Streptococcal toxic shock syndrome in a patient with rheumatoid arthritis.
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Aged↗
Biomedical subjects
M Nagashima
Publications and source records attributed to M Nagashima.
Does being easily moved to tears as a response to psychological stress reflect response to treatment and the general prognosis in patients with rheumatoid arthritis?
OBJECTIVE: Psychological stress affects the condition of patients with rheumatoid arthritis (RA). We evaluated the neuroendocrine and immune responses (NEIRs) in the peripheral blood to psychological stress induced by deep emotion with tears in patients with RA. METHODS: We compared the levels of plasma cortisol and interleukin-6 (IL-6), the CD4/CD8 ratio, and natural killer (NK) cell activity in peripheral blood between the patients with easily controlled RA (CRP < 1.0 mg/dl) and those with difficult-to-control RA (CRP > or = 1.0 mg/dl) before and after the stress session. RESULTS: Psychological stress induced by deep emotion with tears had a greater influence on NEIRs in patients with difficult-to-control RA (CRP > or = 1.0 mg/dl) than in those with easily controlled RA (CRP < 1.0 mg/dl). The levels of plasma cortisol, IL-6, and the CD4/CD8 ratio were lower, while NK cell activity in the peripheral blood was higher in those who were not moved to tears than in those who were moved to tears. Patients who were moved to tears were apt to obtain good control of RA (CRP < 1.0 mg/dl) within one year. CONCLUSION: The patients with better RA control are easily moved to tears as an emotional expression; shedding tears is considered to suppress the influence of stress on the NEIRs, thus preventing the buildup of stress. Patients who were moved to tears had a more easily controlled RA compared with those who were emotionally affected but not moved to tears.
Adult↗
The ability of disease modifying antirheumatic drugs to induce and maintain improvement in patients with rheumatoid arthritis. epidemiology of DMARDs treatment in Japan.
OBJECTIVE: The effectiveness of the disease-modifying antirheumatic drugs (DMARDs) methotrexate (MTX), bucillamine (BUC), salazosulphapyridine (SASP) and gold sodium thiomalate (GST) over two courses of treatment with a follow-up period of at least 12 months was evaluated in 425 patients with rheumatoid arthritis. METHODS: Clinical efficacy was evaluated on the basis of the numbers of painful and swollen joints, morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels before and after treatment. Results were evaluated on the basis of the survival rate (Kaplan-Meier method) and the incidence and types of adverse drug reactions (ADR) following single and combined therapies. RESULTS: In the first course of treatment, the survival rates for MTX, GST, BUC and SASP were 52.3%, 40.4%, 33.0% and 24.8%, respectively. The rates of development of ADR were 22.9%, 23.5%, 26.3% and 30.0% for BUC, SASP, GST and MTX, respectively. In the second course, the survival rates for MTX, BUC and SASP were 36.6%, 14.1% and 10%, respectively. CONCLUSION: DMARDs used in the first course of treatment improved the clinical parameters until the 6th month after initiation of treatment. Combination treatments showed some effectiveness, but because of the high incidence of ADR the survival rate was low. DMARDs used in the second course of treatment were not efficacious and there was no improvement in the survival rate compared to the first course of treatment.
Adolescent↗
Treatment continuation rate in relation to efficacy and toxicity in long-term therapy with low-dose methotrexate, sulfasalazine, and bucillamine in 1,358 Japanese patients with rheumatoid arthritis.
OBJECTIVE: To evaluate the effectiveness of disease-modifying antirheumatic drugs, namely, methotrexate (MTX), sulfasalazine (SSZ) and bucillamine (BUC) at low-doses (4, 6 or 8 mg MTX, 500 or 1,000 mg SSZ, and 100 or 200 mg BUC) in 1,358 patients with a follow-up of at least 12 months and more than 120 months. METHODS: Clinical assessments were based on the number of painful joints (NPJ) and that of swollen joints (NSJ), CRP level, erythrocyte sedimentation rate, rheumatoid factor level and morning stiffness before and after treatment. Results were evaluated on the basis of the duration of treatment for each drug with inefficacy or inadequate efficacy as one endpoint for discontinuation and adverse drug reactions (ADRs) as the other in single agent and combination therapy. The incidence and nature of ADRs in single and combination treatment are described. RESULTS: The effects of MTX, SSZ and BUC on clinical parameters were monitored over the first three months, and in particular, NPJs and NSJs were found to decrease significantly during single agent MTX or BUC treatment over 108 months. CRP levels remained significantly improved for more than 120 months with MTX. In the single and combination long-term treatments, continuation rate with inefficacy or inadequate efficacy as the end point achieved for each of the treatments were 83.1% for MTX, 76.0% for BUC, 68.5% for SSZ, and in the case of the combination treatments, these rates were 83.3% for MTX + BUC and 71.0% for MTX+SSZ. Continuation rates using ADRs as the end point were 88% for SSZ, 79.6% for BUC and 79.4% for MTX. The incidences of ADRs for the various treatments were: MTX 22.2%, SSZ 11.0%, BUC 20.6%, MTX + BUC 30.0% and MTX + SSZ 31.2%. CONCLUSION: MTX showed the highest efficacy even though it was administrated at a low dose (6-8 mg), as a single agent or in combination with other treatment. However, in combination treatments, the continuous duration of treatment ending in ADRs as the end point were lower than those in single treatments with MTX, SSZ and BUC.
