RESUMO
To assess bladder function in systemic lupus erythematosus (SLE) patients with recurrent urinary tract infections (UTIs). A convenience sample of consecutive patients with SLE (American College of Rheumatology criteria), with recurrent UTIs (>/=3 events in the preceding 12 months), without history of central nervous system involvement, urolithiasis or preceding tuberculosis were studied. Disease activity (SLEDAI-2K), damage (SDI), lower urinary tract symptoms [Pelvic pain and Urgency/Frequency (PUF) and the Interstitial Cystitis Symptom and Problem Index (ICSPI) scales] and Autonomic Symptom Profile (ASP) were assessed. All patients underwent urological examination and urodynamic assessment with cystometry, uroflow, micturition and urethral pressure profile. Ten patients (nine women) were included. The majority of the patients reported urinary symptoms: urgency (n = 8), frequency (n = 8), nocturia (n = 9) and pain (n = 10). The patients had a mean (SD) ICSPI score of 18.4 (9.8), PUF score of 17.4 (5.3) and ASP weighted score of 31.7 (16.1). Abnormal urodynamics findings were identified in seven of the 10 patients, including small bladder capacity (two patients), reduced bladder sensation (four patients), subnormal urinary flow rate (one patient) and a significant amount of residual urine (two patients). The urodynamics findings suggest that bladder dysfunction could be one of the mechanisms involved on the occurrence of recurrent UTIs in patients with SLE. These findings have potential implications for the proper assessment and management of SLE patients with recurrent UTIs. Further studies are needed to corroborate our results.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças da Bexiga Urinária/etiologia , Infecções Urinárias/etiologia , Transtornos Urinários/etiologia , Feminino , Humanos , Masculino , Recidiva , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/fisiopatologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/fisiopatologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Urina , UrodinâmicaRESUMO
The rheumatic conditions found in New Spain during the sixteenth century were not different from those seen in Mexico in present times. We present the humoral conceptions on which medical theory was based in those times, and the contributions made by Alonso López de Hinojosos during his practice in the Hospital Real de San Josef de los Naturales, in Mexico City. Among them were the clinical distinction between gout and rheumatoid arthritis more than one hundred years before Sydenham, and the identification of arthritis and ocular involvement associated with a contagious disease more than three hundred years before Reiter. We conclude that the analysis of ancient medical traditions is an interesting and fruitful enterprise.
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Hospitais/história , Doenças Reumáticas/história , História do Século XVI , Humanos , Indígenas Norte-Americanos/história , México/epidemiologia , Doenças Reumáticas/epidemiologia , Espanha , Livros de Texto como Assunto/históriaRESUMO
OBJECTIVE: To assess whether prednisone (PDN) produces anxiety and/or cerebral glial changes in rats. METHODS: Male Wistar rats were studied and 3 groups were formed (8 rats per group). The moderate-dose group received 5 mg/kg/day PDN released from a subcutaneous implant. In the high-dose group, implants containing PDN equivalent to 60 mg/kg/day were applied. In the control group implants contained no PDN. Anxiety was assessed using an open field and elevated plus-maze devices. The number of cells and cytoplasmic transformation of astrocytes and microglia cells were assessed by immunohistochemical analyses. RESULTS: Anxiety was documented in both groups of PDN treated rats compared with controls. The magnitude of transformation of the microglia assessed by the number of intersections was significantly higher in the PDN groups than in controls in the prefrontal cortex (moderate-dose, 24.1; high-dose, 23.6; controls 18.7; p < 0.01) and striatum (moderate-dose 25.6; high-dose 26.3; controls 18.9; p < 0.01), but not in hippocampus. The number of stained microglia cells was significantly higher in the PDN treated groups in the prefrontal cortex than in controls (moderate-dose, 29.1; high-dose, 28.4; control, 17.7 cells per field; p < 0.01). Stained microglia cells were significantly more numerous striatum and hippocampus in the high-dose group compared to controls. CONCLUSION: Subacute exposure to PDN induced anxiety and reactivity of microglia. The relevance of these features for patients using PDN remains to be elucidated.
