Deforming arthritis of the hands in polymyositis.

Arthritis of the hands with erosions, periosteal calcification, and interphalangeal thumb joint instability was seen in 6 patients with polymyositis. "Overlap" features such as Raynaud's phenomenon, positive LE clot test, and positive antinuclear antibody test were present, but clinically the primary disease was clearly polymyositis. This rather unusual constellation of roentgenographic findings strongly suggests the possibility of polymyositis.     

Deforming arthropathy of the hands in systemic lupus erythematosus

Forty-one of 858 patients with systemic lupus erythematosus (SLE) developed clinical deformity of their hands. This deformity was clinically and radiologically different from that found in 40 patients with classical or definite rheumatoid arthritis (RA), and tended to appear early in the course of disease. Characteristics of this arthropathy included nonerosive carpal collapse; exceptional erosion of the styloid processes; Z deformity of the thumb; nonerosive ulnar deviation and subluxation of MCP joints; parametacarpophalangeal joint hook formation; scant and asymmetric joint erosions; and swan neck deformity of the fingers. Most of these changes seemed to be due to involvement of the ligaments rather than to the destructive effect of synovitis. Patients with SLE with deforming arthropathy had a higher frequency of rheumatoid factor positivity, sicca symptoms and antibodies to native DNA, whereas they had lower incidence of facial rash and photosensitivity than did those without. Other manifestations did not differ. We propose that most patients with SLE with deforming arthropathy belong to a subset of SLE rather than representing the coexistence of SLE and RA.     

Deforming arthritis in systemic lupus erythematosus.

Of 45 patients in the McGill Lupus Registry 6 were found to have Jaccoud's deformities. One of these 6 and 4 others had fixed flexion contractures of the elbows. Those with Jaccoud's deformities were similar to the other patients with systemic lupus erythematosus in all respects except that those with Jaccoud's syndrome had had their disease and their arthritis significantly longer. It is concluded that Jaccoud's deformities are the result of longstanding arthritis and that elbow contractures occur via a different mechanism.     

Association of polymyositis with rheumatoid arthritis

The association of polymyositis (PM) and rheumatoid arthritis (RA) is described in a 40-year-old female Mexican patient who was studied for a long period of time. The characteristic changes of PM that preceded the onset of RA for 7 years included proximal symmetrical muscle weakness, increased creatine kinase activity, and distinctive electromyography and muscle biopsy results. The occurrence of RA during the final 4 years of the 11-year period was characterized by long-lasting deforming and symmetric polyarthritis, high positive rheumatoid factor, subcutaneous nodules, and erosive joint changes. Through observation, myopathic changes other than those from PM were excluded. Joint changes other than from RA were also ruled out. A review of the literature revealed few specific reports of the coexistence of both diseases.     

D-penicillamine-induced polymyositis in patients with rheumatoid arthritis

Among 329 patients with rheumatoid arthritis treated with D-penicillamine (DP), we found 4 cases of polymyositis. This incidence was significantly higher than the expected coincidence of rheumatoid arthritis and polymyositis/dermatomyositis or than the presumed frequency of this complication among patients treated with DP. In the present report, we summarize and discuss the clinical findings in DP-induced polymyositis/dermatomyositis in our patients and others described in the literature.     

Development of polymyositis after long-standing rheumatoid arthritis

Rheumatoid arthritis (RA) and polymyositis (PM) are distinct clinical syndromes. The concurrent diagnoses of RA and PM in the same patient are rare. We describe a patient who developed outright PM after 16 years of well established RA, review the literature, and highlight the need to consider a broad base of differentials including PM in the diagnosis of muscle weakness in RA.     

Leflunomide-induced polymyositis in a patient with rheumatoid arthritis

Although rheumatoid arthritis (RA) and myositis are major autoimmune diseases, co-occurrence of the two is rare. We treated a patient who developed polymyositis (PM) following the treatment of RA with leflunomide. Prednisolone (PSL) in combination with methotrexate (MTX) was effective in managing the PM, but the RA relapsed during the treatment. Based on the clinical course, we suspect that the PM was induced by the leflunomide treatment and suggest that clinicians should consider the possibility of this rare adverse event in cases of cholestyramine-resistant elevation of transaminases.     

Leflunomide-induced polymyositis in a patient with rheumatoid arthritis

Abstract

Although rheumatoid arthritis (RA) and myositis are major autoimmune diseases, co-occurrence of the two is rare. We treated a patient who developed polymyositis (PM) following the treatment of RA with leflunomide. Prednisolone (PSL) in combination with methotrexate (MTX) was effective in managing the PM, but the RA relapsed during the treatment. Based on the clinical course, we suspect that the PM was induced by the leflunomide treatment and suggest that clinicians should consider the possibility of this rare adverse event in cases of cholestyramine-resistant elevation of transaminases.     

