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ID PMID Title PublicationDate abstract
10517404 Fatal bacterial endocarditis following aortic valve replacement in a patient being treated 1999 Sep A 41-year-old man being treated with methotrexate for psoriasis underwent aortic valve replacement. He subsequently developed fulminating bacterial endocarditis. Bacterial endocarditis occurs in 1-2% of cases after prosthetic valve replacement and has a high mortality. The long-term use of methotrexate and similar drugs is increasing in conditions such as psoriasis, rheumatoid arthritis and inflammatory bowel disease. Thus, more patients undergoing heart valve surgery will be taking these preparations for coexisting disease. As methotrexate increases the risk of infection, its perioperative use in these patients requires further evaluation.
10334177 Respiratory distress due to minocycline-induced pulmonary lupus. 1999 May Minoeycline, a semisynthetic tetracycline, is often used to treat acne and rheumatoid arthritis. It has been considered an unlikely drug to be associated with systemic lupus erythematosus; however, many cases of drug-induced lupus related to minocycline have been reported. Some of those reports included pulmonary lupus, but none of the patients described developed respiratory distress. We describe a patient treated with minocycline for 2 years who presented with progressive dyspnea, severe hypoxia, and pulmonary infiltrates necessitating hospitalization and oxygen supplementation.
10068004 Infections associated with dental procedures in total hip arthroplasty. 1999 Jan Dental procedures may lead to a transient bacteraemia lasting for up to 30 minutes. Of the numerous cases of total hip arthroplasty (THA) reported which have been infected from haematogenous sources, dental procedures have been involved only infrequently. We reviewed the records of 2973 patients after THA. Of the late infections identified in 52 patients, three (6%) were strongly associated with a dental procedure. Infection was diagnosed by culture from the affected joint; Streptococcus viridans was identified in two cases and Peptostreptococcus in one. One patient had diabetes mellitus and another rheumatoid arthritis, both conditions predisposing to infection. The dental operations all lasted for more than 45 minutes and no patient received perioperative antibiotics. Infection of a THA after dental procedures is more common than has been previously suspected. Patients with systemic disease, or who are undergoing extensive procedures, should be considered for prophylactic antibiotic treatment.
9744562 Oxidized low-density lipoprotein, a two-faced Janus in coronary artery disease? 1998 Aug 1 The word antioxidant has become a household term, and every day we are bombarded with claims of antioxidant protection against a host of diseases. Atherosclerosis, cancer, gastric ulcers, memory loss, rheumatoid arthritis, endometriosis, pregnancy complications, hypertension, stroke, and a host of other diseases have been suggested to be induced by oxidative stress, and antioxidants have been suggested to be beneficial in the prevention and treatment of these disorders. While some of these may be exuberant claims, atherosclerosis is one disease in which the oxidation hypothesis has taken firm roots. The oxidation of low-density lipoprotein (LDL) has been suggested to be a key step in the initiation of the early atherosclerotic lesion. A number of proatherogenic effects have been described for both the protein and lipid components of oxidized low-density lipoprotein. In this commentary, a brief description of the involvement of oxidation and the potential for antioxidant treatment for cardiovascular disease will be provided. However, there are innumerable questions plaguing the hypothesis; this commentary, therefore, will also serve as a devil's advocate and propose that some form of oxidation might actually be beneficial.
19649818 Inhibition on inducible nitric oxide synthase. 1998 Sep The scientific community has witnessed an exponential growth curve in the number of nitric oxide (NO) related publications over the last ten years. This diatomic radical is remarkably entangled (directly and indirectly) in a multitude of physiological and pathophysiological processes, including blood pressure regulation, inflammation, apoptosis, platelet adhesion, neurotransmission and host-defense mechanisms. Of the three known isozymes responsible for catalyzing the production of NO from L-arginine (L-Arg), it is the inducible form of nitric oxide synthase (iNOS) that we wish to examine here due to its involvement in a collection of diseases, including septic- and cytokine-induced shock, immune-type diabetes, rheumatoid arthritis, tissue damage, inflammation, and inflammatory bowel disease. Controlling the unregulated overproduction of NO from iNOS has been a formidable task; therapeutic intervention strategies range from preventing iNOS mRNA expression (anticytokine antibodies/receptor antagonists) to impeding NO action (NO scavengers, guanylyl cyclase inhibitors). Within these extremes lies the most conventional tactic, prohibiting NO production from iNOS with L-arginine competitive antagonists or irreversible enzyme inhibitors. This review will cover the more recent accounts gauged toward the identification and development of novel inhibitors of iNOS.
