Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The chronic, rheumatoid synovitis in four patients (two children and two adults) with immunodeficiency was studied by means of immunopathological examination of synovial tissues and fluids. Their immunodeficiencies were extensively studied, with various tests for humoral and cell-mediated immunity. The two children were boys with Bruton's disease. One adult, female, had common variable immunodeficiency. One adult male had severe hypogammaglobulinemia. All patients had isolated deposits of complement component C3 in their synovial membranes, usually without traces of immunoglobulins. Depressed levels of complement component C3 were found in the joint fluid, in contrast to high levels in the corresponding serum in one patient. Components of the alternate pathway, properdin and C3A, were found in the tissues, but not components of the classic pathway, C1q and C4. The findings suggest that chronic, rheumatoid arthritis in hypogammaglobulinemic patients may be related to activation of C3 by the alternate pathway.
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PMID:Evidence for complement activation by the alternate pathway in the arthritis of hypogammaglobulinemic patients. 108 30

A 10-month-old Arabian foal was evaluated for a suspected immunoglobulin (Ig) M deficiency. Decreased to nondetectable concentrations of IgM, IgA, and IgG (T), and a normal concentration of IgG, were present. Results of in vitro testing of the blood lymphocyte blastogenesis showed a weak response to the B-cell mitogen, lipopolysaccharide (LPS), but normal responses to T-cell mitogens. Results of postmortem examination showed synovitis of the left tibiotarsal and both scapulohumeral joints. Atrophy and edema of the lymph nodes and lymphocyte depletion in the thymus and spleen were seen. A subacute inflammatory infiltrate was observed in the kidney, synovium, liver, and brain. Etiologic agents were not identified. This case represents a previously unreported form of immunodeficiency disease in the horse.
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PMID:Unusual selective immunoglobulin deficiency in an Arabian foal. 152 50

The article includes a historical review of therapeutic procedures. Two patients with suppurative arthritis are described, one newborn child with delayed diagnosis resulting in necrosis of the femoral head and luxation. This child was in very good health all the time with no signs reflecting the severity of the infection; a fact which explains the failure to diagnose the condition. Immunodeficiency during the first year of life is probably responsible for the subdued clinical findings. Another patient, a 14 year-old boy, had a typical septic coxitis, which was treated early with arthrotomy and antibiotics with good result. Penicillinase-producing staphylococcus aureus was the causative organism in both patients. Osteomyelitis in the metaphysis was also present in the first patient. The most important factors affecting prognosis seem to be delayed diagnosis and arthrotomy. Associated osteomyelitis and penicillinase-producing staphylococcus aureus are also factors having an adverse influence on prognosis. The diagnostic aspects of transient synovitis and the pathogenetic correlation between this and Perthes' disease are discussed. In this field, ultrasonography and bone scintigraphy are essential for planning the strategy of therapy. The high risk of femoral head destruction is obvious.
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PMID:[Coxitis in children]. 152 30

Three patients with inflammatory arthritis were found to be seropositive for human immunodeficiency virus (HIV). Two of these individuals developed synovitis following an episode of yersinia bowel infection. We have studied joint material from all three in an attempt to define the role that HIV may be playing in the aetiology or maintenance of arthritis. Cell-associated HIV DNA was detected within joint fluid by in situ hybridization and the phenotypes of infected cells were established using a double-labelling immunocytochemical technique. Viral DNA was detected in dendritic cells (4-25%) isolated from both the peripheral blood and synovial fluid and in occasional lymphocytes from peripheral blood (less than 0.1%). No infected macrophages were seen. Functional studies using the mixed leucocyte reaction showed that the dendritic cells from synovial fluid were poor stimulators of allogenic peripheral blood lymphocytes whilst being effective at stimulating autologous lymphocytes. In addition, synovial fluid lymphocytes responded poorly to normal control dendritic cells. Infection of these cells with HIV could be contributing to this low stimulatory activity of antigen-presenting cells and to the unresponsiveness of lymphocytes.
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PMID:The detection of human immunodeficiency virus DNA in dendritic cells from the joints of patients with aseptic arthritis. 214 35

Articular manifestations were observed in 10 patients (8 men, 2 women, aged from 23 to 46 years) with human immunodeficiency virus (HIV) infection. All men were homosexuals, except for an intravenous drug addict. One woman was a native of Gabon and the other had multiple transfusions. The joint diseases were of the polyarthritis and acute oligoarthritis types, affecting mainly the knees and ankles but also the wrist and fingers; the spine was involved in one case. The synovial fluid present in 4 patients contained 5,000 to 27,000 cells per cubic millimeter, with a strong predominance of polymorphonuclears. In 3 cases, infective viral particles were found in the fluid with anti-HIV antibodies. In 2 patients biopsy of the synovial membrane provided evidence of non-specific subacute synovitis. All X-ray films, including those of the sacro-iliac joint, were and remained normal. The course of the joint disease was acute and regressive in 5 cases, chronic and prolonged in the remaining 5 cases. In 5 patients the arthropathies were the first clinical manifestations of the HIV infection. Three patients who had stage IV C AIDS died; the others were in stages II (5), III (1) or IV E (1) and did not progress to a more severe stage. This study shows that various types of inflammatory arthritis may occur in HIV positive patients. In most cases the arthritis is reactive, but certain data suggest that it may be directly related to the virus in some patients.
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PMID:[Inflammatory arthropathies in patients with human immunodeficiency virus infection]. 253 May 71

