1/18. giant cell arteritis associated with rheumatoid arthritis monitored by magnetic resonance angiography.A 57-year-old Japanese woman with well controlled rheumatoid arthritis visited our hospital with a severe bitemporal headache and marked fatigue. Based on the classification criteria by the American College of rheumatology, she was diagnosed as having giant cell arteritis. Magnetic resonance (MR) angiography was performed, from which stenotic changes in the bilateral superficial temporal arteries were strongly suspected. Corticosteroid therapy was quickly started. The patient followed an uneventful course with no complications. Therapeutic effect was confirmed by MR angiographic findings obtained 4 weeks after the initiation of therapy.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
2/18. Results of a longer than 10-year follow-Up of patients with rheumatoid arthritis treated by occipitocervical fusion.STUDY DESIGN: Evaluation of results a longer than 10-year follow-up of patients with upper cervical lesions due to rheumatoid arthritis who underwent occipitocervical fusion. OBJECTIVE: To determine the final outcome of patients with upper cervical lesions due to rheumatoid arthritis treated by occipitocervical fusion. SUMMARY OF BACKGROUND DATA: There are few studies reporting the final outcome of patients with rheumatoid arthritis treated by occipitocervical fusion and observed for longer than 10 years. methods: The subjects were 16 patients with rheumatoid arthritis with myelopathy who underwent occipitocervical fusion with a rectangular rod more than 10 years ago. All 16 patients had irreducible atlantoaxial dislocation, and 11 also had vertical dislocation of the axis. All patients had preoperative nuchal pain, and were classified into Class II (two patients), Class IIIA (nine patients), and class IIIB (five patients) according to Ranawat's preoperative neurologic classification. RESULTS: The atlas-dens interval remained the same as immediately after surgery. Vertical dislocation returned to the preoperative condition, despite successful surgical correction. Preoperative occipital pain disappeared or was reduced in all cases. Myelopathy improved in 12 of the 16 patients (75%) by more than one class in the Ranawat preoperative neurologic classification. survival rate at 10 years after surgery was 38%; mean age at death was 70.7 years. The postoperative periods during which patients could walk by themselves ranged from 6 months to 13 years (mean, 7.5 years). CONCLUSIONS: Occipitocervical fusion for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.- - - - - - - - - - ranking = 2keywords = classification (Clic here for more details about this article) |
3/18. Evaluating patients with arthritis of recent onset: studies in pathogenesis and prognosis.Inflammatory synovitis of recent onset poses a diagnostic and prognostic challenge to primary care physicians and rheumatologists. A lack of understanding of the underlying etiologic and pathogenic processes limits the ability to distinguish forms of arthritis that follow a benign, self-limiting course from forms that proceed to an aggressive, erosive disease requiring intensive immunosuppressive therapy. It is estimated that between 30% and 40% of patients presenting with early synovitis have disease that remains unclassified. Using data from a cohort of patients with early synovitis and reviewing current literature, we discuss investigational approaches toward a new classification of patients with early synovitis. Although a lack of understanding of this heterogeneous clinical syndrome has led clinicians to take a largely empirical approach to treatment thus far, the evolving awareness of disease predisposition at a genetic level and the expanding ability to specifically manipulate biological pathways may ultimately change the approach to this clinical problem. JAMA. 2000;284:2368-2373.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
4/18. Possibility of potential VWD misdiagnosis or misclassification using LIA technology and due to presence of rheumatoid factor.von Willebrand's disease (VWD) is now recognised to be the most common inherited bleeding disorder and is due to defects and/or deficiencies in von willebrand factor (VWF). The latex immuno-assay (LIA) procedure has become a popular VWF:Ag detection methodology because of the ability to automate testing. In this report, we present findings which urge caution when normal LIA results are obtained co-incident to striking clinical findings strongly suggestive of VWD, or previous laboratory findings consistent with VWD. As illustrated by a relevant case study, normal LIA results may lead to an "incorrect diagnosis" of "not VWD" or to a potential subtype misdiagnosis, should they be accepted without cross-confirmation using alternative VWF methodologies.- - - - - - - - - - ranking = 4keywords = classification (Clic here for more details about this article) |
5/18. Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine.OBJECTIVE: This is a retrospective study of the outcome of occipitothoracic fusion surgery in rheumatoid arthritis (RA) patients with destruction of the cervical spine, designed to assess the efficacy of halo vest before surgery, the postoperative outcome, and the activities-of-daily living (ADL) problems associated with surgical management. There have been no reports regarding these issues, including surgical effect on subjacent vertebrae. methods: This study included 20 RA patients with destruction of the cervical spine. All patients underwent preoperative halo vest followed by occipitothoracic fusion with an average follow-up of 5 years. The long-term clinical outcomes were analyzed using a modified Ranawat classification. RESULTS: Before halo application, the neurologic status was assessed as IIIC in 15 patients and IIIB in 5 patients. After halo application, the neurologic status improved in all patients: IIIA in 12 patients and IIIB in 8 patients. After surgery, the neurologic status did not improve in six of the eight IIIB patients but improved to IIIA in two patients. Of the 12 IIIA patients, the neurologic status improved to II in 6 patients but did not improve in the other 6 patients. patient satisfaction was excellent for 14 patients, good for 3 patients, and fair for only 3 patients (1 had difficulty drinking, another had back pain, and the last had low back pain associated with a compression fracture of the lumbar spine). CONCLUSIONS: We have performed occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. Preoperative halo vest was very effective for improving the neurologic status, for the general condition, and for an optimal sagittal alignment. Occipitothoracic fusion using unit rods gave satisfactory long-term clinical results compared with the prognosis of patients in whom the disease follows its natural course.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
