Biomedical subjects
Publications and source records attributed to P Oriente.
Peripheral enthesopathies have recently been attributed a crucial role in the definition of seronegative spondyloarthropathies. We report a case of psoriatic oligoarthritis in which a peripheral enthesopathy, occurring at the right olecranon, was the heralding sign of the disease.
Epidemiological and clinical evidence have indicated that apolipoprotein A1 and B determination can better define the lipoprotein pattern in normal subjects and in subjects with coronary heart disease. In this paper, a recent immunoturbidimetric method for routine apolipoprotein A1 and B measurement (using the Turbitimer system and commercially available antisera) has been evaluated. The precision and the accuracy of the method have been previously considered. Within-run and between-run coefficients of variation (ranging from 1.67% to 5.04%) for both assays indicate good precision of the method. Accuracy was evaluated on 2 consecutive days (n = 10 each run) using a standard serum for apolipoprotein A1 and B. The bias obtained was 3.79% for apolipoprotein A1 and 2.30% for B. Apolipoproteins A1 and B were then measured in 100 normal and hyperlipemic sera with the immunoturbidimetric assay and radial immunodiffusion (using the monoclonal antibodies). The data obtained were evaluated by linear regression analysis (Al, r = 0.893; B, r = 0.862). The good correlation between the two methods suggests that the immunoturbidimetric assay can be usefully performed for routine apolipoprotein A1 and B determination because of its lower cost, rapidity, and simplicity.
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Medical records of 138 patients with psoriatic arthritis and 138 with rheumatoid arthritis were reviewed for the occurrence of an environmental factor triggering arthritis. Twelve (9%) of the patients with psoriatic arthritis had had an acute disorder immediately preceding onset of arthritis (an operation in four cases, articular trauma in three, abortion in two, myocardial infarction, thrombophlebitis, and phosphoric ester intoxication in one case each). Peripheral arthritis occurred in all these patients. Among the rheumatoid patients, an acute event immediately preceding the onset of the disease was recorded in two cases (1%) only (chi 2 = 7.52; p = 0.006). No significant association was found in the arthritic patients between the incidence of acute events preceding arthritis onset and positivity of the HLA-B27 phenotype.
Seventy-nine consecutive patients with active ulcerative colitis were studied to establish the prevalence and clinical features of articular involvement. HLA typing for A and B loci was performed. Forty-nine patients showed an articular involvement (62%). Three different clinical patterns were identified: ankylosing spondylitis occurring in 20 subjects; peripheral arthritis in 15; unclassifiable spondylitis in 14. When compared to the general population in our area, patients with colitis showed a significantly higher prevalence of the HLA-A1 (p less than 0.005), B21 (p less than 0.001) and B27 (p less than 0.05); among patients with colitis, those with arthritis revealed higher frequency of HLA-B27 (p less than 0.05). Our study reveals a high prevalence of unclassifiable spondylitis during ulcerative colitis, and suggests a new approach to the classification of seronegative spondarthritis.
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The aim of this study was to evaluate an immunofluorescence skin test, the lupus band test (LBT), in comparison to other criteria as classified by the American Rheumatic Association for the diagnosis of systemic lupus erythematosus (SLE). Twenty patients with SLE and another 24 with different connective tissue diseases (rheumatoid arthritis 16, dermatomyositis 3, necrotizing vasculitis 5) were studied. Antinuclear antibodies (ANA) appeared very sensitive (100%) in the diagnosis of LES, though with a low specificity (63%). LBT was however both sensitive (80%) and specific (100%). Others ARA laboratory criteria (anti-dsDNA, anti-Sm, VDRL and hematological disorders) were also less sensitive and/or less specific than LBT. Most interestingly, LBT was positive in 7 SLE cases in which both dsDNA and Sm antibodies were negative. Thus, LBT appears a useful test in the diagnosis of SLE. In addition, it may be of critical value in certain subsets of patients in which the present ARA criteria may not suffice for diagnosis.
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Clinical experience obtained in the management of 138 patients of psoriatic arthritis is reported. The correct recognition of arthritic subtype (according to Moll and Wright classification) always resulted essentially in the choice of the therapy. Our programme included rehabilitative, pharmacologic and surgical approaches. Our data suggest that psoriatic arthritis is a mild articular disease when compared to other affections such as rheumatoid arthritis or ankylosing spondylitis. Notwithstanding an accurate therapeutical programme, it is necessary to control atypical cases which not infrequently can occur.
