Symptoms Of Arthralgia Research Articles

Arthralgia, AI induced side events: incidence, feature and consequences

After a decade of endocrine adjuvant treatment with AI (Aromatase inhibitors), it is documented that they are somewhat superior to tamoxifen, in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia (pain in one or more joints), has been observed during AI treatment, symptoms more important and problematic than anticipated. The potential mechanisms behind AI-induced arthralgia are not well understood, even if estrogen withdrawal may probably play a role. The frequency is not well-established within the population and clinical predictors of these related arthralgia remain unclear, but this adverse event may result in poor adherence to treatment; interventions to ameliorate are often not efficient and at least, patients and physicians can be dissuading from completing the full AI treatment. Patient educations about some management of arthralgia symptoms can helping patients adhere to AI treatment and improve breast cancer outcomes. For some authors, the occurrence of joint or vasomotor symptoms might be a predictor of treatment effectiveness and might be useful when reassuring patients who present with them, but nevertheless in reality, this opinion is insufficient to avoid adherence. The association between emergent musculoskeletal symptoms and improved outcomes have not been described as consistent in most of experiences.

Health check-ups and family screening allow detection of hereditary hemochromatosis with less advanced liver fibrosis and survival comparable with the general population

Objective. The information concerning the morbidity and mortality of hereditary hemochromatosis is based primarily on clinical cohorts of symptomatic patients. The major aim of this study was to analyze the long-term prognosis for Swedish patients with this condition, with respect to both clinical features and survival, in relation to the route by which the disease was detected. Patients and methods. 373 patients with hemochromatosis detected through routine health check-ups (n = 153), family screening (n = 44), symptoms of arthralgia (n = 23), investigation of other diseases/symptoms (n = 108) or signs of liver disease (n = 45) were monitored for a mean period of 11.9 ± 5.8 years. The degree of liver fibrosis and survival were analyzed. Results. Overall survival among these patients was not significantly different from that of a matched normal population. The patients diagnosed through health check-ups and family screening were detected at an earlier age and had the highest rate of survival. Liver biopsy at the time of diagnosis revealed cirrhosis in 9% of those detected through the health check-ups and 5% in the case of family screening, compared with 13% for the group with arthralgia, 17% for other diseases/symptoms and 42% for liver disease. Conclusion. Health check-ups and family screening allow detection of hereditary hemochromatosis at an earlier age and with less advanced liver fibrosis, although a few of these patients have already developed cirrhosis. Our study indicates that iron indices should be included in health check-ups, and if abnormal, should lead to further investigation.

Krank oder krank gemacht? Rezidivierende Episoden kutaner Ulzera, Aphten, Kolitis, Arthralgien, Haarausfall... eine systemische Erkrankung oder iatrogen?

Recurrent episodes of cutaneous and subcutaneous ulcers, especially in the oral cavity, represent a high psychological and painful burden for the patient. If there in addition are symptoms of arthralgia and/or colitis, an autoimmune disease with vasculitis, particularly a Morbus Behçet has to be considered as a possible differential diagnosis. The therapy therefore would be an immunosuppressive one. Also a wide immunologic diagnostic process has to be started. Furthermore, a chronic inflammatory bowel disease has to be excluded by colonoscopic biopsy. An infectious etiology of the symptoms (viral/bacterial/parasitic) should be investigated by microbiological and laboratory tests. A thrush or a herpes-infection caused by immunosuppression (toxic or due to illness) has to be considered as a further differential diagnosis. Also a precise medical and drug history is very important because of possible toxic adverse effects. Until confirmation of a final diagnosis, only a symptomatic analgetic or antifungal or antiviral therapy in case of a positive thrush or herpes culture respectively should be initiated with respect to the very different kinds of treatment of the diseases included in the differential diagnosis.

Management of arthralgias associated with aromatase inhibitor therapy.

For the upfront adjuvant therapy of postmenopausal estrogen receptor-positive breast cancer, the third-generation aromatase inhibitors (AIS) have shown a more favourable overall risk-benefit profile than has tamoxifen. Benefits of the ais include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence. Although approximately 25% of postmenopausal women with early breast cancer report experiencing symptoms of arthralgia with ai therapy, 68-month data from the Arimidex, Tamoxifen, Alone or in Combination trial showed that, compared with tamoxifen, anastrozole treatment was associated with only a modest increase in the incidence of joint symptoms. The events, which were mostly mild-to-moderate in intensity, led to treatment withdrawal in 2% of patients on anastrozole as compared with 1% in the tamoxifen arm. The symptoms and changes correlate with clinical, biochemical, and radiologic findings in symptomatic women. To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects. The present review explores the advantages of differential diagnosis with an emphasis on history and physical and musculoskeletal examination; laboratory investigations are used to corroborate or rule out clinical impressions. The transient symptoms associated with the ais are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.

Anti-Jo-1 Syndrome presenting as cryptogenic organizing pneumonia

A 50-year-old Chinese lady presented with subacute onset of dyspnoea, bilateral infiltrates on chest X-ray and type I respiratory failure. There were minor symptoms of arthralgia and myalgia. Subsequent investigations confirmed that she had organizing pneumonia, polymyositis and serum anti-Jo-1 antibody. Treatment with corticosteroids resulted in prompt improvement of the respiratory condition and myositis.

