Clin Exp Rheumatol
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Endogenous or exogenous glucocorticoids play a key role in the control of the immune and inflammatory network. Regulation of the effects of the glucocorticoids depends on changes in therapeutic levels, but also, as recently discovered, on modifications of the binding characteristics of the glucocorticoid receptors of target cells. ⋯ Finally, glucocorticoids are also capable of switching CD4 cells from a Th-1 to a Th-2 pattern. A decreased affinity of lymphocyte glucocorticoid receptors could hinder such a switch, with obvious clinical implications.
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The diagnosis and treatment of the mucocutaneous (MC), neuropsychiatric (NP), and renal (RN) manifestations of systemic lupus erythematosus (SLE) remain unsolved issues. To shed light on these issues, a questionnaire was prepared and sent to 153 lupus centres around the world, in order to determine the level of agreement between experts in their approach to these complex aspects of the disease. ⋯ The present survey indicates that, although most of the participating centres had extensive experience in the management of SLE, their approach to the MC manifestations was not homogeneous, and collaborative studies are clearly needed, particularly to optimise the therapeutic protocols.
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The unusual case of reflex sympathetic dystrophy syndrome caused by an acute attack of gout is reported. The syndrome, involving the left ankle and hindfoot, developed twelve days after a classical gouty attack involving the first metatarso-phalangeal joint of the same foot. Diagnosis was based on X-ray and scintigraphic and MRI changes A prompt clinical remission was achieved with a short course of i.v. clodronate.
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To clarify the role of articular innervation during the acute and post-arthritic phases, we investigated the changes taking place over time in the nerve fibers from joint tissues of adjuvant arthritic rats. ⋯ This work supports a close relationship between the nervous system and arthritis. We propose that cycles of nerve destruction and regeneration may be related to the characteristic periods of remission and activity of some forms of chronic arthritis.