RESUMEN
Giant-cell arteritis (GCA) and polymyalgia rheumatica are systemic disorders that reportedly affect primarily white women older than age 50 years. We conducted an 11-year chart review to determine the relative occurrence and pattern of demographic involvement of GCA in the Gulf Coast region of the United States. Of 101,239 computer-coded entries for individual patients aged 40 years or older, 60 charts listed GCA as a differential diagnosis. Twenty-seven patients had temporal GCA; 21 temporal artery biopsy specimens were identified. Two patients had associated systemic GCA (one with aortitis). A striking finding was that 13 of the 27 patients were black women (about 50% of the entire study population). The group with GCA and polymyalgia rheumatica (17 patients) had a significantly higher mean erythrocyte sedimentation rate than the group with "pure" GCA. Jaw claudication and blindness were rare. We concluded that temporal GCA seems relatively uncommon in the Gulf Coast region and in the southern United States as a whole. Furthermore, GCA seems rare in Hispanics (only one patient identified). Nonetheless, this is the first report to document a proportionally high occurrence of GCA in black patients in this part of the country.
Asunto(s)
Arteritis de Células Gigantes/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Sedimentación Sanguínea , Femenino , Arteritis de Células Gigantes/sangre , Arteritis de Células Gigantes/complicaciones , Arteritis de Células Gigantes/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , TexasRESUMEN
An accident at an oil refinery in Texas City, Texas, released around 40,000 lb of hydrogen fluoride, exposing the community to the highly toxic and corrosive substance. A population-based epidemiologic study was conducted to evaluate the impact of the accident on the health of the community. Exposure assessment was done using a multipronged approach through a door-to-door survey of 10,811 individuals. A symptom survey resulting in 1994 completed interviews was conducted with a stratified random sample selected from the exposure study database. The sampling was balanced with respect to age, gender, and predisposition across the three ordinal exposure categories. The results show a strong dose relationship (P < 10(-4)) between the exposure and symptoms reported following the accident and 2 years later, most notably breathing and eye symptoms. However, substantial improvement in health was reported over the 2-year period regardless of the level of exposure. Problems of recall bias and behavioral sensitization are considered and it is recognized that the study may have overestimated the effect. It is also recognized that the study may not have completely unraveled the relative importance of exposure and host response in health outcome, since the two were probably conflated in the exposure measure. Nevertheless, the independence of predisposition and reported level of exposure, the magnitude of effect and its consistency, the unmistakable dose response, the large sample size, and the mutual corroboration of various findings make it difficult to dismiss the interpretation that the hydrofluoric acid exposure indeed caused health problems in the community that continued for at least 2 years after the accident.
Asunto(s)
Accidentes de Trabajo , Contaminantes Ocupacionales del Aire/efectos adversos , Ácido Fluorhídrico/efectos adversos , Adolescente , Adulto , Actitud Frente a la Salud , Industria Química , Niño , Preescolar , Exposición a Riesgos Ambientales , Oftalmopatías/inducido químicamente , Oftalmopatías/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Prevalencia , Enfermedades Respiratorias/inducido químicamente , Enfermedades Respiratorias/epidemiología , Texas/epidemiologíaRESUMEN
Acetylsalicylic acid (ASA) is a short-acting oral inhibitor of the cyclooxygenase enzyme. Ingestion of ASA is associated with a decrease in prostaglandins, including those of the E2 series, as well as prostacyclin, and thromboxane. Consumption of therapeutic doses is associated with decreased pain and inflammation and is therefore used in a variety of inflammatory conditions. Platelet aggregation is also inhibited. Because of these observations, and the fact that platelet aggregation has been noted to be altered during exercise, the effects of ASA on exercise tolerance was of interest. We studied 17 healthy male volunteers who regularly ran as a source of exercise. During the study they ingested either 650 mg of ASA or placebo 30 min before running 2 miles (3.2 km). Outcome of the double-blind crossover study was measured by the time required to run a 2-mile distance. No differences between ASA or placebo were noted in the subjects. These data suggest that 650 mg of ASA as a premedication has little effect on exercise performance in normal endurance runners. However, whether ASA may affect pain after exercise or whether other dosage intervals would be more beneficial needs further study.
Asunto(s)
Aspirina/farmacología , Ejercicio Físico/fisiología , Carrera , Adulto , Análisis de Varianza , Método Doble Ciego , Humanos , Masculino , Persona de Mediana Edad , Placebos , Factores de TiempoRESUMEN
Although a rare disorder, ankylosing spondylitis is often considered in the differential diagnosis of low back pain. The disease primarily affects young white men and is characterized by early morning stiffness in the lower back that typically improves with activity. Patients often have tenderness over one or both sacroiliac joints and limited spinal mobility. With large doses of nonsteroidal antiinflammatory drugs and prompt physical therapy, disability may be kept to a minimum and survival is near normal.