Assuntos
Ansiedade/induzido quimicamente , Córtex Cerebral/efeitos dos fármacos , Glucocorticoides/efeitos adversos , Neuroglia/efeitos dos fármacos , Prednisona/efeitos adversos , Córtex Pré-Frontal/efeitos dos fármacos , Animais , Astrócitos/efeitos dos fármacos , Astrócitos/metabolismo , Astrócitos/patologia , Córtex Cerebral/patologia , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/patologia , Comportamento Exploratório/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Técnicas Imunoenzimáticas , Masculino , Neuroglia/química , Neuroglia/patologia , Córtex Pré-Frontal/patologia , Ratos , Ratos WistarRESUMO
The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.
Assuntos
Educação de Pacientes como Assunto , Doenças Reumáticas/psicologia , Doenças Reumáticas/reabilitação , Avaliação da Deficiência , Humanos , Morbidade , Doenças Reumáticas/mortalidade , Reumatologia/métodosRESUMO
OBJECTIVE: To determine the effects of HLA Class II genes, particularly LMP2 and previously implicated Class I genes, on susceptibility and disease expression in HLA-B27 negative ankylosing spondylitis (AS). METHODS: Patients included 41 HLA-B27 negative Caucasians from a total AS population of 546 and 17 HLA-B27 negative Mexican Mestizo. Controls included 4352 random HLA-B27 negative Caucasians. LMP2 genotype assignments were made on all patients and 282 random Caucasian controls by polymerase chain reaction-restriction fragment length polymorphism with the Cfo I restriction enzyme while HLA typing was performed on patients and controls using microcytotoxicity assays for Class I, and sequence specific probe-PCR for HLA-B60, B39, B38, and DR. RESULTS: The LMP2BB genotype was significantly decreased in Caucasian AS patients without extraspinal (ES) disease (25%) compared to AS patients with ES (64.7%) (p = 0.01) and random Caucasian controls (53.9%) (p = 0.007), even when those with colitis and psoriasis were excluded from analysis (ES+ 55.6% versus ES- 22.2%). This finding remained significant after stratification by HLA-DR. Similar trends were noted in the Mexican population. A potential role for HLA-DR8 and DR2 in susceptibility to disease was observed in Caucasian patients, although this observation requires confirmation. We could not confirm reported associations with HLA-B60 or B39. Peripheral arthritis was significantly more commonly observed in those who had had acute anterior uveitis (AAU) (75%) than in those who had not developed AAU (27.3%) (p = 0.04). CONCLUSION: HLA Class II encoded genes may have effects on disease susceptibility and/or phenotype in HLA-B27 negative individuals similar to those noted in HLA-B27 positive AS. Eccentric and axial phenotypes of disease may be immunogenetically determined.
Assuntos
Cisteína Endopeptidases , Antígeno HLA-B27/sangue , Complexo Principal de Histocompatibilidade/genética , Proteínas/genética , Grupos Raciais , Espondilite Anquilosante/genética , Adulto , Idoso , Alelos , Suscetibilidade a Doenças , Feminino , Genótipo , Humanos , Masculino , México , Pessoa de Meia-Idade , Fenótipo , Polimorfismo Genético , Proteínas/análise , Espondilite Anquilosante/sangue , Espondilite Anquilosante/imunologiaRESUMO
The increasing prevalence of complementary and alternative medicine usage by the general population and rheumatic patients worldwide is reviewed. The many potential concerns about this type of therapy are addressed, ranging from toxicity issues to changes in behavioral attitudes. Finally, the authors speculate on some major socioeconomic outcomes associated with these therapies.
