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ID PMID Title PublicationDate abstract
9805359 A light and ultrastructural study of rice bodies recovered from a case of date thorn-induc 1998 Jul Rice bodies are most commonly found in inflammatory joints of patients with rheumatoid arthritis and have traditionally been considered to be a nonspecific response to inflammatory synovial disease. In the present study 18 rice bodies were found in the tibialis tendon sheath of a nine-year-old Omani boy subsequent to a date thorn injury. The rice bodies consisted of three major components: fibrin, collagen, and fibroblasts. In contrast to the findings of other authors there were no type A, B, or C synoviocytes, cartilage, or vascularisation of the rice body. At this extra-articulate site it would appear that rice bodies are composed chiefly of fibrin and that the fibrosis of the rice body occurs as a result of the entrapment of fibroblasts, which subsequently produce collagen. These findings shed doubt on the synovial origin of rice bodies and suggest that rice bodies may have multiple origins, depending on their location. This is the first ultrastructural study of rice bodies associated with a date thorn injury.
9780724 [Drug-associated hemorrhagic enteritis]. 1998 Sep Drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (AAHC) and other drug associated hemorrhagic colitis. AAHC are mainly caused by oral usage of Ampicillin and its derivatives (85%). Initially AAHC are believed to be caused by Klebsiella oxytoca overgrowth. However, these organisum has no exotoxin like Clostridium difficile and pathogenesis of AAHC are still unresolved. Typical AAHC are diagnosed by colonoscopy with diffuse hemorrhage and edema mainly found in descending colon and transverse colon. NSAIDs are also the cause of hemorrhagic colitis like AAHC. Mephenamic acid are famous for this complication. Diarrhea is one of the main complication of oral 5-fluorouracil administration and even causes hemorrhagic colitis. Its histology are characteristic in gland atrophy. Gold colitis are reported 36 cases in rheumatoid arthritis patients. Exact mechanism of bleeding are not understood. NSAIDs may cause collagenous colitis and or lymphocytic colitis in RA patients. Other rare hemorrhagic colitis are associated with azathioprine, methyl dopa, interferon alfa etc. NSAIDs and anticoagulants are well known drugs for complication of GI bleeding making hemorrhagic enteritis.
9428971 Photodynamic therapy: the clinical perspective. Review on applications for control of dive 1997 Nov Photodynamic therapy (PDT) is an innovative and attractive modality for the treatment of small and superficial tumours. PDT, as a multi-modality treatment procedure, needs both, a photosensitizer with distinct tumour selectivity and a powerful light source that matches the absorption spectrum of the photosensitizer. The purified haematoporphyrin derivative Photofrin is so far the only sensitizer approved for phase III/IV clinical trials. Major drawbacks of this product are: lack of chemical homogeneity, skin phototoxicity, unfavourable physicochemical properties and poor selectivity in terms of uptake and retention by tumour versus normal cells. Most second generation photosensitizers, including the phthalocyanines, show an increased photodynamic efficiency in the treatment of animal tumours and reduced phototoxic side effects. In 1997, there were more than half a dozen new sensitizers in or about to start clinical trials. To introduce the basic principles of photodynamic therapy, the current review article discusses in some more detail the treatment of endobronchial lung cancer, one of the leading indications of PDT. Moreover, a broad overview is given on the use of PDT for treatment of a wide variety of tumorous and nontumorous diseases, including new strategies for control of rheumatoid arthritis and application of PDT for extracorporeal bone marrow purging.
