1/19. Photosensitivity with sulfasalazopyridine hypersensitivity syndrome.Five weeks after the start of treatment with an association of sulfasalazopyridine and piroxicam, a 30-year-old woman presented with an eczematous eruption in light-exposed areas, hepatomegaly and fever (38 degrees C). Laboratory studies showed leukocytosis, eosinophilia and hepatic cytolysis. Treatment consisted of withdrawing the two drugs and topical steroids. The clinical signs regressed in 6 days. An increase in eosinophilia and hepatic cytolysis was observed until the tenth day, after which the trend reversed. Laboratory parameters were normal on the twentieth day. One month later, photopatch testing was performed. A patch test with sulfanilamide irradiated with UVA was positive. Clinical and laboratory findings were highly suggestive of drug hypersensitivity syndrome. The positive result from the UVA photopatch test with sulfanilamide suggests that sulfasalazopyridine was involved in the occurrence of hypersensitivity syndrome in our patient. We conclude that photodistributed eruptions can be observed in drug hypersensitivity syndrome with photosensitizing drugs.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/19. gynecomastia and sexual impotence associated with methotrexate treatment.methotrexate (MTX) is the disease modifying antirheumatic drug most frequently used for rheumatoid and psoriatic arthritis (PsA). Several reports associate sexual dysfunction to MTX use. We describe 2 cases of sexual impotence and gynecomastia in patients with PsA treated with MTX. Although the mechanism underlying MTX induced sexual dysfunction is unknown, the potential consequences should be taken in account in view of the steady increase in the number of patients.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
3/19. psoriasis: response to high-dose intravenous immunoglobulin in three patients.Treatment of recalcitrant psoriasis and psoriatic arthritis can be challenging, with treatment options limited by drug intolerance or poor efficacy. High-dose intravenous immunoglobulin (hdIVIg) has been used successfully in Kawasaki's disease and idiopathic thrombocytopenic purpura, where it has become the standard treatment. The literature also suggests its positive effect in the treatment of dermatological conditions, such as autoimmune chronic urticaria, atopic dermatitis, scleromyxoedema, dermatomyositis and autoimmune bullous disorders. We report three patients with treatment-resistant psoriasis and psoriatic arthritis who improved with hdIVIg.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
4/19. Psoriatic arthritis: clinical response and side effects to methotrexate therapy.In the last decade, methotrexate (MTX) has emerged as a useful second line agent for a variety of arthritides. However, there still exists some reluctance for its wider use mainly because of concerns about its liver side effects. We describe our clinical experience with this drug in psoriatic arthritis (PsA). The study group included 24 men and 16 women, with a mean age of 47 years (16-75), with oligoarticular (13) or polyarticular (27) involvement, with a mean disease duration of 12 years (1-36). patients received a mean dose of 11.2 mg of MTX orally/week during a mean period of 34 months (6-132). Seven had been previously treated with other second line agents. Thirty-eight patients had an excellent or good response. In them, the erythrocyte sedimentation rate dropped in a mean of 38 mm/h. Only 2 patients had a rather poor response. Two patients discontinued the medication because of side effects: leukopenia in one and stomatitis in the other. Eleven patients presented with liver test abnormalities: 3 mild, 6 moderate and 2 severe. Seven patients had 11 liver biopsies. Except for one, none had evidence of cirrhosis or inflammation. Indeed, no changes were observed in the histopathology in those with repeated biopsies. The case reported as cirrhosis occurred very early in the course of MTX therapy. He continued taking MTX treatment without further deterioration of liver chemistry and/or histology. It is concluded that MTX is an effective and safe agent in PsA. Results also indicate that it is not necessary to perform liver biopsies on a routine basis.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
5/19. Psoriatic arthritis.Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. It can be difficult to diagnose and symptoms might vary from being mild to chronic and progressive. Julie Holdsworth discusses the objectives of care management for patients with psoriatic arthritis and explains the rationale for the drugs used to treat this disease.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
