DOCSLIB.ORG

Management of Systemic Lupus Erythemathous with Polymyositis Overlap Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Systemic Lupus Erythemathous with Polymyositis Overlap Syndrome ILLUSTRASION CASE MEDICINA 2019, Volume 50, Number 3: 543-549 P-ISSN.2540-8313, E-ISSN.2540-8321 Management of systemic lupus erythemathous with Illustrasion case polymyositis overlap syndrome Doi: http://dx.doi.org/10.15562/medicina.v50i3.575 Suryo Gading,* Ketut Dewi Kumara Wati, Komang Ayu Witarini, Hendra Santoso, I Gusti Ngurah Suwarba CrossMark Volume No.: 50 ABSTRACT There has been an increase in SLE cases among children in Sanglah of Rheumatology. Neurologic examination and electromyography General Hospital. In the rare case, there is a possibility SLE occurs were significant for the decrease in motoric power on the right lower Issue: 3 not as a single entity but overlap with another connective tissue limb, gastrocnemius atrophy, steppage gait, and reduction of the disease. Polymyositis is a disease with a primary symptom of muscle sensory sensation of right L4-S1 dermatome. Hence, the diagnose weakness associated with muscle pain and swollen. Polymyositis very of SLE and polymyositis was concluded. This is a case of SLE overlap rarely becomes overlapping syndrome with SLE, occurring in 4-6% syndrome with polymyositis. The patient was treated with prednisone First page No.: 543 of SLE patients. The aim of this study is to describe clinical findings 2 mg/kg/day for 2 weeks, and also given ibuprofen 10 mg/kg/dose for and management of SLE and Polymyositis. This case is a 12-year-old pain relief, continued with azathioprine plan for one year. The patient girl presented with arthralgia and myalgia since one month before showed an excellent result with the disappearance of symptoms and P-ISSN.2540-8313 admission, accompanied by a 1-month episode of relapsing fever, normal laboratory examination. The conclusion of the study is SLE decrease in appetite, facial rash, photosensitivity, muscle weakness overlap syndrome with polymyositis treated with prednisone and numbness and tingling sensation on the right foot. Diagnosis of ibuprofen continue with azathioprine showed good outcome with the E-ISSN.2540-8321 SLE was based on the diagnostic criteria of the American College disappearance of symptoms and normal laboratory examination. Keywords: Systemic Lupus Erythematous, polymyositis, children, overlap syndrome Cite This Article: Gading, S., Wati, K.D.K., Witarini, K.A., Santoso, H., Suwarba, I.G.N. 2019. Management of systemic lupus erythemathous with polymyositis overlap syndrome. Medicina 50(3): 543-549. DOI:10.15562/Medicina.v50i3.575 ABSTRAK Peningkatan kasus SLE terjadi pada anak di Rumah Sakit Umum elektromiografi signifikan menunjukkan penurunan kekuatan Sanglah, pada kasus yang jarang SLE bukan sebagai satu kesatuan motorik pada tungkai kanan bawah, atrofi gastrocnemius, steppage namun tumpang tindih dengan penyakit jaringan ikat lainnya. gait, dan penurunan sensasi sensorik pada dermatom L4-S1 kanan. Polymyositis adalah penyakit dengan gejala utama kelemahan Oleh karena itu dapat disimpulkan kasus ini adalah kasus sindrom otot yang berhubungan dengan nyeri otot. Polymyositis sangat SLE overlap dengan polymyositis. Pasien diobati dengan prednison jarang menjadi sindrom yang tumpang tindih dengan SLE, namun 2 mg/kg/hari selama 2 minggu, dan juga diberikan ibuprofen terjadi pada 4-6% pasien SLE. Tujuan dari penelitian ini adalah 10 mg/kg/dosis untuk menghilangkan rasa sakit, dilanjutkan untuk menggambarkan manajemen dan temuan klinis pada SLE dengan pemberian azathioprin yang direncanakan selama satu dan Polymyositis. Kasus ini seorang perempuan berusia 12 tahun tahun. Pasien menunjukkan hasil yang baik dengan hilangnya gejala yang mengalami artralgia dan mialgia selama 1 