Extra-articular rheumatoid arthritis: prevalence and mortality. (1/33)

OBJECTIVE: The prevalence and distribution of extra-articular manifestations of rheumatoid arthritis (ExRA) and associated mortality were studied retrospectively in a cohort of RA patients admitted to University Hospital, Malmo, Sweden, during the period 1990-94. RESULTS: Of 489 patients who fulfilled the 1987 ACR criteria for RA, 37 manifested onset of ExRA, predominantly serositis and cutaneous vasculitis, during the period, corresponding to a cumulative incidence of 7.9%. The occurrence of ExRA was independent of disease stage. Among patients with ExRA, 1 death/4.3 person-years at risk (pyr) occurred, as compared with 1 death/11.4 pyr in the non-ExRA subgroup. The age- and sex-adjusted mortality rate ratio was 2.49 (95% confidence interval 1.43-4.03). The major cause of death among ExRA cases was heart disease, which occurred in 9/13 cases (69%) in comparison to the expected 2.4 cases. CONCLUSION: In this series, serositis and cutaneous vasculitis were predominant extra-articular manifestations of RA; and mortality was greater in the ExRA than in the non-ExRA subgroup, perhaps due to a high frequency of associated heart disease.  (+info)

Serosal complications of single-agent low-dose methotrexate used in gestational trophoblastic diseases: first reported case of methotrexate-induced peritonitis. (2/33)

Methotrexate (MTX) is a folate antagonist widely used both as an anticancer drug and as an immunosupressant. Administration of an 8-day methotrexate and folinic acid regime may be associated with pleuritic chest pain and pneumonitis. We have reviewed the toxicity seen in 168 consecutive patients treated with low-dose MTX for persistent trophoblastic disease. Twenty-five per cent of patients developed serosal symptoms, pleurisy was the commonest complaint. The majority of patients had mild to moderate symptoms which were controlled with simple analgesia and did not necessitate a change in treatment; 11.9% had severe symptoms which necessitated a change in treatment. One patient developed a pericardial effusion and a second patient developed severe reversible peritoneal irritation. The possible aetiology and pathophysiology of methotrexate-induced serosal toxicity is discussed.  (+info)

Serial antinuclear antibodies titre in pleural and pericardial fluid. (3/33)

The antinuclear antibodies (ANA) test has been a cornerstone of the evaluation of connective tissue disease. The aim of this study was to investigate the diagnostic value of the ANA test in pleural or pericardial effusions of unknown causes. Over a 3-yr period, a total of 126 pleural fluid and 30 pericardial fluid samples were analysed. ANA tests were performed using a commercially available kit. The ANA kit used an indirect immunofluorescent antibody method with a human epithelial (HEP-2) cell line as substrate. Patients with high fluid ANA titre (>1:160) received a second aspiration 2 weeks after the initial aspiration if diagnosis was not confirmed. ANA results were positive in 39 pleural and 10 pericardial fluid samples. All but one of the effusions with positive ANA testing were exudative. Eleven pleural or pericardial effusions due to active systematic lupus erythematosus were identified and all had high ANA titres (1:160) with various staining patterns. Thirty-eight of 145 patients (26%) with effusions of nonlupus aetiologies had positive ANA testing in pleural or pericardial fluid. Thirteen of these 38 patients had high ANA titre. Malignant or paramalignant effusions constituted 11 of the 13 samples. In conclusion, although a negative antinuclear antibodies test makes a diagnosis of lupus serositis unlikely, high antinuclear antibodies titres in pleural or pericardial fluid are not diagnostic of lupus serositis even when as high as 1:5,120. An unexplained high antinuclear antibodies titre in pleural or pericardial effusion warrants search for malignancy.  (+info)

Polyserositis in pigs due to generalized Escherichia coli infection. (4/33)