Assuntos
Terapias Complementares/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Doenças Reumáticas/terapia , Reumatologia/tendências , Saúde Global , HumanosRESUMO
OBJECTIVE: To assess the prevalence, practices, beliefs, and expectations of patients with rheumatic diseases in relation to the use of alternative therapies. METHODS: We conducted a cross-sectional survey of 300 consecutive patients with rheumatic diseases at 3 outpatient rheumatic disease clinics in Guadalajara, Mexico to evaluate the use of alternative therapies. A face-to-face structured interview was administered by a trained assistant to evaluate the prevalence of use and patient beliefs, perceptions, and expectations in relation to alternative therapies. RESULTS: Two hundred fifty patients (83%) had used a total of 1,386 alternative therapies (range 1-19); 203 (68%) patients had used alternative therapy in the previous 12 months. Sixty-one percent received at least one alternative treatment before the first rheumatology consultation, but an additional 18% initiated these therapies after their initial contact with a rheumatologist at our clinics. Only 66 (26%) of the patients using alternative therapy notified their rheumatologist about their use. Thirty-six patients (14%) discontinued formal treatment at least on one occasion in order to receive alternative therapies, and only 8 (22%) notified their rheumatologist. Alternative therapy practitioners recommended discontinuation of conventional therapy on 57% of the occasions when formal treatments were discontinued. Mean expenditures per patient for fees to alternative therapy providers were equivalent to 28 days of the official minimum daily wage, and per patient costs for the remedies themselves were equivalent to 13 days of the official minimum daily wage. Patients who used alternative therapy in the past 12 months had lower education (7 versus 10 years, P < 0.001) and were slightly more disabled (1.7 versus 1.5, modified Health Assessment Questionnaire, P < 0.01). CONCLUSIONS: In this survey most patients used alternative therapies for the treatment of their rheumatic disease. Alternative therapies were costly and appeared to decrease adherence to conventional therapy. Health care providers should openly discuss the use of alternative therapy in patients with rheumatic diseases.
Assuntos
Terapias Complementares/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Doenças Reumáticas/etnologia , Doenças Reumáticas/terapia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Doenças Reumáticas/psicologia , Inquéritos e QuestionáriosRESUMO
STUDY DESIGN: Cross sectional. RESEARCH QUESTIONS: (a) Is any clinical variable of ankylosing spondylitis (AS) associated with the presence of ossification of the posterior longitudinal ligament (OPLL)? and (b) Is OPLL present in patients with AS from different geographical or genetic backgrounds? METHODS: Three groups were assembled: (1) a prospective group of 103 consecutive AS patients from two community based rheumatology clinics from Guadalajara, who were evaluated using: a questionnaire with disease characteristics variables; clinical assessment by a neurologist; lateral radiographic views of the cervical spine and somatosensory evoked potentials (SSEP). (2) Fifty one spondyloarthropathies (SpA) patients from Mexico city whose cervical spine films were retrospectively reviewed. (3) Thirty nine AS patients from Edmonton, Canada whose cervical spine films were retrospectively reviewed and compared with 72 controls. RESULTS: Group 1: 74% of the 103 patients were men and 86% were HLA-B27 positive. The mean age was 35 years, and mean (SD) disease duration 10 (8) years. OPLL was reported in 16 patients (15.5%; 95% CI 9, 22). OPLL was statistically associated with older age (p = 0.001), longer disease duration (p = 0.001), clinical myelopathy (p = 0.03), worst functional index (p = 0.042), restricted axial movement measurements (all p < 0.001), radiological sacroilitis (p < 0.001 for linear association), osteitis pubis (p = 0.009), hip involvement (p = 0.006 for linear association), and abnormal SSEP (p = 0.008). Group 2: 92% of 51 patients were men; the mean age was 30 years and the mean (SD) disease duration 11 (7) years. OPLL was reported in 15 (29%, 95% CI 17, 41) patients (nine AS, two psoriatic arthritis, three juvenile AS, and one Reiter's syndrome). Group 3: 95% of the 39 patients were men; the mean of age was 46 years and disease duration of 18 (10) years. OPLL was reported in nine (23%; 95% CI 10, 36) patients, including one with psoriatic arthritis, and two with Crohn's disease. OPLL was observed in two of the control group. CONCLUSIONS: The prevalence of OPLL in AS and SpA is higher than previously recognised and seems to be associated with variables identifying more severe axial disease.