bulan, disertai dan pemeriksaan laboratorium normal. Kesimpulan dari penelitian demam selama 1 bulan, penurunan nafsu makan, ruam pada wajah, ini adalah sindrom SLE overlap dengan polymyositis yang diobati fotosensitifitas, mati rasa, kelemahan otot dan kesemutan pada dengan prednison dan ibuprofen dilanjutkan dengan azathioprin kaki kanan. Diagnosis SLE dibuat berdasarkan kriteria diagnostik menunjukkan hasil yang baik dengan hilangnya gejala serta hasil Department of Child Health, American College of Rheumatology. Pemeriksaan neurologis dan pemeriksaan laboratorium yang normal. Faculty of Medicine,Udayana University Denpasar Kata kunci : Systemic Lupus Erythematous, polymyositis, children, overlap syndrome *Correspondence to: Cite Pasal Ini: Gading, S., Wati, K.D.K., Witarini, K.A., Santoso, H., Suwarba, I.G.N. 2019. Management of systemic lupus erythemathous with Suryo Gading, Department of Child polymyositis overlap syndrome. Medicina 50(3): 543-549. DOI:10.15562/Medicina.v50i3.575 Health, Faculty of Medicine,Udayana University Denpasar [email protected] INTRODUCTION Diterima: 2018-12-26 Systemic Lupus Erythematous (SLE) is a hetero- causing widespread clinical manifestation on one Disetujui: 2019-04-08 genic autoimmune disease caused by the formation or more organs and pathologically characterized by Publis: 2019-12-01 of antibodies against our own cellular nucleus, wide inflammation of blood vessel and connective 543 ILLUSTRASION CASE tissue.1 The incidence of SLE varies accordingly in to another, except in the right leg where the pain each country; in the United States, the prevalence of persisted. The pain was not alleviated by rest. The SLE averaged 51/100.000 per population. In other pain was severe enough to impede walking and felt countries data revealed an estimated 2.9/100.000 – persistently throughout the day. Arthralgia was also 400/100.000.2 Women tend to be 9 times more prone accompanied by myalgia. The joint involved was to have SLE compared to men. Sixty-five per cent palpated to be warm. The numbness was thought of SLE occurred in the age of 16-55 years old. The from the right foot to the dorsum foot. The numb- aetiology of SLE is yet to be defined. Multifactorial ness and tingling sensation were felt persistently pathogenesis including genetics, environment, and hormonal component, is estimated to be involved. Monozygotic twins have a higher risk compared to dizygotic. Ninety percent of SLE patients were women, this is expected to be related to the effect of hormone against X chromosome, yet the under- lying mechanism is still undefined.3,4 SLE is clinically manifested by a chronical and relapsing onset of a disease, and symptoms included continuous or intermittent fever, red rashes, buccal ulcer, and arthritis. Patients also experienced constitutional symptoms including fatigue, decrease in body weight, and anorexia.3,5 The American College of Rheumatology (ACR) in 1997 or Systemic Lupus International Collaborating Clinics (SLICC) in 2012 classification is the stan- dard guideline in classifying SLE with a sensitivity of 96% and specificity of 100%.1,2 Recommended laboratory examination included inflammation indicator, autoantibody test, organ-specific func- tional tests and examinations to monitor ther- apeutic effect. Initially, during the acute phase, laboratory examination would reveal an increase in LED but a normal C-RP.2,3 Hematologic examina- tion could manifest as anaemia, leucopenia, and/or thrombocytopenia. Urinary examination manifest as proteinuria, hematuria, and a cast of heme glan- Figure 1 Spine asymetrical deformity dular, or red blood cell on the urine. Antinuclear antibody (ANA) test could be used as a screening test for patients with SLE, with a positive result in 90-100% of SLE patients. Anti-dsDNA is a pathog- nomic criterion