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Biomedical subjects

C M Wise

Publications and source records attributed to C M Wise.

At least 19 recordsLinked to original sources
PubMed1992

Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis?

BACKGROUND: It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE: Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS: We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS: In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION: Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.

Adult↗
PubMed1992

Presenting features and outcomes in patients undergoing temporal artery biopsy. A review of 98 patients.

BACKGROUND: Although temporal arteritis is a well-recognized syndrome, controversy still exists regarding the optimal approach to diagnosis and treatment of this condition. We undertook this review to further define the spectrum of presenting features and outcomes of patients undergoing temporal artery biopsy. METHODS: We reviewed the records of all patients undergoing temporal artery biopsy over a 5-year period. Presenting features were compared in biopsy-positive and biopsy-negative patients. In patients with positive biopsy specimens, treatment regimens, disease, treatment-related morbidity, and outcomes were recorded. Alternative diagnoses and therapy were reviewed in biopsy-negative patients. RESULTS: Of 98 patients, 30 had positive and 68 had negative biopsy specimens. Biopsy-positive patients had an increased incidence of headache (93% vs 62%), jaw claudication (50% vs 18%), and prior polymyalgia rheumatica (23% vs 3%), but the sensitivity and specificity of these indicators were relatively low. Other clinical and laboratory parameters, including prior steroids and erythrocyte sedimentation rate, were similar between the two groups. In 30 patients with positive biopsy specimens, response to initial high-dose steroid was excellent. Serious manifestations after initial treatment were not seen, but mild flares were common after 1 year of therapy. Steroid-related morbidity was common, and steroids were seldom discontinued (0/22 patients at 1 year, 6/19 patients at 2 years, 5/11 patients at 3 years). In 68 patients with negative biopsy specimens, alternative diagnoses included neurologic diseases (15 patients), "pure" polymyalgia rheumatica (14 patients), and other inflammatory rheumatologic diseases (10 patients). Fourteen patients with negative biopsy specimens were treated for temporal arteritis, and were similar to biopsy-positive patients. CONCLUSIONS: Temporal arteritis remains a challenging condition to diagnose and to treat. Presenting features are seldom helpful in predicting biopsy results. Initial treatment is effective but frequently toxic. Although late disease-related complications are rare, most patients continue to take long-term low-dose steroid therapy.

Adrenal Cortex Hormones↗
PubMed1992

Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients.

One hundred patients with chest pain and negative coronary arteriography were evaluated for musculoskeletal chest wall findings. Sixty-nine patients had chest wall tenderness. Typical chest pain was evoked by palpation in 16 patients. Tender areas were not found in a control group of patients without chest pain. A diagnosis of fibrositis could be made in five patients, including two in whom chest palpation reproduced typical chest pain. The sternal and xiphoid area, left costosternal junctions, and left anterior chest wall were the areas where tenderness was most common, but no significant differences were found comparing locations of tenderness in those with reproduction of typical pain. There was no significant difference in location, exacerbating factors, or other musculoskeletal symptoms among different groups of patients. Thus, most patients with noncardiac chest pain have chest wall tenderness that is not found in a control group without chest pain. However, reproduction of pain by palpation, a more specific diagnostic finding, is found in a minority of these patients.

Adult↗
PubMed1992

Osteoarthritis of the knee: effects on gait, strength, and flexibility.

This study examined the differences in gait mechanics, isokinetic knee strength, and flexibility between a group of adults with symptomatic osteoarthritis (OA) of the knee (n = 15) and an age-, mass-, and gender-matched group of control subjects (n = 15). Both groups performed under similar environmental conditions. Our results suggest that patients with symptomatic OA of the knee have poorer flexibility in both the affected and unaffected legs and demonstrate significantly less (p less than .05) knee angular velocity and, to a lesser extent, knee range of motion during gait. They have an increased loading rate in the unaffected leg after heel strike, exert less peak vertical force during pushoff, and are significantly weaker in both the dominant and nondominant legs compared to adults with no lower extremity disease.

