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Biomedical subjects

Naomi Schlesinger

Publications and source records attributed to Naomi Schlesinger.

14 recordsLinked to original sources
PubMed2006

Response to application of ice may help differentiate between gouty arthritis and other inflammatory arthritides.

AIM: The aim is to determine whether response to topical ice versus heat differentiates between patients with gout versus other arthritides. METHODS: The first 150 patients seen in our clinic with joint pain from February 2004 onward were asked to fill out questionnaires regarding their response to heat and ice. Patients who responded that topical ice eased their pain and who did not have a diagnosis of crystal-induced arthritis were asked to have a joint aspiration if they had active synovitis on presentation to the clinic. RESULTS: Of 150 completed questionnaires, 26 patients never tried heat or cold as adjuvant treatment for their arthritis. The remaining 124 patients were divided into 6 groups: patients with crystal-proven gout (n = 20), rheumatoid arthritis (RA; n = 32), osteoarthritis (OA; n = 32), other forms of inflammatory arthritis (n = 18), and soft tissue conditions (n = 22). None of the patients with gout benefited from topical heating of their affected joints and all preferred topical ice (P < 0.001). Most patients with RA preferred heat (n = 24). Of 4 patients with RA who preferred topical ice, 3 had effusions and arthrocentesis was performed. Intracellular monosodium urate (MSU) crystals were seen in 2 and intracellular calcium pyrophosphate dihydrate (CPPD) crystals were seen in one patient raising questions about coexistence of 2 diseases or previous misdiagnoses. Most patients with OA preferred heat (n = 28). A significantly higher percentage of the patients with gouty arthritis found that topical ice helped relieve their joint pain as compared with patients with RA (P = 8 x 10(-11)) and other inflammatory arthritides (P = 3 x 10(-8)). DISCUSSION: Heat and cold are adjuvant treatments for arthritis. In gouty arthritis, cold applications are a useful adjunct to treatment and may help discriminate patients with gout from other forms of inflammatory arthritis.

Arthritis↗
PubMed2006

Mycobacterium marinum arthritis mimicking rheumatoid arthritis.

Mycobacterium marinum is an atypical mycobacterium found in salt and fresh water. M. marinum infection occurs following skin trauma in fresh or salt water and usually presents as a localized granuloma or sporotrichotic lymphangitis. It rarely affects the musculoskeletal system. We describe a patient who presented with subcutaneous nodules and an inflammatory arthritis that was thought to be rheumatoid arthritis, and was treated as such with corticosteroids, methotrexate, and anti-tumor necrosis factor-alpha therapy, with worsening of his arthritis.

Aged↗
PubMed2006

A survey of current evaluation and treatment of gout.

OBJECTIVE: To record diagnostic and treatment approaches to gouty arthritis among US rheumatologists. METHODS: Questionnaires were faxed to 2500 US rheumatologists. RESULTS: Responses were received from 518 rheumatologists. Respondents reported performing crystal analysis 80% of the time for new suspected gout; 64% use combination therapy for acute gout; nonsteroidal antiinflammatory drugs alone are used in only 27%. Urate-lowering drugs (ULD) are given to most patients. ULD treatment is given occasionally to patients with asymptomatic hyperuricemia (4%) but most frequently to patients after 2 (59%) or 3 (34%) attacks. ULD are given with the aim of achieving a serum urate (SU) level of 6 mg/dl. CONCLUSION: Combination antiinflammatory agents are used frequently for acute gout despite absence of evidence in the literature to support this practice. There seems to be consensus regarding the necessity of lowering SU to < 6 mg/dl. Approaches vary widely, supporting the need for longterm prospective, placebo controlled studies to provide more evidence-based guidance.

Adrenal Cortex Hormones↗
PubMed2005

Tuberculosis of the spine: experience in an inner city hospital.

BACKGROUND: It is estimated that 10 to 15 million people are infected with Mycobacterium tuberculosis in the United States. Spinal involvement is said to occur in less than 1%. METHODS: A review of the clinic records of all patients having a diagnosis of spinal tuberculosis at the New Jersey Medical School National Tuberculosis Center from January 1994 to January 1999 was done. RESULTS: Twelve patients with spinal TB were identified (2.2%). Spinal tuberculosis is characteristically chronic and slowly progressive. Presenting symptoms are usually back and neck pain or pain at the site of involvement. Pain was noted in a majority (83%) of our patients. Despite proven diagnoses by culture or histology, only 41% were purified protein derivative-positive. Unlike pulmonary tuberculosis, which may present with a constellation of symptoms, including cough, weight loss, fever, and night sweats, if tuberculosis only involves bone, pain may be the only symptom. Most patients were successfully treated with surgery and anti-TB medications. Tuberculosis remains a major public health problem. CONCLUSIONS: Before the disease can be treated, it must be recognized. Tuberculosis should be considered a diagnostic possibility when spinal osteomyelitis is seen, even in the absence of pulmonary disease or HIV infection. Back pain in a patient with tuberculosis should be evaluated. Early initiation of an appropriate treatment regimen may reduce the need for surgical intervention, but most patients require surgery.

