigate the cause, treatment and its result of infected total knee replacements (TKRs). METHODS: Between 1987 and 1999, 13 infected TKRs in 13 patients were treated with surgical debridement and one-stage or two-stage reimplantation. The preoperative average ROM of knees was 55 degrees and the average Hospital for Special Surgery (HSS) knee score was 36.5 points. Clinical results were evaluated after average follow-up for 3 years and 5 months. We analyzed the factors for TKR infection. RESULTS: No recurrent infection was noted, and pain was significantly alleviated in all patients. The average ROM of knees was 85 degrees and the average HSS knee score was 73.5 points. CONCLUSIONS: The high risk factors for TKR infection are rheumatoid arthritis, steroid administration, associated diabetes mellitus, hinged prosthesis and previous knee surgery. Early surgical debridement with intravenous antibiotics is necessary as soon as deep infection is detected. Two-stage reimplantation is more effective in eradicating deep infection than single debridement or one-stage reimplantation.
10941715 Gold and palladium burden from dental restoration materials. 2000 Jun From 81 volunteers (16 without dental restorations, 65 with gold crowns or inlays) samples of saliva before and after chewing gum, blood, serum, urine and faeces were taken and analysed for gold (Au) and palladium (Pd). The Au concentration in all analysed biomonitors correlates significantly to the number of teeth with gold restorations. For Pd the correlations were still significant, but weaker than for Au. Persons with gold restorations show maximal Au and Pd concentrations, 10(2)-10(3) higher than the background burden. The calculated maximal daily Au load in saliva (1.38 mg Au per day) reaches the range of an oral Au therapy for rheumatoid arthritis with 6 mg Auranofin (= 1.74 mg Au per day). During this therapy severe and frequent side effects are reported. In contrast, the Au concentration in serum maximally reached from Au restorations, amounts to only approximately 1/20 of the Au level during arthritis therapy. But even under subtherapeutic doses of 1 mg Auranofin/day severe side effects have been reported (4 out of 56 cases). The mean Au blood concentration from 1 mg Auranofin daily was only 3 times higher than our maximum value. A toxicological classification of the Pd values is difficult, because no toxicological threshold limit has been established, especially for the low-level long-term burden with Pd.
10067389 Takayasu arteritis--a case report of aortic aneurysm. 1998 Nov Aortic pseudo-aneurysm is a rare manifestation of Takayasu arteritis. We present a 16-year-old girl who first complained of multiple arthritis, recurrent abdominal pain and malaise at the age of 15 years. The initial working diagnosis was juvenile rheumatoid arthritis. Follow-up abdominal ultrasonography for her hepatomegaly incidentally revealed an aortic aneurysm. Total aortography showed diffuse aortic narrowing and an infra-renal aortic pseudo-aneurysm. Vascular reconstruction with an interposition Dacron graft was performed with uneventful recovery. Early non-specific presentation of Takayasu arteritis often results in delay of diagnosis. The presence of a vascular bruit in a young female with non-specific symptoms should point to a differential diagnosis of Takayasu arteritis. We review the role of surgery in the management of this condition.
10050456 [A comparative evaluation of the efficacy of peroral and intravenous pulse therapy with me 1998 Oct Pulse therapy with methylprednisolone (Solu-Medrol, Upjohn), 1000 mg daily over three successive days, was administered to patients in two randomized groups of 14 patients in each (23 patients with systemic lupus erythematosus, 5 with rheumatoid arthritis). In one of the groups the drug was taken per os, the other received it intravenously. There was no significant difference between the two groups in terms of clinical effectiveness and incidence of side effects However, the time-related course of such indices as erythrocyte sedimentation rate, the level of leukocytes, of total protein, urea, the blood antioxidant potential, permeability of erythrocytic membranes and capillary and tissue barrier proteinuria as well as the content of immune complexes in the arterial and venous blood was more striking with per os intake. Of the 14 patients, 11 demonstrated short-continued asymptomatic 35% rise in the activity of alaninaminotransferase.
11828720 [Multiple myeloma with Sweet disease developing from monoclonal gammopathy of undetermined 2001 Dec A 57-year-old woman was diagnosed as having monoclonal IgG kappa gammopathy of undetermined significance with Sjögren syndrome. Five years later, she was admitted with an increased level of serum IgG and diagnosed as having multiple myeloma. After admission, fever and painful erythema developed. Combined chemotherapy with adrenal cortical steroid diminished the skin lesions. Erythema recurred during treatment with granulocyte colony-stimulating factor for neutropenia due to chemotherapy. A biopsy specimen from the skin revealed dense neutrophilic infiltration in the dermis, and a diagnosis of Sweet disease was made.
