Scandinavian journal of rheumatology
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Scand. J. Rheumatol. · Sep 2006
Review Case ReportsLiver infarction in a woman with systemic lupus erythematosus and secondary anti-phospholipid and HELLP syndrome.
We report a 39-year-old primigravida, a case of systemic lupus erythematosus (SLE) and secondary anti-phospholipid syndrome (APS) with a smooth antenatal course who delivered by caesarean for non-reassuring foetal heart rate. On day 2 postoperatively, she developed a sudden severe colicky upper abdominal pain with tachypnoea, dyspnoea, and tachycardia, and blood pressure (BP) reaching 150/95 mmHg. Computed tomography of the abdomen revealed lesions consistent with liver infarction. ⋯ On day 3, BP normalized, respiratory symptoms improved but abdominal symptoms persisted. Methylprednisolone was increased to 80 mg/day on day 8 when she had significant clinical response and was discharged on day 16. This case emphasizes that a morbid clinical course including liver infarction should be anticipated in patients with SLE and APS complicated with HELLP syndrome.
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In this review on the genetic aspects of rheumatic diseases, the approach was taken (i) to discuss, in general, important principles in the identification of susceptibility genes and (ii) to focus on five autoimmune rheumatic diseases that have the characteristics of complex diseases and in which important advances have been made in the identification of the genetic component. A decade ago, most reviews on the genetics of rheumatic diseases focused almost exclusively on a discussion of the human leukocyte antigen (HLA) but in this fast-moving field it is now apparent that genes outside the HLA also contribute to susceptibility. Current hypotheses concerning the pathogenesis of autoimmunity have led to the inclusion of hundreds of genes as potential candidates. ⋯ The identification of the genes involved in complex diseases will contribute to an understanding of disease mechanisms and disease biology. The disease pathways by which the genes exert their effects or functions could lead to the discovery of new therapeutic targets that may be modulated. An increased understanding of the interactions between genes and environment might also be attained.
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Scand. J. Rheumatol. · Jan 2004
Review Comparative StudyPrevalence and incidence of shoulder pain in the general population; a systematic review.
To investigate the incidence and prevalence of shoulder complaints in the general population. ⋯ The reported prevalence figures on shoulder complaints diverged strongly. Health professionals and policymakers who estimate the amount of medical care needed and related costs should be aware of the variations in prevalence rate and the underlying reasons for these differences.
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Scand. J. Rheumatol. · Jan 2004
ReviewStabilisation surgery for chronic low back pain: indications, surgical procedures, and outcome.
Spinal fusion was introduced as a treatment option for chronic low back pain >70 years ago. However, few areas of spinal surgery have caused as much controversy. The debate about whether to use an anterior-, posterior- or anterior + posterior approach has persisted since the 1930s. ⋯ Two recent RCTs have dealt with the question of conservative versus operative treatment of patients with low back pain, and both studies have shown a significant better functional outcome for spinal fusion in situ, compared with a more or less organized exercise programme at 2-year follow-up. The choice of postoperative rehabilitation strategy has also been shown to be of importance for overall functional outcome. One study has demonstrated the importance of the inclusion of coping schemes, and questioned the role of intensive exercises in a rehabilitation programme for spinal fusion patients.
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Scand. J. Rheumatol. · Jan 2004
ReviewThe genetic background of tumour necrosis factor receptor-associated periodic syndrome and other systemic autoinflammatory disorders.
Systemic autoinflammatory disorders are hereditary diseases with symptoms of acute inflammation and a rise in serum acute phase proteins as a consequence, but with no signs of autoimmunity. By the end of the 1990s, four types of hereditary periodic fever had been described in the medical literature: familial Mediterranean fever, hyperimmunoglobulinemia D with periodic fever syndrome (HIDS), tumour necrosis factor receptor-associated periodic fever syndrome (TRAPS) and Muckle-Wells syndrome. ⋯ In patients of Nordic descent, cases of HIDS and TRAPS have been reported. We provide an overview of the genetic background and main clinical aspects of the different autoinflammatory disorders, with an emphasis on TRAPS.