Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027121 (myositis)
 4,538 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Results are presented of measurements of skeletal blood flow made in 80 patients with painful benign or malignant diseases of the skeleton, excluding patients with Paget's disease. In crush fracture osteoporosis, total bone blood flow was slightly lower than normal although skeletal perfusion was normal. High values of bone blood flow were seen in 14/20 patients with osteomalacia and 3/12 patients with primary hyperparathyroidism. Very high values, comparable to those seen in the most severely affected patients with Paget's disease, were seen in polyostotic fibrous dysplasia, 2 out of 4 cases of Engelmann's disease and 1 out of 3 cases of renal osteodystrophy. Results were less elevated in myositis ossificans, secondary skeletal involvement with breast and prostatic carcinomata, myelomatosis and sympathetic osteodystrophy.
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PMID:Skeletal blood flow in metabolic disorders of the skeleton. 342 88

Revision total hip replacement has traditionally required a trochanteric osteotomy for successful cement removal and component reinsertion. In this study the authors have concluded that in most instances the revision total hip replacement procedure can be successfully performed without trochanteric osteotomy. The advantages are underscored by the high percentage of trochanteric complications with trochanteric osteotomy for revision total hip replacement and the ease of rehabilitation without trochanteric osteotomy. Also, improved functional results without trochanteric osteotomy were noted. The specific indications for the procedure included revision total hip replacement with ununited prior trochanteric osteotomy, revision total hip replacement with femoral shaft fractures, and revision total hip replacement with stem fractures requiring only acetabular revision. The contraindications to the procedure are fibrous union or ununited trochanteric osteotomy from prior total hip replacement, severe acetabular protrusion of the acetabular component, advanced myositis ossificans, ankylosis of the hip, and advanced proximal femoral osteoporosis. The operating room records, x-rays, and outpatient records of 63 total hip revisions in 52 patients were reviewed. There was a minimum 2-year follow up with a range from two years to seven years. The patients were divided into two groups, comparing 21 trochanteric osteotomized revisions to 44 with trochanteric sparing techniques. Both groups were analyzed for age, type of implant, intraoperative perforation of femur, intraoperative femoral shaft fractures, intraoperative cortical window, component malpositioning extraneous cement, intraoperative blood loss, operating time, postoperative leg length inequality, persistent abductor weakness, average first day of ambulation, wound infection, dislocation, nonunion of the trochanter, and postoperative pain. In the nonosteotomized group, there was a 21% decreased blood loss, a 14% decrease in persistent abductor weakness, a 14% decrease in subluxation and dislocation, a 30% decrease operating time and a 50% reduction in intraoperative femoral perforation. In the osteotomized group there were six cases of fibrous union of the greater trochanter, two cases requiring removal of broken wires for trochanteric bursitis. A detailed surgical technique and representative cases are presented. In carefully selected cases, revision total hip replacement is optimally performed without trochanteric osteotomy. Postoperative trochanteric problems of nonunion, broken wires, bursitis, and abductor weakness can effectively be eliminated by avoiding trochanteric osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Revision total hip replacement without trochanteric osteotomy. 358 21

Thirty-six hips were studied because of significant hip pain. Radiography of the hip and bone scintigraphy showed subtle changes. Magnetic resonance imaging (MRI) was performed using a 1.5 Tesla superconductive unit. All MRI findings were confirmed by surgical or pathologic results. Twenty-nine hips had a single lesion, including: infection (one), fracture (eight), avascular necrosis of the femur(two), or contralateral hip (four), transient osteoporosis (six), osteoporosis (one), post-irradiation myositis (one), metastasis (four), and synovitis (two). Twenty-six lesions (89.6%) appeared normal on the radiographs of the hip, while three lesions (10.4%) showed only osteoporotic change. Another seven hips had more than one lesion, including: avascular necrosis and fracture (four), fracture foci (two), and metastasis and fracture (two). Radiography of the hip showed either a negative finding or detected only a single lesion, missing other important pathologic foci. MRI is extremely sensitive to alterations in the bone marrow that may represent pathology occult to plain radiography and bone scintigraphy of the hips. For diagnosis and treatment planning, MRI of the hips should be performed early in patients with persistent pain and negative radiography findings.
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PMID:Evaluation of hip disorders by radiography, radionuclide scanning and magnetic resonance imaging. 790 50

Patient complaints arising as manifestations of medication side effects are commonly encountered in clinical practice. A rheumatologist must routinely consider side effects of drugs in the differential diagnosis of many symptoms. This review will remind the reader of certain well-described and some newly reported side effects commonly encountered in an internal medicine practice. Focal points incude arthralgias/arthritis, myopathy/myositis, ANA/drug-induced lupus, bone loss/osteoporosis, and tendon rupture.
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PMID:Rheumatic manifestations of current pharmacopeia. 1112 52