15989631 Meloxicam: a selective COX-2 inhibitor non-steroidal anti-inflammatory drug. 1997 Mar Meloxicam is a new non-steroidal anti-inflammatory drug (NSAID) that selectively inhibits the inducible isoform of the cyclo-oxygenase (COX)-2 enzyme. This enzyme has a major role in mediating the inflammatory response, while synthesis of prostaglandins required for normal physiological functioning of the stomach and kidneys is under the control of the constitutive isoform, COX-1. Other NSAIDs in clinical use show varying degrees of selectivity towards COX-1. Only meloxicam and (albeit to a lesser extent) nimesulide could be described as selective for COX-2. In comparative trials of patients with osteo- and rheumatoid arthritis, meloxicam has been found to be at least as effective as other NSAIDs, but with a greatly reduced incidence of gastrointestinal side-effects. There is no evidence that meloxicam causes any deterioration in renal function in patients with moderate degrees of renal failure, and no evidence of drug accumulation with continued use. Meloxicam's half-life of 20 h makes it ideal for once daily administration, and it is 99% converted to inactive metabolites prior to excretion. No clinically significant drug interactions have been detected, making it suitable for use in patients with co-existing pathology. Meloxicam's safety and tolerability make it a significant advance in the treatment of rheumatic disease.
11808998 Transfer of genes to intervertebral disc cells: proposal for a treatment strategy of spina 2001 Dec Current treatments for spinal disease are unsatisfactory, and gene therapy holds promise as a means of ensuring prolonged and consistent delivery of therapeutic proteins into the spine. Direct injection of vectors into spinal structures is limited by the current lack of vectors with a satisfactory efficacy and safety profile. Conversely, ex vivo gene transfer into cells from the spine or other tissues (bone, nervous tissue, synovial membrane) followed by re-injection of these cells into the spine seems both appropriate and feasible in patients with degenerative disk disease. Candidate genes include genes encoding interleukin-1 antagonists, tumor necrosis factor antagonists, and growth factors. Further work is in order to move gene therapy research to the clinical trial stage in patients with degenerative disk disease, thus following in the footsteps of research on rheumatoid arthritis.
11757271 [Autoimmune neutropenias]. 2001 Sep 15 Primary auto-immune neutropenia (AIN) is usually described in children. Secondary AIN occurs in collagen vascular diseases such as rheumatoid arthritis and (Felty's syndrome), Gougerot-Sjogren syndrome, and systemic lupus erythematosus. Some cases of other immune cytopenia (idiopathic thrombocytopenic purpura, Evans's syndrome) or lymphoproliferative disorders (large granular lymphocyte leukemia, malignant lymphoma) may be associated with AIN. Some cases of primary AIN occur, especially in children. The diagnosis of AIN depends on the demonstration of autoantibodies directed against neutrophil-specific antigens like CD16. The availability of granulocyte-colony stimulating factor for the treatment of AIN has been a major advance. In some cases, immunosuppressive therapy using prednisone, methotrexate, cyclosporine A must be added, especially in cases of secondary AIN.
11597407 Design, synthesis, and biological activity of diiminoisoindolines as complement component 2001 Nov 5 The failure to fully regulate the inflammation response has been linked to diseases such as rheumatoid arthritis, septic shock syndrome, and asthma. The human complement system initiates and regulates the inflammation response through a cascade of regulatory factors. Complement Component 3a (C3a) is an essential regulatory factor and inhibiting its binding to a C3a receptor will diminish the inflammation response by disrupting the cascade. We report the design, synthesis, in vitro and in vivo activity of diiminoisoindolines as C3a antagonists.
11286671 Complementary and alternative therapies for fibromyalgia. 2001 Apr Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders. These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments. This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mind-body therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes. Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up. However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.
11185688 [A young male of systemic lupus erythematosus with hepatic lesions showing multiple low de 1999 Feb A 19-year-old man was admitted to our hospital due to low grade fever and polyarthralgia with history of photosensitivity. Laboratory findings showed the elevated transaminases, leukocytopenia and thrombocytopenia. Examinations in regard to autoimmune diseases revealed the positive antinuclear antibody and positive LE test. The computed tomography (CT) showed the multiple low density spots in liver. CT guided liver biopsy specimens regarding to these low density spots showed the hepatic lesions with mild inflammatory cell infiltration and subtle piecemeal necrosis. The patient was diagnosed as systemic lupus erythematosus (SLE) with hepatic lesions based on the clinical symptoms and the laboratory data. Rheumatoid arthritis was excluded because of intact joints X-ray findings. Autoimmune hepatitis was also denied because of the fulfillment of definite diagnostic criteria of SLE and minimal histological changes of liver. Prednisolone therapy improved his clinical manifestations and normalized both the laboratory data of liver function and the immunological abnormalities in SLE, so the multiple spots in CT of liver also disappeared.
