Hyperpigmentation of the skin along the thoracic and lumbar spine in progressive systemic sclerosis.
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Biomedical subjects
Publications and source records attributed to D Buskila.
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We describe a patient with sarcoidosis involving the lungs, muscles and tendons of the forearms who developed Jaccoud's-type arthropathy of the hands. This is the first reported case to the best of our knowledge of sarcoidosis associated with this type of arthropathy.
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We describe a woman with psoriatic arthritis who experienced a remarkable improvement of her skin and joint disease while only taking bromocriptine therapy. She was treated with bromocriptine for primary infertility due to hyperprolactinemia. The improvement in joint symptoms appeared to parallel that of the skin. More studies are required to determine the reproducibility of this observation.
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Assessment of diabetic autonomic neuropathy in a representative sample of 91 noninsulin-dependent diabetics was performed in 3 community clinics. A difference of less than 10 beats/min in heart rate between deep inspiration and deep expiration determined by ECG recording served as the criterion for autonomic neuropathy. By this test, 86% of the patients had diabetic autonomic neuropathy, a slightly higher proportion than that reported by others using similar criteria in more selected populations. The test is very sensitive and can be used for screening.
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A patient with systemic lupus erythematosus (lupus) is described, in whom stress fractures of both legs developed, accompanied by swelling of both ankles. The swelling of the right ankle associated with fracture mimicked lupus synovitis, but resolved with healing of the fracture. On the left side the swelling represented true lupus synovitis coexistent with the tibial stress fracture. This presentation posed a diagnostic dilemma. It is necessary to maintain vigilance in the diagnosis of these fractures in lupus.
Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel. The patients were divided into four groups of 10. Group I was treated with daily mud packs, group II with daily hot sulphur baths, group III with a combination of mud packs and hot sulphur baths, and group IV served as a control group. The patients were assessed by a rheumatologist who was blinded to the treatment modalities. Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices. Improvement in the control group was minor in comparison and not statistically significant. No significant improvement was observed in any of the laboratory variables measured. Except for three mild cases of thermal reaction there were no side effects.
Two patients receiving maintenance dialysis therapy developed osteonecrosis, the first in the humeral head and the second in the talus. Both patients lacked known risk factors for developing osteonecrosis. A possible pathogenic role of secondary hyperparathyroidism in this disorder is suggested. Rheumatologists evaluating patients receiving maintenance dialysis with rheumatic manifestations should be aware of this potential complication.
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Recent reports have suggested an association between psoriasis, psoriatic arthritis and human immunodeficiency virus infection (HIV). However, few cases of coincidental occurrence of HIV infection and psoriatic arthritis have been described. We present another patient with psoriasis who developed a sudden flare-up of this skin disease associated with onset of psoriatic arthritis, during the course of HIV infection. Psoriatic arthritis should be added to the expanding spectrum of musculoskeletal manifestations of HIV infection.
Tenderness was assessed by point count and by scored palpation in 51 patients with human immunodeficiency virus (HIV) infection as well as 51 patients with rheumatoid arthritis (RA) and 50 patients with psoriatic arthritis (PsA). Fifteen of 51 (29%) patients with HIV infection met criteria for fibromyalgia, based on the presence of 10 tender (of 14) "fibrositic" points. Similar results were observed among patients with PsA (24%). The prevalence of fibromyalgia was higher among patients with RA (57%). Patients with HIV and PsA were less tender than patients with RA. Fibromyalgia in patients with HIV was significantly associated with myalgia and arthralgia, but not with age, duration of HIV infection, stage of HIV disease, or zidovudine therapy.
We have shown that low cortisol catabolism by lymphocytes correlates with a high sensitivity of the cells to the steroid. In the present study, we aimed to assess whether high resistance to corticosteroid treatment correlates with a high rate of cortisol catabolism by lymphocytes. Since patients with systemic lupus erythematosus (SLE) usually require high doses of corticosteroids, while patients with rheumatoid arthritis (RA) respond to relatively low doses of steroids, we compared the capability of lymphocytes of patients with SLE and RA to catabolize cortisol. The rate of cortisol catabolism obtained with the RA group was not significantly different from that obtained with the control group. The catabolism of cortisol by lymphocytes of the SLE group was significantly higher than both the control group (p less than 0.05) and the RA group (p less than 0.01). A significant correlation was demonstrated between the SLE disease activity index and rates of cortisol catabolism attained by lymphocytes of SLE patients (p less than 0.001).
Our aim was to test the reliability of clinical measurements in psoriatic arthritis. The study involved clinical assessments of inflammatory activity as well as damage in 10 patients with psoriatic arthritis seen at the psoriatic arthritis clinic. Five rheumatologists examined these patients according to a latin square design. For the clinical measurements of actively inflamed joints and damaged joints there was no significant observer effect. This suggests that these are reliable measurements. There was, however, significant observer effect in the radiologic assessment, and further refinement of the measurement is required.
A case of skin psoriasis and psoriatic monoarthritis triggered by physical trauma is reported. Possible pathogenic mechanisms of this phenomenon are discussed.