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Biomedical subjects

R S Panush

Publications and source records attributed to R S Panush.

At least 91 records · Page 5Linked to original sources
PubMed1985

Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis.

Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). Pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). Sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were Staphylococcus aureus in three patients and Staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.

Adult↗
PubMed1985

Rheumatoid vasculitis: experience with 13 patients and review of the literature.

Rheumatoid vasculitis is an uncommon but potentially catastrophic complication of RA. There are few current extensive experiences and no consensus regarding the clinical, laboratory, histologic features, and management or prognosis of rheumatoid vasculitis. We therefore reviewed selected observations in 13 patients followed over the past decade and compared them with patients reported and with results of a survey of North American Rheumatologists. Our patients were seven men and six women (age, 33 to 70 years) who had had active RA for 4 to 36 years. They exhibited sensory neuropathy, mononeuritis multiplex, Felty syndrome, cutaneous lesions, leg ulcers, gangrene, anemia, leukocytosis, eosinophilia, high titers of RF, hypocomplementemia, and CICs or cryoglobulinemia approximately as frequently as other reported patients with rheumatoid vasculitis, but they displayed constitutional symptoms, subcutaneous nodules, ischemic changes, and proteinuria rather less consistently than in other series. These observations were not necessarily as expected by survey respondents. We, as in other series and suggested by survey respondents, tended to select penicillamine or cytotoxic drugs (or plasmapheresis) for patients with mononeuritis, gangrene, or leg ulcers, and nonsteroidal antiinflammatory drugs, antimalarials, gold, or penicillamine for sensory neuropathy or digital lesions. Four patients died, two deteriorated, and seven were stable or improved, a finding that was also similar to the experiences of others. Rheumatoid vasculitis is an uncommon, potentially catastrophic syndrome with varying clinico-pathologic features that have different prognostic implications and should be managed individually.

Adult↗
PubMed1985

Detection and quantitation of circulating immune complexes in arterial blood of patients with rheumatic disease.

We developed antigen-nonspecific enzyme-linked immunoassays (ELISA) to quantitate IgG-C3- and IgM-C3-containing circulating immune complexes (CIC) in venous and arterial blood from rheumatic disease patients. Standards were diethylaminoethyl (DEAE)-purified, heat-aggregated IgG incubated with fresh human serum (for IgG-C3 CIC) and IgM rheumatoid factor-rich serum incubated with reduced, alkylated IgG and then with fresh human serum (for IgM-IgG-C3 CIC). Venous serum and plasma IgG-C3 and IgM-C3 CIC correlated closely (P less than 0.01). Rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) patients had elevated levels of venous IgM-C3 CIC (P less than 0.0001) but not IgG-C3 CIC; patients with vasculitis, inflammatory rheumatic diseases, or noninflammatory rheumatic diseases had mean values similar to normal individuals. Venous IgG-C3 and IgM-C3 CIC did not correlate. Paired venous and arterial samples from 16 rheumatic disease patients averaged comparable amounts of IgG-C3 and IgM-C3 CIC, respectively; venous and arterial IgM-C3 CIC levels in patients significantly exceeded normals (P less than 0.05). Venous and arterial IgG-C3 CIC levels correlated closely (P less than 0.01) as did venous and arterial IgM-C3 levels (P less than 0.05). Thus, arterial CIC offered no advantage over venous determinations for rheumatic disease patients. IgM-C3 CIC were elevated in patients with RA and SLE when IgG-C3 CIC were not. Ig isotype-specific CIC quantitation may be useful for certain rheumatic diseases.

Antigen-Antibody Complex↗
PubMed1985

IgM rheumatoid factor elaboration by blood, bone marrow, and synovial mononuclear cells in patients with rheumatoid arthritis.