21340853 Assessment of angiogenic factors the chick chorioallantoic membrane assay. 2001 Angiogenesis is the growth of new vessels from existing vessels. It is important in the physiological processes of wound healing, embryogenesis, and the female menstrual cycle and involved in pathologies such as diabetic retinopathy and rheumatoid arthritis (1). There is now abundant evidence that tumors are angiogenesis dependent. Unless tumors can stimulate angiogenesis, and generate their own blood supply, they fail to grow larger than 2-3 mm(3). The angiogenic status of a tumor can be assessed directly using immunohistochem istry on pathology sections (see Chapter 13 by Kilic and Ergün in this volume and Chapter 7 by Ranieri and Gasparini and Chapter 8 by Turner and Harris in the companion volume) to count the number of blood vessels within a given area (microvessel density [MVD]). MVD is a prognostic indicator in a number of tumors including breast, bladder, and prostate (2). Angiogenic capacity can also be measured by assaying the various stimulatory and inhibitory factors that regulate angiogenesis. This can be done either by determining the mRNA level using ribonuclease protection (see Chapter 16 by Jones et al. in the companion volume) or the protein by either Western blotting (see Chapter 11 by Blancher and Jones in the companion volume) or with one of the commercially available enzyme-linked immunosorbent assay (ELISA) kits. Again, levels of these factors have been shown to be prognostic in a number of tumors.
11125324 Pemphigus vulgaris in association with silicosis. 2000 Dec We report on a sixty-seven year old miner with pemphigus vulgaris characterised clinically by a three month history of relapsing oral lesions and blisters/erosions on the trunk, axillae and extremities, histologically by suprabasal cleavage due to acantholysis, immunologically by the epidermal intercellular net-like pattern due to deposits of IgG- and IgM-antibodies and complement C3 in the direct immunofluorescence as well as by serum antibodies to desmoglein 3 (130 KD) and plakoglobin (85 KD) by immunoblotting analysis. Silicosis has already been known for 6 years. In addition, antinuclear antibodies, anti-ssDNA-antibodies and anti-topoisomerase antibodies were found. Clinical improvement and clearing of skin symptoms could be achieved by systemic steroids in combination with cyclophosphamide. However, the patient died of sepsis deriving from recalcitrant pneumonia. Although the association of silicosis with various autoimmune diseases such as systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis and dermatomyositis has been reported many times, our patient is, to the best of our knowledge, the second case with features of the two diseases: pemphigus vulgaris and silicosis.
11019525 [Neopterin: new immunological marker of autoimmune rheumatic disease]. 2000 Serum neopterin (SN), concentration of soluble (s) TNF-receptors (R) with molecular mass 55 kD and sIL-2R, C-reactive protein (CRP), Willebrand factor antigen (WF Ag) were measured in enzyme immunoassay (EIA) or radioimmunoassay (BRAHMS, Berlin, Germany) in 189 patients with autoimmune rheumatic diseases: 52 patients with systemic lupus erythematosus (SLE), 67 patients with rheumatoid arthritis (RA), 44 patients with polymyositis/dermatomyositis and 26 patients with Wegener granulomatosis. SN appeared elevated in autoimmune rheumatic diseases correlating with the disease activity and concentrations of sTNF R and sIL 2R. Assay for neopterin is clinically essential for examination of the immunopathological process activity, prediction of the outcomes, better knowledge about cytokine synthesis profile in autoimmune rheumatic diseases.