Adult↗
PubMed2005

Dietary factors and hyperuricaemia.

The connection of gout and hyperuricaemia with gluttony, overindulgence in food and alcohol and obesity dates from ancient times. Studies from different parts of the world suggest that the incidence and severity of hyperuricaemia and gout may be increasing. Uric acid (urate) is the end product of purine degradation. Although most uric acid is derived from the metabolism of endogenous purine, eating foods rich in purines contributes to the total pool of uric acid. Sustained hyperuricaemia is a risk factor for acute gouty arthritis, chronic tophaceous gout, renal stones and possibly cardiovascular events and mortality. Before starting lifelong urate-lowering drug therapy, it is important to identify and treat underlying disorders that may be contributing to hyperuricaemia. It is relevant to recognize the strong association of the insulin resistance syndrome (IRS) (abdominal obesity, dyslipidaemia, hypertension, raised serum insulin levels and glucose intolerance) with hyperuricaemia. Consumption of meat, seafood and alcoholic beverages in moderation and attention to food portion size is important. Moderation in the consumption of not only beer but also other forms of alcohol is essential. In the obese, controlled weight management has the potential to lower serum urate in a quantitatively similar way to relatively unpalatable "low purine" diets. Non-fat milk and low-fat yogurt have a variety of health benefits and dairy products may have clinically meaningful antihyperuricaemic effects. In addition, fruits, such as cherries and high intakes of vegetable protein diet may reduce serum urate levels.

Alcohol Drinking↗
PubMed2005

Seasonal variation of lupus nephritis: high prevalence of class V lupus nephritis during the winter and spring.

OBJECTIVE: Systemic lupus erythematosus is a multisystem disease with many clinical variations, including renal involvement. Our aim was to determine whether lupus nephritis (LN) has a specific seasonality. METHODS: Reports of renal biopsies performed from 1990 to 2002 were reviewed. Three hundred and seventy-three patients with class II, III, IV, and V LN were identified. Using the modified WHO classification of LN, diagnoses were tabulated and the seasonality (season of diagnosis) of LN was statistically analyzed. RESULTS: Class IV LN was detected in 179 patients (48%), class II in 63 patients (16.9%), class III in 73 patients (19.57%), and class V in 74 patients (19.9%). No difference could be detected in the number of patients diagnosed in each season when all 373 patients were analyzed as one group. The number of patients with class IV LN was higher during summer and fall than during the winter and spring. In contrast, a higher number of patients with class V LN were observed during the winter and spring seasons than during the summer and fall seasons. The percentage of patients with class V LN was significantly higher during winter and spring than during summer and fall. A similar, though non-significant, trend was seen for class III LN. A striking parallelism was found between the month of occurrence of class III and class V LN. The monthly distribution of the percentage of patients in each month with class III and V LN showed a significant correlation. The monthly distribution of patients with class IV LN was different from those with either class III or V LN. CONCLUSION: We found that the prevalence of class V LN was significantly higher and that of class III LN non-significantly higher in winter and spring. Parallelism between the monthly occurrences of class III and class V may suggest a common trigger. Analysis of the seasonality of LN may contribute to the understanding of the pathogenesis of LN, which may be multifactorial, as the different classes of LN represent different types of glomerular injury. Further studies are needed to clarify this potentially important observation.

Adolescent↗
PubMed2005

Diagnosis of gout: clinical, laboratory, and radiologic findings.

Acute gouty arthritis typically presents with a sudden and severe exquisitely painful joint, most classically in the first metatarsophalangeal joint (toe). Demonstrating the presence of monosodium urate (MSU) crystals in the joint fluid or tophus has been the gold standard for the diagnosis of gout. However, many physicians do not perform synovial fluid analysis. In the absence of demonstrating the presence of MSU crystals in aspirated joint fluid or tophus, clinical, radiologic, and laboratory criteria are helpful. This article presents an overview of the various classification criteria, clinical presentations, and laboratory and radiologic studies needed to make the diagnosis of gout.

Acute Disease↗
PubMed2005

Outcome measures for acute and chronic gout.