Aged↗
PubMed1991

Temporal arteritis with low erythrocyte sedimentation rate: a review of five cases.

We compared 5 patients who had biopsy-proven temporal arteritis and erythrocyte sedimentation rates (ESR) less than 50 mm/hour with 25 patients who had temporal arteritis and high ESR and with 10 patients who had negative temporal artery biopsy results and low ESR. Patients with low-ESR temporal arteritis were similar to the other groups, except that they had a higher mean hemoglobin level than the high-ESR group and a significant increase in the percentage of patients (4 of 5) who had a previous diagnosis of polymyalgia rheumatica or had received steroid therapy compared with either of the other groups. The latter finding suggests that even low-dose steroid therapy can lower the ESR in patients with temporal arteritis. We conclude that the ESR is low in only a small percentage of patients with temporal arteritis, and that most of these patients have a history of polymyalgia rheumatica or steroid therapy.

Aged↗
PubMed1991

Low-dose weekly methotrexate for unusual neutrophilic vascular reactions: cutaneous polyarteritis nodosa and Behçet's disease.

Low-dose weekly methotrexate therapy has been used to treat patients with psoriasis for more than 20 years. This regimen has also been used to treat rheumatoid arthritis, inflammatory bowel disease, primary sclerosing cholangitis, and corticosteroid-dependent asthma. We report two patients with Behçet's disease with cutaneous neutrophilic vascular reactions and three with cutaneous polyarteritis nodosa who responded dramatically to low-dose weekly methotrexate therapy.

Administration, Oral↗
PubMed1991

Gout and hyperuricemia.

Although our understanding of hyperuricemia and gout has changed little over the past several years, questions remain in defining the many metabolic abnormalities that can result in these problems. In the past year, several papers have further addressed heritable mechanisms for the development of hyperuricemia, as well as environmental factors that contribute to its onset in adulthood. Consequences of hyperuricemia other than clinical gout have received further attention. Although typical gout is easily recognized and treated, several recent papers have addressed atypical presentations of gout, as well as other causes of podagra that might have been attributed previously to gout. The treatment of patients whose disease is uncomplicated by other conditions remains straightforward. However, the presentation of gout in patients with multiple comorbidities not only increases recognition of the toxicity of nonsteroidal anti-inflammatory drugs and colchicine, but often requires innovative approaches to its treatment.

Adult↗
PubMed1990

Therapeutic exercise for rheumatoid arthritis and osteoarthritis.

Therapeutic exercise in rheumatoid arthritis and osteoarthritis may be useful in improving aerobic capacity, strengthening muscles, improving endurance and increasing flexibility. This article reviews the major studies of exercise in these conditions and summarizes the authors recommendations regarding the use of therapeutic exercise in the treatment of rheumatoid arthritis osteoarthritis.

Arthritis, Rheumatoid↗
PubMed1988

Comparison of parotid and minor salivary gland biopsy specimens in the diagnosis of Sjögren's syndrome.

We conducted a prospective study comparing minor salivary gland and parotid gland biopsy specimens obtained simultaneously from 24 patients who were undergoing evaluation for primary Sjögren's syndrome (SS). Adequate tissue for study was obtained with all minor salivary gland biopsies and 19 of 24 parotid gland biopsies. Parotid inflammation was seen in 6 of 11 patients whose minor salivary gland biopsy results indicated SS, but in none of 8 patients who had normal findings on minor salivary gland biopsy. Patients with parotid inflammation were older and had a higher frequency of dry eyes and mouth, abnormal results on Schirmer's test, serious extraglandular involvement, and serologic abnormalities. We conclude that parotid gland biopsy adds very little to the minor salivary gland biopsy in the diagnosis of primary SS, but that parotid inflammatory changes may reflect disease duration and/or severity.

Aged↗
PubMed1988

Chest pain: a rheumatologist's perspective.