Nine men positive for antibody to human immunodeficiency virus (HIV) who developed peripheral, non-erosive arthritis were followed up. The clinical features were compatible with reactive arthritis but were atypical in several respects: the joint symptoms were generally severe, persistent, and unresponsive to non-steroidal anti-inflammatory drugs. The onset of arthritis was associated with various infections, none of which are known to be associated with the development of reactive arthritis. HLA typing was performed for three patients, all of whom were positive for HLA-B27. HIV was isolated from the synovial fluid of one patient. No patient had AIDS before developing arthritis, but four progressed to having AIDS after a mean of 7.5 months, and two died. Arthritis resolved in only one patient. The possibility of HIV infection should be considered in all patients with conditions suggesting reactive arthritis. Synovitis in patients with severe immunodeficiency has important pathogenetic implications.
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PMID:Inflammatory joint disease and human immunodeficiency virus infection. 313 44

A subacute, oligoarthritic syndrome developed in four patients with human immunodeficiency virus (HIV) infection. Three had true acquired immunodeficiency syndrome (AIDS) and all had lymphocyte abnormalities. The arthritis was characterized by extreme pain and disability in three patients and moderate pain in one. Knees and ankles were affected. Symptoms developed over a one- to six-week interval; response to treatment was rapid, especially to intra-articular corticosteroids. Despite the clinical severity of the arthritis, synovial fluids were non-inflammatory and biopsy specimens revealed only mild chronic synovitis. A definite etiology could not be established. None of the patients had recognized infections predisposing to reactive arthritis, and the three patients who underwent tissue typing were HLA-B27-negative. A viral infection, including HIV, is a possible cause. In distinction to these four patients, arthritides with clearly established etiologies developed during this same time period in four other HIV-infected patients.
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PMID:Acquired immunodeficiency syndrome-associated arthritis. 336 41

Between 1977 and 1992, we performed ninety-two synoviortheses (destruction of synovial tissue by intra-articular injection of a radioactive agent) on forty-eight patients who had a severe congenital disorder of hemostasis and chronic hemophilic synovitis that was resistant to conventional treatment. Colloidal 32P chromic phosphate was injected intra-articularly: 1.0 millicurie for knees and 0.5 millicurie for other joints. The duration of follow-up ranged from one to fifteen years. The frequency and importance of bleeding decreased in most of the patients. The range of motion of half of the joints remained stable or improved and that of the other half continued to decrease. Radiographic scores worsened progressively despite the decreased frequency of hemarthrosis. In most patients, the extra-articular leakage of the radioactive agent was slight. Chromosome breakages were observed almost exclusively in patients who were seropositive for human immunodeficiency virus and in whom the CD4-lymphocyte count was decreased from normal. The patients' level of satisfaction with the results was high.
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PMID:Synoviorthesis with colloidal 32P chromic phosphate for the treatment of hemophilic arthropathy. 774 8

There is a complex relationship between recurrent bleeding, synovitis, and the development of arthritis in the patient with hemophilia. There are many options available for the treatment of recurrent bleeding and hemophilic synovitis, indicating that none works very well. Conservative treatment, including replacement of the missing clotting factor for 3 to 6 months, intermittent steroids, immobilization, and physical therapy should be tried before synovectomy is indicated. Synovectomy can be achieved through an open procedure, arthroscopically, or by injection of a radioactive material into the joint. Radioactive synovectomy is indicated in patients with inhibitors to the clotting factor, patients with advanced human immunodeficiency virus and advanced hepatitis, and in those patients with multiple joint involvement. Arthroscopic synovectomy is the procedure the authors recommend for the knee and ankle joints, although open synovectomy offers an excellent alternative. The greatest risk to these procedures is a decreased range of motion, and this is most problematic in the young child who cannot cooperate with a program of physical therapy.
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PMID:Therapeutic options in the management of hemophilic synovitis. 934 12

Reiter's syndrome is an acute inflammatory arthritis with no standard treatment options for patients unresponsive to nonsteroidal antiinflammatory drugs (NSAID). In patients positive for human immunodeficiency virus (HIV), HIV-RNA levels have been correlated with elevated tumor necrosis factor-alpha (TNF-alpha) levels. We investigated the safety and activity of infliximab, an anti-TNF-alpha chimeric monoclonal antibody, in the treatment of an HIV positive patient with Reiter's refractory to NSAID therapy. A 41-year-old HIV positive man with Reiter's syndrome was treated with infliximab 300 mg intravenously at Weeks 0, 2, and 6 and then every 6 to 7 weeks thereafter. He presented with severe fatigue, pain, muscle wasting, synovitis of the elbows, wrists and knees, a scaly rash in the groin area, burning during urination, and severe onycholysis on all digits. Laboratory assessment revealed hemoglobin 7.8 g/dl, erythrocyte sedimentation rate (ESR) 152 mm/h, white blood cell count 5700 cells/mm3, and C-reactive protein (CRP) 65.7 mg/dl. HIV viral load on presentation was 1600 quantitative:ultrasensitive (Qn:US) copies/ml, decreased from a maximum of 428,000 Qn:US copies/ml at the start of antiretroviral therapy. After 6 months taking infliximab, all complaints resolved, nails regrew, and the rash cleared. CRP decreased to 0.8 mg/dl and ESR to 22 mm/h. During this 6 month period antiretroviral therapy remained unchanged, and the viral titer remained below 400 Qn:US copies/ml.
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PMID:Infliximab in the treatment of an HIV positive patient with Reiter's syndrome. 1256 4


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