Assuntos
Ossificação do Ligamento Longitudinal Posterior/complicações , Espondilite Anquilosante/complicações , Adulto , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/genética , Prevalência , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/genética , Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/genéticaRESUMO
OBJECTIVE: To assess the prevalence and severity of autonomic dysfunction (AD) in patients with systemic lupus erythematosus (SLE). METHODS: Fifty-nine consecutive patients with SLE and 97 healthy controls were assessed for AD using 4 noninvasive tests: heart rate responses to the Valsalva maneuver (Val), maximum-minimum heart rate (MM) response to deep breathing, heart response to standing up (30:15 ratio), and changes in blood pressure to sustained handgrip (Hand). AD was categorized as incipient, definite, severe, or atypical according to criteria proposed by Ewing. Disease characteristics, comorbid conditions, disease activity index [Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI)], cardiac complaints, and drug history were also documented. Laboratory analysis included rheumatoid factor, antinuclear antibodies, anti-dsDNA antibodies, and anticardiolipin antibodies (aCL). RESULTS: Forty-eight percent of the patients with SLE had one or more abnormal tests compared with 33% of the controls (p=0.05); differences were greater when the severity of the neuropathy was considered: 12 (21%) patients with SLE had definite or severe AD using Ewing's criteria, compared with only 2 (2%) controls (p < 0.001). No statistical associations were observed between AD and age, disease duration, hypertension, Mex-SLEDAI, anti-dsDNA, aCL antibodies, or other drugs. CONCLUSION: The prevalence of AD in SLE using noninvasive tests is high. One-fifth of our patients had definite or severe AD. No significant associations were observed between AD and clinical or serological variables of disease activity. Prospective studies are needed to determine the potential effect of AD in the morbidity of patients with SLE.
Assuntos
Doenças do Sistema Nervoso Autônomo/complicações , Lúpus Eritematoso Sistêmico/complicações , Adolescente , Adulto , Anticorpos Anticardiolipina/análise , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Criança , Feminino , Força da Mão/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Manobra de Valsalva/fisiologiaRESUMO
INTRODUCTION: An association between polymorphism of the HLA linked LMP2 locus and the development of acute anterior uveitis (AAU) has previously been described in B27 positive white subjects with ankylosing spondylitis (AS). This study evaluated LMP2 alleles in two HLA-B27 positive Mexican populations of patients with spondyloarthropathy known to have a different clinical spectrum of disease from white people. PATIENTS AND METHODS: The study populations consisted of 90 AS patients from Guadalajara with predominantly adult onset disease and 80 AS patients from Mexico City with predominantly juvenile onset disease. LMP2-CfoI amplified fragment length polymorphisms were determined after polymerase chain reaction amplification and digestion with CfoI restriction enzyme. RESULTS: There was an increased LMP2A allelic frequency in patients who had had AAU in both Guadalajara (31.8%) and Mexico City (33.3%) when compared with non-AAU patients (15.2% and 17.7% of Guadalajara and Mexico City populations, respectively). The odds ratio relating LMP2A allelic frequency and AAU for the combined population, stratified by age at onset of disease, was 2.51 (p = 0.01). LMP2 alleles did not influence the age at onset of disease or the development of peripheral arthritis. CONCLUSIONS: These data support the view that polymorphism at the LMP2 locus is associated with the development of AAU in B27 positive subjects with AS. The requirement for both the less common LMP2 allele and HLA-B27 is consistent with the low prevalence of AAU in Mexican patients with spondyloarthritis.
Assuntos
Antígeno HLA-B27 , Polimorfismo Genético , Espondilite Anquilosante/genética , Uveíte Anterior/genética , Proteínas da Matriz Viral/genética , Doença Aguda , Adolescente , Adulto , Idade de Início , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Espondilite Anquilosante/complicações , Espondilite Anquilosante/etnologia , Espondilite Anquilosante/imunologia , Uveíte Anterior/complicações , Uveíte Anterior/imunologiaRESUMO
OBJECTIVE: HLA class II encoded factors may influence the phenotype of ankylosing spondylitis (AS). These include HLA DRB1*07 for peripheral arthritis, and polymorphism of the HLA-linked LMP2 locus and HLA DRB1*08 for acute anterior uveitis (AAU). We studied the relationship between DRB1*08 and disease phenotype in additional populations of individuals with AS. METHODS: The patient population included 385 unrelated HLA-B27 positive individuals with AS. These included 204 Caucasians and 2 populations of Mexican Mestizo with AS: 106 with predominately adult onset disease from Guadalajara and 75 with predominately juvenile onset disease from Mexico City. The control population of 428 individuals included 210 random and 36 HLA-B27 positive unrelated Canadian Caucasians and 173 random and 9 HLA-B27 positive Mexican Mestizo from Mexico City. DRB1*08 typing was by sequence specific polymerase chain reaction. RESULTS: A significantly higher prevalence of DRB1*08 was observed in Mexican patients with juvenile onset disease (44.9%) and especially those with undifferentiated spondyloarthropathy (55.6%) compared to normal unrelated Mexican Mestizo (25.4%) (p < 0.01 for both) and in patients with undifferentiated spondyloarthropathy versus B27 controls (11.1%) (p = 0.03), although no significant differences were observed in within patient group comparisons based on phenotypic features of disease such as AAU and age at onset. No significant relationship between DRB1*08 and disease phenotype was evident in Caucasian individuals. CONCLUSION: Our data suggest DRB1*08 may influence the phenotype of spondyloarthritis in Mexican Mestizo, but do not support the view that DRB1*08 influences the development of AAU, as reported in a Japanese population.
