Prevention of symptomatic thrombosis with short term (low molecular weight) heparin in patients with rheumatoid arthritis after hip or knee replacement.

The need for prevention of venous thromboembolism (VTE) after total hip or knee replacement is obvious. However, the optimal regimen to achieve this remains to be defined. In patients with rheumatoid arthritis (RA) long term coumarins may not be necessary owing to the use of non-steroidal anti-inflammatory drugs (NSAIDs). 103 patients in whom 151 surgical procedures were performed (55 hip and 96 knee prostheses) were treated only with short term subcutaneous heparin. NSAIDs were used daily in 85% of the patients, and they were continued after hospital discharge. Only one patient developed symptomatic deep venous thrombosis during one year follow up. Bleeding complications were seen in 20/151 (13%) of the surgical procedures, all clinically judged as minor, and recovery was not delayed except in one case. Short term (low molecular weight) heparin appears to be an adequate, simple, and safe method for prevention of symptomatic VTE in patients with RA after knee or hip replacement, though further studies are necessary to confirm these preliminary findings.

Septic arthritis with Listeria monocytogenes during low-dose methotrexate.

We describe a 22-year-old female with systemic lupus erythematosus and lymphopenia, who developed septic arthritis of the right knee with Listeria monocytogenes type 1/2 A, whilst on low-dose methotrexate (MTX). So far, septic arthritis due to this microorganism has been reported in two other patients treated with low-dose MTX, one having rheumatoid arthritis and the other psoriatic arthritis. No reports exist on patients treated with other cytotoxic antirheumatic therapies.

Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications.

The prevalence of malnutrition and its predictive value for the incidence of complications were determined in 155 patients hospitalized for internal or gastrointestinal diseases. At admission, 45% of the patients were malnourished according to the Subjective Global Assessment (physical examination plus questionnaire), 57% according to the Nutritional Risk Index [(1.5 x albumin) + (41.7 x present/usual weight)], and 62% according to the Maastricht Index [(20.68 - (0.24 x albumin) - (19.21 x transthyretin (prealbumin) - (1.86 x lymphocytes) - (0 04 x ideal weight)]. Crude odds ratios for the incidence of any complication in malnourished compared with well-nourished patients during hospitalization were 2.7 (95% CI: 1.4, 5.3) for the Subjective Global Assessment, 2.8 (1.5, 5.5) for the Nutritional Risk Index, and 3.1 (1.5, 6.4) for the Maastricht Index. Odds ratios were reduced to 1.7 (0.8, 3.6), 1.6 (0.7, 3.3), and 2.4 (1.1, 5.4), respectively, after a multivariate analysis that included disease category and disease severity. Because the confounding factors adjusted for are not only a measure of the severity of the disease but may also be influenced by malnutrition itself, the actual risk for complications due to malnutrition could be higher than the adjusted odds ratios. In conclusion, malnutrition was frequent in patients with gastrointestinal disease and other internal diseases at the time of admission. The severity of malnutrition in the patients predicted the occurrence of complications during their hospital stay and this association was not completely explained by confounding factors.

Nutritional status of elderly female nursing home residents; the effect of supplementation with a physiological dose of water-soluble vitamins.

OBJECTIVE: To assess the nutritional status of female elderly nursing home residents and to study the effect of dietary supplementation with a physiological dose of water-soluble vitamins. DESIGN: Single-blind, randomised, placebo-controlled intervention trial. Daily consumed supplement consisted of fortified fruit juice containing 50 g carbohydrate and 50% of the daily dietary recommendations of water-soluble vitamins. Regular fruit juice was used as placebo. Dietary intake assessment at baseline. Fasting blood sample, anthropometric measurements and medical record at baseline and after 4 and 12 weeks of supplementation. SETTING: Three nursing homes within 40 km of the coordination centre (Department of Human Nutrition, Wageningen Agricultural University, the Netherlands). SUBJECTS: Forty-two female nursing home residents aged 60 years and older, in relatively stable health condition, at least 3 months resident at baseline. In each nursing home, 14 subjects were randomly assigned to the supplement or control group. INTERVENTIONS: Twelve weeks of supplementation. RESULTS: Participants had a poor nutritional status. Dietary supplementation significantly improved the concentrations of thiamin pyrophosphate and pyridoxal 5'-phosphate, increased body weight and decreased serum homocysteine concentration in the supplement group. Plasma vitamin C levels were significantly increased in both supplement and control group. CONCLUSIONS: Even in this heterogeneous population of female nursing home elderly it is possible to improve the nutritional status through dietary intervention with a physiological dose of water-soluble vitamins.

Chronic polyarthritis due to Pseudomonas aeruginosa.

We present a 45-year-old male patient with chronic obstructive lung disease treated with low-dose corticosteroids, who developed a chronic septic polyarthritis due to Pseudomonas aeruginosa following a surgical wound infection. Due to the mild synovitis and the absence of systemic signs of infection the diagnosis was delayed for nearly 2 years and resulted in severe joint destruction.

[Chorea and primary antiphospholipid syndrome]. / Chorea en het primaire antifosfolipidensyndroom.

Primary antiphospholipid syndrome or PAPS is characterised by antiphospholipid antibodies and arterial and/or venous thromboses. Numerous other clinical features have been shown to be related to this syndrome. Chorea is a well known but rare phenomenon in systemic lupus erythematosus; it has been shown to be strongly related to the presence of antiphospholipid antibodies. We describe two patients with chorea that appeared to be caused by the PAPS.

Intravenous nicardipine in Raynaud's phenomenon: a controlled trial.

The hemodynamic effects of intravenously administered nicardipine (5 mg/h during 85 min) were investigated in 12 Raynaud patients and in 12 healthy volunteers in a double-blind placebo-controlled cross-over study. In both groups we found no change in systolic blood pressure, but a significant fall in diastolic blood pressure of 7 mm Hg (p less than 0.001). Heart rate increased 14 beats/min (p less than 0.001) and forearm blood flow increased 1.0 ml/100 ml/min (p less than 0.01) with a concomitant decrease of 10 arbitrary units (AU) in forearm vascular resistance (p less than 0.001). In healthy volunteers the recovery of the finger skin temperature after cold challenge improved significantly (p less than 0.05). In patients with primary Raynaud's phenomenon we observed a significant (p less than 0.001) increase in skin temperature of 4.6 degrees C before cooling, together with a better recovery after cold induced vasospasm (p less than 0.001). In secondary Raynaud's patients, nicardipine caused no vasodilatation within the skin vessels. There were no significant correlations between the plasma nicardipine concentration and any of the observed pharmacological effects.