for SLE.6,7,8 Management of SLE aims to control inflamma- tion, achieve remission phase, increase the quality of life, decrease exacerbation, prevent serious organ damage, and decrease death.1,2 The mainstay ther- apy for SLE is glucocorticoid with close monitor- ing of side effects. Other options include Disease Modifying Anti Rheumatic Drugs (DMARDs) types of drug. Non-steroid anti-inflammation drugs could be used to manage musculoskeletal symptoms.1,2 CASE ILLUSTRATION This is a case of 12 years and 9-month girl from Buleleng Bali. The Patient presented with arthralgia for 1 month before admission, 10th October 2016. The pain was reported to move from one joint Figure 2 Legs and gait disorder 544 Medicina 2019; 50(3): 543-549 | doi: 10.15562/Medicina.v50i3.575 ILLUSTRASION CASE Table 1 pGALS screening problems pGALS screening Documentation Pain symptoms? Right Leg Problem on using shirt? No problem Problem when walking? Problem when walking Visible Movement Gait + + Arms - - Legs + + Spine + - pGALS screening found problems including: Gait and Legs Table 2 Classification criteria of systemic lupus erithemathous SLICC 2012 criteria ACR 1997 criteria Requires ≥ 4 criteria (at least 1 clinical and 1 - Butterfly rash laboratory criteria) Clinical Criteria: - Discoid lupus eash - Acute cutaneous lupus - Photosensitivity - Chronic cutaneous lupus - Oral or nasal mucocutaneus lesion - Oral or nasal mucocutaneus ulceration - Non erosive arthritis - Alopecia - Nephritis - Arthritis - Proteinuria > 0,5 g/24 hours, positive cylinder cell - Serocitis - Enchepalopathy (seizure, psychosis) - Renal Involvement - Peluritis or pericarditis (serocytis) - Neurologic (convulsion, phycosis, myielitis - Cytopenia (leukopenia <4000/mm3, atau limfopenia <1500/mm3, atau trombositopenia <100.000/mm3, not caused by drugs - Hemolytic Anemia - Positive immuoserology - Leukopenia (<4000/µL) or limfopenia (<1000/µL) Antibody against dsDNA - Trombositopenia (<100.000/µL) Antibody against nuclear antigen Sm Antibodiyantifosfolipid positive, based on : Immunologic criteria: • Anticardiolipin antibody IgG
Load more

Recommended publications
  • Does Previous Corticosteroid Treatment Affect the Inflammatory Infiltrate Found in Polymyositis Muscle Biopsies? M.M
    Does previous corticosteroid treatment affect the inflammatory infiltrate found in polymyositis muscle biopsies? M.M. Pinhata1, J.J. Nascimento1, S.K.N. Marie2, S.K. Shinjo1 1Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 2Laboratory of Molecular and Cellular Biology, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Abstract Objective The aim of the study was to evaluate the effect of the prior use of corticosteroids (CS) on the presence of inflammatory infiltrates (InI) in muscle biopsies of polymyositis (PM). Methods We retrospectively evaluated 60 muscle biopsy samples that had been obtained at the time of the diagnosis of PM. The patients were divided into three groups according to the degree of the InI present in the muscle biopsies: (a) minimal InI present only in an interstitial area of the muscle biopsy (endomysium, perimysium) or in a perivascular area; (B) moderate InI in one or two areas of the interstitium or of the perivascular area; and (C) moderate InI throughout the interstitium or intense inflammation in at least one area of the interstitium or of the perivascular area. Results The three groups were comparable regarding the demographic, clinical and laboratory features (p>0.05). Approximately half of the patients in each group were using CS at the time of the muscle biopsy. The median (interquartile) duration of CS use [4 (0-38), 4 (0–60) and 5 (0–60) days: groups A, B and C, respectively] and the median cumulative CS dose used [70 (0–1200), 300 (0–1470) and 300 (0–1800)mg] were similar between the groups (p>0.05).