A fibrinous polyserositis syndrome due to generalized Escherichia coli infection in pigs was observed in 13 out of 17 systematically monitored herds. The mortality rate was approximately 0.1% among liveborn pigs. The occurrence was usually sporadic but a minor enzootic was observed in one herd. Most of the affected pigs succumbed during first or second week of life but cases were observed throughout the suckling period. The clinical signs included marked depression, anorexia, rough haircoat, laboured respiration and death in two to five days. Predominant gross pathological lesions were signs of septicaemia and a voluminous, gelatinous and fibrinous exudate in the pleural, the pericardial and the peritoneal cavities. Frequently also a firbinous polyarthritis and a fibrinous pneumonia were present. The majority of the isolated invasive E. coli strains were nonhaemolytic. Serologically 11 different E. coli O groups were encountered. O group most frequently represented was 020. None of the examined E. coli strains belonged to the serogroups which frequently are associated with enteropathogenicity in pigs.  (+info)

Mycoplasma alligatoris sp. nov., from American alligators. (5/33)

Mycoplasmas were isolated from multiple tissues of diseased American alligators (Alligator mississippiensis). This paper presents biochemical, serological and molecular genetic characterizations of a lethal pathogen of alligators for which the name Mycoplasma alligatoris sp. nov. is proposed. The type strain is A21JP2T (ATCC 700619T).  (+info)

Mortality patterns in Malaysian systemic lupus erythematosus patients. (6/33)

A retrospective analysis of the case records of 494 systemic lupus erythematosus (SLE) patients under follow-up at University Hospital, Kuala Lumpur during 1976-1990 was performed. Overall mortality was 20.2% (100 patients). The causes of death were infection (30%), renal (15%), respiratory (14%), neurological (5%), cardiovascular (7%), other causes (2%) and unknown (27%). Active SLE was a contributing factor in 19% of the deaths. The patients who died had significantly more renal disease, neurological disease, serositis or thrombocytopenia by the end of the first year of disease compared to the survivors. As in other series, infection and active SLE remain important causes of death.  (+info)

A case of erythema nodosum and serositis associated with myelodysplastic syndrome. (7/33)

Myelodysplastic syndrome (MDS) is a heterogenous group of stem cell disorders usually characterized by progressive refractory cytopenias, which could progress to acute myeloid leukemia. MDS may be associated with a wide spectrum of skin lesions, including neoplastic cell infiltration, Sweet's syndrome, pyoderma gangrenosum, erythema elevatum diutinum, vasculitis, and panniculitis. However, erythema nodosum is rarely associated with MDS. Unusual rheumatologic manifestations in patients with MDS also have been reported, which range from asymptomatic serological abnormalities to classic connective tissue disorders such as Sjogren's syndrome, relapsing polychondritis, systemic lupus erythematosus, rheumatoid arthritis and mixed connective tissue disease. However, concurrent erythema nodosum and serositis has rarely been reported. We describe a case of MDS with erythema nodosum and immune-mediated pericardial effusion in a 34-year-old woman.  (+info)

Serosal appendicitis: incidence, causes and clinical significance. (8/33)

BACKGROUND: Serosal appendicitis is a histopathological diagnosis of an inflammatory reaction on the surface of the appendix caused by an extra appendiceal source of inflammation. OBJECTIVE AND METHODS: A retrospective review of a pathology database in a district general hospital identified patients with serosal appendicitis and a preoperative diagnosis of appendicitis. Two groups emerged: patients with serosal appendicitis secondary to a known cause of intra-abdominal inflammation and those in whom the cause remained unknown. The groups were compared with respect to postoperative complications, referral to outpatient clinics, admissions and procedures by case-note analysis. RESULTS: The incidence of serosal appendicitis was 0.01% (19/1379); 17 women; mean age 31.63 (10.49) years. Lanz incision was used in 16 patients, midline laparotomy in two and laparoscopy in one. A preoperative ultrasound scan was carried out in 5 of 19 patients. The cause of serosal appendicitis was confirmed in eight patients (intraoperatively or postoperatively) and remained unknown in 11 patients. The groups were comparable with respect to age, sex and mean follow-up. No significant difference was observed between them with respect to the above parameters. CONCLUSIONS: No further investigation is necessary in patients who undergo an appendicectomy but in whom the pathological diagnosis is serosal appendicitis. However, considering the patient demographics and the fact that patients with serosal appendicitis have probably undergone an unnecessary appendicectomy, the proportion of patients who underwent ultrasound scanning and diagnostic laparoscopy was small.  (+info)

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