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Meenakshi Jolly

Publications and source records attributed to Meenakshi Jolly.

12 recordsLinked to original sources
PubMed2006

Hyperuricemia and associated diseases.

After introduction of urate-lowering therapy, asympotomatic hyperuricemia was treated with allopurinol or uricosuric agents in the belief that hyperuricemia and/or gout caused chronic kidney disease. Epidemiologic studies in the 1970s, however, failed to confirm the view that hyperuricemia and gout were independent risk factors for chronic kidney disease. As a result, urate-lowering pharmacotherapy is generally not recommended at the present time in the management of asymptomatic hyperuricemia even though recent epidemiological, experimental, and clinical studies have prompted reexamination of a causal role for hyperuricemia (with or without gout) in chronic kidney disease as well as other important disorders including cardiovascular disease, hypertension, and metabolic syndrome. The issue of such a role remains unresolved and this article reviews the current status of the relationship between hyperuricemia and associated disorders.

Animals↗
PubMed2005

Infliximab-responsive uveitis and vasculitis in a patient with Takayasu arteritis.

Uveitis rarely occurs in patients with Takayasu arteritis (TA) and may be the presenting manifestation in some. We present the case of a 22-year-old black woman who presented with bilateral uveitis. She was subsequently diagnosed with TA and treated with high doses of corticosteroids and methotrexate. However, she experienced recurrent episodes of uveitis and arteritis on this regimen. Addition of infliximab resulted in resolution of both uveitis and arteritis, thereby permitting tapering of steroids and discontinuation of methotrexate over a period of 1 year. The case highlights the importance of keeping TA in the differential in patients with uveitis and considering infliximab in resistant uveitis and patients with TA.

Adult↗
PubMed2005

How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses?

OBJECTIVE: Comparison of health related quality of life (HRQOL) of patients with systemic lupus erythematosus (SLE) with other common chronic illnesses. METHODS: Responses from self-administered Medical Outcomes Study Short Form-36 (SF-36) questionnaires from 90 patients with SLE, recorded in the lupus database at the University of Chicago Hospital, were analyzed. Comparative norms and domain scores for patients with other chronic diseases [hypertension, congestive heart failure (CHF), adult onset diabetes mellitus, myocardial infarction, and depression] were used and are based on the general US population. T tests were used to make comparisons. RESULTS: Patients with SLE were younger than patients with most reference chronic conditions except for depression. Their Physical Component Scores and Mental Component Scores were 30 +/- 10.5 and 45.1 +/- 11, respectively. SLE patients fared significantly worse than age matched norms from the general US population for women (p = 0.0001) in all 8 domains. Their quality of life was significantly worse than for those with hypertension, diabetes, or myocardial infarction in all domains (p < 0.004). Patients with CHF were no worse than those with SLE in regard to physical function, role-physical, role-emotional, and vitality. CHF patients fared significantly better in mental health, bodily pain, social functioning, and general health, compared to patients with SLE. Patients with depression were significantly impaired in role-emotional and mental health domains (p = 0.0001) compared to SLE patients, but were no worse (role-physical, vitality, and social functioning) and even better (physical function, bodily pain, and general health) in some. General health of SLE patients was significantly lower than all comparative groups. CONCLUSION: HRQOL of patients with SLE seems to be significantly worse and affects all health domains at an earlier age in comparison to patients with some other common chronic diseases.

Adaptation, Psychological↗
PubMed2004

Chlamydial infection preceding the development of rheumatoid arthritis: a brief report.

Chlamydia trachomatis-triggered reactive arthritis is a well-documented entity that has been extensively described. We do not have a clear understanding about the inflammatory oligoarthritis associated with the presence of this organism. It is rarely cultured from the synovial fluid, but is usually detectable by molecular biological techniques. Typically, Chlamydia trachomatis causes a sterile but inflammatory oligoarthritis. We report an unusual case of inflammatory monoarthritis in a young woman in whom Chlamydia was isolated from the synovial fluid. This is the first case of documented isolation of Chlamydia from synovial fluid, which subsequently was diagnosed as rheumatoid arthritis.

Adult↗
PubMed2004

Benign angiopathy of the central nervous system.

Apparent central nervous system vasculitis could have a benign course in a subset of patients and is referred to as benign angiopathy of the central nervous system (BACNS). This is mostly is seen in young women and presents with acute onset of neurologic symptoms, usually in the form of severe headache and/or a focal neurologic event. Cerebrospinal fluid analysis could be normal or nearly normal. Brain angiogram typically shows segmental narrowing, ectasia, or beading in multiple vascular territories on brain angiogram. Like in all cases of CNS vasculitis, exclusion of other systemic diseases or its mimickers associated with cerebral involvement is important.BACNS could respond favorably to treatment with corticosteroids alone or in combination with a calcium channel blocker, thereby avoiding unnecessary and prolonged treatment with other immunosuppressants like cyclophosphamide with their side effects. Little is published in the literature about BACNS, but is a rapidly emerging concept. It is thus important to recognize. We report a patient with classic presentation of BACNS to highlight the significance of distinguishing benign angiopathy from the more aggressive form of CNS vasculitis, because the treatment and response varies in these 2 entities.