11061090 [A case of Sjögren's syndrome with pleural effusion]. 2000 Aug A 45-year-old woman was admitted to our hospital because of a fever. A round erythema was noted on the skin, suggesting collagen disease. Bilateral pleural effusion developed during hospitalization, and serum and pleural effusion were positive for antinuclear antibody, RA factor, anti-SS-A antibody, and anti-SS-B antibody. A diagnosis of Sjögren's syndrome was made on the basis of reduced lacrimation and the histological findings in a biopsy specimen from the lip. The cells in the pleural effusion were predominantly lymphocytes, and so a pleural lesion associated with Sjögren's syndrome was suspected, but reports of this condition have been scarce. Good therapeutic results were obtained by corticosteroid administration. Sjögren's syndrome should be considered in the differential diagnosis of pleural effusion associated with collagen disease.
10862414 [Hyperferritinemia and diseases]. 2000 Jun 1 Ferritin is the principal iron storage protein participating in iron metabolism. As serum ferritin levels often reflect the amount of storage iron in the body, physicians have measured serum ferritin in order to evaluate iron deficiency or overload. Although a rise in serum ferritin concentration occurs in iron overload, hyperferritinemia without it has been reported in some inflammatory diseases and malignancies. Some cytokines have been reported to be responsible for the elevation of ferritin production. Studies on serum isoferritin in adult Still's disease and other diseases, especially measurements of the proportion of glycosylated ferritin, have been widely accepted. Pathophysiological properties of the increased serum ferritin are not clear. However, we should be aware that the hyperferritinemia is not a result, but is profoundly participating in the disease process.
9844659 Sjögren syndrome: comparison of assessments with MR sialography and conventional sialogra 1998 Dec PURPOSE: To compare the diagnostic accuracy of magnetic resonance (MR) sialography with that of conventional sialography in the assessment of salivary gland disease in Sjögren syndrome. MATERIALS AND METHODS: Thirty-five patients (32 women, three men; age range, 18-69 years) suspected of having Sjögren syndrome were examined with MR sialography and conventional sialography. Gradient and spin-echo MR sialography was performed with a 1.5-T system. MR sialographic findings were compared with conventional sialographic findings. RESULTS: In 31 (89%) patients, the stage of salivary gland disease determined with MR sialography accurately correlated with that determined with conventional sialography. However, the stage at MR sialography was higher in two patients: They had stage I disease but were determined to have stage II disease. In two other patients, the stage at MR sialography was lower: A patient with stage II disease and a patient with stage III disease were determined to have stage I and stage II disease, respectively. The correlation between the stage at conventional sialography and that at MR sialography (P < .001) can be estimated with the following equation: conventional sialographic stage = 0.021 + 0.982 x (MR sialographic stage). Both the sensitivity and the specificity of MR sialography in the diagnosis of Sjögren syndrome were 100%. CONCLUSION: MR sialography is highly accurate in the evaluation of salivary gland disease in Sjögren syndrome.
9649023 Extreme right lobar atrophy of the liver: a rare complication of autoimmune hepatitis. 1998 Jun Lobar atrophy is a rare morphologic change of the liver. We describe a 73-year-old woman with mild liver dysfunction and history of Sjögren's syndrome who had right hepatic lobar atrophy. Serum biochemistry levels were as follows: albumin, 4.5 g/dl; total bilirubin, 1.0 mg/dl; alanine aminotransferase, 25 international units/l; aspartate aminotransferase, 27 international units/l; alkaline phosphatase, 333 international units/l; and gamma-glutamyl transpeptidase, 332 international units/l. Serological data were as follows: rheumatoid factor, 27.9; anti-nuclear antibody, 1:640; and antismooth muscle antibody, 1:80. Viral markers for hepatitis B were all negative. Anti-hepatitis C virus (anti-c-100) was negative. Portal hypertension developed thereafter, and the patient died of hepatic failure at age 76. Postmortem examination revealed autoimmune hepatitis with moderate fibrosis, portal vein thrombus, and complete obstruction of the right hepatic duct due to hepatolithiasis. Terminal hepatic failure resulted from combination of decreased hepatic volume due to the right lobar atrophy, exacerbation of autoimmune hepatitis in the remnant left hepatic lobe, decreased portal venous blood flow due to thrombosis, portal hypertension, and cholangitis with hepatolithiasis. This is the first reported case of hepatic lobar atrophy due to autoimmune hepatitis. From a clinical standpoint, patients with hepatic lobar atrophy, even if asymptomatic, should be followed up with careful attention to progression of liver diseases, portal hypertension, and biliary complications.
