Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a case of esophageal ulcerations caused by alendronate (Fosamax), a recently marketed medication. The patient presented with a chief complaint of retrosternal pain and severe odynophagia of 5 days duration. She was taking prednisone 10 mg and azathioprine 100 mg p.o. q.d. for systemic lupus erythematosus. To prevent osteoporosis, she was started on alendronate 10 mg q.d. 2 wk before her symptoms started. Endoscopy of the upper GI tract revealed two deep, large ulcers at the gastroesophageal junction. Multiple biopsy specimens revealed necroinflammatory debris and acute esophagitis. However, no organisms were identified, and the result of her HIV test (ELISA) was negative. Alendronate was discontinued, and her symptoms resolved completely in 1 wk. Follow-up endoscopy performed 4 wk later revealed complete healing of the ulcers.
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PMID:A new probable increasing cause of esophageal ulceration: alendronate. 912 31

Systemic lupus erythematosus (SLE) is a chronic relapsing/remitting autoimmune disorder with both primary and secondary effects on nervous system integrity and psychological functioning. In addition to the occurrence of clinical psychiatric syndromes such as psychosis, depression, and anxiety, other psychological problems documented with increased frequency in SLE include cognitive deficits and emotional distress. We examine issues related to cognitive function, including its assessment and prevalence, and confounding factors in interpreting cognitive problems as reflecting primary central nervous system involvement in SLE. Cognitive data in relation to other facets of the disease such as pain and fatigue, and subjective cognitive complaints are also discussed. Finally, we propose a potential role for cognitive assessment in the identification of SLE related depression.
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PMID:Psychological aspects of systemic lupus erythematosus: cognitive function, mood, and self-report. 915 99

Transient musculoskeletal pain may occur in renal transplant patients on cyclosporin (CyA). Of 28 consecutive patients transplanted in this unit between 20 January 1995 and 2 May 1996, eight (two published elsewhere) developed this problem. Before transplantation, three of the patients had received prednisone intermittently or continuously for 15, 5 and 2 years, for asthma, crescentic GN and SLE, respectively. All patients had normal hand radiographs prior to transplantation. Five developed acute rejection following transplantation requiring treatment with methylprednisolone; one also required OKT3 (7 days). Weight-bearing joints of the lower limbs became affected at 3-40 weeks (mean 14) following transplantation. MRI changes (T1-, T2-weighted and STIR images) were consistent with acute bone-marrow oedema. Bone scintigrams showed enhanced tracer uptake in affected joints. A spontaneous complete remission occurred in five patients within 4-16 weeks, and this was supported by serial imaging. The other patient underwent core decompression of the femoral heads with relief of symptoms, but MRI showed bilateral avascular necrosis (AVN) of the femoral heads. MRI proved useful in detecting acute bone-marrow oedema and its possible progression to AVN. The former may be either a distinct entity or a forerunner of AVN.
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PMID:Acute bone-marrow oedema in cyclosporin-treated renal transplant recipients. 920 72

A prospective outcome analysis was conducted on 100 consecutive women who requested explantation of their silicone gel breast implants from January 6, 1992 (the moratorium), through 1995. Eighteen patients were referred by rheumatologists with a diagnosis of autoimmune or rheumatic disease. Six had autoimmune disease (systemic lupus, 2 patients; rheumatoid arthritis, 2 patients; multiple sclerosis, 1 patient; and Raynaud's disease, 1 patient). Twelve had rheumatic disease (fibromyalgia, 10 patients; inflammatory arthritis, 2 patients). All of these 18 patients had developed symptoms of their disease after they had received implants. All 100 patients were extensively evaluated pre- and postoperatively by interviews, clinical assessment, and by assay of the following laboratory tests: rheumatoid factor, ESR, ANA, and anti-Ro/SSA, -La/SSP, -Sm, -RNP, -double-stranded deoxyribonucleic acid, -Scl-70, -centromere, and -cardiolipin. Patients were also evaluated by a questionnaire that was sent at a mean time of 2.7 years postexplantation (range, 1-5 years), which had a 75% response rate. Reasons for implants were augmentation, 75%; lifting, 11%; reconstruction, 12%; and congenital aplasia, 2%. The mean age at first implant was 28.9 years (range, 13-55 years) and at explantation was 41.5 years (range, 25-65 years). The mean duration of implantation was 12.0 years (range, 1-27 years). Thirty-six percent of the patients had undergone at least one closed capsulotomy and 54% at least one open capsulotomy. The mean reasons for explantation were suspected silicone-related health problems, 76%; suspected rupture, 59%; breast firmness, 36%; breast pain, 36%; and musculoskeletal pain, 23%. Before explantation 75% of the questionnaire respondees had lost some sensitivity in their nipples following their breast augmentation. In 36% of those 75 patients, that loss was almost complete. Loss of sensitivity was related to capsular contracture and to pain (p < 0.05). Following explantation there was significant improvement in nipple sensitivity in 38% of breasts in the 75 respondees. A total of 186 implants were removed. Fifty-seven percent had failed by rupturing or leaking. Only 3.2% demonstrated extravasation extracapsularly. Twenty-five percent of the capsules were calcified, demonstrating visible plaques of calcification on their inner surface. Forty-two percent were colonized by bacteria. The prevalence of class III-IV capsular contracture was 61% and it was related to implant location, duration in situ, and capsular calcification (p < 0.05), but not to capsular colonization or implant integrity (p > 0.05). Only 43 of the 100 patients elected to have saline implants inserted. Of the others, 56% felt that the shell of the saline implant could be associated with medical problems. The others felt that breast size was of minor importance to them at this time. There were few complications from the explantation procedure. Two "masses" were discovered-one was an occult carcinoma, the other a galactocele. There was one wound infection, which responded to antibiotics. Three patients developed decreased sensitivity and 3 developed increased breast pain. From the patient questionnaires, in those women who did not have saline implants inserted, 15% felt that their breast appearance was improved after explantation, 36% were "pleased," 33% were disappointed, and 13% felt "mutilated". In women who did have saline implants inserted, 18% felt that their breast appearance was now improved, 60% were "pleased," and 14% were disappointed, mainly because of wrinkling. At a mean time of 2.7 years (range, 1-5 years) after explantation, 45% of the 75 questionnaire respondees felt that their implants had caused permanent health problems and 56% felt that they had not been given adequate informed consent by their original surgeon (particularly regarding implant rupture and a possible relationship to medical disease). (ABSTRACT TRUNCATED)
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PMID:An outcome analysis of 100 women after explantation of silicone gel breast implants. 967 80

