Clinical rheumatology
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Injection to the zygapophysial joint is a procedure which is performed frequently for diagnostic or therapeutic reasons in the management of back pain. It is generally considered to be free of significant complications. We report a patient who developed a paraspinal abscess following a lumbar facet joint injection.
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Clinical rheumatology · Jan 1999
Comparative StudyNeurological involvement in primary Sjögren's syndrome: clinical and instrumental evaluation in a cohort of Italian patients.
To evaluate nervous system involvement in a cohort of Italian patients with primary Sjögren's syndrome (pSS), 87 unselected patients (83 female, and four male) observed consecutively at our institution over a period of 5 years were screened by clinical and instrumental (MRI, SPECT, electrophysiological testing, CSF analysis) investigations for peripheral and central neurological abnormalities. Seroimmunological parameters and extraglandular features other than neurological manifestations were also evaluated. Seven patients had central nervous system (CNS) disease (8%), mostly non-focal dysfunction, and 12 had peripheral nervous system (PNS) disease (13.8%), mostly mild or severe sensory or sensory-motor polyneuropathies. ⋯ From a statistical point of view, the only relevant finding was the detection of a slight increase in serum IgA and IgM levels (p < 0.05) in patients with an intact nervous system. Neurological involvement in pSS, be it central or peripheral, is not a rare finding. A careful clinical neurological evaluation, combined with a multiplicity of instrumental investigations, is recommended in the global assessment of pSS patients.
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Clinical rheumatology · Jan 1999
Case ReportsMarked improvement of severe cardiac dysfunction after one course of intravenous immunoglobulin in a patient with systemic lupus erythematosus.
Intravenous immunoglobulin (IVIg) is currently used with much enthusiasm for the treatment of many autoimmune diseases, including systemic lupus erythematosus (SLE). Among its various indications, IVIg has also been found to be beneficial in myocarditis, whether or not it is associated with an autoimmune disease (e.g. Kawasaki's disease). ⋯ Coronary angiography demonstrating normal coronary arteries supported the diagnosis of myocarditis. High-dose IVIg treatment was started, followed by improved cardiac function a few days later and normalisation of the ejection fraction (50%) 1 month later. This is the second report of a beneficial effect of IVIg in myocarditis secondary to SLE.
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Clinical rheumatology · Jan 1998
Comparative StudyKnee and/or hip joint destruction in rheumatoid arthritis is associated with HLA-DRB1*0405 in Japanese patients.
To determine the prognostic factors for knee and/or hip joint destruction in rheumatoid arthritis (RA) patients, we typed 379 RA patients for HLA-DRB alleles and analysed the antigen frequencies. The DRB1*0405 antigen frequency in RA patients who underwent total knee replacement and/or total hip replacement was significantly higher than in those who did not have replacements, which meant that DRB1*0405 was associated with knee and/or hip joint destruction. This finding may be of value for predicting knee and/or hip joint destruction in RA.
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Clinical rheumatology · Jan 1998
Case ReportsGranulomatous amoebic encephalitis caused by Acanthamoeba in a patient with systemic lupus erythematosus.
A 25-year-old chronically immunosuppressed woman with systemic lupus erythematosus (SLE) died after developing subacute granulomatous encephalitis caused by Acanthamoeba. Amoebic trophozoites were also found in the lung, suggesting a primary pulmonary focus of infection. ⋯ This case illustrates that Acanthamoeba can cause fatal encephalitis in lupus patients, as well as in patients with acquired immunodeficiency syndrome as previously reported. To our knowledge, this is the first reported case of granulomatous amoebic encephalitis due to Acanthamoeba in a patient with SLE.