Polymyositis associated with asymptomatic primary biliary cirrhosis.
Bondeson J. Veress B. Lindroth Y. Lindgren S.
Department of Rheumatology, Malmo University Hospital, Sweden.
We here describe a case of polymyositis associated with asymptomatic primary biliary cirrhosis and a high titer of antimitochondrial antibodies. The patient had remarkable multiorgan engagement: polyarthritis, pericarditis, pleuritis and tachyarrythmia. Atypical changes, suggestive of mitochondrial damage, were observed in a muscle biopsy specimen. Under treatment with azathioprine and steroids, the disease had a favourable outcome.
Sucrose permeability as a marker for NSAID-induced gastroduodenal injury.
Erlacher L. Wyatt J. Pflugbeil S. Koller M. Ullrich R. Vogelsang H. Smolen JS. Graninger W.
Department of Internal Medicine III, University of Vienna, Austria.
OBJECTIVE: To evaluate sucrose permeability as a non-invasive test for the monitoring of upper gastrointestinal mucosal damage (uGMD) in patients treated with NSAIDs. METHODS: 40 patients with non-inflammatory joint pain were enrolled in a prospective study. Before and after 14 days of ibuprofen treatment (3 x 400 mg/day), the rates of urinary sucrose excretion after an oral sucrose load were assessed. Individuals with increased sucrose permeability underwent endoscopy. RESULTS: 8 patients (20%) showed abnormal sucrose permeability before taking any NSAID. In 5/20 patients (25%) who completed 2 weeks of ibuprofen medication, sucrose excretion increased above the normal level. Endoscopic examination and biopsy revealed mild uGMD, but no ulceration in 8/11 (72%) patients with increased permeability to this marker. CONCLUSION: Sucrose permeability testing is a sensitive procedure for research protocols on NSAID-induced gastropathy. Since this test also seems to detect slight and clinically insignificant mucosal damage, however, its use in clinical decision-making regarding gastroprotective medication is limited.
Hepatic hypertrophic osteoarthropathy: the value of liver transplantation.
Taillandier J. Alemanni M. Samuel D. Bismuth H.
Department of Gerontology, Hopital Paul Brousse, Villejuif, France.
We describe 4 cases of hepatic hypertrophic osteoarthropathy treated successfully by liver transplantation. Hepatic hypertrophic osteoarthropathy is a rare and disabling condition associated with severe liver diseases. It responds poorly to conservative management, and liver transplantation is the only radical treatment option.
Association of ankylosing spondylitis, Crohns disease and Takayasus arteritis in a child.
Hilario MO. Terreri MT. Prismich G. Len C. Kihara EN. Goldenberg J. Sole D.
Department of Pediatrics, Sao Paulo Federal University, Brazil.
The authors report the case of a 15-year-old, HLA-B27-positive male patient who presented a rare association of ankylosing spondylitis, Crohn's disease and Takayasu's arteritis, which resulted in death. A brief review of the literature is provided.
Rheumatic manifestations in the course of anaphylaxis caused by Anisakis simplex.
Cuende E. Audicana MT. Garcia M. Anda M. Fernandez Corres L. Jimenez C. Vesga JC.
Rheumatology Unit, Txagorritxu Hospital, Vitoria, Spain.
Human anisakidosis is a parasitic infection caused by the larvae of Anisakis simplex. Classical clinical manifestations include epigastric pain, occlusion, diffuse abdominal pain, appendicitis, and anaphylactoid reactions. Arthralgias or arthritis have been infrequently reported. We present three patients with proven hypersensitivity to A. simplex together with rheumatologic complaints after ingestion of parasitized fishes. A. simplex must be considered in the differential diagnosis of arthralgias/ arthritis especially if associated with urticaria.
99mTc-white cell scanning to detect gut inflammation in children with inflammatory bowel diseases or spondyloarthropathies.
Barabino A. Gattorno M. Cabria M. Sormani MP. Occhi M. Villavecchia G. Gandullia P. Buoncompagni A. Castellano E. Picco P.
Pediatric Gastroenterology Unit, G. Gaslini Scientific Institute for Children, Genoa, Italy.
OBJECTIVE: Gut inflammation is a common feature shared by inflammatory bowel diseases (IBD) and the spondyloarthropathies (SpA). The aim of the present study was to compare the reliability of a number of non-invasive investigations for the detection of an inflammatory process of the intestine. METHODS: Forty-two children were studied: (i) patients with a previous diagnosis of IBD (group A); (ii) patients with suspected IBD (group B); and (iii) patients with predominantly rheumatological manifestations associated with gastrointestinal symptoms (group C). All the patients were studied using 99mTechnetium-HMPAO labelled white cell scanning (99mTc-WCS), and abdominal ultrasound (US). In addition the ESR, serum class A immunoglobulins, faecal occult blood (OB) and faecal alpha 1-antitripsin level (F alpha 1-AT) were determined. Colonoscopy plus multiple biopsies and radiological study of the intestine were used as gold standards. RESULTS: 99mTc-WCS showed the highest sensitivity (85%) and specificity (100%) in detecting the presence of gut inflammation. This was followed by ESR and faecal occult blood (63% sensitivity, 44% specificity), F alpha 1-AT (43% sensitivity, 44% specificity) and IgA (42% sensitivity, 88% specificity). Ultrasound was informative in 28% of the active/affected patients, with a specificity of 75%. CONCLUSION: Although ileo-pancolonscopy remains the gold standard for the histological characterisation of gut inflammation, 99mTc-WCS represents the most reliable non-invasive test for its detection.