Asunto(s)
Espondilitis Anquilosante/diagnóstico , Adulto , Antígenos HLA-B/análisis , Humanos , Masculino , Pronóstico , Espondilitis Anquilosante/terapiaRESUMEN
Rheumatic disorders are not uncommon in patients between 20 and 50 years of age, and the differential diagnosis may be difficult. However, after a careful history and thorough physical examination, the cause usually becomes apparent. Laboratory findings alone should not be relied on for diagnosis. Because the impact on younger adults may be devastating and the potential disability may be present for many years, these patients represent an important challenge for any practicing physician.
Asunto(s)
Enfermedades Reumáticas/diagnóstico , Adulto , Diagnóstico Diferencial , Fibromialgia/diagnóstico , Humanos , Persona de Mediana Edad , Espondilitis Anquilosante/diagnósticoRESUMEN
Polymyalgia rheumatica and temporal arteritis are entities seen chiefly in older adults. Polymyalgia rheumatica is characterized by muscle and joint aches and an elevated erythrocyte sedimentation rate, and it responds rapidly to low-dose corticosteroid therapy. Temporal arteritis is a vasculitic process, the diagnosis of which must be established by invasive procedures. Higher doses of steroids are necessary to treat it, and the potential for steroid-induced side effects is high.
Asunto(s)
Arteritis de Células Gigantes , Polimialgia Reumática , Anciano , Diagnóstico Diferencial , Femenino , Arteritis de Células Gigantes/diagnóstico , Arteritis de Células Gigantes/terapia , Humanos , Masculino , Persona de Mediana Edad , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/terapia , PronósticoRESUMEN
Rheumatoid arthritis is a clinical syndrome, and the diagnosis requires the presence of pain, swelling, and tenderness in the joints. In the absence of these features, identification of rheumatoid factor in the serum is of little use. Because rheumatoid factor is an immune complex, it is a marker of immune activation and, therefore, may be present in the circulation of persons with a variety of inflammatory conditions that stimulate the immune system. Also, 5% of the healthy population have significant titers of rheumatoid factor in their serum.
Asunto(s)
Artritis Reumatoide/inmunología , Biomarcadores/sangre , Factor Reumatoide/inmunología , Factores de Edad , Anciano , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Factor Reumatoide/sangreRESUMEN
A double-blind, randomized study compared the efficacy and safety of a controlled-release naproxen sodium formulation (Naprelan, Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) 1,000 mg once daily; a conventional naproxen formulation (Naprosyn, Syntex Laboratories, Inc., Palo Alto, California) 500 mg BID; and placebo given for 12 weeks to 348 patients with rheumatoid arthritis (RA). This was followed by an open-label study to evaluate the safety of naprelan 1,000 mg once daily for an additional 9 months. In the double-blind phase of this study, the safety and efficacy of Naprelan 1,000 mg once daily were compared with those of Naprosyn 500 mg twice daily and placebo in 348 patients with RA. At the end of 12 weeks of treatment, Naprelan and Naprosyn were numerically superior to placebo in 3 of the 4 primary efficacy variables--physician's global assessment, patient's global assessment, and number of painful joints. Differences between Naprelan and placebo reached statistical significance for the patient's global assessment at Week 12 (Visit 7). Significantly more Naprosyn- than placebo-treated patients had at least 1 severe digestive system adverse event (AE); 1 drug-related AE; or 1 drug-related, digestive-system AE. There was no statistically significant difference in the number of AEs experienced by Naprelan-treated patients compared with those who received placebo. A total of 240 patients enrolled in the Naprelan open-label phase. As would be expected, patients initially treated with placebo showed significant improvement after starting Naprelan. Those initially receiving Naprelan or Naprosyn also maintained their improvement. The AE profile with Naprelan was similar to that reported in the double-blind phase. It was concluded that Naprelan 1,000 mg once daily was as effective as Naprosyn 500 mg BID in the treatment of RA and was particularly effective in relieving pain later in the day. The controlled-release formulation may also offer safety benefits.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Naproxeno/uso terapéutico , Adulto , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Preparaciones de Acción Retardada , Método Doble Ciego , Esquema de Medicación , Femenino , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Naproxeno/administración & dosificación , Naproxeno/efectos adversos , SeguridadRESUMEN
Previous studies have indicated a decreased risk for developing Alzheimer's disease in anti-inflammatory (AI) drug users. Yet few studies have determined whether AI drug use provides a protective effect against normal age-related changes in the brains of older adults. Regional volume changes in gray and white matter were assessed cross-sectionally using optimized voxel-based morphometry in 36 females taking AI drugs as arthritis or pain medication and 36 age- and education-matched female controls. Although mean gray and white matter volume differences between AI drug users and the non-AI group were small, AI drug use interacted with age, such that the non-AI group showed significantly greater age-related volume changes in regions of both gray and white matter compared to the AI drug users. These regions included the superior and medial frontal gyri, middle and inferior temporal gyri, fusiform and parahippocampal gyri, and occipital gray matter as well as temporal, parietal, and midbrain white matter. The results are consistent with the notion that AI drugs provide protection against age-related changes in brain volume. It is possible that inflammation plays a role in volume decreases associated with normal aging, and that suppressing the inflammatory response moderates this decrease.
