1,720,981 research outputs found
Hypokalemic alkalosis, acquired Gitelman's and Bartter's syndrome in chronic sialoadenitis
No full textModifiable and Non-Modifiable Risk Factors and Vascular Damage Progression in Type 2 Diabetes: A Primary Care Analysis
Full text linkBackground/Objectives: Type 2 diabetes mellitus (DM2) is characterized by the development of micro/macro-vascular complications over time. Factors influencing their course may present specific features in the primary care context. This study aims to identify predictive factors for the evolution of micro/macro-vascular pathology in DM2 patients and evaluate interventions implemented by general practitioners (GPs) in this context. Methods: From the medical records of 1169 DM2 patients from 13 Italian GPs, demographic, socio-environmental, and clinical data were recorded, along with the presence and degree of arterial hypertension and components of diabetic micro/macroangiopathy at the time of study entry and 5 years prior. Laboratory parameters and therapies from the last three years were recorded. Results: Compared to 5 years prior, at the study entry, the number of patients presenting at least one micro- or macro-vascular complication increased from 192 (16.4%) to 344 (29.4%) and from 245 (21.0%) to 350 (29.9%). At the logistic regression, microalbuminuria determination appeared to be the strongest predictor of vascular damage progression, followed by decreasing LDL cholesterol values induced by lipid-lowering therapy. Male gender, age >75 years, and smoking history were associated with greater vascular damage progression in the ANOVA repeated measures test. Conclusions: Advanced age, male gender, and smoking history proved strongly associated with the presence and extent of damage progression. GPs appear to adopt a more aggressive approach in treating risk factors (particularly lipid profile) for damage progression in these patients. Microalbuminuria has proven to be by far the marker most strongly associated with vascular damage progression
B cell driving cytokines in eraly rheumatoid arthritis. Assessment of possibile clonal expansions during treatment with cyclosporin A. Arthritis and Rheumatism 1996; 39 (Suppl.): S26.
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Methotrexate in polymyalgia rheumatica: preliminary results of an open, randomized study
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Autoimmune connective tissue disease, chronic polyarthritides and B cell expansion: risks and perspectives with immunosuppressive drugs.
No full textSeveral autoimmune diseases, including Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are characterized by B cell hyperactivity, polyclonal activation, and autoantibody synthesis. Overt B cell clonal expansion occurs in a minority of the patients, while at the tissue level clonotypic B cells may be more easily detected in the majority of patients. The data available suggests that antigen-driven B cell expansion, eventually leading to somatic mutation and transformation, is the main event. Immunosuppressive drugs known to increase chromosomal damage and to lead to earlier transformation should therefore be avoided, unless strictly necessary to preserve vital organ functioning. New immunosuppressive drugs such as methotrexate, cyclosporine A, and Rapamycin are promising for they seem to offer effective control of disease-related organ damage with acceptable side effects. The B cell lymphoproliferative diseases occurring under treatment seem to remit spontaneously after prompt drug withdrawal. Close surveillance, employing new techniques capable of detecting early B or T cell clonal expansion, may allow better monitoring of possible complications. Biological agents such as alpha-interferon and monoclonal antibodies (which are directed against specific immunological mediators and thus target-selected steps of the immune-inflammatory process) have opened promising new research topics in all these diseases
Methotrexate in polymyalgia rheumatica: preliminary results of an open, randomized study.
No full textOBJECTIVE: Steroids are the only treatment of polymyalgia rheumatica (PMR). We report the effects of methotrexate (MTX) plus prednisone versus prednisone alone in PMR.
METHODS: Twenty-four patients with recent onset PMR were studied in a randomized prospective study lasting one year. Patients were given MTX (MTX arm) 10 mg intramuscularly plus prednisone every week, or prednisone alone (Pred arm). After 6 months an attempt was made to stop prednisone, and to use the lowest possible dose over the next 6 months.
RESULTS: At the 12th month, all patients were in clinical remission, acute phase reactants were in the normal range in both arms of the study, 6 patients were no longer taking steroids in the MTX arm versus 0/12 in the Pred arm, and the amount of prednisone in the 2 groups was statistically different (1.84 versus 3.2 g; p < 0.0001). In addition, bone mineral density was significantly decreased in the Pred arm, but not in the MTX arm.
CONCLUSION: The MTX regimen allowed the use of much less prednisone over one year to obtain full control of PMR with no loss of efficacy. It also allowed sparing of bone in elderly patients at increased risk of osteoporotic fractures
Circulating levels of interleukin 10 and other cytokines in rheumatoid arthritis treated with cyclosporin A or combination therapy.
No full textOBJECTIVE: To assess longitudinally over a 12 month period circulating serum levels of interleukin 10 (IL-10) and cytokines IL-3, IL-4, IL-6, and IL-12 in a cohort of patients with early onset rheumatoid arthritis (RA) treated with either cyclosporin A (CyA) or with combination therapy of CyA plus hydroxychloroquine as disease modifying antirheumatic drugs.
METHODS: We studied 8 patients receiving CyA and 12 patients receiving CyA plus hydroxychloroquine. IL-3, IL-4, IL-6, IL-10, and IL-12 were determined by ELISA at entry, after 2 weeks, after one month, after 6 months, and after 12 months. Rheumatoid factor levels and the possible appearance of monoclonal gammopathies over time were studied by immunofixation and immunoblotting techniques.
RESULTS: The pooled data show that at entry only the median baseline levels of IL-10 (3.9 vs 1.6 pg/ml; p < 0.01) and IL-6 (16.9 vs 1.4 pg/ml, p < 0.001) were higher in patients than in controls. IL-4 was not detectable. Some patients at entry (those with the longest disease duration) had detectable levels of IL-3. Only levels of IL-10 decreased significantly between entry and final values, in monotherapy and combination therapy as well. A single transient monoclonal band was observed after 6 months of treatment, which disappeared afterwards. No difference was seen in any of the cytokines between the CyA and the CyA plus hydroxychloroquine treated patients.
CONCLUSION: During treatment with either CyA or CyA plus hydroxychloroquine, IL-10 levels decreased significantly. No additive effect of the 2 drugs was detected
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