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Clinical pattern of pain in rheumatoid arthritis
No full textClinical pattern of pain in rheumatoid arthritis.
La Montagna G, Tirri R, Baruffo A, Preti B, Viaggi S.
Source
Insitute of Clinical Medicine, Faculty of Medicine, 2nd University of Naples, Italy.
Abstract
OBJECTIVE:
To evaluate whether rheumatoid arthritis (RA) is associated with a characteristic clinical pattern of pain which may be useful as a criterion to differentiate RA from other rheumatic diseases.
METHODS:
2300 patients from the ReumaLink data bank project with definite rheumatic diseases were studied. Of these 907 patients (39.5%) fulfilled the ARA/ACR revised criteria for RA, while 1393 had rheumatic diseases other than RA. The following diagnostic attributes of pain were considered: localization, symmetry, continuity, modulation, relationship with time and with loads/movements, tenderness.
RESULTS:
After a descriptive analysis, some pain characteristics were selected individually and others were combined. Only 8 variables were considered for a predictive analysis. Univariate analysis showed that symmetric pain is the most potent discriminating item, with 82.2% sensitivity, 69.2% specificity, a 61% positive predictive value and a 83.3% negative predictive value. A higher probability of RA was present in patients with symmetric pain than in those with asymmetric pain (odds ratio = 7.8). A multivariate analysis performed on 1627 patients showed that a specific clinical pattern of pain (symmetrical pain, pain following joint pressure, mainly present at night or in the morning, continuous) could predict RA patients with a 68.9% likelihood. The lack of these symptoms excluded RA with 92% probability.
CONCLUSION:
The clinical pattern of pain defined by us can predict RA with a 70% probability. This value reaches 86% when the variables "pain in a fixed joint" and "pain decreased by load/movements" are added. These results indicate that determining the clinical pattern of pain is a useful screening tool for suspected RA, in particular early in the disease cours
Effetti dell’H2S sul contenuto di elementi in tracce nel lichene epifita Parmelia sulcata
No full textFalse positivity of prenatal Down's syndrome and neural-tube tests in SLE
No full textFalse positivity of prenatal
Down’s syndrome and
neural-tube tests in SLE
Sir—Combination of maternal age plus
three biochemical markers, maternal
serum fetoprotein (AFP), human
chorionic gonadotropin and
unconjugated oestriol (uE3), is thought
an effective screening protocol for the
antenatal detection of fetal Down’s
syndrome.1 Sensitivity is 60% and falsepositive
rate 5%, at a risk level of one in
250 livebirths or more.
Separately, AFP testing is used for
detection of neural-tube defects. Some
work has shown that AFP increase, in
addition to cancer, liver diseases, acute
bleeding anaemia, renal agenesis,
multiple gestation, and fetal demise,2
can be associated also with rheumatoid
arthritis,3 systemic lupus erythematosus
(SLE) with and without pregnancy, and
other connective-tissue diseases such as
underlying placental pathology and fetal
damage,4,5 or as an effect of the disease
itself. Abnormal maternal serum AFP
concentrations with no increase in
neural-tube or other birth defects have
been associated with higher prednisone
dose, preterm delivery, and antibodies
to cardiolipin (aCL).4
We have found an increased risk for
Down’s syndrome (one per 255)
detected by the Wald and colleagues’
screening protocol,1 and of fetal neuraltube
defects (one per 897), in a
primipara SLE patient aged 28 years on
low-dose steroids during pregnancy.
Multiple of median for unaffected pregnancies
of the same gestational age was
1·71 for AFP, 4·14 for human chorionic
gonadotropin, and 0·43 for uE3,
respectively. By contrast, normal
amniocentesis without chromosome abnormalities,
normal ultrasound fetal
biometric indices during pregnancy, and
healthy babies born at week 40 was
seen.
Patients, obstetricians, and, overall,
physicians must be aware of dual false
positivity in SLE pregnancy for Down’s
syndrome and neural-tube defects.
*Giovanni La Montagna,
Antonietta Baruffo, Giovanni Buono,
Rosella Tirri
Divsione di Reumatologia, Seconda Università
degli Studi di Napoli, via Pansini 5,
80131 Napoli, Italy
1 Wald NJ, Cuckle HS, Densem JW, et al.
Maternal serum screening for Down’s
syndrome in early pregnancy. BMJ 1988;
297: 883–87.
2 Thomas RL, Blakemore KJ. Evaluation of
elevation in maternal serum alpha
fetoprotein: a review. Obstet Gynecol Surv
1990; 45: 269–83.
3 Andrews LG, Souma JA. Elevated serum
alpha-fetoprotein in a pregnant woman wit
ESCREZIONE URINARIA DI PIRIDINOLINE IN PAZIENTI DI SCLEROSI SISTEMICA E LUPUS ERITEMATOSO SISTEMICO
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Assessment of pituitary gonadotropin release to gonadotropin releasing hormone/thyroid-stimulating hormone stimulation in women with systemic sclerosis
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