10941353 Clinically significant and biopsy-documented renal involvement in primary Sjögren syndrom 2000 Jul Clinically significant renal involvement in patients with primary Sjögren syndrome (pSS) has been described previously only in isolated case reports. The prevalence and significance of the 2 described syndromes, interstitial nephritis (IN) and glomerulonephritis (GMN), are not well known. In a cohort of 471 patients with pSS who were followed for a mean of 10 years, 20 patients (4.2%) developed overt renal disease. Eighteen patients underwent a percutaneous renal biopsy; 2 patients declined. Ten patients had IN, 8 patients had GMN, and 2 patients presented with both entities. Glomerular histology disclosed changes compatible with membranoproliferative GMN in 5 patients and mesangial proliferative GMN in 4 patients. Patients with IN had a younger disease onset compared with patients with GMN (mean, 36.8 compared with 46.0 yr, p 5 0.063). Patients with GMN had longer disease duration compared with patients with IN (mean, 2.2 compared with 8.0 yr, p 5 0.001). The majority of patients with GMN (80%) had mixed monoclonal cryoglobulinemia IgMk (type II) and lower complement C4 levels. Two patients (both with GMN) developed chronic renal failure requiring hemodialysis. Overall, clinically significant renal involvement is infrequent in pSS. IN occurs early in the disease process, while GMN is a late sequela and may have a less favorable prognosis.
11477481 Glutathione S-transferase genotypes in systemic sclerosis and their association with clini 2001 Jun The glutathione S-transferases (GSTs) are a family of enzymes involved in limiting oxidative damage to tissues. Null alleles for one or more of the GST enzymes, especially GSTM1, reportedly occur more frequently in patients with Sjögren's syndrome and systemic lupus erythematosus who possess certain autoantibodies. Because systemic sclerosis (SSc) is a disease in which oxidative damage has been hypothesized to contribute both to immune dysfunction and tissue damage, we sought to determine if patients from a multi-ethnic cohort of SSc patients with early disease (< or =5 years) were more likely than ethnically-matched normal controls to have null alleles for GSTM1 (M1) and/or GSTT1 (T1), and if the null allele status correlated with any major disease features. The data show that while M1 and T1 null genotypes were not significantly increased in SSc compared to ethnically matched controls, their frequencies (especially T1 nulls) were significantly higher among SSc patients with hypertension and pulmonary involvement. This suggests that GST genotype may be a genetic factor that contributes to clinical disease expression in SSc.
10524558 A complex case of hepatitis in a patient with systemic lupus erythematosus. 1999 Liver involvement in patients with systemic lupus erythematosus (SLE) is considered rare. Previous treatment with potentially hepatotoxic drugs or viral hepatitis have usually been implicated as the main causes of liver disease in SLE patients. On the other hand, even after careful exclusion of these aetiologies, the problem remains whether to classify the patient as having a primary liver disease with associated autoimmune clinical and laboratory features resembling SLE, such as autoimmune hepatitis, or as having liver disease as a manifestation of SLE. We report the case of an elderly woman who presented with acute hepatitis, who had been diagnosed with SLE 14 years ago and who also had Sjögren's syndrome and anti-phospholipid's syndrome for several years. The histology depicted chronic active hepatitis and, after drug-induced hepatitis and viral hepatitis were excluded, the serological and clinical features were shown to be typical of liver damage caused by SLE. The patient was treated with azathioprine 100 mg/d and prednisone 30 mg/d. The clinical symptoms resolved in 10 days and the laboratory values were normal at the end of the first month of therapy. Prednisone was progressively reduced, during a period of 4 months, to 10 mg/d but azathioprine was kept to the same dose. One year after the diagnoses the patient is still in remission. Although uncommon, hepatic involvement is well recognised in SLE. The interest of this case lies in the differential diagnosis and recognition of this condition, which deserves an aggressive treatment.
10437043 [Biopsy of labial salivary glands and lacrimal glands in the diagnosis of Sjögren's syndr 1997 May OBJECTIVES: To determine the diagnostic value for Sjögren's syndrome (SS) by evaluating the presence of focal adenitis in labial salivary gland (LSG) and lacrimal gland (LG) biopsy specimens. METHODS: 109 suspected cases with SS underwent the biopsies. The diagnostic criteria of Fox et al. were followed. Both Chisholm-Manson's grading standard and Greenspan's focus score were used for the evaluation. RESULTS: Myoepithelial islands and severe lymphocyte infiltration with germinal centers were observed only in LG biopsy specimens. The lymphocytic foci scored of LG were significantly higher than that of LSG in 23 cases having both biopsy results. The evaluation of both kinds of specimen for such a patient was significantly more effective in diagnosing SS than using either one of them alone. CONCLUSION: We recommend that both LSG and LG biopsies be performed in patients suspected of having SS to reduce false negative results and improve diagnostic accuracy.