Assuntos
Antígenos HLA-DR/genética , Indígenas Norte-Americanos , Espondilite Anquilosante/imunologia , Adolescente , Adulto , Idade de Início , Idoso , Criança , Feminino , Cadeias HLA-DRB1 , Humanos , Indígenas Norte-Americanos/genética , Masculino , México , Pessoa de Meia-Idade , Fenótipo , Prevalência , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/genética , População Branca/genéticaRESUMO
OBJECTIVE: To evaluate the potential efficacy of intravenous bolus cyclophosphamide (IVCY) in patients with pyoderma gangrenosum. METHODS: Consecutive patients with a diagnosis of pyoderma gangrenosum seen in a period of 3 years in tertiary care referral center were included. Patients received IVCY 500 mg/m2 of body surface area, every month until reaching a maximum of 6 doses, or healing of their ulcers or a lack of response after 3 doses. Patients were assessed every month during the time they received IVCY and every 3 months thereafter. The assessments included number and size of ulcers, and a safety profile of the study drug. Complete remission was defined as 100% ulcer healing, partial remission as a decrease > or = 50% but less than 100%, and therapeutical failure if the size of the ulcer increased or decreased < 50%. RESULTS: Nine patients were included, 6 were men, the mean age was 46 yrs (range 24-76). The mean disease duration was 3.3 yrs (range 1 week to 9 yrs). Four patients had idiopathic pyoderma gangrenosum, 3 had associated rheumatoid arthritis, and 2 had associated systemic lupus erythematosus. Complete remission was observed in 7 patients, partial in one, and failure in one. Relapses were observed, 3 months after the last IVCY (2 cases) and 12 months after the last IVCY (one case). Transitory thrombocytopenia and leukopenia developed in one patient and nausea and vomiting in another. CONCLUSION: IVCY appears effective in controlling the lesions of pyoderma gangrenosum and inducing remission for a substantial period in many individuals.
Assuntos
Ciclofosfamida/uso terapêutico , Pioderma Gangrenoso/tratamento farmacológico , Adulto , Idoso , Ciclofosfamida/administração & dosagem , Avaliação de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Pioderma Gangrenoso/patologia , RecidivaRESUMO
OBJECTIVE: To describe the clinical and radiological 2-yr followup of 22 patients with anterior atlantoaxial subluxation (AAS) from a prospective cohort of patients with ankylosing spondylitis. METHODS: The 2-yr assessment included a structured questionnaire for rheumatologic and neurologic complaints and lateral cervical radiographs in maximal flexion view. Initial and 2-yr radiographs were assessed blind to patient data. The course of anterior AAS was classified as unchanged (< 1 mm), progression (> or = 1 mm) or regression (> or = 1 mm) at 2 yrs compared with baseline. Vertical AAS was classified using the Sakaguchi-Kauppi method. Magnification factor was corrected using the ratio of C3 width. RESULTS: Anterior AAS was detected in 22 patients at baseline examination. Two patients also had vertical AAS; 86% were male. Mean age was 33 +/- 9 yrs and mean disease duration was 12 +/- 7 yrs. At followup, one patient had died of acquired immunodeficiency syndrome, 3 could not be reached, and 2 had undergone surgical fusion due to severe myelopathy and now showed complete neurological recovery. Of the remaining 16 patients, 7 (32%) showed progression and 9 (41%) showed no change in the C1-odontoid distance. Vertical AAS developed in one patient. After the 2-yr assessment, 3 additional patients had surgical fusion because of notable progression of AAS, despite absence of neurological signs. CONCLUSION: Anterior AAS progressed in a number of these patients in the 2 yrs following its detection, and with or without neurological signs, surgical management was thought appropriate in a considerable number of them.
