Treatment of progressive rheumatoid interstitial lung disease with cyclosporine.

A 62-year-old man with longstanding rheumatoid arthritis (RA) presented with dyspnea. Active rheumatoid interstitial lung disease was documented by high resolution computed tomography, gallium scan, and bronchoalveolar lavage. He responded to high dose prednisone, but had unacceptable side effects. Chlorambucil and cyclophosphamide were not steroid sparing. After starting cyclosporine 3 mg/kg/day he was able to stop prednisone and his symptoms improved and stabilized. Pulmonary function showed sustained improvement during 2 years of followup. His RA has been well controlled. Side effects have been mild hypertension and increased serum creatinine.

Acute local reactions after intraarticular hylan for osteoarthritis of the knee.

OBJECTIVE: To describe acute local reactions following intraarticular hylan injection and determine their frequency. METHODS: Retrospective review of all patients with osteoarthritis of the knee treated with hylan by 3 rheumatologists. RESULTS: Twenty-two patients had 88 injections to 28 knees. Six patients had reactions within 24 h of injection characterized by pain, warmth, and swelling, lasting up to 3 weeks. This occurrence was unpredictable. Corticosteroid injections were sometimes required. Synovial fluid cell counts were 5.0-75.0 x 10(9)/l, often with a prominent mononuclear component. Crystal studies and cultures were negative. Radiographic chondrocalcinosis was present in only 1 patient. One patient had serum antibodies to chicken serum proteins. CONCLUSION: Intraarticular hylan was associated with significant local inflammatory reactions in 27% of patients, or 11% of injections. The mechanism(s) and long term sequelae are unclear.

Soft tissue tuberculosis: a series of 11 cases.

OBJECTIVE: To describe the clinical characteristics of soft tissue tuberculosis (TB). METHODS: Retrospective review of all cases of soft tissue TB seen by the authors. RESULTS: Eleven cases were seen between 1988 and 1994. All patients but one were foreign born. Six patients had collagen vascular disorders and another had a kidney transplant. Five were taking immunosuppressive therapy and/or prednisone. Three had preceding trauma to the affected area. Five had evidence of previous TB by history or chest radiograph. Symptoms (mean duration 4.4 months) included swelling and pain and often mimicked the underlying disease. Six patients had definite or suspected active TB at other sites. Good initial responses were seen with debridement or drainage and multiple drugs for 6 to 12 months. Two patients have had possible relapses at other sites. Medication intolerance was frequent. CONCLUSION: TB should be considered in patients who present with unexplained soft tissue swelling and pain, particularly if they are immunosuppressed, were foreign born in an endemic area, have an abnormal chest radiograph, or have had trauma to the affected area.

Itraconazole: Precautions regarding drug interactions and bioavailability.

OBJECTIVE: To describe patients with fungal infections in whom drug interactions and bioavailability problems were associated with itraconazole treatment failure. DESIGN: Retrospective chart review. SETTING: Two tertiary care university-affiliated teaching hospitals. POPULATION STUDIED: Itraconazole-treated patients between 1990 and 1992. MAIN RESULTS: Four patients treated with itraconazole were identified in whom suboptimal serum itraconazole levels were associated with relapse of disseminated histoplasmosis, treatment failure of invasive aspergillosis or development of superficial mycoses. Low serum itraconazole levels were associated with concurrent therapy with rifampin or agents inhibiting gastric acid secretion, with administration of itraconazole capsule contents through a nasogastric tube or with the presence of aids. CONCLUSIONS: It is recommended that serum itraconazole levels be measured in patients with potentially life-threatening mycoses if coexistent factors may interfere with itraconazole therapy.