    [Show full text]
  • Malignant Granular Cell Tumour with Generalized Metastases And
    310 Letters to the Editor ovoid-shaped Giardia cysts. A one-day oral treatment with REFERENCES ornidazole (Tiberal® , Roche) at dosage of 1,500 mg, then 1. Smith LA. Still around and still dangerous: Giardia lamblia and repeated after 2 weeks, was given. The cutaneous lesions Entamoeba histolytica. Clin Lab Sci 1997; 10: 279–286. gradually improved after the rst dose of the drug. After one 2. Ridley MJ, Ridley DS. Serum antibodies and jejunal histology in month, however, new papules on elbows appeared and a giardiasis associated with malabsorption. J Clin Pathol 1976; 29: 30–34. coproparasitological control revealed the persistence of the 3. Luja`n HD, Mowatt MR, Byrd LG, Nash TE. Cholesterol starva- parasitic infection. A new cycle of ornidazole (1,500 mg/day tion induces diVerentiation of the intestinal parasite Giardia for 3 days) was prescribed. One month later both cutaneous lamblia. Proc Natl Acad Sci USA 1996; 93: 7628–7633. lesions and Giardia cysts in stools were still present. An 4. Geller M, Geller M, Flaherty DK, Black P, Madruga M. Serum alternative treatment with oral paromomycin (Humatin® , levels in giardiasis. Clin Allergy 1978; 8: 69–71. Parke-Davis), 500 mg q.i.d for 5 days was prescribed. The 5. Nash TE, Herrington DA, Losonsky GA, Levine MM. parasitological follow-up at 1, 3 and 6 months was negative Experimental infections with Giardia lamblia. J Infect Dis 1987; and cutaneous signs and symptoms completely resolved. 156: 974–984. 6. Di Prisco MC, Hagel I, Lynch NR, Jimenez JC, Rojas R, Gil M, et al.
    [Show full text]
  • Inclusion Body Myositis: a Case with Associated Collagen Vascular Disease Responding to Treatment
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.3.270 on 1 March 1985. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1985;48:270-273 Short report Inclusion body myositis: a case with associated collagen vascular disease responding to treatment RJM LANE, JJ FULTHORPE, P HUDGSON UK From the Regional Neurological Centre, Newcastle General Hospital, Newcastle-upon-Tyne, elec- SUMMARY Patients with inclusion body myositis demonstrate characteristic histological and muscle and are generally considered refractory to treatment. tronmicroscopical abnormalities in autoimmune A patient with inclusion body myositis is described with evidence of associated disease, who responded to steroids. muscles. He felt that his legs were quite normal. He denied guest. Protected by copyright. The diagnosis of inclusion body myositis depends symptoms. There was no relevant family or of the characteristic any sensory ultimately on the demonstration drug history. dis- intracytoplasmic and intranuclear filamentous inclu- On examination, he had a prominent bluish/purple sions, and cytoplasmic vacuoles originally described colouration of the knuckles, thickening of the skin on the by Chou in 1968.' However, reviews of reported dorsum of the hands and a slight heliotrope facial rash. The features which facial muscles were slightly wasted and he had marked cases have also emphasised clinical sternomastoids, deltoids, appear to distinguish inclusion body myositis from weakness and wasting of the Prominent among spinatti, biceps and triceps, with relative preservation of other forms of polymyositis.2-7 distal muscles. All upper limb reflexes were grossly these are the lack of associated skin changes or other bulk, power and to diminished or absent.