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.
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PMID:Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore. 928 17

The goal of treatment for juvenile rheumatoid arthritis (JRA) and other pediatric rheumatic disorders is to minimize joint destruction, pain, and deformity and to maximize all aspects of growth and development. Oral and injectable methotrexate are now often given early in the treatment of JRA, childhood dermatomyositis, difficult-to-control arthritis in the pediatric spondyloarthropathies, SLE, sarcoidosis, several of the vasculopathies, and idiopathic iritis. Weekly low-dose MTX has become a mainstay of long-term improved control of these disorders, and is associated with strikingly few documented long-term side effects. Dosages, pharmacology, side effects, efficacy, and treatment strategies are discussed. Although formal studies are lacking, MTX for the pediatric rheumatic disorders seems to be associated with less frequent physician visits, lower total costs, improved function, and fewer late reconstructive surgeries.
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PMID:Methotrexate in the treatment of juvenile rheumatoid arthritis and other pediatric rheumatoid and nonrheumatic disorders. 936 Nov 57

Four patients with myeloma disease were examined. The debut was characterized by stubborn strong pain in the temporomandibular joint (TMJ). Involvement of the TMJ presents as arthralgia but not arthritis. A specific feature of the disease is possibility of rather long functioning of the joint and absence of any inflammatory changes. X-Ray examinations show multiple round clearly seen 1 to 5 mm defects in the bone without any destructive or degenerative changes. Myeloma disease is to be differentiated from TMJ involvement in systemic lupus erythematosus, rheumatoid arthritis, Bechterew's disease, in elderly patients or patients with a long disease standing from involution involvement of the TMJ (Costen's syndrome) or osteoarthrosis deformans.
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PMID:[The involvement of the temporomandibular joints in multiple myeloma]. 938 6

A 47-year-old female was admitted for severe pain of 1 month's duration in the third and fourth toes of the right foot, culminating in gangrene. Laboratory findings revealed liver enzyme abnormalities, and anti-mitochondrial, anti-phospholipid and antinuclear and doubtful anti-DNA antibodies. Systemic lupus erythematosus (SLE) was excluded on clinical grounds after a 6-year follow-up. Therefore, a diagnosis was made of the primary antiphospholipid syndrome, complicated by microvasculopathy, and associated with primary biliary cirrhosis.
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PMID:Primary biliary cirrhosis associated with antiphospholipid syndrome. 946 53

The non-healing leg ulcer is examined by discussing three disease processes: peripheral vascular occlusive disease (PVOD), chronic venous insufficiency (CVI), and vasculitis. For PVOD, management decisions are based on risk factors and disease history. Comprehensive management includes the discontinuation of smoking, exercise conditioning and regulation of diabetes, hyperlipidemia, hypertension, and the appropriate application of anticoagulant/antiplatelet drugs. Methods of surgical management include bypass with autogenous or synthetic material in addition to reconstructive surgery with patch angioplasty or extra-anatomic bypass, amputation, percutaneous transluminal angioplasty/stents, thrombolytic infusion, atherectomy, intraluminal ultrasound, and angioscopy. The optimal healing environment for all ulcers prevents contamination, pain, and fluid loss. In CVI, higher venous pressure in the veins of the lower limb during exercise results in ambulatory venous hypertension and ulceration. Various theories are associated with the disease and ulceration process; the classic treatment of elevation, ambulation, and compression for venous disease remains unchallenged. Diagnosis is based on history, physical examination, invasive venography, and/or non-invasive studies. Two groups of vasculitic disorders that share varying degrees of vascular inflammation and necrosis are arteritis (lupus, erythematosus, periarteritis nodosa, dermatomyositis) and blood dyscrasias (sickle cell disease, thalassemia). Leg ulcers associated with vasculitis are due to inadequate tissue oxygenation at the local level, are typically chronic, slow to heal, and commonly recur.
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PMID:The non-healing leg ulcer: peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis. 939 80

This report describes the case of a woman in whom multiple compression fractures of the lower thoracic and lumbar spine occurred in association with long-term corticosteroid therapy for systemic lupus erythematosus. Pain markedly limited the patient's mobility and daily activities, and conservative therapy with bracing and narcotic analgesics gave little improvement. Affected vertebrae were treated with polymethylmethacrylate, introduced percutaneously under fluoroscopic guidance. The resulting reinforcement of the fractured vertebral bodies eliminated the pain and the need for narcotic analgesics. The utilization of percutaneous verterbroplasty as a therapeutic alternative for the treatment of pain resulting from osteoporotic compression fractures is described.
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PMID:Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. 943 83


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