Six hundred and forty-seven patients with psoriasis were studied in order to define prevalence and clinical features of psoriasis and psoriatic arthritis. After medical history review all patients were observed by a dermatologist and a rheumatologist. Successive laboratory tests and radiological and scintiscan examinations of joints were also performed. Diagnosis of arthritis was made according to Wright and Moll. In our district, the prevalence of psoriasis in respect to other dermatological diseases was 1.86%. Vulgaris pattern occurred in 85% of the total cases while eruptive was found in 10.5%. Erythrodermic and pustular forms were uncommon, occurring in 2.47% and in 1.23%, respectively. In 84.8% of the total cases, psoriasis onset was clinically evident while in 10.8% it affected non-evident cutaneous sites. Onycopathic onset occurred in 4.3%. Altogether 138 psoriatic patients exhibited arthritis and spondylitic and polyarticular patterns were very common (occurring in 42.7% and 33.3%, respectively). Psoriasis antedated arthritis in 68.4% of the cases but followed it in 21%. Synchronous onset occurred in 10.8%. The data obtained strengthen those of our previous reports. In particular, the marked articular involvement of psoriatic patients is confirmed. Moreover, our results, when compared with data of other authors, show a different distribution among the arthritic subtypes.
Erythema Nodosum (EN) is a painful nodular syndrome, most likely of immunologic origin, which involves dermis and subcutaneous tissue. Pathologic process is that of vasculitis of the small veins with inflammation of the septa of the fat lobules (septal panniculitis). It is generally agreed that EN represents a hypersensitive reaction to a variety of antigenic stimuli and thus may be observed in the course of several diseases (infections, immunopathies, malignancies) as well as during drug therapy (with halides, sulfonamides, oral contraceptives). In approximately 50 per cent of the cases an underlying etiology is not apparent (idiopathic form). The clinical picture is always that of a nonspecific systemic illness with low-grade fever (in 60%), malaise (in 67%), arthralgias (in 64%) and arthritis (in 31%), while when there is an associated illness, this may dominate the presentation. Laboratory tests show no specific abnormalities except for those related to an underlying disease. Treatment of idiopathic form includes nonsteroidal antiinflammatory agents which usually ease the discomfort. Steroids, although highly effective, are not recommended because of the benign nature of EN and the danger of disseminating an underlying disease.
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Forty-three psoriatic patients with spondylitic involvement (19 women and 24 men, mean age 41 years) have been reviewed. Three different subsets were recognized. The first (PS1), with predominant involvement of the axial skeleton, occurred in 22 (seven women and 15 men, mean age 39). The second (PS2) and the third (PS3) showed an overlap of spondylitis and peripheral articular disease. In PS2 this consisted of distal interphalangeal (DIP) arthritis (five women and three men, mean age 41), while in PS3 there was symmetrical polyarthritis (seven women and six men, mean age 42). Spinal involvement, present in every case, was characterized by unilateral and asymmetrical syndesmophytes, often nonmarginal and randomly affecting the vertebral column. Sacroiliitis, absent in the PS2 subset, was present in 15 of the PS1 and in two of the PS3 subgroup and was bilateral in six and unilateral in 11. The HLA-B27 antigen, absent in the PS2 subgroup, was found in 12 of the PS1 and in two of the PS3 subset. It was associated with sacroiliitis in 13 cases and with spondylitis without sacroiliitis in only one case. Nail changes were recorded in 30% of the total cases and showed a strict relationship with the PS2 subset (40%). Extra-articular symptoms, consisting almost exclusively of ocular involvement, occurred in three patients only (two cases of conjunctivitis and one of acute anterior uveitis). The clinical course of psoriatic spondylitis appeared less disabling than that of the idiopathic form.
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Thirteen patients with Raynaud's phenomenon were studied; six patients had the primary disorder and in the other seven progressive systemic sclerosis was diagnosed. Each patient received 10 mg of nifedipine; telethermographic evaluation of the hands was performed in basal conditions and 30 minutes after the administration of the drug. A more marked increase of hand tissue temperature was observed in the patients with progressive systemic sclerosis than in those with the primary disorder.
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Five male patients with polyarteritis nodosa were treated with cyclophosphamide as follows: 3 mg/Kg/die i.v. up to maximum of 3 g.; subsequently, 200 mg/die per os for two weeks, then 100 mg per os every other day for three months; finally, 100 mg every fourth day until the 18th month. One patient, who also had fever, received 25 mg/die of prednisone for the initial three weeks of treatment. Before treatment ESR, WBC, and circulating immune-complexes were increased, while C3a, C3c and C4 serum complement components levels were normal. Skin ulcers healed within 4 months. A progressive marked improvement of visceral damages in the first months of therapy have been noted (e.g. blood pressure values in normal range after suspension of concomitant antihypertensive treatment, regression of peripheral neuropathy, etc. etc.). No further ischemic lesions occurred during treatment. Significant decreases of ESR and serum immune-complexes levels were detected. No untoward effects due to cyclophosphamide were observed. These findings support the effectiveness of this drug in polyarteritis. The possibility of association with glucocorticoids during the acute phase of disease is also discussed.
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