Antirheumatic Agents↗
Effects of simvastatin on serum lipids and atherosclerosis in WHHL rabbits.
Watanabe heritable hyperlipidemic rabbits aged three months (young group) or 10 months (adult group) received 10 mg/kg of simvastatin daily for 24 weeks. Serum levels of total cholesterol, triglycerides, and beta-lipoproteins were reduced significantly in the treated animals but not in untreated controls. The decreases were greater in the young than in the adult animals. Levels of high-density lipoprotein cholesterol were not affected by treatment. At 24 weeks, the extent of atheromatous lesions on the thoracic-abdominal aorta was lower in the treated animals than in the controls, but the difference was significant only in the young animals. The results indicate that simvastatin would be effective in the treatment of atherosclerosis.
Age Factors↗
Effects of thyrotropin-releasing hormone analogues on body shaking and prolactin levels in estrogen-primed and nonprimed rats.
The effects of a thyrotropin-releasing hormone (TRH) analogue, MK-771, in comparison with TRH and another TRH analogue, DN-1417, on body shaking and prolactin secretion were investigated in estrogen-primed and nonprimed rats. Intraperitoneal injections of TRH (20, 40 mg/kg), MK-771 (0.5-4 mg/kg) or DN-1417 (5-20 mg/kg) elicited marked body shaking in male rats. MK-771-induced shaking did not increase upon daily administration of the drug (0.5 mg/kg, s.c.) for 20 days or after treatment with estradiol benzoate (35 micrograms/kg, s.c.) for a 3 days period. Furthermore, following daily administration of MK-771 (0.5 mg/kg, s.c.) for 20 days, serum prolactin levels remained unchanged in male rats. Behaviorally active doses of TRH (20 mg/kg, i.p.), MK-771 (2 mg/kg, i.p.) and DN-1417 (10 mg/kg, i.p.) also failed to elevate serum prolactin levels in both ovariectomized rats and normal male rats. These drugs did, however, markedly elevate prolactin levels which had been increased in estrogen-primed male rats. The results suggest that TRH, MK-771 and DN-1417, in behaviorally active doses, exert a marked endocrine effect on prolactin secretion in estrogen-primed rats, but not in ovariectomized rats or normal male rats.
Animals↗
Induction of neonatal immunologic tolerance to heart transplantation by intrathymic myocardial cell inoculation in rats.
To induce immunologic tolerance, intrathymic inoculation of myocardial cells in rats was performed during the neonatal period. Isolated myocardial cells from Wistar-Lewis (LEW/Crj) rat hearts were inoculated into the thymi of incompatible neonatal Wistar-King (WKAH/HKm) rats without use of immunosuppressants. Ten weeks later the heart from the LEW donor was transplanted heterotropically to the pretreated male WKAH rat (group 1, n = 14). As controls (groups 2 through 4), heart transplantation was performed in each of 10-week-old rats as follows: (1) The syngeneic heart was transplanted (group 2, n = 4); (2) the allogeneic heart was transplanted without use of immunosuppressants (group 2, n = 12); and (3) the allogeneic heart was transplanted with use of immunosuppressants (cyclosporine, 20 mg/kg/day, for 10 days after transplantation, (group 4, n = 5). In groups 1 through 3, four rats with heart transplants in each group were killed on the seventh day after transplantation and were histopathologically examined. No early rejection was seen in group 1. Hematoxylin-eosin staining of the thymus from the inoculated recipient revealed that donor myocardial cells continued to survive in the thymic tissue. The remaining rats in groups 1, 3, and 4 were saved for study of graft survival time. The longest proven graft survival in group 1 was 390 days, whereas it was only 7 days in group 3. These results indicated that intrathymic inoculation of donor myocardial cells in rats into incompatible neonatal recipients induced donor-specific tolerance for subsequent heart transplantation.
Animals↗
Immunosuppressive acidic protein (IAP) level in serum and peritoneal washings, and its implication in determining multidisciplinary treatments.
In this study we examined the efficacy of the measurement of IAP (serum ancl peritoneal washings) during the treatment of colorectal cancers, and determined the possible benefits of using the IAP measurements from both serum and peritoneal washings. One hundred and six patients (peritoneal washings: 58, peritoneal fluid: 67) were investigated. Serum IAP levels were significantly higher in patients who underwent complicated surgical procedures which involved greater time and blood loss compared to those patients who underwent less involved surgical procedures with little loss of blood and time. In peritoneal washings, up to 66. 7% of cases with peritoneal dissemination showed elevated levels of IAP in the peritoneal cavity, while 37% of cases with no dissemination at surgery macroscopically had positive IAP levels (8 mg/g protein). The results suggest the value of IAP in determining the need for combined immunochemotherapy for patients in an immunosuppressive environment.
Adult↗