Creating a care-effective cost-effective strategy for methotrexate liver toxicity monitoring in rheumatoid arthritis: comment on the article by Kremer et al.
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Arthritis, Rheumatoid↗
Biomedical subjects
D Torretti
Publications and source records attributed to D Torretti.
Suppurative extensor tenosynovitis caused by Staphylococcus aureus.
Suppurative tenosynovitis is a rare infection, occurring almost exclusively in the flexor tendon sheath as a posttraumatic event. We report the case of a systemically ill woman with suppurative tenosynovitis of the extensor tendons caused by Staphylococcus aureus. Early recognition of this unusual infection may prevent unnecessary morbidity.
Female↗
Systemic lupus erythematosus and Down's syndrome.
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Adult↗
Polymyalgia rheumatica. Duration of therapy and long-term outcome.
The duration of therapy and outcome were examined in 76 patients with polymyalgia rheumatica without evidence of temporal arteritis at presentation. Seventy-five patients received corticosteroids, with a mean prednisone dosage of 22.8 mg per day initially. Duration of therapy was assessed using life-table methods. No significant difference could be ascertained between groups segregated on the basis of age, sex, or initial steroid dosage. The median duration of therapy was 37.3 months. It was estimated that 40 percent of patients will require therapy longer than four years. Corticosteroids were permanently discontinued in 31 patients after a mean of 23.7 months of therapy. The data support the concept of two patient populations--one with limited disease and another requiring long-term therapy. Relapses were frequent, occurring in 56 percent of patients. Evolution of arteritis during the course of therapy was infrequent, occurring in only one patient. Steroid-related adverse effects occurred in 22.7 percent of patients and were more common in females. The data suggest that, although corticosteroids may be discontinued in some patients with polymyalgia rheumatica, prolonged therapy is required in a significant number.
Actuarial Analysis↗
Pulmonary hypertension, hypoxemia, and death in a patient with scleroderma.
Pulmonary hypertension in systemic sclerosis is usually secondary to pulmonary fibrosis or vascular changes. We have described a patient with systemic sclerosis who had pulmonary hypertension as a result of unsuspected thromboembolic disease.
Female↗
Reye's syndrome associated with long-term aspirin therapy.
Reye's syndrome has been infrequently described in children receiving long-term salicylate therapy. We report the clinical and laboratory findings of two children in whom Reye's syndrome developed while taking salicylates for systemic inflammatory disorders. Monitoring of hepatocellular function should be considered in children who are receiving long-term salicylate therapy.
Adolescent↗
Central nervous system manifestations after pulse therapy for systemic lupus erythematosus.
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Adolescent↗
Clostridium perfringens: an unusual case of septic arthritis.
Anaerobic joint infections may be a more common occurrence than previously reported. A nine-year-old with a septic knee due to Clostridium perfringens following a puncture wound was seen in the emergency department. Diagnosis was established by isolating the organism from an anaerobic synovial fluid culture. The patient was treated successfully with open drainage and parenteral penicillin. This case illustrates the necessity for specifically requesting anaerobic cultures on synovial fluid of patients with acute septic monoarthritis.
Arthritis, Infectious↗
Error in anti-DNA antibody radioimmunoassay after gallium scanning.
Significant interference with the accurate measurement of anti-DNA antibodies occurs after gallium-67 scanning. The observed effect is dependent on the radioimmunoassay used. False-negative results are observed with a modified Farr assay whereas false-positive results are noted in the millipore filter assay. These spurious values are the result of persistent radioactivity in the patients' sera after administration of 67Ga citrate.
Antibodies, Antinuclear↗
Ureteral obstruction and pyelonephritis caused by an inguinal hernia: report of a case.
An elderly man had pyelonephritis and sepsis owing to ureteral obstruction. Retrograde pyelography showed entrapment of the right ureter in an inguinal hernia. This condition, which may be congenital or acquired, should be considered before herniorrhapy is performed and as a possible cause of ureteral obstruction.
Aged↗
Hereditary angioedema and coronary arteritis.
A 30-year-old white male with hereditary angioedema developed substernal chest pain with multiple arterial stenoses at coronary angiography. Histopathologic studies of the fibromembranous thickening removed from the left coronary artery at the time of the revascularization procedure revealed an inflammatory lesion compatible with an arteritis. The significance of this association in the spectrum of immunologically-mediated disorders in hereditary angioedema is discussed.
Adult↗
Bone destruction and ankylosis in Whipple's disease.
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Ankylosis↗
The efficacy and safety of auranofin compared to placebo in rheumatoid arthritis.
This double-blind multicenter study compares the effect of adding auranofin (AF) 3 mg bid or placebo to patients already taking nonsteroidal antiinflammatory drugs for rheumatoid arthritis. The 242 patients who completed 3 months of therapy demonstrated that the group receiving AF responded better than those receiving placebo. Of the 144 patients who completed 6 months coded medication, the efficacy in the AF group was superior to the placebo group in several parameters including a reduction in the number of painful or swollen joints, grip strength, dropout rate, and global efficacy as judged by the evaluating physician. A significant lowering of the Westergren erythrocyte sedimentation rate and immunoglobulin levels was noted in the AF treated patients. This study includes data summarizing the difference between both groups with respect to on-therapy conditions and toxicity.
Arthritis, Rheumatoid↗