| The incidence of abnormal results in liver function tests was determined in 37 of 51 patients with polymyalgia rheumatica (PMR) or temporal arteritis. Fine-needle biopsies fo the liver were performed on 6 of these patients and the bile canalicular network and liver cytology were studied in the aspirate by enzyme-cytochemical methods. Of the 37 patients in whom it was measured, 23 (62%) had elevated concentrations of serum alkaline phosphatases (AP), mainly of hepatic origin. The concentrations of other serum enzymes associated with hepatic function were normal in all 37 patients. BSP retention was studied in 13 patients and was abnormal in 6 (46%). Three of the 4 patients for whom smears were stained for AP activity had an increase in this activity in their bile canaliculi that corresponded to a rise in the serum concentration of AP. In one of these 3 patients, smears stained for naphthylamidase showed that bile canaliculi had a calibre wider than normal and had granular walls. A second biopsy performed 10 days showed a partial reversal of these changes. Mild fatty infiltration of the liver cells was seen in 2 patients; one patient whose serum concentration of AP was normal also had normal liver cells and bile canaliculi. The structural changes in the bile canaliculi detected in one patient may be evidence of a subclinical hepatic disease associated with PMR. The cholestatic hepatic dysfunction, common in PMR and manifested in over half of our patients by elevated serum AP levels, can easily be confirmed with special staining methods for visualizing the bile canaliculi in cytological liver specimens. ( info) |
2/163. Polymyalgia, hypersensitivity pneumonitis and other reactions in patients receiving HMG-CoA reductase inhibitors: a report of ten cases. Ten patients who take hydroxy-methylglutaryl coenzyme a reductase inhibitors, or statin medications, and experience adverse reactions are described. All patients experienced various manifestations of hypersensitivity while receiving the drugs. One patient is described with hypersensitivity pneumonitis, which was graphically demonstrated by both high resolution computerized axial tomography and open lung biopsy. ( info) |
| The association of bronchiolitis obliterans organizing pneumonia (BOOP) with polymyalgia rheumatica is rare, and only one case has previously been described. This study reports on the case of an 80 yr-old male who presented with malaise, nonproductive cough and exertional dyspnoea for several weeks, along with a history of bilateral shoulder and pelvic girdle pain of several months' duration. The chest radiograph revealed a pneumonic infiltrate in the right lower lobe, which was unresponsive to antibiotics. bronchoscopy, bronchoalveolar lavage and a transbronchial lung biopsy established the diagnosis of BOOP. The patient improved consistently on steroids. As in other connective diseases, organizing pneumonia may be one of the early manifestations of polymyalgia rheumatica. ( info) |
4/163. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome). A 63-year-old man presented with acute symmetrical polysynovitis associated with pitting edema of both the hands and feet. He was seronegative for rheumatoid factor and no radiologically evident erosion was noted in the joints of his hands and feet. Evaluation excluded congestive heart failure, nephrotic syndrome, and hypothyroidism as the cause of edema. Treatment with nonsteroidal anti-inflammatory drugs and low-dose steroids induced complete remission. The clinical manifestations of this patients were consistent with those of a distinctive, although rare, form of arthritis called remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. This syndrome has a good prognosis in elderly patients. ( info) |
| Several cases of systemic amyloidosis associated with polymyalgia rheumatica (PMR) or giant-cell arteritis (GCA) have been described. Nevertheless, the type of amyloid deposit has not been characterized in most of them. Here we report on two patients with PMR (one with associated GCA) who developed nephrotic syndrome and end-stage renal failure caused by massive amyloid deposition. Immunohistochemical analysis showed that the amyloid deposits were of AA type (secondary amyloidosis) in both cases. ( info) |
6/163. Peripheral joint scanning with technetium pertechnetate. Application in clinical practice. Results of a prospective study to evaluate the clinical usefulness of radioisotope joint scanning in the practice of rheumatology are reported. The radiopharmaceutical used was technetium pertechnetate, increased synovial blood flow being the main contributory factor to abnormal joint images. Strict adherence to a procedural protocol was necessary to assure reproducible images. Joint scintigraphy was performed on 56 control subjects without joint disease and 51 patients with different rheumatic disorders. There was excellent agreement between clinical examination and joint scintigraphy in all groups studied. In cases of disagreement, the joint scintigram generally was more sensitive. This high sensitivity for the detection of synovitis was accompanied by a lack of specificity, because it failed to diagnose the nature of the joint involvement. The joint scan was helpful for diagnosing early or steroid-suppressed synovitis and also for suspected nonarticular rheumatism. It aided in delineating the pattern of joint involvement. Joint scintigraphy is the only objective nontraumatic permanent record documenting joint inflammation. ( info) |
| polymyalgia rheumatica (PMA) and temporal arteritis (TA) are common clinical syndromes that affect the elderly population. Both syndromes may include similar constitutional complaints, an increase in acute phase reactants, a rapid response to corticosteroids, and the presence of anteritis giant cells upon temporal artery biopsy. Differential diagnosis is one of exclusion. A case presentation is included to assist practitioners in recognizing presenting symptoms, identifying diagnostic testing, and proceeding with appropriate therapy and follow-up. ( info) |
| A 59-year-old woman presented with polymyalgia rheumatica which was refractory to conventional anti-inflammatory and steroid therapy. A full investigation for an underlying occult malignancy showed only the presence of a giant cavernous hepatic hemangioma. To our knowledge, polymyalgia rheumatica has never been described in association with giant cavernous hepatic hemangioma; resection of the latter lesion resulted in complete and, to this date, definite resolution of rheumatologic complaints in our patient. ( info) |
| polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions that affect different cellular targets in genetically predisposed persons. Compared with temporal arteritis, polymyalgla rheumatica is much more common, affecting one in 200 persons older than 50 years. Temporal arteritis, however, is more dangerous and can lead to sudden blindness. The diagnosis of polymyalgia rheumatica is based on the presence of a clinical syndrome consisting of fever, nonspecific somatic complaints, pain and stiffness in the shoulder and pelvic girdles, and an elevated erythrocyte sedimentation rate. Temporal arteritis typically presents with many of the same findings as polymyalgia rheumatica, but patients also have headaches and tenderness to palpation over the involved artery. Arterial biopsy usually confirms the diagnosis of temporal arteritis. early diagnosis and treatment of polymyalgia rheumatica or temporal arteritis can dramatically improve patients' lives and return them to previous functional status. Corticosteroid therapy provides rapid and dramatic improvement of the clinical features of both conditions. Therapy is generally continued for six to 24 months. Throughout treatment, clinical condition is assessed periodically. patients are instructed to see their physician immediately if symptoms recur or they develop new headache, jaw claudication or visual problems. ( info) |
10/163. pasteurella dagmatis septicaemia in an immunocompromised patient without a history of dog or cat bites. We report a rare case of pasteurella dagmatis septicaemia in a 66-year-old immunocompromised patient, without a history of cat bites, dog bites or scratches. ( info) |