J Rheumatol
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Patients with musculoskeletal disorders, including fibromyalgia syndrome (FS), often state that weather conditions modulate their complaints. There have been a few studies concerning this issue, but the results appear to be contradictory. ⋯ Correlation analyses showed no relation between the subjective complaints and the meteorological factors. The symptoms pain, stiffness and fatigue, however, showed a strong intercorrelation.
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We describe a case of a 64-year-old Filipino man who presented with cholesterol emboli syndrome manifesting as worsening hypertension, renal failure and livedo reticularis involving the upper legs and lower abdomen. The livedo reticularis became very prominent with the patient standing, but completely vanished after several minutes of lying supine. Deep cutaneous biopsy of an area of skin that was found to be consistently involved with livedo reticularis demonstrated cholesterol clefts in several vessels, thus establishing the diagnosis in this patient, and avoiding the more problematic option of biopsying an involved visceral organ.
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Antibodies directed against components of neutrophil cytoplasm have been detected in various systemic vasculitides and especially in Wegener's granulomatosis. In polyarteritis nodosa (PAN) and Churg-Strauss syndrome, few data are available and correlation between clinical manifestations and antineutrophil cytoplasm antibodies (ANCA) has not been established. Therefore, we tested, before treatment of vasculitis, 62 consecutive patients suffering from PAN with hepatitis B virus (HBV) markers, PAN of unknown etiology or Churg-Strauss syndrome. ⋯ Regardless of the technique used, Churg-Strauss syndrome was associated with ANCA in about 60% of the cases while, in PAN of unknown etiology, ANCA were found in about 25% of cases. In contrast, IFA and ELISA only detected ANCA in a limited number of cases of PAN related to HBV infection. ELISA positivity in patients with PAN and Churg-Strauss syndrome was usually associated with antimyeloperoxidase antibodies. In our cases of PAN, ANCA and purpura were significantly correlated, suggesting that, in these cases, small vessels are involved and therefore macroscopic and microscopic PAN coexist. Thus it seems that ANCA are essentially present in the cases of small vessel vasculitis, as has been described, and are not a marker of pure macroscopic PAN, at least at our present level of understanding of these antibodies.
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Heart block in neonatal lupus erythematosus is typically complete and detected in utero or in the neonatal period. We describe a child diagnosed with incomplete heart block at 9 years of age whose mother was diagnosed with Sjögren's syndrome and anti-Ro(SSA) 2 years after diagnosis of heart block in her child. This is the first case of late detection of incomplete heart block in a child felt to be causally related to the presence of anti-Ro(SSA) in the mother.
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We describe the use of low doses of warfarin to treat calcinosis in a patient with systemic sclerosis or CREST syndrome. Our patient had Raynaud's phenomenon, skin sclerosis of the neck and the distal surface of the elbows, and pitting ulcers and scarification of the fingers as well as cutaneous calcinosis. ⋯ Sequential radiographs of the hands showed that calcinosis had improved. Since there seem to be few adverse effects, the use of warfarin in patients with calcinosis warrants further study.