Asunto(s)
Envejecimiento/efectos de los fármacos , Antiinflamatorios/efectos adversos , Artritis/patología , Mapeo Encefálico , Encéfalo/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Envejecimiento/patología , Análisis de Varianza , Antiinflamatorios/clasificación , Arizona , Artritis/tratamiento farmacológico , Encéfalo/patología , Estudios de Casos y Controles , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Persona de Mediana EdadAsunto(s)
Brazo/irrigación sanguínea , Cocaína , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tromboflebitis/epidemiología , Adulto , Vena Axilar , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Vena Subclavia , Texas , Tromboflebitis/etiología , Trombosis/etiologíaAsunto(s)
Arteriosclerosis/epidemiología , Angiopatías Diabéticas/epidemiología , Indígenas Norteamericanos , Adulto , Arizona , Colesterol/sangre , HDL-Colesterol , Angiopatías Diabéticas/sangre , Retinopatía Diabética/epidemiología , Femenino , Humanos , Lípidos/sangre , Lipoproteínas HDL/sangre , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , RiesgoRESUMEN
This study examined levels of tryptase, a specific mast cell product, in synovial fluid. Samples of synovial fluid from eight patients with rheumatoid arthritis and ten with other arthritides were measured in solid-phase immunoradiometric assays. Elevated concentrations of tryptase were present in samples from three patients with rheumatoid arthritis, one with psoriasis, and one with Reiter's syndrome. The data support the theory that mast cell activation is involved in the pathogenesis in some inflammatory joint diseases, but activation does not appear to be disease specific.
Asunto(s)
Artritis/enzimología , Serina Endopeptidasas/análisis , Líquido Sinovial/enzimología , Adulto , Anciano , Artritis Reactiva/enzimología , Artritis Reumatoide/enzimología , Sedimentación Sanguínea , Quimasas , Femenino , Humanos , Masculino , Mastocitos/fisiología , Persona de Mediana Edad , TriptasasRESUMEN
After a patient with a history of systemic lupus erythematosus in remission was given salsalate, all of her hematologic elements, especially leukocytes, profoundly decreased within hours, although the patient was receiving steroids. She had been challenged with salsalate at an earlier date, with a similar but less impressive drop in blood counts. Granulocytotoxic antibodies persisted during this episode in contrast to declining lymphocytotoxic and anti-native DNA antibodies that accompanied a remission of systemic lupus. This is the first case of this kind occurring with salsalate therapy and may have represented preformed antibodies induced by salsalate.
Asunto(s)
Lupus Eritematoso Sistémico/tratamiento farmacológico , Pancitopenia/inducido químicamente , Salicilatos/uso terapéutico , Adolescente , Anticuerpos/metabolismo , Afinidad de Anticuerpos , Suero Antilinfocítico/análisis , Femenino , Granulocitos/inmunología , Humanos , Inducción de Remisión , Salicilatos/efectos adversosRESUMEN
Recombinant (r) human IL-2 was administered in vivo to improve homing and engraftment of rheumatoid arthritis (RA) patients' peripheral blood mononuclear cells (PBMC) into severe combined immunodeficient (SCID) mice. Human rIL-2 treatment resulted in augmented human Ig production and induced IgM rheumatoid factor (RF) of human origin in SCID-RA chimeras. The increment of human serum IgG in SCID-RA chimeras after IL-2 treatment ranged between 15 and 43% and for IgM between 50 and 98% during 2-8 weeks postengraftment. Human IgM-RF was detectable after 1 to 2 weeks after engraftment and persisted over a period of 10-13 weeks. No RF was produced in SCID mice engrafted with PBMC from healthy individuals with or without exogenous rIL-2 administration. Thus, human rIL-2 expanded autoreactive clones involved in the production of RF in the SCID-RA chimeras. The present study provides a novel approach to establish an in vivo SCID-RA model to study the cellular and molecular mechanisms involved in the production of RF and development of a RA-like lesion.
