Bullous systemic lupus erythematosus with antiphospholipid syndrome.

We report the case of a 44-year-old male with a 10-year history of manifestations of the rare form of bullous systemic lupus erythematosus (SLE) with coexisting antiphospholipid syndrome (APS) that remained undiagnosed until thrombotic-embolic episodes appeared and high titres of anticardiolipin (ACL) antibodies were detected. The patient fulfilled the criteria for SLE and the atypical cutaneous manifestations together with histopathological changes and a favourable response to sulphones were the grounds for the diagnosis of the bullous variety of SLE. Treatment with prednisolone, acenocoumarol and dapsone resulted in marked clinical improvement, reduction in antinuclear antibodies (ANAs) and normalization of ACL antibody titres.

MRI evaluation of pathological changes taking place in the hand in patients with rheumatoid arthritis.

The aim of this study was to use magnetic resonance imaging (MRI) to evaluate the pathological changes taking place in the hands of patients with rheumatoid arthritis (RA), and to attempt to characterize early and persistent changes. 42 patients were examined, including 31 women and 11 men in age from 23 to 75, the duration of illness ranged from 1 month to 27 years (average 7.1 years). The MRI examination was performed using a 1,5 T Magnetom 63 SP whole body system. The SE sequence was used in T1-weighted (TR600, TE15) and fat-suppressed images (A-250, TR1155, TE22), obtained with 3 mm scans, matrix 256 x 512. A knee coil was used. In 30 patients erosion was detected on the joint surfaces of the bones, including 7 patients whose erosion was not visible in plain ordinary x-ray photos. In 31 patients bone marrow edema was detectable, including 6 patients in whom advanced pathological changes were absent. In all patients signs were discovered of thickening of the synovial membrane with (30 of 42) or without (12 of 42) the presence of pannus. Periarticular effusion was observed in all patients, and in 6 patients it occurred together with bone marrow edema. Tendonitis was visible in 25 patients who were in an advanced stage of the disease. For 7 patients, the MR examinations prompted an upgrading of the diagnosed phase of rheumatoid arthritis to a more advanced stage, due to the detection of erosion. In patients with a less advanced stage of the disease, MR examination revealed 11 more joints with pathological changes (periarticular effusion) than were detected by ordinary physical examination. Magnetic Resonance Imaging seems to be the examination of choice in patients with rheumatoid arthritis at an unclear or early stage.