Assuntos
Articulação Atlantoaxial/lesões , Luxações Articulares/diagnóstico por imagem , Espondilite Anquilosante/complicações , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Luxações Articulares/complicações , Luxações Articulares/epidemiologia , Masculino , Pessoa de Meia-Idade , Radiografia , Compressão da Medula Espinal/etiologia , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologiaRESUMO
OBJECTIVE: To evaluate temporomandibular joint (TMJ) osseous morphology in a consecutive sample of Mexican patients with ankylosing spondylitis. METHODS: Consecutive patients with a diagnosis of ankylosing spondylitis who attended two secondary care outpatient rheumatology clinics were included in the study. Patients had a rheumatological assessment using a structured questionnaire and examination. Recorded variables included demographic data, disease characteristics, TMJ symptoms, and axial mobility measurements. Hypocycloidal tomography of the TMJ was obtained on all subjects. Radiographic variables included condyle position, superior joint space, range of movement, condylar osseous changes, and temporal osseous changes. Patients also underwent standard cervical spine radiography. A control group of normal people without either TMJ symptoms or systemic rheumatic disease was obtained. RESULTS: 65 subjects were studied (65 right sided and 63 left sided tomograms). The control group consisted of 22 individuals. Both groups were similar in age [33 (SD 11) v 34 (9) years, P = 0.8]. Patients with ankylosing spondylitis had more variability in TMJ mobility than controls (P < 0.05) and showed increased frequency of condylar erosions (P < 0.01), flattening (P < 0.01), sclerosis (P < 0.01), and temporal flattening (P < 0.01). Condylar erosions were associated with longer duration of ankylosing spondylitis (P < 0.05), neck complaints (P < 0.05), and atlantoaxial subluxation (P < 0.05). CONCLUSIONS: TMJ involvement is frequent in this population of patients with ankylosing spondylitis and is associated with variables that suggest more severe disease.
Assuntos
Espondilite Anquilosante/complicações , Transtornos da Articulação Temporomandibular/etiologia , Adulto , Feminino , Humanos , Masculino , Côndilo Mandibular/patologia , Movimento , Variações Dependentes do Observador , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/patologia , Tomografia por Raios XRESUMO
Rheumatic manifestations of diseases primarily of the gastrointestinal tract, liver, or pancreas are frequent and vary from soft tissue rheumatism and carpal tunnel syndrome to Raynaud's phenomenon, osteoporosis, arthritis, and vasculitis. Some patients with celiac disease develop osteoporosis and arthritis responsive to a gluten-free diet. It seems that osteoporosis is a frequent feature in patients with inflammatory bowel disease, and steroid use is an important risk factor. The use of steroids in patients with Crohn's disease and ulcerative colitis has generated medicolegal questions. This year a wealth of information has been published regarding hepatitis C virus infection. Arthritis, myopathy, and antibody production are some of the reported manifestations of chronic hepatitis C virus infection. There is evidence that may link chronic hepatitis C virus infection with the antiphospholipid syndrome.
Assuntos
Gastroenteropatias/complicações , Hepatopatias/complicações , Pancreatopatias/complicações , Doenças Reumáticas/complicações , Gastroenteropatias/patologia , Humanos , Hepatopatias/patologia , Pancreatopatias/patologia , Doenças Reumáticas/patologiaRESUMO
OBJECTIVE: To describe the functional and anatomic heart abnormalities of patients with dermato-polymyositis. METHODS: Thirty-two consecutive patients with dermato-polymyositis (DM/PM) were studied. Patient assessments included a questionnaire for cardiac symptoms, physical examination, muscular enzymes, standard electrocardiogram (EKG), chest radiographs, spirometry, Holter monitoring and color Doppler flow (CDF) studies. Features evaluated with CDF included left ventricular diastolic dysfunction (LVDD), hyperdynamic heart, mitral valve prolapse, and endomyocardial fibrosis. RESULTS: Twenty-five patients (78%) were female. The mean age was 43 years and the mean disease duration 6 years. Twenty-six (81%) patients had dermatomyositis. Only 2 (6%) had cardiac symptoms. Spirometry was performed in 20 patients, Holter monitoring in 23 and CDF in 26 patients. Electrical disturbances detected by either EKG or Holter were present in more than half of the patients studied. LVDD was identified in 11 patients (42%) and hyperdynamic heart in 4 (15%). None of the 26 patients studied by CDF had mitral valve prolapse. No significant differences in the frequency of cardiac abnormalities, including LVDD, were observed in relation to the diagnosis of DM or PM, the presence of Raynaud's phenomenon or calcinosis, or the disease activity status at the moment of the study. CONCLUSIONS: Subclinical heart abnormalities are frequent in patients with DM/PM. LVDD appears to be common. Our findings suggest that cardial assessment of patients should be performed in order to detect abnormalities requiring specific therapy.