Chest pain is a frequent patient complaint that requires a careful history and physical examination to determine its cause. Cardiac and esophageal causes of chest pain are common, but musculoskeletal disorders such as Tietze's syndrome, chest wall pain syndromes, fibrositis, inflammatory arthritic conditions, cervical osteoarthritis, and disease of the thoracic spine may also result in chest pain. Musculoskeletal diseases must be differentiated from other causes of chest pain, since specific treatment of these rheumatic conditions often produces good results.

Bone Diseases↗
PubMed1988

Subacute bacterial endocarditis in a patient with ankylosing spondylitis.

A 57 year old white man with aortic insufficiency and previously undiagnosed ankylosing spondylitis, who developed subacute bacterial endocarditis (SBE), is described. Emergency aortic valve replacement was necessary, and the aortic valve pathology showed diffusely fibrosed and thickened valve leaflets with bacterial vegetations. This is the first recorded case of SBE in ankylosing spondylitis.

Aortic Valve Insufficiency↗
PubMed1988

Pure red cell aplasia in procainamide induced systemic lupus erythematosus. Report and review of the literature.

We describe a patient who developed pure red cell aplasia as part of a lupus-like syndrome while taking procainamide. Pure red cell aplasia resolved spontaneously after discontinuation of this drug. Although pure red cell aplasia has been reported in several patients with idiopathic systemic lupus erythematosus (SLE), this represents the first such report in a patient with drug induced SLE.

Aged↗
PubMed1988

Optic neuropathy as an initial manifestation of Sjögren's syndrome.

Although optic neuropathy is a known complication of systemic lupus erythematosus, its association with other connective tissue diseases is less well documented. We describe 3 previously asymptomatic women presenting with optic neuropathy in whom changes highly suggestive of primary Sjögren's syndrome (SS) were found by minor salivary gland biopsy 1-6 years after initial presentation. Typical symptoms of SS were absent initially and developed slowly, while serologic abnormalities were consistently present. Optic neuropathy may be a presenting neurologic feature of SS and may antedate typical signs and symptoms of SS. Primary SS should be considered in the differential diagnosis of optic neuropathy.

Adult↗
PubMed1988

Fibrositis.

Fibrositis is a common clinical syndrome characterized by diffuse musculoskeletal pain and multiple tender points on physical examination. The symptoms wax and wane but do not produce severe disability. Although no single treatment is curative, a comprehensive program of patient education, drug therapy and appropriate physical activity is beneficial in many patients.

Diagnosis, Differential↗
PubMed1987

Synovial fluid lipid abnormalities in various disease states: review and classification.

Although lipids are not usually present in large quantities in normal synovial fluids or in the usual synovial fluid seen in most rheumatologic conditions, their presence in synovial fluid may have diagnostic importance. As summarized in Table 2, analysis of synovial fluids for lipid constituents is relatively simple. On standing or after centrifugation, significant amounts of lipids may layer out and be visible as a supernatant. On microscopic examination, lipid droplets are usually easily seen and should be stainable with appropriate dyes (oil red O or Sudan III or IV), or may occasionally be visualized as intracellular or extracellular inclusions by polarized microscopy. Small (0.5 to 2.0 microns) intracellular inclusions containing triglycerides may be seen in neutrophils from most synovial fluids, and are of no diagnostic importance. Cholesterol crystals may be readily recognized microscopically by their characteristic flat, plate-like appearance and notched corners Synovial fluid may also be analyzed for cholesterol and triglycerides in routine clinical laboratories, and free fatty acids and lipolytic enzymes in special lipid laboratories. The presence of massive increases in cholesterol associated with microscopically visible cholesterol crystals is usually associated with chronic RA, occasionally in the setting of super-imposed bacterial infection. The presence of gross or microscopic lipid droplets is usually associated with trauma and hemorrhagic effusions. When present in this setting, the clinician should entertain a high suspicion for a significant intraarticular injury, such as fracture, meniscal tear, or severe ligamentous injury. In addition, however, several instances of non-traumatic inflammatory effusions associated with intracellular and extracellular lipid droplets have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