Asunto(s)
Anafilaxia/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Tiosulfato Sódico de Oro/efectos adversos , Lisinopril/uso terapéutico , Adulto , Diarrea/inducido químicamente , Interacciones Farmacológicas , Femenino , Humanos , Parestesia/inducido químicamente , Enfermedades de la Piel/inducido químicamenteRESUMEN
Although intralesional corticosteroid injection of subcutaneous rheumatoid nodules was mentioned in 1968, this simple procedure is not commonly practised. A placebo-controlled, double-blind trial of intralesional corticosteroid injection using 24 rheumatoid nodules from 11 patients was carried out to determine the efficacy and safety of the procedure. Nodules injected with methylprednisolone and lignocaine regressed significantly more than nodules injected with placebo (lignocaine alone). This was consistently shown in all modalities of assessments which included patients' assessments (P < 0.001) and investigator's assessments (P < 0.001) of the percentage change in nodule size, and gross measurements of nodule volumes using a pincer (P < 0.001). Nine of 12 active injections produced > or = 50% loss in nodular volume with complete disappearance of two nodules. This compares with only one out of 12 placebo injections which resulted in > or = 50% loss in nodular volume. The patients found all 12 active injections to be worthwhile compared to only two of 12 placebo injections being worthwhile. The only complication of injection therapy observed was that of pain during the procedure.
Asunto(s)
Corticoesteroides/administración & dosificación , Nódulo Reumatoide/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Inyecciones Intralesiones/efectos adversos , Masculino , Dolor/etiología , Nódulo Reumatoide/patologíaRESUMEN
A 30-year-old male with eosinophilic fasciitis (EF) associated with morphoea and vitiligo is described. The patient showed a partial response to prednisone, but did not respond to hydroxychloroquine, D-penicillamine and cimetidine. In the light of reports of increased plasma histamine levels, and a putative role of mast cells in the pathogenesis of EF, ketotifen (a mast cell stabilizer) was prescribed. This non-toxic drug has allowed the patient to continue hard physical labour without further relapses and without corticosteroid therapy.
Asunto(s)
Eosinofilia/tratamiento farmacológico , Fascitis/tratamiento farmacológico , Cetotifen/uso terapéutico , Adulto , Fascitis/complicaciones , Fascitis/patología , Estudios de Seguimiento , Humanos , Cetotifen/administración & dosificación , Masculino , Esclerodermia Localizada/complicaciones , Factores de Tiempo , Vitíligo/complicacionesRESUMEN
A 13 year old school boy presented with seronegative inflammatory polyarthritis after a flu-like illness. Four months later clinical features of eosinophilic fasciitis became apparent. After histological diagnosis treatment was started with prednisone 40 mg daily, with a good response. Routine investigations showed persistent selective IgA deficiency.
Asunto(s)
Artritis/etiología , Disgammaglobulinemia/complicaciones , Eosinofilia/complicaciones , Fascitis/complicaciones , Inmunoglobulina A/metabolismo , Adolescente , Artritis/tratamiento farmacológico , Artritis/patología , Tejido Conectivo/patología , Disgammaglobulinemia/tratamiento farmacológico , Disgammaglobulinemia/patología , Eosinofilia/tratamiento farmacológico , Eosinofilia/patología , Fascitis/tratamiento farmacológico , Fascitis/patología , Humanos , Masculino , Músculos/patología , Prednisolona/uso terapéuticoRESUMEN
A survey was conducted to identify the attitude of consultant orthopaedic surgeons and rheumatologists in Scotland, North East England and Ireland, to the prevention of blood-borne infection in prosthetic joints. Of the 61% who completed the questionnaire, 65% gave advice about intercurrent infection, a similar number gave advice about the use of prophylactic antibiotics before certain surgical procedures, with less than half of the patients receiving any written instructions about inter-current infection, and less than a quarter of the patients receiving any written instructions about antibiotic prophylaxis. 36% of the respondents were confused as to what to advise or ignored the problem. The reality of late infection is discussed and a policy to minimise the risk of late infection in prosthetic joints is presented for consideration.