Asunto(s)
Artritis Reumatoide/sangre , Quimera , Inmunoglobulinas/biosíntesis , Interleucina-2/farmacología , Linfocitos/efectos de los fármacos , Linfocitos/inmunología , Factor Reumatoide/biosíntesis , Adulto , Anciano , Animales , Artritis Reumatoide/inmunología , Artritis Reumatoide/metabolismo , Autoinmunidad/inmunología , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Femenino , Humanos , Activación de Linfocitos/efectos de los fármacos , Transfusión de Linfocitos , Linfocitos/metabolismo , Masculino , Ratones , Ratones SCID , Persona de Mediana Edad , Neutrófilos/inmunología , Neutrófilos/metabolismo , Proteínas Recombinantes/farmacología , Bazo/citología , Bazo/inmunologíaRESUMEN
We describe two patients with deep venous thrombosis of the upper extremity who initially were thought to have septic arthritis of the shoulder. These patients had a history of recent intravenous cocaine abuse. The diagnosis of deep venous thrombosis should be considered when a patient with a swollen shoulder has an appropriate history.
Asunto(s)
Artritis Infecciosa/diagnóstico , Cocaína , Articulación del Hombro , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tromboflebitis/etiología , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Tromboflebitis/diagnósticoRESUMEN
Only seven patients with coexistent gout and systemic lupus erythematosus have been reported in the English-language literature. We describe an eighth case, which is the first, to our knowledge, in the dermatologic literature. The patient met four of the eleven new American Rheumatism Association criteria for the diagnosis of systemic lupus erythematosus, and clinical, laboratory, roentgenographic, and histologic assessments confirmed the diagnosis of gout.
Asunto(s)
Gota/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Adulto , Gota/patología , Humanos , Lupus Eritematoso Sistémico/patología , MasculinoRESUMEN
The risks of microvascular complications over periods of 3 and 6 years in relation to baseline plasma glucose concentrations were estimated in Pima Indians of Arizona aged 25 years or more and who were not taking hypoglycaemic medicine at their initial examinations. Retinopathy (microaneurysms, haemorrhages, or neovascularisation) developed within 3 years in 1% of 181 subjects with initial fasting plasma glucose concentrations less than 140 mg/dl (1 mg/dl = 0.0555 mmol/l) and in 13% of 39 subjects with higher initial fasting plasma glucose levels. No one with an initial 2 h glucose concentration less than 200 mg/dl had retinopathy within 3 years, but the rate was 12% in 60 subjects with higher glucose concentrations. Retinopathy developed within 6 years in 1% of 446 subjects whose 2 h post-load glucose concentrations were less than 200 mg/dl and in 20% of 113 subjects with higher levels. Subsequent development of heavy proteinuria (urine protein/creatinine ratio at least 1.0) was less common than that of retinopathy, but was similarly related to the initial fasting and 2 h plasma glucose concentrations. The finding that these microvascular complications rarely appeared in individuals with fasting plasma glucose concentrations less than 140 mg/dl or 2 h plasma glucose concentrations less than 200 mg/dl supports the validity of these concentrations as part of the new diagnostic criteria for diabetes mellitus.
Asunto(s)
Glucemia/análisis , Retinopatía Diabética/etiología , Hiperglucemia/complicaciones , Indígenas Norteamericanos , Proteinuria/etiología , Arizona , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Humanos , Riesgo , Factores de TiempoRESUMEN
Mortality according to body mass index (weight/height2) was studied in 2197 Pima Indians aged 15-74 years, as part of the longitudinal study of diabetes begun in 1965 in the Gila River Indian Community of Arizona. The Pima Indians are a population with a high prevalence of obesity, and they have the highest known incidence of type II (non-insulin dependent) diabetes mellitus. Among males, mortality was greatest in those with a body mass index of at least 40 kg/m2, but obesity had little effect on mortality at body mass indices below 40 kg/m2. Age-specific death rates in women were not consistently related to obesity, although mortality in subjects with diabetes was higher than in those without. In men, diabetes had little effect on mortality. In this study, as in several other mortality studies, the lowest mortality rates were experienced by people with body weights well above those recommended as "desirable" by the Society of Actuaries in 1959. Thus, the applicability of the "desirable" weight standards in common use is questioned.
Asunto(s)
Diabetes Mellitus/mortalidad , Indígenas Norteamericanos , Obesidad/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Antropometría , Arizona , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
A 30-year-old Mexican woman had rash, deep ulcerations of her lower extremities, and debilitating polyarthritis. Her disorder simulated rheumatoid vasculitis, but serum rheumatoid factor was absent. The diagnosis of gout was confirmed by uric acid crystals in joint fluid and skin biopsy specimens and by x-ray crystallography. The age and sex were unusual for a patient with gout, and she had none of the commonly associated metabolic defects. This unique presentation for urate arthropathy needs further study.