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PubMed1996

[Differential diagnosis of multiple pulmonary coin lesions--pulmonary hyaline granuloma].

In addition to metastases, the differential diagnosis of pulmonary nodules also includes tuberculosis, sarcoidosis, and silicosis. Rarer diseases such as amyloid tumors, rheumatic nodules, and plasma-cell granulomas can, depending on the clinical situation, be the cause of this finding. For the example of the clinical picture of pulmonary hyalinizing granuloma, the differential diagnosis of multiple pulmonary nodules is illustrated under consideration of the pathognomonic, morphologic observations.

Adult↗
PubMed1983

The changing prevalence and pattern of acute rheumatic fever and rheumatic heart disease in Hong Kong--(1968-1978).

The occurrence and pattern of rheumatic fever and rheumatic heart disease in Hong Kong in the years 1968 to 1978 were surveyed. The incidence of rheumatic fever in hospitals had decreased by four-fifths in the past 10 years. Rheumatic fever nowadays still predominantly affects children and younger adults, but middle-aged patients may also be affected. There are a slight female dominance (1.3 to 1) and a relative predominance of patients from urban areas. A less severe form of manifestation in adult patients is encountered nowadays. Carditis was the dominant feature in 1968, but joint involvement was more common in recent years. Rheumatic nodules, chorea or erythema marginatum remained uncommon throughout the years. Only 49% of cases satisfied the revised Jones criteria (1965). In comparison, chronic rheumatic heart disease still remained prevalent, with a slower trend of decreasing prevalence. It accounted for (36 to 50%) of total cardiac admissions. The mitral valve was involved in (82.7 to 91.7%), aortic valve in (15.5 to 36.3%), while involvement of tricuspid or pulmonary valve was relatively uncommon. The socio-economic implication of this changing trend was analysed, and the problem encountered in diagnosing rheumatic fever discussed.

Acute Disease↗
PubMedDate not supplied

Subcutaneous nodules in acute rheumatic fever--an analysis of age old dictums.

It is assumed that subcutaneous nodule (SCN), one of the major criteria in acute rheumatic fever (ARF), is rare and whenever these nodules appear, they are invariably associated with carditis. Further large number of nodules appear in crops and they are evanescent. This prospective study of 42 cases of ARF with SCN attempts to analyse the accuracy of such statements. The group comprised of 12.5% of 336 consecutive cases of ARF. Other major criteria associated with SCN were carditis in 38 (90.4%), arthritis in 33 (78.5%) and chorea in two (4.7%). No evidence of carditis could be found in 4 (9.5%). When a detailed study of SCN was done the average number of nodules found in the group was 18 (range 4-49). Thirteen (30.9%) had less than 10 nodules and 5 (11.9%) had only 4-5 nodules. With initiation of treatment SCN disappeared within 4 weeks in 29 (69%), within next 5-8 weeks in 8 (19%) and within 9-12 weeks in 3 (7.1%). In two cases (4.7%) multiple nodules were observed 12 weeks later when all other evidences of activity had disappeared. The study shows a comparative high incidence of SCN in ARF, not all being associated with carditis. Number of nodules appearing in ARF might be quite small and they could persist for long inspite treatment.

Adolescent↗
PubMed1995

[Deep granuloma annulare in children].

BACKGROUND: The granuloma annulare is a common benign disorder in childhood which may be difficult to recognize in its atypical forms, like deep granuloma annulare. CASES REPORT: Case 1: A 5-year-old girl suffered from subcutaneous nodules occurring on her soles. Open biopsy at the age of 6 years showed typical features of granuloma annulare. These nodules were still present one year later. Case 2: A 2-year-old girl suffered from nodular lesions on the anterior aspect of the lower legs similar to erythema nodosum with spontaneous outbreaks over 6 months. Histological examination showed typical features of granuloma annulare. CONCLUSIONS: Diagnosis of the deep granuloma annulare is often difficult. Its relation with rheumatic nodules which have similar histological patterns is discussed.

Child↗
PubMed1990

Hand handicap and rheumatoid arthritis in a fish-eating society (the Faroe Islands).

