Interstitial immunofluorescence in nephritis of Sjögren's syndrome.

A patient with Sjögren's syndrome (SS) developed mild renal insufficiency without significant proteinuria; the diagnosis of interstitial nephritis secondary to SS was made on the basis of history, serological data and renal biopsy. The renal biopsy revealed immunofluorescence of the interstital infiltrates and the importance of this finding in the differential diagnosis of interstitial nephritis is considered. In addition, further studies to detect anti-renal antibodies and circulating immune complexes are reported and the possible interpretation of the results is discussed in regard to pathogenesis.

Acute sarcoidosis occurring during the course of systemic lupus erythematosus.

A diagnosis of systemic lupus erythematosus (SLE) was established in a 54-year-old woman with a compatible history, as well as patchy alopecia, anemia, arthralgias, and a positive LE cell preparation. Sixteen months later bilateral hilar and mediastinal lymph nodes appeared on chest roentgenogram. Sarcoidosis was diagnosed when hypercalcemia and noninfectious, noncaseating epithelioid granulomas were found in the skin and liver. The sarcoidosis remitted with corticosteroid therapy, but slowly advancing renal failure ultimately resulted in the patient's death. We believe the concurrence of SLE and sarcoidosis had not been previously reported in the English literature. Immune mechanisms are discussed.

Gastrointestinal blood loss. Effect of aspirin, fenoprofen, and acetaminophen in rheumatoid arthritis as determined by sequential gastroscopy and radioactive fecal markers.

The feasibility of determining the exact site and amount of drug-induced gastric bleeding was tested. Fourteen patients with rheumatoid arthritis received equivalent therapeutic doses of the antinflammatory drugs aspirin, 4 gm/day, and fenoprofen calcium, 2.4 gm/day, in randomized order for seven days. Acetaminophen was given for 14 days just prior to each of these periods. By fiberoptic gastroscopy, antral ulceration and acute mucosal lesions were found in seven patients following aspirin ingestion, in one taking fenoprofen, and in none taking acetaminophen. Fecal blood loss in four-day stool collections, quantitated by autologous chromium 51-labeled erythrocytes shed into the stool averaged 5.0 ml/day while taking aspirin, 2.2 ml/day while taking fenoprofen calcium, and 0.8 ml/day while taking acetaminophen. The mean blood loss was greater for those in whom gastric lesions developed while taking aspirin than for those in whom lesions did not develop. The short-term risk of erosive gastritis was greater for aspirin than fenoprofen.

Pustulotic arthro-osteitis: a cause of atypical chest pain and a new arthritic syndrome.

We have described a 38-year-old white American woman who had a 7-year history of pain in the left anterior chest, neck, right wrist, and buttocks. The pain fluctuated in severity and appeared to coincide with worsening of her skin condition, palmoplantar pustulosis (PPP). She manifested the typical skeletal features of an arthritic condition referred to as pustulotic arthro-osteitis, which is frequently associated with the characteristic rash of PPP. This is an infrequently described disorder in the United States, possibly reflecting lack of familiarity or confusion with related disorders.

Diffuse nail dyschromia in black patients with systemic lupus erythematosus.

Diffuse dark blue-black chromonychia was observed in 17 of 33 (52%) black patients with systemic lupus erythematosus (SLE), but not in 47 non-SLE black patients. About half of these patients had active disease. A comparison was made between patients with SLE with chromonychia and those without but no distinctive clinical or laboratory variable differentiated the 2 groups. This pattern of nail hyperpigmentation has not previously been associated with SLE.