Journal Article↗
PubMed2003

Underuse of intra-articular and periarticular corticosteroid injections by primary care physicians: discomfort with the technique.

Musculoskeletal disorders account for 11% to 13% of office visits in ambulatory care clinics and 9% of all physician visits in the United States. Intra-articular or periarticular aspiration or injections are an integral part of the management of arthritis or periarthritis. Our aim was to determine the use and level of comfort of administering intra-articular and periarticular injections by primary care physicians (PCPs) practicing in a university setting.A self-administered questionnaire with 20 questions querying experience and training in local injection therapy was mailed to 82 physicians (junior residents, senior residents, and faculty) offering primary care at the University of Chicago. Comfort scores were measured with a scale of 1 to 10 (1 = minimum and 10 = maximum). The response rate to the questionnaire was 67% (36 residents and 19 faculty). Seventy-one percent of PCPs routinely suggested the procedure for severe arthritis and bursitis, but only 19% had (self-administered) performed it themselves. Eighty-nine percent of the PCPs referred their patients to specialty clinics. Forty-eight percent referred their patients to rheumatology, 11.5% to orthopedics, and 29% to both. Other PCPs were consulted for the procedure by 9.6%. Discomfort with the performance of the technique was the predominant reason for 83% of the referrals. The mean comfort score for intra-articular or periarticular injections was 3.10 +/- 2.14 in general and 4.45 +/- 2.92 for knee joint. The mean comfort score for other joints and bursae ranged from 1.20 to 2.15. Ninety-five percent of PCPs regarded themselves to be inadequately trained. Regarding the training, 41% had received a lecture during medical school and residency, while 40% had received demonstration of the techniques during residency. Of the faculty, 26% had never received any formal lecture, and 5.2% had never received formal demonstration of the techniques during their training. Joint injections observed ranged from 89% for knee to 59% for shoulder and 22% for wrist joints. Only 11% of faculty had performed more than 5 intra-articular injections during their training. A need for formal training in these techniques was identified by 95% of the subjects, of whom 65% thought the residency period was the best time to do so. Performing 5 to 10 intra-articular injections during residency was considered optimal training by 60%. On subanalysis, the mean comfort scores were higher in the residents in general (3.60 +/- 2.29 versus 2.18 +/- 1.47;P = 0.01) as compared with faculty. The residents' scores were also higher across different joints as compared with those of faculty but assumed statistical significance only for olecranon bursa injection (2.32 +/- 2.76 versus 1.27 +/- 0.67;P = 0.04) and subacromial bursa injection (2.08 +/- 2.27 versus 1.27+/- 0.75;P = 0.06). The mean comfort scores were lower by 1.74 (P = 0.007) for women physicians. There is underuse of self-administered intra-articular and periarticular injection techniques by PCPs in the management of arthritis or periarthritis. The reasons include inadequate training and low comfort in performing these procedures. Eighty-nine percent of PCPs would refer their patients to subspecialty clinics for these "routine" injections. There is a clear need for a training in these procedures during residency.

Journal Article↗
PubMed2003

Are isolated antinucleolar antibodies a marker of scleroderma?

This study was designed to determine the prevalence and positive predictive value of isolated antinucleolar antibody (ANA) in scleroderma patients. We identified 73 rheumatology clinic patients with isolated ANAs. ANA titers greater than 1:160 were considered positive. The overall prevalence of isolated ANAs was 2.9%. The prevalence of isolated ANAs in scleroderma, systemic lupus erythematosus (SLE), and rheumatoid arthritis were 20.3%, 2.68%, and 3.3%, respectively. Scleroderma and SLE were present in 12 patients (16.4%) each. Other rheumatologic disorders identified in these patients were RA (12.3%), undifferentiated connective tissue disease (8.2%), mixed connective tissue disease (4.1%), vasculitis (6.8%), fibromyalgia (8.2%), osteoarthritis (5.4%), crystal-related arthropathy (6.8%), seronegative arthritis (2.7%), sarcoidosis (4.1%), and others (8.2%). There were no statistically significant differences in the median ANA titers in scleroderma versus systemic lupus (P = 0.16) or undifferentiated connective tissue disease (P = 0.18). The median titers were higher in scleroderma in comparison with rheumatoid arthritis (P = 0.01), osteoarthritis (P = 0.007), fibromyalgia (P = 0.001), and crystal-related arthropathy (P = 0.009). Isolated ANAs have poor sensitivity (20.3%) and the positive predictive value for this test is only 16.4% for scleroderma.

Journal Article↗