In the county of Klaksvik, the Faroes, a simple hand test was used for screening all inhabitants between the ages of 40 and 74 years. With its high sensitivity and specificity it revealed a diagnostic panorama entirely different from that seen in previous investigations in other nordic countries. In Klaksvik the prevalence of hand handicap was about 40%, which is due to the high incidence of osteoarthrosis. The prevalence of rheumatoid arthritis was 1.1%. The high functional capacity and the lower occurrence of rheumatic nodules and erosions found in the patients with rheumatoid arthritis as compared with previous studies suggest that the disease takes a milder course in Klaksvik. This should support the hypothesis that RA patients benefit from a diet rich in fish.

Adult↗
PubMed1996

Use of methotrexate in older patients. A risk-benefit assessment.

Methotrexate is eliminated almost entirely by the kidneys. The risk of methotrexate toxicity is therefore increased in patients with poor renal function, most likely as a result of drug accumulation. Declining renal function with age may thus be an important predictor of toxicity to methotrexate. Up to 60% of all patients who receive methotrexate for rheumatoid arthritis (RA) discontinue taking it because of adverse effects, most of which occur during the first year of therapy. Gastrointestinal complications are the most common adverse effects of methotrexate, but hepatotoxicity, haematological toxicity, pulmonary toxicity, lymphoproliferative disorders and exacerbation of rheumatic nodules have all been reported. Decreased renal function as a result of disease and/or aging appears to be an important determinant of hepatic, lymphoproli ferative and haematological toxicity. Concomitant use of low doses of folic acid has been recommended as an approach to limiting toxicity. Interactions between methotrexate and several nonsteroidal anti-inflammatory drugs have been reported, but they may not be clinically significant. However, caution is advised in the use of such combinations in patients with reduced renal function. More serious toxicities (e.g. pancytopenia) may result when other inhibitors of folate utilisation [e.g. cotrimoxazole (trimethoprim-sulfamethoxazole)] or inhibitors of renal tubular secretion (e.g. probenecid) are combined with methotrexate. Before starting low dose methotrexate therapy in patients with RA, a full blood count, liver function tests, renal function tests and chest radiography should be performed. Blood counts and liver function tests should be repeated at regular intervals. Therapeutic drug monitoring of methotrexate has also been suggested as a means of limiting toxicity. Patients with RA usually respond very favourably to low dose methotrexate therapy, and the probability of patients continuing their treatment beyond 5 years is greater than for other slow-acting antirheumatic drugs. Thus, given its sustained clinical utility and relatively predictable toxicity profile, low dose methotrexate is a useful addition to the therapy of RA.

Aged↗
PubMedDate not supplied

[X-ray characterization of changes of the lungs in juvenile rheumatoid arthritis].

The results of chest x-ray were analyzed in 66 pediatric patients with juvenile rheumatoid arthritis (JRA). X-ray signs of pneumofibrosis were revealed in 37 (56%) patients. Besides, rare pulmonary changes (emphysema, rheumatic nodules, infiltrates) were detected in the JRA patients. The absence of clinical symptoms in the presence of x-ray changes necessitates the performance of chest x-ray in JRA for early detection of the pulmonary symptoms of this disease.

Adolescent↗
PubMed1995

[Aortic valve replacement for rheumatoid aortic valve regurgitation].

Valve replacement for aortic regurgitation in patient with rheumatoid arthritis was rare in Japan. We report a successful case in which aortic regurgitation necessitated aortic valve replacement. A 62-year-old woman was admitted for shortness of breath, chest pain and progressive edema. She had been treated for rheumatoid arthritis for more than ten years using steroids. The aortic valve was successfully replaced by a prosthetic mechanical valve. The histopathological examination of the excised aortic valve demonstrated rheumatic nodules in the right- and non-coronary cusp. It was supported that these changes caused shrinkage of cusp and resulted in aortic regurgitation. This patient was discharged on the 20th postoperative day. There was no evidence of detachment of the prosthetic valve.

Anti-Bacterial Agents↗
PubMed1986

Palindromic rheumatism with rheumatoid nodules: a case report with ultrastructural studies.

Rheumatoid nodules developed on the finger tips of a patient with palindromic rheumatism. The patient had no bone cysts or erosions and had no rheumatoid factor. A light microscopic and ultrastructural study of a nodule showed a necrotic centre with fibrin, collagen, and granular material surrounded by large histiocytes, fibrocytes, lymphocytes, and vessels with adjacent mast cells as has been seen with nodules in classical rheumatoid arthritis (RA). We describe the first immunoperoxidase studies on a rheumatoid nodule and have identified reaction products for immunoglobulins and C3 in perivascular and endothelial cell vacuoles and in the necrotic centre.

Humans↗