10826120 Rehabilitation in the community. 2000 Mar The Project applied rehabilitation in community (RIC) in Zagreb, Croatia as a model of care with the aim of maximizing physical and mental abilities in a persons' own life environment as well as social integration. From September 96 to June 98, 785 patients with primary physical disablement were admitted: 80% with musculoskeletal conditions, and 20% with traumatic brain or spinal injury, stroke, multiple sclerosis, amputation or rheumatoid arthritis. They were residents of Trnje community (55%), Zagreb area (40%) and Croatia area (5%). Mean age was 44 years (men 39, women 48, range 7-76); 52% of patients were women and 17% were recent war wounded. The RIC programme focused on training for physical condition, activities of daily living, preservation of energy and instructions on self-rehabilitation measures, application of aids, and psychosocial consultation. Patients' families were actively involved. Educational activities involved 1100 participants and RIC was promoted by 182 health and social care agencies, humanitarian organizations, the Church, Red Cross, the University and public. The Project demonstrated that primary health care nurse, social worker, and peer counsellor joined to rehabilitation professionals were able to develop interdisciplinary teamwork and to confirm their roles as CBR workers.
10800810 Is early tracheostomy safe in cardiac patients with median sternotomy incisions? 2000 Apr BACKGROUND: Tracheostomy after cardiac operation through a median sternotomy is believed to increase the risk of mediastinitis, leading to debate as to whether early tracheostomy is safe in these patients. METHODS: A record search of patients undergoing cardiac operation through median sternotomy was done. Day and duration of tracheostomy were correlated to day of positive bacteriological evidence and clinical outcome for the patient. The method of tracheostomy was also recorded. RESULTS: Of 174 cases, 4 patients had mediastinitis, 3 before tracheostomy was performed. Of these three patients, 2 survived and the third died of multiorgan failure 46 days after the procedure. The fourth patient, on immunosuppressive therapy for severe rheumatoid arthritis and pulmonary fibrosis, had tracheostomy performed at primary operation, developed fatal mediastinitis after 6 days, and died 18 days postoperatively of multiorgan failure. Of the tracheostomies performed, 24 (14%) were percutaneous, and 110 (63%) were achieved using standard surgical techniques (in 40 cases type was unrecorded). In 72 cases (41%), tracheostomy was performed on or before day 7, 11 (6%) being performed before 48 hours. Mortality occurred in 38 (22%). CONCLUSIONS: There is no demonstrable relationship between early tracheostomy and mediastinitis in median sternotomy patients.
10763711 Neonatal tolerant immunity for vaccination against autoimmunity. 2000 Autoimmunity arises when the immune system no longer tolerates self and precipitates lymphocyte reactivity against our own antigens. Although the developing T cell repertoire is constantly purging, self-recognition events do exist when such tight control is evaded and autoreactive lymphocytes escape the thymus (the sites of T cell development) and migrate to the periphery. Upon activation these autoreactive cells may exert aggressive behavior toward one's own tissues and organs leading to autoimmune disease. Multiple sclerosis, Rheumatoid arthritis, and type I diabetes are autoimmune diseases mediated by autoreactive T cells. A logical approach to prevent such autoimmunity would be to reprogram those lymphocytes to tolerate the self antigen. Injection of antigen at the neonatal stage promotes a state of tolerance such that successive encounter with antigen does not precipitate aggressive reactions. The mechanism underlying neonatal tolerance involves priming of T cells whose effector functions do not cause inflammatory reactions upon recognition of antigen but rather induce protective immunity. This form of tolerant immunity provides an attractive strategy for vaccination against autoimmunity. Herein, it is shown that neonatal exposure to a self-peptide-immunoglobulin chimera drives a tolerant immunity toward the self-peptide and protects against the autoimmune disease, experimental allergic encephalomyelitis.
10751012 Health services in rheumatology. 2000 Mar Studies of the costs associated with rheumatic diseases, the referral of patients to rheumatology subspecialty care, rheumatology practice patterns, and the relation between medical care and patient outcomes are reviewed. Direct medical costs in patients with rheumatoid arthritis (RA) are higher among those with more functional disability. Direct medical costs in patients with systemic lupus erythematosus (SLE) did not differ among Canadian, American, and British patients, despite substantial differences in the mechanisms by which medical care is financed and delivered in these three countries. The diagnostic accuracy of rheumatic complaints by primary care physicians may be low, and concomitant psychiatric disorders may not be uncommon among patients referred to rheumatologists. Most patient visits to rheumatologists involve patients with rheumatic diseases or musculoskeletal complaints, and few visits involve primary care. Fewer than half of elderly patients with RA or SLE are seen by a rheumatologist in a given year; access is particularly limited among black women. Early access to rheumatology subspecialty care may be associated with improved health status in patients with RA, and mortality among patients with SLE varies with the experience a hospital has in treating patients with SLE.
