Clin Exp Rheumatol
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Lyme arthritis is the late manifestation of a multi-systemic infectious disease designated Lyme borreliosis (LB) which is caused by the spirochete Borrelia burdorferi. Its arthritic manifestations were first recognized in the small New England villages, "Lyme" and "Old Lyme", for which the disorder is named. ⋯ The intensive study of this disorder, however, has taught important lessons which may also be true for other forms of chronic arthritis in which an infectious cause has not been elucidated. Rather than just adding another review on Lyme arthritis to the many good ones that already exist, this paper will focus on these messages.
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Human immunodeficiency virus (HIV) infection predisposes to bacterial infection at may sites but septic arthritis is notably uncommon. An HIV seropositive patient who presented with oligoarticular septic arthritis due to Salmonella enteritidis and who responded poorly to antibiotic therapy and repeated aspiration of involved joints is described. ⋯ Cure of Salmonella septic arthritis in HIV infected patients may be difficult and require aggressive prolonged treatment. Septic arthritis should be considered in the differential diagnosis in a patient with HIV infection and arthritis.
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A retrospective study of 79 juvenile arthritic patients with reactive amyloidosis for a mean of 10 years (3 months-24.25 years) from the onset of amyloidosis was performed. Eighty percent of those treated with chlorambucil (n = 57) were alive compared with 23.5% of patients not treated with chlorambucil (n = 19) 10 years after diagnosis. Renal failure was the cause of death in 82.3% and infection in 11.7%. ⋯ Analysis of their fertility status showed that there were 5 normal births in 3 women and 2 terminations of pregnancy in 23 chlorambucil-treated women of child bearing age. Six women had ovarian failure. None of the male patients fathered a child.
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Randomized Controlled Trial Comparative Study Clinical Trial
Corticosteroid injection for osteoarthritis of the knee: peripatellar compared to intra-articular route.
Intra-articular injection of micro-crystalline corticosteroid is used to treat symptomatic osteoarthritis (OA) of the knee, but its duration of effect and efficacy are uncertain. From the observation that pain in OA of the knee can often be blocked by infiltration of the soft tissues at the patella margin with local anaesthetic, this study investigated an injection technique in which corticosteroid was infiltrated around the patella. Thirty-eight patients with radiologically demonstrable and painful OA of the knee were treated either with peripatellar or intra-articular methylprednisolone in a randomised double blind study. ⋯ Analysis of individual responses showed that the majority of good outcomes were in the peripatellar group. Five patients receiving intra-articular injections but only one receiving a peripatellar injection withdrew because of treatment failure. Peripatellar injection is an alternative method of local administration of corticosteroid which is highly effective in a proportion of patients and merits further evaluation.
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Case Reports
Systemic lupus erythematosus, pulmonary hypertension and adult respiratory distress syndrome (ARDS).
The patient, a 30 year-old Caucasian female with a 6-year history of systemic lupus erythematosus was suspected of having pulmonary hypertension following chest X-Ray and routine echocardiography. Whilst awaiting further cardiological investigations she developed acute respiratory distress accompanied by gross signs of cor pulmonale and died despite full intropic and ventilatory support, in addition to intravenous "Pulse" methyl prednisolone. Postmortem findings showed typical features of the adult respiratory distress syndrome ('ARDS') but minimal vascular changes attributable to the pulmonary hypertension. The 'ARDS' was presumably associated with an acute 'flare' of the lupus.