    [Show full text]
  • Behçet's Disease Associated with Malignancies. Report of Two Cases
    Behçet’s disease associated with malignancies. Report of two cases and review of the literature V.G. Kaklamani1, A. Tzonou2, P.G. Kaklamanis3 1Feinberg School of Medicine, Northwest- ABSTRACT Introduction ern University, Chicago, USA; 2Depart- Objective. To investigate the incidence Behçet’s disease (BD) is a chronic, re- ment of Hygiene and Epidemiology, Med- of malignancies in a cohort of Behçet’s lapsing multi-system disorder. T h e ical School, Athens University, Greece; disease patients and review the world principal manifestations are: oral apht- 3Department of Rheumatology, Athens Medical Center, Athens, Greece. literature. hous ulcers, genital ulcers, skin lesions, Methods. Our database of 128 patients eye, joint, neurological and vascular Vir ginia G. Kaklamani, MD, DSc, As s i s t a n t Professor in Haematology/Oncology; was searched and the age standardized manifestations (1-3). Rare clinical find- Anastasia Tzonou, Associate Professor, rate (ASR) for cancer was calculated. ings include: cardiac, pulmonary and De p a r tment of Hygiene and Epidemiology; F u rt h e r m o re, we performed a MED - renal disorders (1-3), as well as, epidi- Phaedon G. Kaklamanis, MD, Emeritus LINE search from 1970 through 2003, dymoorchitis (4). The epidemiology of Professor of Internal Medicine. as well as, a search in the proceedings BD in most parts of the world has re- Please address correspondence to: of international conferences for cases cently been reviewed (5-7). The patho- Phaedon Kaklamanis, MD, 61 Ipsilantou of malignancies associated with Beh - genesis of the disease has not been elu- St., Athens 11521, Greece.
    [Show full text]
  • Autoimmunity Mixed Connective Tissue Disease (CTD)
    Autoimmunity Mixed Connective Tissue Disease (mixed CTD) and Undifferentiated Connective Tissue Disease (UCTD) Autoimmunity and Connective Tissue Disease (CTD) The immune system normally produces antibodies which attack bugs (viruses, bacteria and fungi). Sometimes, for reasons we don’t fully understand, the immune system goes into ‘overdrive’ and produces antibodies which attack the body’s own tissues, causing inflammation. This is called autoimmunity and may cause an autoimmune disease. A common example of this is underactive thyroid where antibodies are produced which attack the thyroid gland. The connective tissues are the structural portions of our body that essentially hold the cells of the body together. These tissues form a framework or matrix for the body. Connective Tissue Disease (CTD) Connective tissue disease is an autoimmune disease where the body produces antibodies against its own connective tissue, causing inflammation. The ‘classic’ connective tissue diseases include: Lupus Rheumatoid arthritis Scleroderma (or systemic sclerosis) Polymyositis and Source: Rheumatology Reference No: 6252-1 Issue date: 26/9/19 Review date: 26/9/22 Page 1 of 4 Dermatomyositis Each of these diseases has a typical presentation with clinical findings that doctors can recognise during an examination. Each also has certain blood test abnormalities and abnormal antibody patterns. However, each of these diseases can start with very mild symptoms before developing the classic features that help in the diagnosis. Undifferentiated Connective Tissue Disease (UCTD) Almost one in four people seen in rheumatology clinics develop an autoimmune disease which doesn't fit neatly into a category, so they are not given a definite disease label. When these conditions have not developed the classic features of a particular disease, doctors will often refer to the condition as "undifferentiated connective tissue disease" or UCTD for short.