19078457 Pneumocystis carinii pneumonia prophylaxis in patients with rheumatic diseases undergoing 2000 Apr Pneumocystis carini (PCP) has been recognized as a cause of pneumonia in immuocompromised patients, most notably in AIDS patients, but also in those receiving immunosuppressive therapy for a variety of other conditions, including malignancy, having an organ transplant, connective tissue diseases, and vasculitic syndromes. In non-HIV PCP patients, presentations may be more dramatic than in HIV-related PCP and the mortality may be higher, thus emphasizing the need to identify and provide prophylaxis for those at highest risk for PCP. The incidence of PCP varies in different rheumatic disorders, with the highest rated noted in Wegener's granulomatosis and the lowest noted in rheumatoid arthritis. Prophylactic regimens should be used in patients with Wegener's granulomatosis taking cyclophosphamide and daily corticosteroids and in other rheumatic disease patients who are treated with this regimen, such as in PAN, microscopic polyarteritis, or severe systemic lupus erythematosus. Prophylaxis should be strongly considered in patients taking prolonged, high doses of daily corticosteroids (>40mg/day for > 3 months) with a second immunosuppressive agent other than cyclophosphamide, such as methotrexate, for example, as in PM/DM and in alternative regimens for Wegener's granulomatosis. Emerging data suggest the utility of CD4 counts as a method to distinguish those at highest risk for PCP to selectively apply prophylactic therapy. TMP-SMX is the usual first choice for prohpylaxis.
10680198 The evidence for acupuncture as a treatment for rheumatologic conditions. 2000 Feb Individuals with rheumatic disorders, particularly those with more severe, chronic conditions, are likely to be frequent users of complementary and alternative medical therapies. Although large-scale clinical trials have yet to be conducted, there is moderately strong evidence that acupuncture may be effective for treating both osteoarthritis and fibromyalgia. The utility of acupuncture in treating rheumatoid arthritis has not been demonstrated in large, randomized controlled trials. Physicians who treat patients with rheumatic conditions should become knowledgeable about the literature on both the effectiveness of acupuncture for these conditions as well as its potential to cause adverse side effects in particular patient groups.
10491480 [Paraneoplastic syndrome as a manifestation of cancer of the hypopharynx]. 1999 Jun A 45-year-old male patient had a squamous-cell carcinoma of the laryngopharynx (T1pN2bM0). The first clinical manifestation was polyarthritis of large and small joints and a skin rash. The symptoms were identified as paraneoplastic syndrome associated with squamous-cell carcinoma of the laryngopharynx. After treatment (surgery + radiotherapy), the articular symptoms, initially treated with conventional therapy for rheumatoid arthritis, disappeared. Paraneoplastic syndrome can be defined as a set of physiological signs and symptoms of malignant origin that occur remote from the tumor. Squamous-cell carcinoma is the most frequent malignant tumor of the head and neck that produces paraneoplastic syndrome. We reviewed the most common features associated with malignant tumors and the pathogenic mechanisms involved. We conclude that paraneoplastic disorders can be markers of treatment response and predictors of recurrence.
10419856 Phosphodiesterase 4 inhibitors as novel anti-inflammatory agents. 1999 Aug Preclinical and clinical studies of phosphodiesterase 4 inhibitors have shown that these agents may find utility in a wide range of inflammatory disorders, including asthma, chronic obstructive pulmonary disease, atopic dermatitis, rheumatoid arthritis, multiple sclerosis and various neurological disorders. The future of this class of drugs will depend upon the ability to demonstrate a reasonable safety margin against emesis and other typical phosphodieserase (PDE4) side effects, as well as in identification of the inflammatory disorder(s) most relevant to PDE4 inhibition.