Transient Polyarthritis Research Articles

Recurrent Postpartum Episodic Rheumatoid Arthritis

It is well known that rheumatoid arthritis improves in the majority of patients during pregnancy and that aggravation of disease symptoms occurs within the first 6 months postpartum. We report a female patient who had 4 postpartum episodes of transient polyarthritis typical of rheumatoid arthritis with positive serum rheumatoid factor and anti-CCP antibodies. All bouts resolved within 4 to 10 weeks after onset without any symptoms in between the episodes.

Isolated renal sarcoidosis: a rare presentation of a rare disease treated with infliximab

Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous reaction frequently involving the lymph nodes, lungs, liver, skin, and eyes. Acute renal failure (ARF) as an isolated manifestation of sarcoidosis is rare. We describe a case of sarcoidosis presenting as transient polyarthritis and ARF due to isolated granulomatous infiltration of the renal parenchyma. Renal biopsy showed granulomatous interstitial nephritis with noncaseating granulomas consistent with sarcoidosis. Bacterial, fungal, and mycobacterial infections were excluded. There was no evidence of extrarenal sarcoid involvement. Prednisone of 60 mg daily resulted in significant improvement in renal function. Because of recurrent flares on steroid taper and steroid toxicity, treatment with infliximab, an anti-tumor necrosis factor-alpha (TNF-alpha) antibody, was instituted and resulted in stabilization of renal function despite steroid taper. Although uncommon, renal sarcoidosis should be considered in the differential diagnosis of acute or chronic renal failure of uncertain etiology, as early diagnosis and treatment can lead to recovery of renal function and prevent interstitial fibrosis. Corticosteroids are mainstay of therapy. Steroid-dependent or refractory cases may respond to other immunosuppressants including anti-TNF-alpha agents.

関節破壊を伴ったサルコイドーシス症例の検討

We present four cases of sarcoidosis with destructive arthropathy. Acute transient polyarthritis, chronic arthritis and tenosynovitis may occur in patients with sarcoidosis, however, such bone changes are relatively rare. Plain roentgenograms of the four cases exhibited osteolytic or sclerotic appearance in some joints except for the operated joint. One case showed positive correlation between laboratory data (CRP/ESR) and actual disease activity, while the other three cases did not. Histopathologic specimens showed chronic synovitis, lymphocyte aggregates, synovial hypertrophy, hyperplasia, and accumulations of fibrin-like material. None of the four cases exhibited non-caseating epitheloid granuloma. It is known that sarcoidosis may be accompanied with symptoms of autoimmune diseases in some cases. Some unknown factor may play an important role in systemic osteoarthritis in sarcoidosis.

Primo-infection à parvovirus B19 chez l'adulte immunocompétent: variété d'expression clinique et biologique. Étude rétrospective de 16 patients

The spectrum of clinical and biological expressions of parvovirus B19 infection is incompletely described. We report 16 retrospective cases of primary parvovirus B19 infection that occurred in immunocompetent adults and were diagnosed by serology. Most cases conformed to the classical descriptions of parvovirus-induced arthropathy (transient polyarthritis often accompanied by erythema, dysesthesia and pruritus). However, the diagnosis of primary parvovirus B19 infection should also be considered in other clinical and biological situations such as edema, acute anemia or cytopenia, vascular purpura, neuro-ophthalmologic manifestations, and hepatitis. Parvovirus infection may mimic diseases such as lupus erythematosus or systemic necrotizing vasculitis. The risk for confusion with both diseases is increased, as immunological abnormalities such as hypocomplementemia, when they are systematically searched for, prove to be common.

Arthritis associated with lithium toxicity

A 33-year-old man developed transient polyarthritis associated with lithium toxicity. The arthritic symptoms resolved after lithium was discontinued. A link between lithium, autoimmune mechanisms, and arthritis is postulated.

Musculoskeletal disorders in patients with hyperlipidaemia.

We have assessed the nature and significance of musculoskeletal disorders in 166 patients with the commonly encountered forms of hyperlipidaemia attending a lipid clinic. The incidence of musculoskeletal disorders was determined by questionnaire to the patients, inquiries to general practitioners, and a review of hospital records. To ensure the sensitivity of these methods a series of negatively responding cases were seen and examined; none had identifiable musculoskeletal disease. Eight males with type IV hyperlipidaemia had recurrent acute attacks of gout. The only other musculoskeletal disorder possibly attributable to an association with hyperlipidaemia was a transient polyarthritis in 3 patients. This was inflammatory, recurrent, but nondeforming, and involved the small joints of the hand. It did not require any specific therapy or lead to disability. We suggest that, while we have confirmed the association of type IV hyperlipidaemia and gout, there is little evidence for clinically significant arthritis being associated with other commonly presenting forms of hyperlipidaemia, although we accept that the rarely met homozygous familial hypercholesterolaemia may also be complicated by a crystal arthropathy due to the presence of crystalline cholesterol in joints.