    [Show full text]
  • Scleroderma, Myositis and Related Syndromes [4] Giordano J, Khung S, Duhamel A, Hossein-Foucher C, Bellèvre D, Lam- Blin N, Et Al
    Scientific Abstracts 1229 Ann Rheum Dis: first published as 10.1136/annrheumdis-2021-eular.75 on 19 May 2021. Downloaded from Scleroderma, myositis and related syndromes [4] Giordano J, Khung S, Duhamel A, Hossein-Foucher C, Bellèvre D, Lam- blin N, et al. Lung perfusion characteristics in pulmonary arterial hyper- tension and peripheral forms of chronic thromboembolic pulmonary AB0401 CAN DUAL-ENERGY CT LUNG PERFUSION hypertension: Dual-energy CT experience in 31 patients. Eur Radiol. 2017 DETECT ABNORMALITIES AT THE LEVEL OF LUNG Apr;27(4):1631–9. CIRCULATION IN SYSTEMIC SCLEROSIS (SSC)? Disclosure of Interests: None declared PRELIMINARY EXPERIENCE IN 101 PATIENTS DOI: 10.1136/annrheumdis-2021-eular.69 V. Koether1,2, A. Dupont3, J. Labreuche4, P. Felloni3, T. Perez3, P. Degroote5, E. Hachulla1,2,6, J. Remy3, M. Remy-Jardin3, D. Launay1,2,6. 1Lille, CHU Lille, AB0402 SELF-ASSESSMENT OF SCLERODERMA SKIN Service de Médecine Interne et Immunologie Clinique, Centre de référence THICKNESS: DEVELOPMENT AND VALIDATION OF des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de THE PASTUL QUESTIONNAIRE 2 France (CeRAINO), Lille, France; Lille, Université de Lille, U1286 - INFINITE 1,2 1 1 1 J. Spierings , V. Ong , C. Denton . Royal Free and University College - Institute for Translational Research in Inflammation, Lille, France; 3Lille, Medical School, University College London, Division of Medicine, Department From the Department of Thoracic Imaging, Hôpital Calmette, Lille, France; 4 of Inflammation, Centre for Rheumatology and Connective
    [Show full text]
  • Diagnosis and Treatment of Dermatomyositis-Systemic Lupus
    Diagnosis and Treatment of Dermatomyositis-Systemic Lupus Erythematosus Overlap Syndrome Preston Williams1; Benjamin McKinney, MD2 1Texas A&M College of Medicine; 2Baylor University Medical Center Family Medicine Residency Introduction Case Description Discussion Dermatomyositis is an autoimmune condition classically A punch biopsy of her rash showed atrophic epithelium with This case of overlap syndrome between dermatomyositis and characterized by symmetric proximal muscle weakness, dyskeratotic keratinocytes, vacuolar interface changes, superficial systemic lupus erythematosus presents a rare but important inflammatory muscle changes, and dermatologic abnormalities.1 perivascular and lichenoid inflammation, and pigment challenge to the primary care physician. Our patient presented Several studies have shown that the inflammatory myopathies, incontinence consistent with systemic lupus erythematosus initially with arthralgias and fatigue, symptoms more such as dermatomyositis, commonly overlap with other (SLE). The patient was started on prednisone 40 mg daily for a 2- characteristic of systemic lupus erythematosus. However, these connective tissue disorders, significantly complicating the week taper to 10 mg and hydroxychloroquine 200 mg daily with symptoms were followed by a facial rash that involved the diagnosis.2 The reported incidence of overlap syndrome ranges marked improvement in symptoms. Further lab work-up was nasolabial folds and periorbital regions more in line with from 11% to 40% in patients diagnosed with significant
    [Show full text]
  • Myositis 101
    MYOSITIS 101 Your guide to understanding myositis Patients who are informed, who seek out other patients, and who develop helpful ways of communicating with their doctors have better outcomes. Because the disease is so rare, TMA seeks to provide as much information as possible to myositis patients so they can understand the challenges of their disease as well as the options for treating it. The opinions expressed in this publication are not necessarily those of The Myositis Association. We do not endorse any product or treatment we report. We ask that you always check any treatment with your physician. Copyright 2012 by TMA, Inc. TABLE OF CONTENTS contents Myositis basics ...........................................................1 Diagnosis ....................................................................5 Blood tests .............................................................. 11 Common questions ................................................. 15 Treatment ................................................................ 19 Disease management.............................................. 25 Be an informed patient ............................................ 29 Glossary of terms .................................................... 33 1 MYOSITIS BASICS “Myositis” means general inflammation or swelling of the muscle. There are many causes: infection, muscle injury from medications, inherited diseases, disorders of electrolyte levels, and thyroid disease. Exercise can cause temporary muscle inflammation that improves after rest. myositis