Two cases of rheumatoid arthritis developed after polymyositis]

We report two cases of rheumatoid arthritis (RA) who later had developed after polymyositis (PM). The first patient was 64-year old male who experienced muscular weakness of the four limbs in proximity 10 years ago. He was diagnosed as PM because of the elevated serum CK and the myogenic pattern of EMG, and his symptoms were improved by treatment with corticosteroid. He started to complain polyarthralgia 2 years ago, followed by interstitial pneumonia, pleuritis and skin ulcer. He was admitted because of exacerbated polyarthralgia, multiple subcutaneous nodules, skin eruption and fever. The level of serum CK was within normal range but CRP was elevated and CH 50 was decreased. The laboratory examination showed positive cryoglobulin and high titer of rheumatoid factor, but anti-Jo 1 antibody was negative. The hand X-ray showed bone erosions in bilateral wrist joints. Skin biopsy revealed leukocytoclastic vasculitis. Based on these findings, he was diagnosed as malignant RA. He was successfully treated with methylprednisolone pulse therapy, cyclophosphamide and prostaglandin E 1. The second patient was 77-year old male with pneumoconiosis who experienced muscular weakness of the four limbs in proximity 4 years ago. He was diagnosed as PM based on his clinical and laboratory findings and was treated with temporary corticosteroid. He started to have polyarthralgia last year, and he was admitted because of increasing arthralgia after the treatment of pulmonary tuberculosis. The level of serum CK was slightly elevated due to hypothyroidism, and CRP was highly elevated. Rheumatoid factor and cryoglobulin were positive, but anti-Jo 1 antibody was negative. The hand X-ray showed bone erosions in bilateral wrist joints. Crystals of pyrophosphate calcium was observed in knee joints. He was diagnosed as RA associate with pseudogout. His symptoms were relieved with corticosteroid, salazosulfapyridine and anti-tuberculous therapy. These two cases had altered their clinical features from PM to definite RA, and both had pulmonary complications. Previous reports described the cases of RA followed by PM, most of which were induced by such drugs as D-penicillamine, but the cases of PM who later had developed RA are extremely unusual. The overlapped cases of RA and PM tend to highly associate with pulmonary lesions.     

D-penicillamine–induced polymyositis in patients with rheumatoid arthritis

Among 329 patients with rheumatoid arthritis treated with D-penicillamine (DP), we found 4 cases of polymyositis. This incidence was significantly higher than the expected coincidence of rheumatoid arthritis and polymyositis/dermatomyositis or than the presumed frequency of this complication among patients treated with DP. In the present report, we summarize and discuss the clinical findings in DP-induced polymyositis/dermatomyositis in our patients and others described in the literature.     

The assessment of radiological changes in the hands and wrists in rheumatoid arthritis

Two methods of assessing changes in hand and wrist radiographs, the Larsen Index and Amos Index, were compared and contrasted in 48 patients with rheumatoid arthritis (RA). X-rays were taken before and after 1 year of treatment with remission-inducing drugs and scored independently by three observers using both methods. Single readings of radiographs using the Larsen Index were highly reproducible (intra- and inter-observer correlations greater than 0.90 on all occasions), but reproducibility fell when changes were determined from paired films (intra- and inter-observer correlations 0.47-0.82). Variability was greatest in the proximal interphalangeal and wrist joints. The Amos Index, which assesses erosive progression and not the appearance of single films, was more reproducible (intra- and inter-observer correlations 0.72-0.94); it would therefore be better able to detect small changes in groups of patients. The scoring systems were significantly correlated (r = 0.63; P less than 0.001), and with both different observers scored the films at the same "level'. The Amos Index is simple, reproducible, and does not require standard films. It is the assessment of choice.     

Mud compress therapy for the hands of patients with rheumatoid arthritis

Objective The aim of this study was to evaluate the efficacy of home treatment with mud compresses for the hands of patients with rheumatoid arthritis (RA).Methods Forty-five patients suffering from RA were enrolled in a double-blind, randomized, controlled study. Twenty-two were treated with true mud compresses (treatment group) and 23 were treated with attenuated mud compresses (control group). The compresses were applied in the patients homes five times a week during a 3-week period. Patients were assessed four times: at baseline, upon completion of the 3-week treatment period, 1 month after the treatment, and 3 months after conclusion of the treatment period. Positive response was defined as reductions of 30% or more in the number of tender and swollen joints, 20% or more in physician global assessment of disease activity, and 20% or more in patient global assessment of the severity of joint pain.Results In the treatment group, significant reductions in the number of swollen and tender joints and patients global assessments of pain severity was observed at all post-treatment assessments. Significant improvement in the scores of physician global assessment was seen at the end of therapy and 1 month later. In the control group, no improvement in the number of swollen and tender joints or physician global assessment was found in any post-treatment evaluation. However, a significant reduction in patient global assessment of joint pain severity was reported at the end of therapy and 3 months after concluding treatment.Conclusion Treatment with mud compresses relieves pain affecting the hands and reduces the number of swollen and tender joints in the hands of patients suffering from RA. This treatment can augment conventional medical therapy in these patients.     

Moderate incidence of prior rheumatoid arthritis in patients with polymyositis and dermatomyositis

Clinical Rheumatology -