6/19. Generalized pustular psoriasis following withdrawal of efalizumab.Efalizumab is one of the new biologic therapies targeting T-lymphocyte activity for the treatment of chronic plaque psoriasis. Common adverse effects include headaches, nonspecific infection, nausea, chills, and fever. Rebound of psoriasis following discontinuation of the drug has been reported. Relapse events can manifest as recurrent plaque psoriasis, guttate psoriasis, psoriatic erythroderma, and pustular psoriasis. We report a second case of withdrawal flare resulting in generalized pustular psoriasis.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
7/19. Reduced full-field electroretinogram (ERG) in a patient treated with methotrexate.PURPOSE: To examine retinal function in a patient with decreased vision possibly due to treatment with methotrexate. methods: Ophthalmological examination included testing of visual acuity (VA), fundus inspection, fundus photography, and kinetic perimetry. Retinal function was tested objectively with three electrophysiological methods: full-field electroretinography (ERG), multifocal electroretinography (mfERg) and also electro-oculography (EOG). RESULTS: A 13-year-old boy with psoriasis arthritis had been treated with methotrexate on a weekly basis for 8.5 years. After terminating treatment, his VA, which was reduced to 0.3 in both eyes initially, improved during the following 3 years but did not return to normal. No visual field defects were found with kinetic perimetry. The rod and cone responses in the full-field ERG were markedly reduced in b-wave amplitude initially, but grew slowly to nearly normal values 3 years later. After withdrawal of the drug, the mfERG demonstrated normal responses in the macular region. The Arden index in the EOG was normal. CONCLUSION: Chronic treatment with methotrexate may affect VA, and mat reversible reduce rod and cone function. In patients who use systemic medication and who vision is reduced, objective evaluation of retinal function with electrophysiological methods is recommended.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
8/19. Etanercept therapy for patients with psoriatic arthritis and concurrent hepatitis c virus infection: report of 3 cases.psoriasis and psoriatic arthritis are exacerbated by interferon alfa and other treatments for hepatitis c virus infection. Immunosuppressants and hepatotoxic drugs are relatively contraindicated in hepatitis c. Data in the literature suggest that etanercept is a safe option in the treatment of patients with rheumatoid arthritis and concurrent hepatitis c. We present three cases in which we have successfully used etanercept to treat psoriatic arthritis/psoriasis in patients with hepatitis c without worsening their hepatitis or interfering with their hepatitis treatment. With close monitoring of viral load and hepatic enzymes, etanercept may be a safe option for treating psoriatic arthritis/psoriasis in patients who also have hepatitis c.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
9/19. Successful treatment of psoriatic onycho-pachydermo periostitis (POPP) with adalimumab.Psoriatic onycho-pachydermo periostitis (POPP) is recognized as a rare subset of psoriatic arthritis, characterized by psoriatic onychodystrophy, connective tissue thickening above the distal phalanx, and a periosteal reaction. Therapy for this rare disease is based on treatments used for psoriatic arthritis, but traditional disease-modifying antirheumatic drugs, such as sulfasalazine and methotrexate, have shown inconsistent and unsatisfactory results. We report herein a successful therapeutic approach for POPP using the fully human anti-tumor necrosis factor (TNF) antibody adalimumab in a 42-year-old male patient. After 4 months of anti-TNF treatment, a remarkable normalization of the clinical appearance was achieved and magnetic resonance imaging showed complete resolution of the initial inflammatory lesions. Therefore, we consider a TNF-blocking strategy as promising for treatment of POPP.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
10/19. Development of Crohn's disease in a patient taking etanercept.In addition to its well known proinflammatory effects, tumor necrosis factor-alpha (TNF-a) has complex effects on the growth, differentiation, and death of immune cells. TNF antagonists have had dramatic effects on the suppression of rheumatoid arthritis and other rheumatic inflammatory diseases. However, TNF inhibition of RA has led to an increased incidence of drug induced anti-dsDNA production, with cases of systemic lupus erythematosus as well as exacerbations of multiple sclerosis. While etanercept does not generally alter the course of Crohn's disease we describe a rare instance where this agent may have contributed to the development of clinically significant inflammatory bowel disease.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
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