9421191 Structure of a novel phosphocholine-containing aminoglycoglycerolipid of Mycoplasma fermen 1997 Nov 8 Mycoplasma fermentans is thought to be a pathogen of rheumatoid arthritis or a cofactor of AIDS (acquired immunodeficiency syndrome). To elucidate the possible involvement of membrane constituents in the pathogenesis of these diseases, we studied its lipid components. Several alkali labile glycophospholipids were detected and named glycoglycerophospholipids (GGPLs). Previously, we purified and determined the structure of one of them as 6'-O-phosphocholine-alpha-glucopyranosyl-(1'-3)-1,2-diacyl-sn-glycerol (GGPL-I). The present paper describes the purification and structural characterization of GGPL-III, the major GGPL of M. fermentans using 1H-, 13C- and 31P-nuclear magnetic resonance spectroscopy, and mass-spectroscopy as 1"-phosphocholine,2"-amino dihydroxypropane-3"-phospho-6'-alpha-glucopyranosyl-(1'-3)-1,2-dia cyl-glycerol.
9131192 Interactions between dietary proteins and the human system: implications for oral toleranc 1997 Mounting evidence suggests that there are a number of important, but poorly understand, interactions between dietary proteins and the human immune system. The usual response of the human immune system to dietary proteins seems to be that of oral tolerance, a phenomenon involving up-regulation of protective gut localized immune mechanisms and down-regulation of potentially harmful systemic immunity to the protein in question. Abrogation of oral tolerance may play an important role in the development of food allergies and food enteropathies. Immune mechanisms underlying oral tolerance are therefore discussed in light of current understanding of such food-related diseases as IgE mediated food allergies and gluten sensitive enteropathy. Possible development of oral vaccines to immune-related diseases like multiple sclerosis and rheumatoid arthritis is also discussed.
28246739 Wrist joint arthrodesis. Technique and outcome. 1999 Oct Arthrodesis of the wrist joint is indicated in degenerative joint desease, instability and restricted and painful range of motion. Further indications are: failed reconstruction, partial arthrodesis or arthroplasty/total joint replacement. The surgical technique depends mainly on the quality of bone substance and degree of joint degeneration. Differences can be made concerning the type of bone graft and osteosynthesis being used. The aim is to create, a stable joint in a good functional position. The position of arthrodesis depends on the patients needs. In patients with rheumatoid arthritis a straight position is generally accepted, where as in patients with degenerative joint desease, a slight wrist extension and ulnar deviation is preferred. A stable osteosynthesis with plates is reliable and allows early rehabilitation. We present 28 cases of arthrodesis with intramedullary rods and 61 cases of arthrodesis with plates. The complication rate was low, the functional results were good. We saw significant reduction of pain, increase of strength and handfunction. Arthrodesis of the wrist joint has proven to be a long term reliable and safe procedure. Loss of motion is accepted to obtain sufficient pain relief.
15992161 Clinical and pharmacological experience with etanercept. 1999 Sep Tumour necrosis factor (TNF) is the dominant mediator of the cytokine cascade that causes inflammation and joint destruction in rheumatoid arthritis (RA). A new class of agent under investigation, the biological TNF inhibitors, inhibit the activity of TNF. Recombinant human TNF receptor p75 Fc fusion protein (TNFR:Fc; etanercept) blocks the activity of the cytokine TNF. Etanercept (Enbrel) was recently approved by the Food and Drug Administration for the treatment of RA. Etanercept is a genetically engineered recombinant soluble TNF receptor fusion protein that binds to TNF body and inhibits its biologic action; it is the first biotechnology product approved for the treatment of RA. Remarkable progress has been achieved in the treatment of RA with the development of TNF antagonists. Recent clinical trials have improved our understanding of the major role played by the cytokine TNF in provoking joint inflammation in RA.
15304899 Increased bone mineral density in a man with known compression fractures. 1998 Fall A 70-yr-old man was referred for bone mineral density because of a history of vertebral and hip fracture. His past history included prednisone-treated rheumatoid arthritis and stroke resulting in hemiparesis and expressive aphasia. He had received injections for back pain at another hospital. The overall spine T-score was +3.40 with L3 at +10.92. The overall hip T-score was -1.09 with the femoral neck at -1.75 and Ward's triangle at -2.94. Radiographs of the spine revealed increased densities of L2-4. The patient's wife provided information the aphasic patient could not. The back injections were part of a vertebroplasty for stabilization. The patient had such great pain relief that he ambulated too soon, fell, and suffered a right hip fracture. Injection of polymethylmethyacrylate is a new addition to the treatment of spinal osteoporosis. The case demonstrates the importance of acquiring a complete medical history.
