APLAR Journal of Rheumatology

Abstract Inflammatory myopathies like dermatomyositis are associated with increased incidence of malignancies. This association has been commonly reported with malignancies of ovaries, gastro‐intestinal tract, breast and non‐Hodgkin's lymphomas but occurrence of dermatomyositis with bladder cancer has been rarely reported. We report a patient with carcinoma bladder who developed dermatomyositis while being treated for the bladder cancer.

Aman SHARMA

Susheel KUMAR

Ajay WANCHU

A. K. MANDAL

Surjit SINGH

Pradeep BAMBERY

Dermatomyositis in a patient with high grade papillary urothelial carcinoma of urinary bladder

尿路上皮癌高级别乳头状癌患者中的皮肌炎

Abstract Background and method: This clinical experience involved the treatment of resistant systemic lupus erythematosus (SLE) patients with CD20 monoclonal antibody. Five patients failed conventional therapy, two developed complications and one needed rituximab as an emergency measure. Four patients had lupus nephritis, three had autoimmune hemolytic anemia, two had immune thrombocytopenia and one had lupoid hepatitis. The patients were aged 14–49 years, (mean 28.63). Three were Malays, two Chinese, two Indian and one Turkish; six were females. Mean disease duration was 63.25 months and mean total rituximab dose received was 2812.50 mL. Results: Hemoglobin levels improved from 9.3 ± 5.7 to 13.1 ± 8.6 g/dL for two SLE patients with autoimmune hemolytic anemia after 34 weeks ( P = 0.180). Platelet counts improved from 25 ± 17 to 198 ± 97 × 10 9 /high powered field from 0 to 10 weeks for three SLE patients with immune thrombocytopenia ( P = 0.109). In the lupus nephritis patients on rituximab, serum albumin improved from 24.5 ± 23.2 to 37.5 ± 31.8 mmol/L ( n = 3) from week 0 to week 17 ( P = 0.100). Urine protein creatinine ratio improved from 0.55 ± 0.23 to 0.08 ± 0.03 g/mmol creatinine ( P = 0.068) from week 0 to week 13. C3 and C4 improved from 90.8 ± 36.5 to 120.7 ± 37.9 ( P = 0.07) and 21.6 ± 10.1–27.3 ± 16.2 mg/dL ( P = 0.27), respectively, and Systemic Lupus Erythematosus Activity Disease Index was reduced from 17.9 ± 11.2 to 6.3 ± 6.8 ( P = 0.375) after 8 weeks. Two patients developed drug reactions to rituximab. Conclusion: All of the patients responded to rituximab on top of their conventional therapy.

M. S. MOHD SHAHRIR

A. G. ABDUL HALIM

Z. SOEHARDY

C. T. NORELLA KONG

Clinical experience in using CD20 monoclonal antibody in treating severe systemic lupus erythematosus

使用CD20单克隆抗体治疗重症系统性红斑狼疮的临床经验

Abstract Budd–chiari syndrome is a well known complication of Behcet's disease. All cases of Behcet's disease with Budd–Chiari syndrome that have been reported in the literature had thrombosis of hepatic veins or inferior vena cava. We describe a 33‐year‐old woman with Behcet's disease who developed Budd–Chiari syndrome due to a membranous web of the inferior vena cava.

Mahmood EBRAHIMI

Mohammadhassan JOKAR

Reza TAHERI

Budd–Chiari syndrome due to membranous obstruction of inferior vena cava in a patient with Behcet's disease

贝赫切特病患者下腔静脉膜性梗阻所致布加综合征

Abstract Aim: We performed a small study to examine the efficacy of caudal epidural analgesia in our patients with lumbosacral radicular pain, to assess the patient's tolerance of the procedure and to assess the willingness of patients to have the procedure repeated in future if offered. Method: Patients with low back pain/sciatica being examined by rheumatology consultants were selected for caudal epidural injection. The procedure was done in the rheumatology ward as a day procedure. Bupivacaine 0.25% (15–25 mL) and triamcinolone (40 mg) were used. Results: The majority of patients found improvement in pain. We did not come across any major side effects. A majority of patients were willing to have further injections. Conclusion: Caudal epidural analgesia for sciatica and low back pain is a relatively safe and straightforward procedure.

Shanmugam SARAVANA

Tim GILLOTT

A study on caudal epidural analgesia for lowback pain/sciatica

腰椎痛/坐骨神经痛的骶管硬膜外麻醉研究

Abstract Aim: To determine the frequency of anti‐cyclic citrullinated peptide antibody (anti‐CCP) in a group of patients with rheumatoid arthritis and another group with other rheumatic diseases. Patients and methods: Anti‐CCP1 and rheumatoid factor (RF) titres were determined in 320 serum samples; 136 from RA patients, 184 from control patients (165 patients with rheumatic diseases other than RA, and 21 patients with lymphoproliferative diseases). Results: The sensitivity of Anti‐CCP was 62.5% (95% CI: 53–70%) for the diagnosis of RA with a specificity of 89.1% (95% CI: 83–93%). The sensitivity of RF was 85.3% (95% CI: 79–91%). The specificity was 64.7% (95% CI: 57–71%). Conclusions: Anti‐CCP1 has not very high specificity for RA regarding other rheumatic disease. However it is still very helpful for the diagnosis of RA.