IgM rheumatoid factor (RF) elaboration by rheumatoid arthritis (RA) synovial, bone marrow, and blood mononuclear cells (MNC) is reported. IgM RF was prepared from RF-positive sera by sequential euglobulin precipitation, Sephacryl S300 gel filtration, and IgG-Sepharose affinity chromatography. Purified material, which contained no detectable IgG or IgA, was used in an enzyme-linked immunosorbent assay (ELISA) to quantitate cellular elaboration of IgM RF. Excellent standard curves (r2 = 0.98) were obtained without nonspecific binding of samples or antisera to IgG-coated microtiter plates and without cross-reactivity of standards with antisera other than anti-IgM. We found RA blood MNC (11 patients) spontaneously averaged 15 ng/ml IgM RF (6% of total IgM produced), but elaborated 254 ng/ml IgM RF following pokeweed mitogen (PWM) stimulation (22 patients), exceeding that of 13 normal controls. Bone marrow MNC spontaneously (4 patients) produced 71 ng/ml IgM RF and secreted 78 ng/ml IgM RF with PWM stimulation (9 patients). In contrast synovial fluid MNC (5 patients) spontaneously elaborated 6652 ng/ml IgM RF, significantly (P less than 0.05) more than blood or bone marrow MNC; PWM-stimulated synovial fluid MNC (5 patients) produced 5472 ng/ml IgM RF. These observations confirm selective localization of activated, IgM RF-producing cells to the rheumatoid synovial space.

Antibody-Producing Cells↗
PubMed1985

Clinical utility of assays for circulating immune complexes.

There are now many assays for the quantification of circulating immune complexes, each with distinct specificity and sensitivity. In a wide variety of rheumatic, infectious, neoplastic, and metabolic conditions, levels of circulating immune complexes may be elevated. In select situations, determination of circulating immune complex levels may help clinicians in the management of their patients. In lupus erythematosus, circulating immune complex levels, in conjunction with other immune parameters, may provide more insight into the disease course and activity than assessment of end organ parameters alone. In the differential diagnosis of infective endocarditis, serial levels of circulating immune complexes may provide evidence of effectiveness or failure of treatment. There is evidence that assays for circulating immune complexes may be of potential benefit in the management of Lyme disease and acute myelogenous leukemia.

Antigen-Antibody Complex↗
PubMed1985

Food allergies and other adverse reactions to foods.

Adverse reactions to foods do occur. Their true degree of prevalence remains unknown. Many mechanisms are involved, including events at the gut mucosa surface, immunologic pathways, and nonimmunologic and possibly genetic influences, not all of which have yet been well studied. The major manifestations of food allergy have been cutaneous, gastrointestinal, and pulmonary. Others are less convincingly established. Of particular interest is the likelihood that certain rheumatic symptoms may be related to food sensitivity. Establishing a diagnosis of adverse food reaction requires thoughtful clinical evaluation and laboratory testing, confirmatory immunologic studies, and double-blind food challenge. Skin testing is a valuable screening tool and can help direct the physician to those patients for whom double-blind food challenge may be indicated. The simplest therapy is avoidance of foods to which an individual is sensitive. Sodium cromoglycate, antihistamines, prostaglandin synthetase inhibitors, and steroids have been used, but their efficacy has not yet been carefully evaluated.

Dermatitis, Atopic↗
PubMed1985

Weber-Christian disease. Analysis of 15 cases and review of the literature.

We report 15 patients encountered over 13 years who presented with inflammation of subcutaneous fat and were given clinical and pathologic diagnoses of Weber--Christian disease (WCD). Prominent clinical features included female predominance, lower extremity nodules, fevers, arthritis/arthralgias, and myalgias. Notable laboratory features were elevated erythrocyte sedimentation rate, anemia, leukopenia, and hypocomplementemia, frequently with circulating 7S IgM or immune complexes at times of active symptoms. Histologic findings were lobular--together with frequent septal--panniculitis, fat-laden macrophages, variable cellular infiltrates, necrosis, and occasional vasculitis. Follow-up revealed the death of 2 patients and disease stabilization or improvement in 13 patients. Six patients developed features of other diseases (factitial disease, erythema nodosum, acute myelogenous leukemia, rheumatoid arthritis, systemic lupus erythematosus, and sarcoid) and a seventh may have had erythema induratum. We suggest that classic WCD, as originally described, reflects an increasingly recognized spectrum of panniculitides. These are syndromes of diverse etiology that share many clinical, inflammatory, and immunologic features.