6/18. A case of overlap syndrome with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and secondary sjogren's syndrome.We report an unusual case of overlap syndrome that had the coexistence of five autoimmune diseases. A 45-year-old woman initially developed seropositive erosive rheumatoid arthritis (RA) 11 years ago. She then developed progressive systemic sclerosis (PSS) (including pulmonary hypertension, esophageal dysfunction, cardiac involvement and sclerodactilitis), systemic lupus erythematosus (SLE) (including photosensitivity, nephritis, leukopenia, lymphopenia, thrombocytopenia and Coombs positive hemolytic anemia and positive anti-dsDNA), and secondary sjogren's syndrome (SSS) in the last 7 years before she was admitted to our clinic. The patient fulfilled classification criteria for RA, SLE, PSS and SSS, as determined by American College of rheumatology. hypothyroidism with positive autoantibodies due to Hashimoto's thyroiditis, the beginning of which could not be defined, was coexistent with this overlap syndrome. In the literature, although overlap syndromes in different combinations were reported, we very rarely observed a complex case like this patient. In our opinion, this is the first well-documented case of RA, PSS, SLE, SSS and Hashimoto's thyroiditis existing together in the same patient. Although immunosuppressive therapy was administered, the disease rapidly deteriorated and the patient died.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
7/18. adult variant of self-healing papular mucinosis in a patient with rheumatoid arthritis: predominant proliferation of dermal dendritic cells expressing CD34 or factor xiiia in association with dermal deposition of mucin.According to a recent classification, self-healing papular mucinosis (SHPM) is a subtype of papular mucinosis (also known as lichen myxedematosus), which is in turn a type of idiopathic localized cutaneous mucinosis. SHPM tends to occur in children, but there have been a few reports of an adult type. We report a 70-year-old Japanese woman who presented with reddish, rice-kernel-sized papules of a few days' duration on her right arm. She had a 25-year history of rheumatoid arthritis, which had been well treated with a low dose of corticosteroid as well as some other medications. No paraproteinemia or thyroid dysfunction were observed. The eruptions spontaneously resolved within 2.5 months of onset. Histological findings showed a well-circumscribed mucinous stroma surrounded by dermal mesenchymal cells, such as fibroblast-like cells in the middle of the dermis. Immunohistochemically, these cells were positive only for vimentin on the mucinous lesion. On the circumference of the mucinous lesion, these cells expressed either CD34 or factor xiiia (FXIIIa). Because vimentin was common to dermal mesenchymal cells, we defined the cells expressing CD34 or FXIIIa, except for vimentin cells lacking CD34 or FXIIIa, as dermal dendritic cells (DDC). The findings of the present case suggest that CD34 or FXIIIa DDC and tryptase-positive mast cells on the perilesional area in combination with vimentin cells on the mucinous lesion might have given rise to the dermal deposition of mucin in our case. These cells, which are possibly activated in an autoimmune manner associated with rheumatoid arthritis, might play important roles in the development of dermal deposition of mucin in SHPM.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
8/18. Examination of IgM rheumatoid factor (IgM-RF) and anti-cyclic citrullinated peptide antibody (anti-CCP Ab) in Japanese patients with palindromic rheumatism.We have studied the serology of 6 patients with palindromic rheumatism. None of the patients fulfilled the classification criteria for rheumatoid arthritis at the entry; however, 4 out of the 6 patients were seropositive for IgM rheumatoid factor (IgM-RF) at entry. Sequential serological study was performed in 4 patients; IgM-RF changed from seronegative to seropositive in one patient, and the titer increased in another patient. Anti-cyclic citrullinated peptide antibody (anti-CCP Ab) at the entry was detected in only one of the 6 patients; that patient later developed RA. Although follow-up is necessary, the present study may suggest the importance of serological examination, especially anti-CCP Ab, in patients with palindromic rheumatism.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
9/18. Technique for detecting early rheumatoid arthritis.The authors are of the opinion that the controversy surrounding the value of radiography in the early diagnosis of RA and subsequent assessment of drug therapy is due to the poor resolution of the radiographs used in many of these studies. Given that radiographic findings correlate with the pathological changes occurring in the hands and wrists of the RA patient, the ARA 1987 revised criteria for the classification of RA requires a PA projection of the hands and wrists. With this in mind, it is obvious that a standard radiographic technique offering high-resolution be developed and implemented. Direct magnification procedures as previously described offer high-resolution, however, they are either too cumbersome to use, require specialized, limitedly available equipment, produce partial images, have prolonged exposure times leading to part motion and are too expensive. In addition, radiation dosages to the skin are higher. These problems also preclude their use in the establishment of screening procedures for early RA. By comparison, the authors' optical magnification technique eliminates the major problems encountered in direct magnification. More importantly, the described optical magnification technique provides high-resolution radiographs utilizing readily available equipment and offers a practical means for the effective screening and diagnosis of early RA.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
10/18. The coexistence of rheumatoid arthritis and systemic lupus erythematosus.A 29-year-old white female with longstanding classical rheumatoid arthritis (RA) developed clinical and serological manifestations of systemic lupus erythematosus (SLE) with prominent signs of diffuse proliferative lupus nephritis. She fulfilled the ARA criteria for the classification of SLE as well as the ARA criteria for classical RA. The concomitant presence of these two affections in the same patient is rare and the discriminating features suggest that this coexistence may be coincidental. With respect to treatment, our patient had good relief of symptoms by a combined administration of methylprednisolone pulses and cyclophosphamide.- - - - - - - - - - ranking = 1keywords = classification (Clic here for more details about this article) |
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