Sarcoidosis is a systemic granulomatous disorder of unknown cause. It has protean manifestations and can affect any organ, including bones, joints, muscles, and vessels. This article reviews the most recent information on the immunologic and inflammatory pathogenesis of sarcoidosis and its implications for therapy. Sarcoidosis results from an overexuberant T cell-mediated immune response to the unknown antigen. This antigen presentation/T cell antigen recognition event occurs in a microenvironment that is suffused in proinflammatory cytokines and growth factors that promote cell attraction, adhesion, permeability changes, further cytokine production, and release. An amplified cellular immune response ensues, leading to granuloma formation and fibrosis. The article summarizes the new developments in the medical literature related to the rheumatologic manifestations and their detection and management in sarcoidosis patients. Osseous involvement in sarcoidosis is often underdiagnosed because it can be asymptomatic. New imaging techniques improve detection. Management of osteoporosis in sarcoidosis patients requires special attention because these patients often have an underlying disorder in calcium metabolism that results in hypercalcuria and hypercalcemia. Joint manifestations, such as the classic Lofgren syndrome with accompanying erythema nodosum, may be self-limited or may become chronic, presenting an ongoing therapeutic challenge. Sarcoidosis vasculitis can be devastating, affecting virtually any vessel in any organ and causing significant morbidity. Muscle involvement, like the bony involvement, is underdiagnosed. Symptoms of muscle weakness, aches, tenderness, and fatigue should prompt consideration of occult sarcoid myositis, often with accompanying neurogenic atrophy. Sarcoidosis treatment usually starts with a period of observation before pharmacologic intervention. Corticosteroids remain the first-line therapy. Alternatives to corticosteroids are often introduced either because of steroid intolerance or in an attempt to reduce steroid dose and side effects. The advantages and disadvantages of these second line therapies are reviewed. Medical vigilance, with attention to new patient symptoms, is important in the management of sarcoidosis, because of the tendency of this disease to present in so many and diverse patterns.
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PMID:Sarcoidosis: immunology, rheumatic involvement, and therapeutics. 1114 21

Bisphosphonates have been in clinical use since the first approval of etidronate for myositis ossficans progressiva. They have now been used since the early 1990s for osteoporosis. As patients are continued on bisphosphonates and with consideration for bisphosphonate application in younger postmenopausal women, questions of 'how long to treat' are emerging in the clinical community. What is the evidence for continual efficacy and safety? The longest efficacy data where a placebo group was maintained is the 5-year risedronate vertebral fracture data, which demonstrated additional fracture reduction benefit with this bisphosphonate during years 4-5 of use. As bone mineral density (BMD) or biochemical markers of bone resorption (BCM) change very little for at least 1-2 years (and possibly longer) after discontinuing long-term (3-5 years) bisphosphonate use, it seems reasonable to suggest discontinuation for some indefinite period of time after 5 years of use in younger lower-risk postmenopausal women. Monitoring of both BMD and BCM may indicate when to consider reinitiation of bisphosphonate therapy. In higher-risk elderly postmenopausal women who are doing well on long-term bisphosphonate therapy as defined by a stable BMD, height and no incident fractures, the same discussion of a 'honeymoon' period of no treatment could be entertained. However, because there are no data on fracture events post-treatment even without changing BMD or BCM, this author is reluctant to stop bisphosphonates in elderly high-risk patients. My opinion on the continuation of the use in high-risk patients is also predicated on the observations that there does not appear to be any clinically important safety issues with long-term (10-year) use. Concerns about 'oversuppression' of bone turnover and accumulation of microdamage are theoretical and, so far, have no clinical basis for discontinuation in high-risk patients. It will be important, however, for the continual surveillance of bone safety issues by capturing postmarketing fracture data in patients on long-term therapy as well as long-term bone histomorphometry and measurements of bone quality to reassure clinicans about long-term bisphosphonate continuation.
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PMID:Efficacy and safety of long-term bisphosphonates in postmenopausal osteoporosis. 1464 Sep 24