Role of thymus for N-acetyl muramyl-L-alanyl-D-isoglutamine-induced polyarthritis and granuloma formation in euthymic and athymic nude rats or in neonatally thymectomized rats.

A synthetic adjuvant, N-acetyl muramyl-L-alanyl-D-isoglutamine (MDP), produced extremely severe polyarthritis with almost 100% incidence in Rowett euthymic rnu/+ rats, but the same dose of MDP (100 microgram) did not produce the disease in athymic rnu/rnu rats. Five hundred micrograms of MDP or 0.2 mg of heat-killed Mycobacterium bovis BCG, however, produced mild and transient polyarthritis in nude rats with very low incidence. We have not yet succeeded in reconstituting the disease susceptibility of nude rats by using thymus cells from normal rnu/+ rats. After intradermal inoculation of 100 microgram of MDP, nude rats developed small granulomas with a little necrosis and very few multinucleated giant cells only in the regional lymph nodes, whereas, in addition to the development of polyarthritis, euthymic rnu/+ rats developed typical granuloma with massive necrosis accompanied by numerous polymorphonuclear leukocytes and sparse multinucleated giant cells in the regional lymph nodes. Thymus cell-reconstituted rnu/rnu rats developed granuloma with sparse giant cells, relatively large areas of necrosis, and many polymorphonuclear leukocytes. Neonatal thymectomy may depress adjuvant-induced arthritis in the high-responder Lewis rats and enhance the disease development in the low-responder F344 rats. These findings suggested that (i) thymus plays an important role in promoting the development of MDP-induced arthritis; (ii) MDP-induced granuloma formation does not require thymus functions; (iii) the thymus functions may however be involved in the development of massive necrosis surrounded by considerable polymorphonuclear leukocyte infiltration, the mechanisms of which remain to be determined; and (iv) there is no direct correlation between granuloma formation and development of adjuvant arthritis.

Polyarthritis, polyarteritis and hepatitis B.

An association between viral hepatitis and two rheumatic disease syndromes has been observed. Twenty-nine patients manifested a transient polyarthritis, sometimes associated with a rash (Group I). Ten patients were seen with a multisystem disease (Group II). Histologic evidence of arteritis or glomerulonephritis was present in seven of ten patients with multisystem disease. Liver tissue from 18 patients showed morphologic evidence of hepatitis with viral features in 9 of 10 patients in Group I and in 6 of 8 patients in Group II. Hepatitis B surface antigen (HBsAg) and/or antibody to HBsAg were detected in sera of all 39 patients. Abnormal liver functions were present in 36. Twelve Group I patients and 2 Group II patients became jaundiced. Rheumatoid factor was present in sera of seven patients in each group. The third component of complement (C3) was depressed in 13 patients in Group I and 7 patients in Group II. The fourth component of complement (C4) was decreased in 8 of 21 Group I and 3 of 7 Group II patients. Synovial fluid C3 was decreased in 2 of 11 Group I and 1 of 4 Group II patient's fluids. Articular inflammation in patients with transient polyarthritis responded in three to seven days to aspirin, acetominophen and/or bedrest alone and rashes disappeared spontaneously. Patients with multisystem disease generally had a prolonged illness and responded somewhat unpredictably to prednisone or a combination of prednisone and cyclophosphamide.

Childhood sarcoidosis involving joints and kidneys.

So uncommon are some diseases and atypical their manifestations that failure to appreciate them and recognize their importance may lead to unduly prolonged studies, unnecessary treatment, or irreversible damage. Sarcoidosis is such a disease. Sarcoidosis, a nonspecific syndrome characterized by presence, in any organ or tissue, of epithelioid cells and tubercles with inconspicuous necrosis or without necrosis, and by a chronic course, is uncommon among children. Though there are over 200 cases reported in patients under 15 years of age, this number is only a small proportion of the number of cases in adults. 1-8 Patients with childhood sarcoidosis frequently have clinical features that are different from those seen in adults. 8,9 Even though transient polyarthritis has been reported in from 6% to 25% of adult patients, 7,9-12 it occurs only rarely in children. North and co-workers 17,18 compiled four such cases from the literature 13-16 and added six