Gout provides some unique challenges in classification and measurement of outcomes. Our aim was to evaluate criteria for classification and to develop and validate optimal instruments to measure outcomes for acute and chronic gout. A planning committee and interested attendees met to propose classification criteria and domains for outcomes. Seven of the current American Rheumatism Association preliminary criteria for classification were proposed as the best current criteria for acute gouty arthritis, pending further studies. The presence of gout is best established by crystal identification, although this technique has limitations. Five domains for acute gout outcomes and 9 for chronic gout were identified along with proposed instruments for testing and validation. The unique problems of gout evaluation can and will be addressed.

Acute Disease↗
PubMed2004

Management of acute and chronic gouty arthritis: present state-of-the-art.

There are three stages in the management of gout: (i) treating the acute attack; (ii) lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of urate; and (iii) providing prophylaxis to prevent acute flares. It is important to distinguish between therapy to reduce acute inflammation in acute gout and therapy to manage hyperuricaemia in patients with chronic gouty arthritis. During the acute gouty attack nonpharmacological treatments such as topical ice and rest of the inflamed joint are useful. NSAIDs are the preferred treatment in acute gout. The most important determinant of therapeutic success is not which NSAID is chosen, but rather how soon NSAID therapy is initiated. Other treatments include oral and intravenous colchicine, intra-articular and systemic corticosteroids, and intramuscular corticotropin. Optimal treatment of chronic gout requires long-standing reduction in serum uric acid. The urate-lowering drugs used to treat chronic gout are the uricosuric drugs, the uricostatic drugs, which are xanthine oxidase inhibitors, and the uricolytic drugs. Xanthine oxidase inhibitors such as allopurinol, oxipurinol and febuxastat should be used as first-line treatment in patients with renal calculi, renal insufficiency, concomitant diuretic therapy and ciclosporin (cyclosporine) therapy, and urate overproduction. Uricosuric drugs include probenecid, benzbromarone, micronised fenofibrate and losartan. They are the urate-lowering drugs of choice in allopurinol-allergic patients and underexcretors with normal renal function and no history of urolithiasis. The use of recombinant urate oxidase in patients with chronic gout is limited by the need for parenteral administration, the potential antigenicity and production of anti-urate oxidase antibodies, and declining efficacy. The effectiveness of colchicine prophylaxis as an isolated therapy is still to be confirmed by placebo-controlled trials. Another issue is prophylaxis with NSAIDs. There are no comparative studies with colchicine.

Acute Disease↗
PubMed2004

Clues to pathogenesis of fibromyalgia in patients with sickle cell disease.

OBJECTIVE: To investigate the association between sickle cell disease (SCD) and fibromyalgia (FM). METHODS: Nine patients with SCD for whom a rheumatology consult was requested were assessed for FM by retrospective chart review. Eleven inpatients with other forms of anemia referred for rheumatology consult were also assessed for FM. RESULTS: Eight of 9 patients with SCD fulfilled classification criteria for FM compared to one of 11 patients without SCD (p < 0.001). CONCLUSION: Awareness of the high frequency of FM in SCD can improve treatment of sickle cell crisis. Some pain that is labeled as sickle cell crisis pain may be due to FM, and may improve with tender point injections.

Adult↗
PubMed2002

Update on gout.

Explore the source record for details and available documents.

Gout↗
PubMed2002

Local ice therapy during bouts of acute gouty arthritis.

OBJECTIVE: To evaluate the effect of local application of ice on duration and severity of acute gouty arthritis. METHODS: Nineteen patients with acute gout were enrolled and randomized into 2 groups. Group A (n = 10) received topical ice therapy, oral prednisone 30 mg PO tapered to 0 over 6 days and colchicine 0.6 mg/day. Group B was the control group (n = 9), given the same regimen but without the ice therapy. The patients were followed for one week. RESULTS: The mean reduction in pain for those patients treated with ice therapy was 7.75 cm (on 10 cm visual analog scale) with standard deviation +/- 2.58 compared with 4.42 cm (+/- SD 2.96) for the control group. Using a Wilcoxon rank-sum test there was a significant difference (p = 0.021 ) in pain reduction between the ice therapy and control groups. Joint circumference and synovial fluid volume also tended to be more effectively reduced after one week of therapy in the ice group compared with controls, but these did not achieve statistical significance. CONCLUSION: The group treated with ice had a significantly greater reduction in pain compared with the control group. Although the clinical improvement was impressive, due to the small sample size we could not show statistically significant improvement in all the variables that tended to suggest that effect was more than simply analgesic. Cold applications may be a useful adjunct to treatment of acute gouty arthritis.

Arthritis, Gouty↗