Assuntos
Dermatomiosite/complicações , Fibrose Endomiocárdica/complicações , Prolapso da Valva Mitral/complicações , Polimiosite/complicações , Disfunção Ventricular Esquerda/complicações , Adolescente , Adulto , Idoso , Angiocardiografia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Dermatomiosite/tratamento farmacológico , Dermatomiosite/fisiopatologia , Ecocardiografia Doppler em Cores , Eletrocardiografia Ambulatorial , Fibrose Endomiocárdica/diagnóstico , Fibrose Endomiocárdica/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/fisiopatologia , Polimiosite/tratamento farmacológico , Polimiosite/fisiopatologia , Prednisona/uso terapêutico , Espirometria , Inquéritos e Questionários , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Some clinical features observed in diabetes mellitus suggest secondary Sjögren's syndrome, and the effect of autonomic neuropathy on tear production is analyzed. Limited joint mobility in diabetes mellitus continues to attract attention, and a number of suggestions for further studies are discussed. Neurophysiologic assessment of the median nerve distinguishes diabetic polyneuropathy from carpal tunnel syndrome; however, Martin-Gruber anastomosis may modify nerve conduction measurements. Fracture rate does not appear to be increased in diabetes mellitus. The role of confounding variables and a dose-dependent effect of thyroxine therapy on bone mass is discussed. The possible association of hypothyroidism with gout is debated. Autoimmune thyroid diseases may be added to the list of conditions that produce anticardiolipin antibodies without the clinical manifestations of antiphospholipid syndrome.
Assuntos
Doenças do Sistema Endócrino/complicações , Doenças Musculoesqueléticas/complicações , Doenças Autoimunes/complicações , Complicações do Diabetes , Humanos , Doenças Reumáticas/complicações , Doenças da Glândula Tireoide/complicaçõesRESUMO
OBJECTIVE: To determine the prevalence of anterior and vertical atlantoaxial subluxation (AAS) and its neurological effect in a consecutive sample of Mexican patients with ankylosing spondylitis (AS). METHODS: Consecutive patients with a diagnosis of AS who attended 2 secondary care outpatient rheumatology clinic in the city of Guadalajara within a period of 6 mo were included in the study. Patients had prospective rheumatologic and neurologic assessments using structured questionnaires and examinations. Recorded variables included demographic data, disease characteristics, neurologic symptoms and signs, and axial mobility measurements. Somatosensory evoked potentials (SSEP) were performed in all patients. Patients also underwent standard cervical spine radiography with anteroposterior open mouth, and neutral, full flexion and extension lateral views. RESULTS: We studied 103 patients. Mean age was 35 yrs, 74% were male, and mean disease duration was 10 yrs (S/- SD 7.9). Anterior AAS was observed in 22 patients (21%, 95% CI 13-29%) and vertical AAS in 2 cases (2%, 95% CI 0-7%). Ossification of the posterior longitudinal ligament (OPLL) was present in 16 patients. Statistically significant associations were observed between anterior AAS and SSEP (p < 0.0001) and OPLL (p = 0.04). The degree of radiologic sacroiliitis was also associated with anterior AAS. After completion of the study, 2 patients required surgical fusion due to severe cervical cord compression. CONCLUSION: The prevalence of AAS and OPLL in this population was higher than previously reported in other settings. The association of anterior AAS with OPLL and radiological sacroiliitis could identify a subgroup of patients with more severe axial enthesopathy. Although clinically significant neurologic complications are not frequent in these patients, AAS may cause severe spinal cord compression requiring surgical fusion.