Atypical methotrexate dermatitis and vasculitis in a patient with ankylosing spondylitis.

Reports of histologically proven low-dose methotrexate (MTX)-induced vasculitis are uncommon and mostly found for patients with rheumatoid arthritis. Herein we present a patient with ankylosing spondylitis who developed large atypical erythematopurpuric cutaneous lesions after the second oral dose of 7.5 mg MTX therapy. The histological findings of a cutaneous lesion were consistent with vasculitis. The skin lesions regressed significantly after the discontinuation of MTX therapy. As the clinical picture of the patient's rheumatological condition became progressively severe, prednisolone therapy was initiated 8 days later and the skin rash resolved completely in a couple of weeks.

Hydroxychloroquine ototoxicity in a patient with rheumatoid arthritis.

We report a case of reversible sensorineural hearing loss due to hydroxychloroquine (HQ) treatment. The patient was a 34-year-old woman with 1 year of rheumatoid arthritis (RA). She developed reversible hearing loss after 5 months of HQ treatment. Sensorineural deafness has previously been reported with chloroquine treatment, but this is the first report of ototoxicity associated with HQ in RA.

Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis.

OBJECTIVE: It is a well-known fact that pulmonary function is altered in ankylosing spondylitis (AS) mainly due to the restriction of chest wall movements. The objective of this study was to investigate whether alterations in pulmonary function affected exercise capacity. METHODS: Twenty male patients with definite AS and 20 age-matched healthy male controls were recruited for the study. All subjects were assessed for functional status by BASFI and physical activity level. Measurement of chest expansion and lumbar spinal flexion by the modified Schober method were performed. Pulmonary function tests and exercise testing on a treadmill using the Bruce protocol were performed. RESULTS: The physical activity level was similar in both groups. In the AS group the mean BASFI score suggested good functional capacity, while chest expansion and modified Schober measurements were significantly lower and pulmonary function tests revealed restrictive lung disease. The results of the exercise tolerance test were similar in both groups except for the rate of perceived exertion. CONCLUSION: This study demonstrated that exercise capacity in AS patients is not influenced by the limitation of chest wall movements, probably due to the maintenance of moderate physical activity along with an active life style.

Drug consumption in a group of elderly residents of a nursing home: relationship to cognitive impairment and disability.

OBJECTIVES: The incidence of drug interactions and adverse reactions increases exponentially with increases in the number of medications consumed. The objective of this study was to investigate drug consumption, in particular nonsteroidal anti-inflammatory drugs (NSAIDs), and to assess the relationship between drug consumption and cognitive function and disability in a group of older people residing in a nursing home. PARTICIPANTS AND SETTING: Two-hundred residents (108 women, 92 men) of a nursing home in Ankara, Turkey, mean age 77.2 +/- 8.7 years (range, 60-98), were included in the study. Data were obtained about sociodemographic variables and drug consumption, and the Mini-Mental State Examination (MMSE) and Functional Independence Measure (FIM) were used to assess the cognitive and functional status. RESULTS: The majority (94.4% of men and 80.4% of women) were prescribed at least one drug, with a mean of 3.59 prescriptions prescribed to women 2.39 to men. The mean number of self-prescribed drugs used by the elderly was higher than found in previous studies. Although there was not a statistically significant difference in regard to socioeconomic status and self-prescribed drug usage, we found a significant positive correlation between nonprescribed drug use and the scores of FIM and MMSE (P < 0.05). The drugs self-prescribed most commonly were NSAIDs, with a rate of 72.5%. CONCLUSION: This study found high drug consumption correlated with poor cognitive and functional status in elderly residents of a nursing home.

Thiemann's disease: a case report.

In this case report, we describe a patient with the diagnosis of Thiemann's disease, which is a genetically determined rare form of idiopathic avascular necrosis of the proximal interphalangeal joints of the hands.

Protracted familial Mediterranean fever arthritis.

Familial Mediterranean fever (FMF) is an inherited disorder characterized by recurrent attacks of fever and abdominal, chest, and articular pain. The articular attack of FMF is typically an acute, self-limited, large joint monoarthritis most often affecting the knee or hip. Rarely, a more protracted arthritis may occur. We describe two unusual cases of long-standing FMF arthritis with excellent response to synovectomy.