28247005 Arthroscopic ankle surgery. Indications, surgical technique, results, complications. 1999 Jun Based on the one experience and the information that is available in the literature indications for ankle arthroscopy are given, surgical equipment, patient placement and surgical technique of different procedures are described. Finally the results and possible complications are presented. Removal of loose bodies as well as synovectomies in case of an acute infection or rheumatoid arthritis are good indication. Arthroscopic treatment of anterior pathology in the athletic ankle need a thorough diagnostic work-up; the results of the treatment do not always meet the expectations of this especially demanding population. Cartilage treatment is technically possible, however, long term results are still missing. This is also true for the treatment on osteochondritis dissecans. In patients with degenerative joint disease arthroscopic debridement can only lead to a temporary benefit. Arthroscopic assisted arthrodeses (AAA) is technically demanding, but can serve as an excellent alternative to conventional open techniques. The complication rate in ankle arthroscopy is high compared to other joints, which is especially true for neurologic complications and postoperative infections. This should be addressed when performing the informed consent.
11855162 A case of hereditary angioedema associated with idiopathic hypoparathyroidism. 2001 Dec Hereditary angioedema is a rare autosomal dominant disease characterized by the edema of subcutaneous tissues, respiratory tract and bowel. It is caused by the deficiency of C1 esterase inhibitor. Hereditary angioedema may be associated with autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroiditis and glomerulonephritis. We report a 34-year-old male patient with hereditary angioedema who developed idiopathic hypoparathyroidism. Autoimmunity seems to be an important basis of this association and it might be caused by the immune dysfunction due to decreased level of complements; nevertheless, a casual association could not be excluded. To our knowledge, this is the first report of hereditary angioedema in association with idiopathic hypoparathyroidism in the medical literature.
11476764 Treating endometriosis as an autoimmune disease. 2001 Aug OBJECTIVE: To review the literature on the role of autoimmunity in the etiology of endometriosis, compare the similarities in the pathophysiologies between endometriosis and autoimmune diseases, and discuss the use of immunomodulators currently used to treat autoimmune diseases as potential therapies for endometriosis. DESIGN: The literature on endometriosis and other autoimmune diseases was reviewed, and summary data are presented. RESULTS: Endometriosis shares many similarities with autoimmune diseases such as rheumatoid arthritis, Crohn's disease, and psoriasis. These similarities include elevated levels of cytokines, decreased cell apoptosis, and T- and B-cell abnormalities. Because the use of immunomodulators and inflammatory modulators has proven to be an effective means of medical management for these autoimmune diseases, similar therapies may prove useful in treating endometriosis. CONCLUSION(S): Although substantial evidence indicates that endometriosis at least shares many similarities with autoimmune diseases, endometriosis is primarily treated by using compounds that induce a hypoestrogenic environment. A review of the literature combined with the shortcomings of current means of medical management for endometriosis support the postulate that treatment of endometriosis with immunomodulators and inflammatory modulators is warranted.
11296975 Issues of consensus and debate for economic evaluation in rheumatology. 2001 Mar We report initial attempts at developing standards for the conduct of economic evaluations in rheumatology. We surveyed 25 clinicians and economists with an interest in rheumatology regarding the design and reporting of economic evaluations, with particular reference to 4 clinical scenarios relating to treatment for rheumatoid arthritis, osteoarthritis, and osteoporosis. The results demonstrated widespread agreement on a number of methodological issues such as statement of funding source, perspective, discounting, and allowance for uncertainty. However, there was lack of consensus over clinical variables including sources of data for efficacy estimates, specific clinical outcomes, methods of assessing quality of life, and choice of comparators. Some of the disagreement reflects lack of consensus in current general methodological guidelines. Consensus regarding the disease-specific clinical variables is crucial to standardizing analysis and facilitating comparisons within clinical scenarios.
11192789 [Simultaneous occurrence of acute myasthenia gravis and acute polymyositis in 3 patients a 2000 Oct In the Slovak Centre for Neuromuscular Diseases 768 patients with myasthenia gravis are on the records. 112 myasthenics (14.5%) have another associated autoimmune disease. Most frequently a combination with an autoimmune disease of the thyroid gland or rheumatoid arthritis is involved. Extremely rare is the concurrent manifestation of the acute form of mysthenia gravis and acute polymyositis, observed by the authors in three patients,incl. two associated with a thymoma. In all three patients the disease had a serious clinical picture which called for controlled ventilation and a nasogastric tube. From the prognostic aspect rapid and correct diagnosis and early adequate treatment--combined immunosuppressive treatment (prednisone, azathioprin) is most important, incl. large i.v. doses of methylprednisone, repeated plasmaphereses, i.v. administration of human immunoglobulin, 0.4 g/kg body weight for a period of five days and optimally timed thymectomy with removal of the thymoma.
