1/4. Open-label study of clarithromycin in patients with undifferentiated connective tissue disease.OBJECTIVE: The macrolide family of antibiotics (erythromycin, clarithromycin, and others), have both antimicrobial and immunomodulatory effects. This study explored the effect of clarithromycin on the clinical course of patients with undifferentiated connective tissue disease (UCTD) in a 12-week open-label study. methods: The diagnosis of UCTD was based on symptoms/signs of connective tissue disease, and the presence of 1 or more positive autoimmune disease tests, but with insufficient criteria to make a definitive diagnosis. Screening and monthly follow-up visits over 12 weeks included the following: history and physical examination; concurrent medications; the 68/66 tender/swollen joint count; visual analog scores 0 to 100 mm for patient and physician global assessment of disease activity, and patient pain; antinuclear antibody panel, rheumatoid factor, erythrocyte sedimentation rate, c-reactive protein, and blood chemistry. RESULTS: Seven patients with rheumatic disease were treated with clarithromycin; 6 of 7 had symptomatic relief. Two subjects treated empirically before the decision to perform an open-label study responded favorably. Four of 5 patients who completed the prospective open-label study had mean maximal improvements from baseline of 78, 75, and 79% in patient pain, patient global, and investigator global assessments, respectively. pain relief occurred as early as 1 week. Drug withdrawal with rechallenge in 2 patients resulted in flare followed by recapture of symptomatic relief. CONCLUSIONS: clarithromycin, a macrolide antibiotic, led to clinical improvement in patients with UCTD. Efficacy and safety data support further investigation of macrolide antibiotic use as a primary or adjunctive treatment in various connective tissue diseases.- - - - - - - - - - ranking = 1keywords = family (Clic here for more details about this article) |
2/4. Familial palindromic rheumatism: a possible association with HLA.Palindromic rheumatism is very rare in children. The familial occurrence of the disease has been only briefly reported previously. A family is described here in which the mother and her 3 children suffered from typical palindromic rheumatism, which ran a benign course. All 4 members were seronegative and the HLA types of the children were identical. The HLA genotype of the mother was HLA A2, Cw4, Bw41, Bw6, DR5, MT2/Aw32, CX, Bw44, Bw4, DR1, MT1. HLA DR5 has previously been found to be associated with juvenile rheumatoid arthritis, while DR1 in jews is significantly associated with adult-onset rheumatoid arthritis. DR5 was shared by the mother and her 3 children. The presence of the antigen DR5 in this sibship suggests that palindromic rheumatism may be a variant of juvenile rheumatoid arthritis with a relatively late onset and a more benign course. Tissue typing of patients with palindromic rheumatism may give a clue to prognosis. The patients' youth and the familial involvement, with identical HLA characteristics, are the outstanding features of this family.- - - - - - - - - - ranking = 2keywords = family (Clic here for more details about this article) |
3/4. Chlamydial infection in a family.In a family comprising parents and two daughters, chlamydia trachomatis (CT) was observed to be the infective agent causing urethritis in the father and conjunctivitis in the newborn. CT was probably a trigger factor in Reiter's syndrome (RS) in the mother, who suffered from arthritis, microscopic pyuria and hematuria, cervicitis and ocular manifestations. The elder daughter's mucocutaneous manifestations, probably keratodermia blennorrhagica, broke out simultaneously with chlamydial infections in the other members of the family. Later she developed joint pains, conjunctivitis and vulvitis. The elder daughter and the father are HLA-B27 negative, whereas the mother is HLA-B27 positive. With this study we would like to emphasize the importance of observing the microbial environment in the family in the etiology of rheumatic disease. Simultaneous treatment of infections in family members might benefit the clinical course of rheumatic disease.- - - - - - - - - - ranking = 8keywords = family (Clic here for more details about this article) |
4/4. Rheumatic manifestations due to human parvovirus B19. A report of four cases.Human parvovirus B19 has been incriminated in the genesis of hematologic, dermatologic, neurologic, and rheumatic disorders. We report four cases in which inflammatory rheumatic manifestations developed during the course of human parvovirus B19 infection documented by the presence of IgM and IgG antibodies. There was one case each of monoarthritis, oligoarthritis, polyarthritis, and enthesitis. Three patients had a favorable outcome under nonsteroidal antiinflammatory drug therapy, and one developed reflex sympathetic dystrophy syndrome. In patients with inflammatory rheumatic manifestations that do not fit any specific diagnosis, a careful family history can provide evidence suggesting human parvovirus B19 infection, which should be confirmed by tests for IgM and IgG antibodies.- - - - - - - - - - ranking = 1keywords = family (Clic here for more details about this article) |