结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

A review of radiographic evaluation of rheumatoid arthritis is given. Standard reference films are introduced for evaluation of rheumatoid arthritis and related conditions in the extremity joints. In this system, numerical evaluation of arthritis is given for individual joints in a patient.

Radiographic Evaluation of Rheumatoid Arthritis and Related Conditions by Standard Reference Films

Background Etanercept, which blocks the action of tumor necrosis factor, reduces disease activity in patients with long-standing rheumatoid arthritis. Its efficacy in reducing disease activity and preventing joint damage in patients with active early rheumatoid arthritis is unknown. Methods We treated 632 patients with early rheumatoid arthritis with either twice-weekly subcutaneous etanercept (10 or 25 mg) or weekly oral methotrexate (mean, 19 mg per week) for 12 months. Clinical response was defined as the percent improvement in disease activity according to the criteria of the American College of Rheumatology. Bone erosion and joint-space narrowing were measured radiographically and scored with use of the Sharp scale. On this scale, an increase of 1 point represents one new erosion or minimal narrowing. Results As compared with patients who received methotrexate, patients who received the 25-mg dose of etanercept had a more rapid rate of improvement, with significantly more patients having 20 percent, ...

A Comparison of Etanercept and Methotrexate in Patients with Early Rheumatoid Arthritis

Objective Remission in rheumatoid arthritis (RA) is an increasingly attainable goal, but there is no widely used defi nition of remission that is stringent but achievable and could be applied uniformly as an outcome measure in clinical trials. This work was undertaken to develop such a defi nition. Methods A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism, and the Outcome Measures in Rheumatology Initiative met to guide the process and review prespecifi ed analyses from RA clinical trials. The committee requested a stringent defi nition (little, if any, active disease) and decided to use core set measures including, as a minimum, joint counts and levels of an acute-phase reactant to defi ne remission. Members were surveyed to select the level of each core set measure that would be consistent with remission. Candidate defi nitions of remission were tested, including those that constituted a number of individual measures of remission (Boolean approach) as well as defi nitions using disease activity indexes. To select a defi nition of remission, trial data were analysed to examine the added contribution of patient-reported outcomes and the ability of candidate measures to predict later good radiographic and functional outcomes. Results Survey results for the defi nition of remission suggested indexes at published thresholds and a count of core set measures, with each measure scored as 1 or less (eg, tender and swollen joint counts, C reactive protein (CRP) level, and global assessments on a 0–10 scale). Analyses suggested the need to include a patientreported measure. Examination of 2-year follow-up data suggested that many candidate defi nitions performed comparably in terms of predicting later good radiographic and functional outcomes, although 28-joint Disease Activity Score–based measures of remission did not

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American College of Rheumatology/European League Against Rheumatism Provisional Definition of Remission in Rheumatoid Arthritis for Clinical Trials

Guidelines for the management of rheumatoid arthritis: 2002 Update

Methods of scoring osseous defects and joint space narrowing in the hands and wrists of patients with definite or classical rheumatoid arthritis were devised. The usefulness of the scores was tested in a group of 90 patients who had one or more sets of X-ray films of the hands and wrists 36 months or more after onset of illness. Correlations were found between the extent of radiographic abnormalities or the rate of progression of radiographic changes and the age at onset, hand and wrist deformities, preceding physical signs of inflammation in the joints of the hands and wrists, hand function as measured by fist formation, the early appearance of subcutaneous nodules, and the titer of anti-IgG. Among black patients the extent of elevation of γ-globulins was associated with roentgenographic changes. The correlations between the scores of radiologic abnormalities and the clinical and laboratory manifestations of rheumatoid arthritis establish the value of the described methods of assessing the roentgenographic changes and indicate the usefulness of these methods in evaluating the effect of therapy in this disease.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780140605

Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities

WE have observed lymphocytotoxic antibodies in sera of patients with connective tissue disorders. The antibodies are cytotoxic to lymphocytes from unrelated random donors using the microcytotoxicity technique1,2. The initial studies were done on 161 coded stored sera submitted to the clinical laboratory for routine immuno-electrophoresis, and confirmatory studies were done on forty-seven coded sera selected from patients followed in the clinic for connective tissue disorders. Results of testing of both series of sera are summarized in Table 1 and show that 74 per cent of all sera tested from patients with systemic lupus erythematosus and 14 per cent of sera from patients with rheumatoid arthritis contained lymphocytotoxic reactivity. Appropriate controls indicated that the cytotoxic effect of lupus sera was dependent on complement; fractionation of one lupus serum by anion exchange chromatography indicated that the cytotoxic factor resides among the IgG globulins. Because cytotoxic antibodies are not present in sera of normal persons except in some cases of immunization by multiple transfusions3,4, pregnancy5,6 or organ transplantation7,8, the results suggest that lymphocytotoxic antibodies develop during the course of systemic lupus erythematosus.

Lymphocyte cytotoxic antibodies in systemic lupus erythematosus.

The presence of lymphocyte cytotoxic antibodies in sera from patients with SLE was related to the presence of fever and dermatologic, central nervous system and hematologic symptoms. Cytotoxic antibodies correlated inversely with the white blood count and serum complement C3. Possibly, the action of lymphocytotoxic antibodies on cell membranes may lead to complement-mediated cell injury which, in turn, results in release of intracellular contents and nuclear antigens.

Relationship of the clinical course of systemic lupus erythematosus to the presence of circulating lymphocytotoxic antibodies.

Gastroduodenal intolerance is one of the major factors limiting the use of aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) in patients with rheumatic diseases. We previously demonstrated that dyspepsia was not a marker for ulcer in NSAID users. We have now evaluated dyspeptic symptoms in 245 arthritic patients (receiving 13 different NSAIDs) from the practices of two rheumatologists. Fifty-seven patients (23%) gave a history of previous peptic ulcers. Heartburn, indigestion, or sour stomach at least once within the past year was present in 62.5%; 36.7% had experienced these symptoms within the previous 2 months and 28.6% within the previous week. Only 39 patients (15.9%) had experienced dyspepsia more than once daily within the previous month, and 8 (3.3%) had dyspepsia greater than 5 times/day. Thirty-four of the 39 patients with daily dyspepsia claimed to obtain relief with cimetidine or antacids (34 patients) or food (2 patients), whereas 3 had not discovered anything that provided relief. Women smokers were more likely than nonsmokers to experience dyspepsia (p less than 0.001). Neither men smokers nor those with a history of previous ulcer were more likely to have dyspepsia than nonsmokers or those without a history of ulcer (p greater than 0.5). We were not able to find a statistical association between any NSAID, or combination of NSAIDs, and the frequency of dyspepsia.

Dyspepsia in NSAID users: the size of the problem

Recurrent inflammation of cartilage in multiple sites is a hallmark of relapsing polychondritis (RP). Neurologic complications of this disease have begun to attract increasing attention, but the neuropathologic basis of these complications has not been described. We report a patient with RP whose autopsy showed extensive cerebral and systemic vasculitis.

Martin D. Lidsky

Papers

Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities

Lymphocyte cytotoxic antibodies in systemic lupus erythematosus.

Relationship of the clinical course of systemic lupus erythematosus to the presence of circulating lymphocytotoxic antibodies.

Dyspepsia in NSAID users: the size of the problem

Cerebral vasculitis in relapsing polychondritis