Basic Calcium Phosphate Crystal Periarthritis Involving the Distal Interphalangeal Joints in a Patient with Systemic Lupus Erythematosus.

BACKGROUND Increased serum levels of basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) are found in patients on dialysis, following trauma, and are associated with connective tissue diseases (CTDs), including dermatomyositis, scleroderma, and systemic lupus erythematosus (SLE). The shoulder is the joint most commonly associated with BCP crystal periarthritis. A report is presented of a case of BCP crystal periarthritis involving the distal interphalangeal (DIP) joints in a patient with SLE. CASE REPORT A 34-year-old woman with SLE presented with destructive arthritis of the DIP joints that developed during a two-year period, despite immunosuppressive therapy. Aspiration of synovial fluid from a DIP joint showed a lack of inflammatory cells, but the fluid was positive for the presence of crystals on alizarin red S histochemical staining. CONCLUSIONS A case of BCP crystal periarthritis is reported in a patient with SLE with chronic joint symptoms that were unresponsive to immunosuppressive therapy. This case has shown that chronic joint symptoms that are unresponsive to immunosuppressive therapy may be due to causes other than connective tissue disease (CTD) and that imaging studies and diagnostic workup that includes synovial fluid examination may support the diagnosis of BCP crystal periarthritis.

[Analgesic and anti-inflammatory effects of balance acupuncture on experimental scapulohumeral periarthritis in rabbits].

OBJECTIVE: To investigate therapeutic effects of balance acupuncture on scapulohumeral periarthritis (SP)and the mechanisms. METHODS: Thirty male New Zealand rabbits were randomly divided into a blank group (group B), a model group (group M) and a balance acupuncture group (group BA) with 10 rabbits in each group. SP model was established by using persistent mechanical strain and ice compress. Balance acupuncture at "Jiantong" point was applied in the animals in group BA, but not in the rabbits of the other two groups. Joint movement and pathological changes in tissues around the affected shoulder joint were observed, and interleukin-1beta (IL-1beta), 5-hydroxytryptamine (5-HT) in plasma and the affected surrounding tissues, and DNA contents in tendon of supraspinatus muscle were measured. RESULTS: The content of plasma 5-HT in group BA [(18.16 +/- 4.44) ng/mL] was significantly lower than that in group M [(23.28 +/- 5.89) ng/mL] (P < 0.05), but without obvious difference in IL-1beta content between the two groups (P > 0.05). Compared with group M, the contents of IL-1beta, 5-HT in affected surrounding tissues, and DNA expression in tendon of supraspinatus muscle were significantly lowered to va rious extent in group BA (P < 0.01, P < 0.05). CONCLUSION: Balance acupuncture can effectively improve local and systemic pathological situation induced by SP by way of reducing pain-producing factors, inflammatory factors and DNA expression to alleviate local organization and adhesions in rabbits with experimental SP.

Clinical and laboratory parameters in adult diabetics with and without calcific shoulder periarthritis.

The clinical and laboratory parameters of calcific shoulder periarthritis (CSP) were examined in 900 patients with type II diabetes mellitus as well as in 350 age- and sex-matched control subjects. A threefold increased prevalence of CSP in diabetics compared with the control group was associated with the presence of longstanding and poorly controlled diabetes, hypercholesterolemia, and hypertriglyceridemia suggesting pronounced diabetic angiopathy, as well as with minor trauma and hypomagnesemia. Aging and serum calcium concentrations were not related to the presence of CSP. Thirty-two percent of diabetics with CSP were symptomatic; 15% of them presented with severe pain and restriction of shoulder movement. These findings confirm a close pathogenetic interrelation between CSP and diabetes mellitus.

Recurrent calcific periarthritis, erosive osteoarthritis and hypophosphatasia: a family study.

We describe a mother and 2 daughters with familial recurrent calcific periarthritis in a family with an inherited tendency to develop generalized osteoarthritis (OA). Low levels of serum alkaline phosphatase were found in 1 of the daughters while the mother developed erosive OA in later life. HLA typing was noncontributory. However, the 3 individuals with periarthritis possessed blood group A+, while the 6 unaffected family members were O+. The experience of this family adds weight to the case that recurrent calcific periarthritis may be due to an inherited abnormality of alkaline phosphatase production and suggest that this may also be responsible for the recently observed association of calcific periarthritis and erosive OA.

Human recombinant erythropoietin in anaemic patients on maintenance haemodialysis. Secondary effects of the increase of haemoglobin.

Twelve anaemic patients on haemodialysis were treated with recombinant human erythropoietin, starting with 72 IU/kg/week. The dose was doubled after 2 weeks until an increase of 2 g/dl of haemoglobin was observed. The effects on various parameters were studied during a 3-month period. Haemoglobin increased from 6.70 +/- 0.74 to 10.49 +/- 1.04 g/dl (mean +/- SD, P less than 0.001), potassium from 5.51 +/- 0.50 to 6.06 +/- 0.65 mmol/l (P less than 0.005), phosphate from 1.78 +/- 0.40 to 2.17 +/- 0.40 mmol/l (P less than 0.001) and the calcium phosphorus product from 4.3 to 5.2 (P less than 0.001). Three patients developed marked periarticular inflammation due to calcified deposits with a high calcium-phosphorus product of 6.8. An increase in arterial blood pressure was observed in three previously well-controlled hypertensive patients, one of whom developed hypertensive encephalopathy. We conclude that recombinant human erythropoietin is very effective in treating the anaemia of end-stage renal failure on haemodialysis. Regular estimations of serum potassium and phosphate are mandatory. In hypertensive individuals a further increase in blood pressure is possible.

[Value and significance of the immunologic determination of various serum sialoglycoproteins in rheumatic diseases of inflammatory nature]. / Valore e significato del dosaggio immunologico di alcune sialoglicoproteine seriche nelle malattie reumatiche a carattere infiammatorio.

A statistical method was used in the evaluation of alpha-1-antitrypsin, acid alpha-1-glycoprotein, and haptoglobin in patients with rheumatic fever, rheumatoid arthritis, gout, periarthritis, arthrosis with inflammation, and primary arthrosis. A highly significant increase was noted in rheumatic fever and rheumatoid arthritis, less so in arthrosis with inflammation and acute gout, while increases were poorly significant for periarthritis and not significant for primary arthrosis. It can be concluded that the determination of these serum sialoglycoproteins serves to distinguish inflammatory and degenerative rheumatism. Haptoglobin proved the most sensitive of the three. Moreover, there was a distinct correlation between ESR and the three indices. It is felt that sialoglycoproteins act as an indirect pointer to acute inflammation, since their degree of increase is related to the formation of inflammatory proteases.

6-Sulfanilamidoindazole arthritis of the rat: complement activity and sulfhydryl group concentration of the serum in three different phases of inflammation.

In 6-sulfanilamidoindazole (6-SAI) arthritis the total haemolytic complement activity of the serum was significantly increased by 69% in developing arthritis at day 4, and by 42% in fully developed arthritis at day 8. In declining arthritis at day 12, 5 days after the last administration of the prophlogistic agent 6-SAI, no difference of the serum complement activity between arthritic rats and non-arthritic controls could be determined. The serum SH group concentration was significantly decreased by 31% at day 4 and by 54% at day 8, but it was nearly normalized at day 12. There was no close correlation between increase of paw diameter and serum complement activity in 6-SAI-arthritic rats. It is suggested that investigations on the role that complement components might play in 6-SAI arthritis could be interest.