Sakineh‐Khatoun SHARIF

Shahin EGHBAL

Farhad GHARIBDOOST

Mahmood A. Kbarian

Farhad SHAHRAM

Abdolhadi NADJI

Ahmad‐Reza JAMSHIDI

Fereydoun DAVATCHI

Comparative study of anti‐CCP and RF for the diagnosis of rheumatoid arthritis

抗CCP和RF诊断类风湿关节炎的比较研究

Abstract A 48‐year‐old male patient with long‐standing ulcerative colitis since February 2001 which was diagnosed by endoscopy, developed acute digital ischemia affecting both hands with fixed colour changes in the left index finger which was followed shortly by digital ulceration. Magnetic resonance angiography (MRA) of both upper limbs showed evidence of vasculitis affecting digital arterioles on both sided and right subclavian occlusion. The patient received pulse methylprednisolone followed by cyclophosphamide pulse therapy, the latter continuing on a monthly basis for 6 months with appreciable improvement and remission of the vasculitic process; follow‐up MRA showed reperfusion of the previously occluded subcalvian artery. To the authors’ knowledge vasculitis complicating the course of ulcerative colitis is a rare association and is only sporadically reported in the literature. This rare entity should be diagnosed early and aggressively treated; MRA is a very promising diagnostic tool that is suitable for both diagnosis and follow‐up of patients with this rare entity.

Yasser EMAD

Yasser RAGAB

Ahmed EL‐MARAKBI

Salama MOHAMED HANFI

Long‐standing ulcerative colitis complicated by right subclavian artery occlusion and upper limbs arteriolitis with digital ischemia

长期溃疡性结肠炎并发右锁骨下动脉闭塞及上肢小动脉炎伴指端缺血

Abstract Multicentric reticulohistiocytosis (MRH) is a rare disease characterized by erosive polyarthritis and nodular skin lesions which is associated with malignancy in some cases. We describe a 44‐year‐old woman with polyarthralgia, numerous skin nodules, mucosal lesions and elevated erythrocyte sedimentation rate who was admitted to hospital for further evaluation. Tissue biopsy of skin nodules showed large histiocytes with ground‐glass eosinophilic cytoplasm, typical of MRH. Clinical manifestation and radiological pattern of MRH may be misdiagnosed as other diseases like rheumatoid arthritis, psoriatic arthritis and nodal osteoarthritis, but histopathology the characteristic pattern can differentiate MRH from any other condition.

Mohammad Bagher OWLIA

Golbarg MEHRPOOR

Hossein SOLEIMANI

Multicentric reticulohistiocytosis

多中心网状组织细胞增多症

Abstract Aim: To determine the diagnostic utility of qualitative nailfold capillaroscopy (NC) in a clinical setting. Methods: One hundred and sixty‐seven patients, generally with Raynaud's phenomena of uncertain significance, were referred to an experienced operator for NC. NC was performed using low power wide field microscopy. Nailfold capillary arcades, number, calibre and presence of microbleeds were assessed on the third fourth and fifth nailfolds in each patient. Patients’ final diagnoses were determined by case note review following a mean of 6.6 years post‐initial NC. Results: Nailfold capillaroscopy was considered abnormal in 86/167 patients (51%), suspicious in eight, technically unsatisfactory in two and normal in the remainder. In those 86 patients with abnormal findings the follow‐up diagnosis revealed scleroderma in 79, dermatomyositis in four and antisynthetase myositis in three. Three patients with suspicious findings also developed scleroderma. Of those 71 patients with initial normal NC only four were found to have developed scleroderma at follow‐up. For a diagnosis of scleroderma NC demonstrated a sensitivity of 95%, a specificity of 91%, a positive predictive value of 92% and a negative predictive value of 94%. Nailfold capillary microbleeds were also frequently observed in patients with scleroderma, but were less specific than capillary morphological changes. Conclusion: Qualitative NC performed by an experienced operator is considered to have high diagnostic utility in the early assessment of patients with Raynaud's phenomena, and when abnormal, is highly suggestive of scleroderma, dermatomyositis or antisynthetase myositis.

P. J. ROBERTS‐THOMSON

S. R. COX

J. G. WALKER

M. DUGAR

M. J. AHERN

M. D. SMITH

Diagnostic utility of nailfold capillaroscopy

甲襞毛细血管镜的诊断价值

Abstract Numerous features distinguish psoriatic arthritis (PsA) from other arthropathies, including the presence of psoriasis, distal interphalangeal (DIP) joint involvement, nail dystrophy, enthesitis, dactylitis and spinal involvement. Two decades ago, the presence of psoriasis was mandatory in the diagnosis of PsA. Up to 15% of patients had joint disease preceding psoriasis. In this group of patients, it may have been years after the onset of arthritis before the definitive diagnosis of PsA could be made. With advancements in treatment modalities, an accurate and proper diagnosis is relevant to the management of PsA. In their case report appearing in this issue, Taniguchi and Kamatani present a case with classical PsA without skin and nail lesions for 21 years. It may not be that unusual to encounter this in clinical practice, but we think it an opportune time to review the classification criteria and illustrate how the diagnosis of PsA can be made earlier.

Y. Y. Leung

K. K. T. Lim

Apsoriatic psoriatic arthritis

银屑病性银屑病关节炎

Abstract Ultrasonography is a useful imaging modality for the diagnosis of pathologic conditions in the biceps tendon. We describe a 64‐year old man with rheumatoid arthritis (RA) who suddenly developed a painless lump in the antecubital region of the right arm. The bulging was prominent when he flexed his forearm. Proximal loss of the long head in biceps tendon could be demonstrated by ultrasonography. The ultrasonographic features of spontaneous isolated biceps tendon rupture occurring in a patient with RA are described.

Hyun‐Sook KIM

Ji Hyeon JU

Chong‐Hyeon YOON

Sung‐Hwan PARK

Ho‐Youn KIM

Ultrasonographic detection of spontaneous rupture in the Biceps tendon of a patient with rheumatoid arthritis

超声检测类风湿性关节炎患者肱二头肌腱自发破裂

Publication Information	Publisher: Wiley-Blackwell Publishing Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2004，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

APLAR Journal of Rheumatology

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