Vitamin D inadequacy is pandemic among rehabilitation patients in both inpatient and outpatient settings. Male and female patients of all ages and ethnic backgrounds are affected. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and worsens proximal muscle strength and postural sway. Vitamin D inadequacy can be prevented by sensible sun exposure and adequate dietary intake with supplementation. Vitamin D status is determined by measurement of serum 25-hydroxyvitamin D. The recommended healthful serum level is between 30 and 60 ng/mL. 25-Hydroxyvitamin D levels of >30 ng/mL are sufficient to suppress parathyroid hormone production and to maximize the efficiency of dietary calcium absorption from the small intestine. This can be accomplished by ingesting 1000 IU of vitamin D(3) per day, or by taking 50,000 IU of vitamin D(2) every 2 weeks. Vitamin D toxicity is observed when 25-hydroxyvitamin D levels exceed 150 ng/mL. Identification and treatment of vitamin D deficiency reduces the risk of vertebral and nonvertebral fractures by improving bone health and musculoskeletal function. Vitamin D deficiency and osteomalacia should be considered in the differential diagnosis of patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or myositis. There is a need for better education of health professionals and the general public regarding the optimization of vitamin D status in the care of rehabilitation patients.
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PMID:Vitamin d and rehabilitation: improving functional outcomes. 1750 30

Apical hypertrophic cardiomyopathy (AHC) is associated with neurological abnormalities such as transient ischemic attack, stroke, limb-girdle muscular dystrophy, or eosinophilic myositis in single cases. The association of AHC and metabolic myopathy has not been reported. In an 84-year-old woman with long-standing gait disturbance, dementia, Parkinson syndrome, ptosis, ophthalmoparesis, tetraparesis, polyneuropathy, lactacidosis, polyarthralgia, dorsalgia, and osteoporosis, cardiac examination for long-standing anginal chest pain and palpitations, revealed supraventricular and monomorphic ventricular ectopic beats, hypertrophic signs, ST-depression and negative T waves on electrocardiogram (ECG), diastolic dysfunction with impaired relaxation, and AHC on transthoracic echocardiography. AHC was confirmed by cardiac magnetic resonance imaging, which additionally showed a small left ventricular apical aneurysm with a wall-thickness of only 3 mm. The patient was suspected to additionally have a multisystem disease, most likely due to impaired oxidative metabolism. This case shows that AHC may take a mild course and be associated with a number of extracardiac abnormalities.
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PMID:Apical hypertrophic cardiomyopathy in encephalomyopathy. 1816 25

Many rheumatic diseases have been observed in HIV-infected persons. We, therefore, conducted a comprehensive literature search in order to review the prevalence, presentation and pathogenesis of rheumatic manifestations in HIV-infected subjects. Articular conditions (arthralgia, arthritis and SpAs) are either caused by the HIV infection itself, triggered by adaptive changes in the immune system, or secondary to microbial infections. Muscular symptoms may result from rhabdomyolysis, myositis or from side-effects of highly active anti-retroviral therapy (HAART). Osseous complications include osteonecrosis, osteoporosis and osteomyelitis. Some conditions such as the diffuse infiltrative lymphocytosis syndrome and sarcoidosis affect multiple organ systems. SLE may be observed but may be difficult to differentiate from HIV infection. Some anti-retroviral agents can precipitate hyperuricaemia and are associated with arthralgia. When indicated, immunosuppressants and even anti-TNF-alpha agents can be used in the carefully monitored HIV patient. Thus, rheumatic diseases and asymptomatic immune phenomena remain prevalent in HIV-infected persons even after the widespread implementation of highly active anti-retroviral therapy.
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PMID:Rheumatic conditions in human immunodeficiency virus infection. 1841 46

This study aims to report the concomitant diseases observed and damage outcome in a cohort of patients with adult idiopathic inflammatory myositis (IIM) during long-term follow-up. All patients with IIM were identified from a single centre (follow-up between 1979 and 2006) and fulfilled at least three of the four Bohan and Peter criteria. Patients with inclusion body myositis, juvenile-onset myositis and overt overlap syndromes were excluded. Medical notes were retrospectively reviewed. Concomitant diseases identified were divided into 12 different organ systems (bone, cardiac, respiratory, gastrointestinal, renal, central nervous, malignancy, infection, endocrine, eyes, dermatological and haematological). Patient damage index was calculated using the Myositis Damage Index tool. Fifty-five patients (31 polymyositis, 24 dermatomyositis) were identified. The most prevalent organ system involved was lung with 40 events per 1,000 patient years follow-up. There was significant steroid-related complications with 17/18 patients with bone involvement having osteopenia/osteoporosis. Sjogren's syndrome (n = 3) was the most frequent concomitant auto-immune disease observed. Patients with a higher number of organ systems involved had a significantly higher damage index (r = 0.48, p = 0.001). White patients showed a significant trend to develop more than three other organ system involvement (p < 0.0001) and myositis-related lung disease (p < 0.0001) compared to other races. There is significant steroid-related morbidity in adult IIM patients under long-term follow-up. The prevalence of another concomitant auto-immune disease unlike patients with lupus or Sjogren's syndrome is low.
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PMID:Concomitant diseases in a cohort of patients with idiopathic myositis during long-term follow-up. 1938 65


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