Autoimmune rheumatic diseases and lymphocytic malignancies are related and this association is bidirectional. Lymphomas occur more frequently in the course of autoimmune disease and autoimmune rheumatic manifestations occur in the course of lymphocytic malignancies. An increased incidence of malignant lymphocytic diseases is present in patients with rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, and autoimmune thyroid disease. Descriptions of lymphocytic malignancies among other autoimmune rheumatic disease have been published. In some patients, the malignant disease is diagnosed months or years before the appearance of the rheumatic disease.

Antigens, Neoplasm↗

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New therapeutic avenues in autoimmunity.

During the last decade, much progress has been made in the understanding of processes that lead to autoimmunity. Cellular interactions mediated through cytokines and adhesion molecules were found to play a major role in the genesis of autoimmune conditions. During this period, we learned to recruit monoclonal antibodies to manipulate these delicate processes and to divert their outcome to a path we control better. Our comprehension of IVIG (intravenous immunoglobulin therapy) has broadened, and new indications for the implementation of this promising therapy have been pursued. In this review, we shed light on new therapeutic modalities that have been published since our previous report and discuss new data concerning the old modalities.

Autoimmune Diseases↗

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Musculoskeletal manifestations of infection with human immunodeficiency virus.

Musculoskeletal manifestations and autoimmune phenomena are recently recognized complications of infection with human immunodeficiency virus (HIV). Patients with HIV infection share several clinical and serologic features with patients with systemic lupus erythematosus and Sjögren's syndrome; these similarities may lead to diagnostic confusion. The significance of the presence of different types of autoantibodies in HIV-infected patients is still uncertain and may reflect polyclonal B cell activation. Musculoskeletal complications--particularly arthritis, arthralgia, and myalgia--are common in advanced stages of HIV infection. Clinical characteristics and serologic findings support the premise that most of the musculoskeletal complications (e.g., Reiter's syndrome, psoriatic arthritis, acquired immunodeficiency syndrome-associated arthritis and arthralgias) are reactive in nature--either a direct consequence of HIV infection or a result of various opportunistic infections. The possibility of HIV infection should be considered in all patients with conditions suggesting reactive arthritis. Further studies are needed to define the full spectrum and frequency of these musculoskeletal abnormalities.

Autoantibodies↗

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Living with a child with familial Mediterranean fever: does it affect the quality of life of the parents?

OBJECTIVE: The aim of the present study was to assess the quality of life (QOL) and the psychological status of parents of children with familial Mediterranean fever (FMF). METHODS: The QOL, anxiety and depression of the parents of 35 children with FMF were evaluated and compared to the parents of 23 healthy children. RESULTS: Mothers of FMF children had lower QOL scores than mothers of healthy children: 5.5 +/- 1.1 versus 6.0 +/- 0.6 (p = 0.048). They also expressed higher levels of anxiety and depression. Within each group, mothers were more anxious and depressed than fathers. Parents with several FMF children were not significantly different from parents with only one FMF child. CONCLUSION: The QOL and psychological well being of parents with FMF children were found to be slightly impaired, especially that of the mothers.

Adolescent↗

PubMedDate not supplied

Rheumatologic manifestations of infection with the human immunodeficiency virus (HIV).

The aim of this study was to assess the type and frequency of rheumatologic manifestations among patients followed at an HIV clinic in a general hospital, and to evaluate the usefulness of a questionnaire in identifying the presence of these manifestations. Fifty-two consecutive patients with HIV infection completed a questionnaire regarding the presence of rheumatologic symptoms. All patients were interviewed and examined for the prevalence and spectrum of musculoskeletal manifestations. The questionnaire was found to be sensitive in identifying patients with rheumatologic manifestations which were detected on clinical examination. The latter were found in 34 patients (65.3%). Twenty-one patients (40.3%) had arthralgias, 8 (15.2%) had spondyloarthropathies (including Reiter's syndrome, psoriatic arthritis and undifferentiated spondyloarthropathy). Two patients (3.8%) had oligoarthritis and one case each had myositis, Sjögren's syndrome and Behçet's syndrome. Muscle pain was common, occurring in 35% of the patients, and it was related to the use of zidovudine therapy. In contrast to previous reports, most of the patients with arthritis had mild disease, responding promptly to non-steroidal anti-inflammatory drugs. This difference may be explained by the use of zidovudine therapy, stage of HIV infection, and lifestyle. A questionnaire may be helpful in identifying the prevalence of rheumatologic manifestations in HIV-infected subjects.

Adult↗

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Dead Sea bath salts for the treatment of rheumatoid arthritis.

Thirty patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fifteen patients each of similar age, sex, duration and severity of disease, and medical treatment. All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes. Group I received Dead Sea bath salts and Group II, the control group, received sodium chloride (NaCl). The study was double-blind and of two weeks' duration. All patients were evaluated by one rheumatologist both before treatment, and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatments. The clinical parameters evaluated included duration of morning stiffness, fifteen meter walk time, hand-grip strength, activities of daily living, circumference of proximal interphalangeal joints, number of active joints, Ritchie index and the patient's own assessment of disease activity. The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A, rheumatoid factor, sodium, potassium, calcium and magnesium. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group I only, in most of the clinical parameters assessed. Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month.

Arthritis, Rheumatoid↗

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Features of SLE in various ethnic groups in Israel.

OBJECTIVE: To assess the association between the ethnic origin of patients with SLE living in Israel, and the clinical and laboratory features of SLE. METHODS: A retrospective review of medical records was carried out. Patients were classified into 3 groups based on their ethnic origin: a) Ashkenazi Jews, b) Sepharadic Jews and c) Arabs. RESULTS: The study included 74 consecutive SLE patients, 69 (93%) women and 5 (7%) men. Their mean age at diagnosis was 32 years and their mean disease duration was 6.4 years. There were 21 (28%) Ashkenazi Jews, 31 (42%) Sepharadic Jews and 22 (30%) Arabs. The demographics, the frequency of various clinical and laboratory variables of SLE, and the mean disease activity index score (SLEDA1) of the three groups were not statistically different. CONCLUSION: The ethnic origin of SLE patients living in Israel is not associated with the clinical and laboratory features of the disease.

Adult↗

PubMedDate not supplied

Quality of life of patients with familial Mediterranean fever.

OBJECTIVE: The aim of the present study was to assess the quality of life (QOL) of patients with Familial Mediterranean Fever (FMF) and to explore its possible contributing factors. METHODS: One hundred and two FMF patients were evaluated using a QOL Scale, and were compared to 124 healthy controls. The QOL scale includes 16 items, each measured on a 7-point scale (7 indicating maximal satisfaction). RESULTS: The total QOL score of FMF patients was significantly lower than that of the controls: 81.6 +/- 19.2 vs 88.0 +/- 12.8 (p < 0.01). Male and female patients reported similar QOL scores. QOL was inversely correlated with the number of FMF attacks in the last year (r = -0.302, p = 0.002), and with the number of FMF hospitalizations (r = -0.238, p = 0.017). Patients with widespread pain, sleep disturbances and headaches had significantly lower QOL scores than patients without them. CONCLUSIONS: The QOL of FMF patients was found to be impaired compared to healthy controls. Further studies are needed to determine the exact factors affecting the quality of life of FMF patients.

Adolescent↗