Ｓｅｃｏｎｄａｒｙ Ａｍｙｌｏｉｄｏｓｉｓを合併した重症慢性関節リウマチ患者に対するＣｒｙｏｆｉｌｔｒａｔｉｏｎの効果について

Cryofiltration was applied to two severe RA patients with secondary amyloidosis, who had been treated with conventional steroids or analgesics administration in vain, in order to remove pathogenic substances such as immune complex and other abnormal proteins. Continuous cryofiltration with double filtration was performed by using the apparatus of Asahi Plasauto 1000 (Asahi medical, Tokyo, Japan) in extra-corporeal circulation with AP-05H (Asahi medical, Tokyo, Japan) as the first plasma separator and AC-1730 (Asahi medical, Tokyo, Japan) as the second macromolecule filter. One processed plasma volume by cryofiltration was about 4000ml at the averaged plasma flow rate of 30ml per minute and separated plasma after the first separator was led to cooling chamber at 4°C and then filtered at the second filter. Cryogel was eluted by saline and analysed immunochemically. After 4 processes of cryofiltration performed at 5 day interval, clinical symptoms of arthralgia, restriction of joint movement, joint swelling and morning stiffness were fairly relieved. Cryogel precipitated at 4°C in the second filter was analysed by gel and ion exchange chromatography. Cryogel was fractioned into very low molecule protein (MW 20-30K), albumin, IgG and high molecule protein designated as X-RF (MW ca. 800K). Molecular weight of X-RF is similar to that of IgM but X-RF was turned out to possess a different property from IgM by ion exchange chromatography. X-RF is regarded as main pathogenic substance and could be reduced from serum by repeated process of cryofiltration. And moreover, low molecule protein is conceived to be compatible to amyloid protein which was shown in the sera of amyloidosis patients by same chromatography method. This low molecule protein could be also reduced like X-RF by cryofiltration.We could conclude that cryofiltration was fairly effective method to remove the pathogenic substance from RA patients and could relieve clinical symptoms.

MECHANISMS INVOLVED IN HYPOCOMPLEMENTEMIA IN HB HEPATITIS OF CHILDREN

Depressed complement & complement component levels are frequently observed in patients with HB hepatitis associated with prodomal symptoms of arthralgia, arthritis or urticarial skin rash. In these cases, hypocomplementemia may be related to low synthesis or consumption by pathogenetic complexes. To better understand the mechanims involved, we studied C & C components in various types of childhood liver diseases:epidemic hepatitis, HB positive hepatitis, chronic active hepatitis, fulminant hepatitis of toxic or viral origin, Wilson's disease & cirrhosis associated with ∝ 1 antitrypsin deficiency. Total C, C components & C1q, C1 INH & immune adherence were measured-The C profile was found unremarkable in most patients with epidemic hepatitis. Reduced C component levels, especially C3, was found in patients with chronic active hepatitis. In HB+ fulminant hepatitis, C components were extremely low: total hemolytic activity was severely depressed; Cl, C4, C2, C3 were two standard deviations below the normal. C3 mediated immune adherence was markedly reduced. These findings suggest that immune complexes may be involved in the pathogenesis of this disease. Results will be discussed, (sup. INSERM ATP 5).

Diffuse interstitial fibrosis of the lung.

Diffuse interstitial fibrosis of the lung remains a perplexing problem for both pathologist and clinician. In this study of 16 cases the microscopic findings have been divided into three phases: I, early (acute); II, intermediate (subacute); and III, late (chronic). No single etiologic factor can be incriminated in all cases. Morphologic features of the late (chronic) phase as seen in “idiopathic diffuse pulmonary fibrosis” are identical to those observed in the late phase of pulmonary fibrosis seen in the collagen diseases. “Honey-combing” was present in all cases; cor pulmonale was present in ten. Collagen diseases were present in three patients and two others had rheumatoid symptoms of arthralgia. Radiologically, diffuse reticular and fibronodular infiltrates most prominent in the lower lobes of the lungs were constant findings. Pulmonary function studies demonstrated restrictive pulmonary disease and hypoxia at rest, becoming more severe after exercise.

The pathogenesis of arthritis associated with viral hepatitis. Complement-component studies.

Abstract Eighteen patients with acute viral hepatitis had initial symptoms of arthralgia, arthritis or urticaria. Total serum hemolytic complement (CH50) and C4 tended to be severely depressed in the nine patients studied in the acute phase of their joint symptoms. The C3 levels were moderately depressed, and the C1q levels were widely variable. C1 inhibitor and C9 serum concentrations were normal. Patients with viral hepatitis in convalescence or remission from arthritis, or without a history of these symptoms, had a normal or elevated serum CH50 and C3 level, a widely variable C1q level and low normal C4 levels. Low serum levels of complement in viral hepatitis were associated with high titers of hepatitis-associated antigen. Five patients with acute nonviral hepatitis had normal or elevated serum complement levels. The correlation of joint and skin symptoms with hepatitis-associated antigen and depressed levels of complement activity in the acute state suggests that this serum-sickness-like syndrome ma...