    [Show full text]
  • Studies with Human Leukocyte Lysosomes. Evidence for Antilysosome Antibodies in Lupus Erythematosus and for the Presence of Lysosomal Antigen in Inflammatory Diseases
    Studies with human leukocyte lysosomes. Evidence for antilysosome antibodies in lupus erythematosus and for the presence of lysosomal antigen in inflammatory diseases. D A Bell, … , J H Vaughan, J P Leddy J Clin Invest. 1975;55(2):256-268. https://doi.org/10.1172/JCI107929. Research Article Human lysosomes were isolated from normal peripheral blood leukoyctes and characterized by electron microscopy, enzyme analysis, and assays for DNA and RNA. Stored sera from 37 unselected patients with systemic lupus erythematosus (SLE), including active and inactive, treated and untreated cases, were tested in complement fixation (CF) reactions with these lysosome preparations. 23 SLE sera exhibited positive CR reactions, as did sera from two patients with "lupoid" hepatitis. The seven SLE sera with strongest CF reactivity also demonstrated gel precipitin reactions with lysosomes. Neither CF nor precipitin reactions with lysosomes were observed with normal sera or with sera of patients with drug-induced lupus syndrome, rheumatoid arthritis (RA), polymyositis, or autoimmune hemolytic anemia. By several criteria the antilysosome CF and precipitin reactions of SLE sera cound not be attributed to antibody to DNA, RNA, or other intracellular organelles. The lysosomal component reactive with SLE sera in CF assays was sedimentable at high speed and is presumably membrane associated. The CF activity of two representative SLE sera was associated with IgG globulins by Sephadex filtration. A search for lysosomal antigen in SLE and related disorders was also made. By employing rabbit antiserum to human lysosomes in immunodiffusion, a soluble lysosomal component, apparently distinct from the sedimentable (membrane-associated) antigen described above, was identified in serum, synovial fluid, or pleural fluid from patients with […] Find the latest version: https://jci.me/107929/pdf Studies with Human Leukocyte Lysosomes EVIDENCE FOR ANTILYSOSOME ANTIBODIES IN LUPUS ERYTHEMATOSUS AND FOR THE PRESENCE OF LYSOSOMAL ANTIGEN IN INFLAMMATORY DISEASES DAVID A.
    [Show full text]
  • Polymyositis, Not Polymyalgia Rheumatica
    Annals ofthe Rhewnatic Diseases 1991; 50: 321-322 321 CASE REPORTS Ann Rheum Dis: first published as 10.1136/ard.50.5.321 on 1 May 1991. Downloaded from Polymyositis, not polymyalgia rheumatica N D Hopkinson, D J Shawe, J M Gumpel Abstract prednisolone 30 mg/day; two weeks later there The distinction between polymyalgia rheu- was improvement and the ESR had fallen to 14 matica and polymyositis is important for mm/h. Six months later she again had proximal treatment and prognosis. Four elderly patients muscle pain but also weakness and she reported were diagnosed and treated for polymyalgia: numerous chest infections, all responding raised creatine kinase led to muscle biopsy poorly to antibiotics. Hospital referral and and a diagnosis of polymyositis. subsequent admission confirmed a broncho- pneumonia and marked proximal muscle wast- ing and weakness. Investigations showed a Polymyositis and polymyalgia rheumatica may haemoglobin concentration of 119 g/l and the both present with a similar distribution of white blood cell count was raised at 14 9x 109/l proximal muscle pain but are not normally with a neutrophil leucocytosis. The ESR was confused. In polymyositis tenderness or weak- raised at 100 mm/h and creatine kinase was ness of muscles may be marked and there may raised at 600 IU/1. Needle biopsy confirmed a be other helpful diagnostic features-for moderate myositis. example, dysphagia, whereas muscle pain or stiffness without weakness are the more prominent symptoms in polymyalgia rheu- CASE NO 3 matica. In older patients the differentiation may A 77 year old woman presented to her general not be easy, especially when muscle weakness is practitioner with pain and weakness of the not marked.