Adult↗
PubMed1985

Idiopathic eosinophilic myositis with preexisting fibromyalgia.

Idiopathic eosinophilic myositis is a rare entity. Only 6 other cases have been reported in the literature. We report a patient with degenerative joint disease and fibromyalgia who subsequently developed eosinophilic myositis over a tender trigger area.

Aged↗
PubMed1985

Monocytes in rheumatoid arthritis. Regulatory, effector, and phenotypic properties.

We reported that rheumatoid arthritis (RA) blood mononuclear cells (MNC) secreted less Ig and IgM rheumatoid factor (RF) than synovial cells. Since antibody elaboration is partly monocyte dependent, we compared regulatory, effector, and phenotypic properties of monocytes from 31 patients with RA with those of 21 normal subjects. RA IgG and IgM elaboration was less than normal. Monocyte, T or B cell numbers were comparable in RA and normal MNC and monocyte enriched/depleted preparations. RA and normal Ig production were monocyte dependent and this differed for IgG and IgM for RA and normals. IgM RF elaboration by stimulated RA MNC was also monocyte dependent and addition of normal monocytes/monocyte culture supernatants to RA monocyte depleted cultures and vice versa had inconsistent effects. RA MNC (Ficoll-Hypaque) phagocytosis was less than normal; killing (acridine orange fluorescent microscopy) was not. RA synovial monocyte phagocytosis - but not killing was also reduced. MNC from RA patients and normals contained similar numbers of monocytes; RA monocyte enriched populations (Percoll) showed less phagocytosis than normal; with similar killing. RA phagocytosis was reduced at 1,2,3,4 and 5 h and differed from normal at 3 and 5 h. Different sera - FCS, autologous, normal, RA - exhibited inconsistent effects on phagocytosis. RA and normal neutrophil phagocytosis and killing were comparable. Lastly, RA monocyte enriched preparations contained populations of OKM1, OKM3, OKM5, OKM6, Leu M1, Leu M2, Leu M3, and HLA-DR-positive cells (FACS analysis) comparable with normals. Regulatory and effector but not phenotypic properties of RA blood monocytes differed from normal and may contribute to inappropriate autoantibody production and chronic inflammation.

Arthritis, Rheumatoid↗
PubMed1984

Spontaneous disappearance of an IgA anti-factor IX inhibitor in a child with Christmas disease.

The few inhibitors to blood coagulation factor IX in patients with Christmas disease (hemophilia B) that have been studied have been shown to belong to the IgG class of immunoglobulins. We report the first case in which a factor IX inhibitor was of the IgA class. Additionally, he appears to be the youngest patient with hemophilia B to have developed an inhibitor. His inhibitor complicated treatment of the patient for several years because of its anamnestic rise following factor IX concentrate administration. It then spontaneously vanished and has not returned in spite of repeated factor IX complex administration.

Antibodies↗
PubMed1984

Practical points on nonsteroidal anti-inflammatory drugs.

All nonsteroidal anti-inflammatory drugs act by inhibiting prostaglandin synthesis, but the particular agent that will best suit an individual patient's needs cannot be predicted. Each drug should be tried for at least three weeks at maximal dosage before it is considered ineffective. When a particular nonsteroidal anti-inflammatory agent is not effective, one from another class should be tried. Levels of drugs metabolized by the liver are altered by nonsteroidal anti-inflammatory agents. Costs are quite variable.

Anti-Inflammatory Agents↗