10919061 Exercise and inflammatory bowel disease: immunological aspects. 2000 Exercise may promote a healthy life, improving functional capacities. Little is known about the effects of physical activity in inflammatory bowel disease. Altered immunity is implicated in the pathogenesis of inflammatory bowel diseases. An acute, albeit transient acute immune response, follows heavy endurance exercise. Epidemiological data support the role of physical activity in lowering the risk of inflammatory bowel disease. Moderate physical exercise (60% VO2max) does not cause significant changes in symptoms, intestinal transit time, and permeability. Neutrophil function appears to be primed at basal conditions with significant activation after exercise. At present, mild exercise can be recommended to patients with quiescent inflammatory bowel disease as well as other chronic diseases such as rheumatoid arthritis, while caution is still needed for active disease patients. Patients with inflammatory bowel disease show a reduced exercise capacity after surgery, especially after extensive resections.
10735134 [Insufficient scientific evidence for efficacy of widely used electrotherapy, laser therap 2000 Mar 11 The Dutch Health Council recently published a report on the efficacy of electrotherapy, laser therapy and ultrasound treatment for musculoskeletal disorders. The assessment was based on three systematic reviews, including 169 randomized clinical trials, and focused on a best-evidence synthesis. Virtually no conclusive clinically relevant effects of the three forms of physical therapy were found. Possible exceptions are electrotherapy for osteoarthrosis of the hip or knee, laser therapy for pain treatment and rheumatoid arthritis, and ultrasound treatment for epicondylitis lateralis. But even for these putative indications, further research is clearly needed before implementation in practice is justifiable. It is strongly recommended that the current widespread use of electrotherapy, laser therapy and ultrasound treatment should be reduced, preferably by self-regulation within the profession itself.
10502528 Introduction to immunology and autoimmunity. 1999 Oct Autoimmune disease occurs when the immune system attacks self-molecules as a result of a breakdown of immunologic tolerance to autoreactive immune cells. Many autoimmune disorders have been strongly associated with genetic, infectious, and/or environmental predisposing factors. Comprising multiple disorders and symptoms ranging from organ-specific to systemic, autoimmune diseases include insulin-dependent diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, thyroiditis, and multiple sclerosis. There are also implications of autoimmune pathology in such common health problems as arteriosclerosis, inflammatory bowel disease, schizophrenia, and certain types of infertility. Largely of unknown etiology, autoimmune disorders affect approximately 3% of the North American and European populations, > 75% of those affected being women. This discussion provides a brief introduction to the immune system and tolerance maintenance, an overview of selected autoimmune diseases and possible mechanisms of immune autoreactivity, and a review of experimental autoimmune models.
10027628 Angiogenesis: a new theory for endometriosis. 1998 Sep Excessive endometrial angiogenesis is proposed as an important mechanism in the pathogenesis of endometriosis. Evidence is reviewed for the hypothesis that the endometrium of women with endometriosis has an increased capacity to proliferate, implant and grow in the peritoneal cavity. Data is summarized indicating that the endometrium of patients with endometriosis shows enhanced endothelial cell proliferation. Results are also reviewed indicating that the cell adhesion molecule integrin alphavbeta3 is expressed in more blood vessels in the endometrium of women with endometriosis when compared with normal women. Taken together, these results provide evidence for increased endometrial angiogenesis in women with endometriosis when compared with normal subjects. Endometriosis is one of the family of angiogenic diseases. Other angiogenic diseases include solid tumours, rheumatoid arthritis, psoriasis and diabetic retanopathy. Excessive endometrial angiogenesis suggests novel new medical treatments for endometriosis aimed at the inhibition of angiogenesis.
9308526 Experience of total wrist arthroplasty with silastic implants plus grommets. 1997 Sep The experience with radiocarpal joint reconstruction in rheumatoid arthritis using silastic implants and titanium grommets is reported. Forty-one implants were placed in 36 patients from 1986 to 1992, with a followup of 32 implants in 29 patients ranging from 2.5 years to 8 years. After a brief review of the crucial points of the procedure, including indications and surgical technique, the results were examined using a protocol derived from the one proposed in 1988 for an international multicenter study. The procedure, when correct indications are selected and correct surgical steps are performed, allows predictable results with a satisfying recovery of wrist function. Preservation of wrist function through the years seems enhanced by titanium grommets.