    [Show full text]
  • Drug-Induced Lupus Erythematosus Incidence, Management and Prevention
    Drug Saf 2011; 34 (5): 357-374 REVIEW ARTICLE 0114-5916/11/0005-0357/$49.95/0 ª 2011 Adis Data Information BV. All rights reserved. Drug-Induced Lupus Erythematosus Incidence, Management and Prevention Christopher Chang1 and M. Eric Gershwin2 1 Division of Allergy, Asthma and Immunology, Nemours/A.I. Dupont Children’s Hospital, Thomas Jefferson University, Wilmington, Delaware, USA 2 Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, California, USA Contents Abstract. 357 1. The History and Epidemiology of Drug-Induced Lupus . 358 2. Drug-Induced Subacute Cutaneous Lupus Erythematosus and Chronic Cutaneous Lupus Erythematosus. 360 3. Clinical Presentation and Laboratory Abnormalities. 361 3.1 Traditional Drug-Induced Lupus. 361 3.1.1 High-Risk Drugs . 361 3.1.2 Moderate-Risk Drugs . 361 3.1.3 Low-Risk Drugs . 362 3.2 Biological Modulators and Drug-Induced Lupus. 363 3.2.1 Tumor Necrosis Factor Inhibitors . 363 3.2.2 Cytokines . 365 4. Diagnosis . 366 5. Pathophysiology. 368 6. Prevention and Treatment . 370 7. Discussion . 371 Abstract The generation of autoantibodies and autoimmune diseases such as sys- temic lupus erythematosus has been associated with the use of certain drugs in humans. Early reports suggested that procainamide and hydralazine were associated with the highest risk of developing lupus, quinidine with a mod- erate risk and all other drugs were considered low or very low risk. More recently, drug-induced lupus has been associated with the use of the newer biological modulators such as tumour necrosis factor (TNF)-a inhibitors and interferons. The clinical features and laboratory findings of TNFa inhibitor- induced lupus are different from that of traditional drug-induced lupus or idiopathic lupus, and standardized criteria for the diagnosis of drug-induced lupus have not been established.
    [Show full text]
  • Liver Damage in Patients with Polymyositis and Dermatomyositis
    Original Contribution Kitasato Med J 2016; 46: 40-46 Liver damage in patients with polymyositis and dermatomyositis Tatsuhiko Wada, Gakurou Abe, Takeo Kudou, Eisuke Ogawa, Tatsuo Nagai, Sumiaki Tanaka, Shunsei Hirohata Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine Objective: To clarify the prevalence of liver damage associated with polymyositis (PM) and dermatomyositis (DM) Methods: Forty-two patients with PM/DM were exhaustively studied. Six patients showed liver diseases of known etiology, including drug-induced hepatitis, fatty liver, metastatic liver tumor, primary biliary cirrhosis and autoimmune hepatitis. As a control, 8 patients with miscellaneous diseases who showed elevation of the creatine kinase (CK) due to extreme exercise were studied. Serum levels of aspirate aminotransferase (AST), alanine aminotransferase (ALT) and CK, as well as the ratios of AST/CK, ALT/CK and AST/ALT were evaluated. Results: ALT levels were significantly elevated in PM/DM compared with control group. The ratios of AST/CK and ALT/CK were significantly elevated in PM/DM compared with the control group. AST/ALT ratios in PM/DM were significantly lower than those in control group (P < 0.0001). Twenty- six of 36 patients (72.2%) with PM/DM showed AST/ALT ratios below the minimum value of AST/ ALT ratios in the control patients. Additionally, 10 of 26 patients (38.5%) showed hepatocellular liver damage. There were no significant differences in the levels of AST, ALT or CK, or in the ratios of AST/CK, ALT/CK or AST/ALT between PM and DM. Conclusions: The results indicate that a disproportionate elevation of ALT takes places in patients with PM/DM.
    [Show full text]