Health-related quality of life in ankylosing spondylitis,fibromyalgia syndrome,and rheumatoid arthritis: a comparison with a selected sample of healthy ındividuals

In this study, we compared health-related quality of life (HRQoL) scores of patients with rheumatoid arthritis (RA), fibromyalgia syndrome (FS), or ankylosing spondylitis (AS), with those of a selected sample of healthy individuals. The study group comprised 530 patients (264 with RA, 149 with FS, and 117 with AS). Three hundred fifteen healthy controls were used for comparison. HRQoL scores were obtained using the Short-Form (SF)-36 Health Survey. Frequency, mean, correlation, and multiple regression analyses were performed; in addition to the Student's t test, one-way ANOVA test, Kruskal–Wallis test, and chi-square test. The average physical component summary (PCS) and mental component summary (MCS) scores of patients in the RA, FS, and AS groups were much lower than those in the control group (p < 0.05). In all three patient groups, the lowest PCS score was found in the RA group, and the lowest MCS score was found in the FS group. The PCS scores of RA patients with disease-related changes in daily activities and the MCS scores of FS patients were lower (p < 0.05). In the three patient groups, the quality of life (QoL) of university graduates and those with a high level of income was good, whereas the QoL of patients who lacked information about the disease was poor. This study shows that AS, FS, and RA have a negative impact on HRQoL. Evaluating the HRQoL of patients with these conditions may provide guidance on their treatment and care.     

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Background:

An experimental study showed that nebivolol is an effective agent in contrast‐induced nephropathy (CIN) prophylaxis.

Hypothesis:

We hypothesized that prophylactic nebivolol use had protective effects on renal function in human beings subjected to iodinated contrast agent since it has vasodilatory effect and antioxidant properties.

Methods:

The present study enrolled 120 patients scheduled for coronary angiography and ventriculography. All patients were hydrated with intravenous isotonic saline. The patients in group I received 600 mg N‐acetylcysteine every 12 hours for 4 days. The patients in group II received 5 mg nebivolol every 24 hours for 4 days. The patients in group III were only hydrated. The primary endpoint was the occurrence of CIN. The secondary endpoint was the change in serum creatinine (Cr) levels at 2 days and 5 days after the contrast exposure.

Results:

Nine (22.5%) patients in group I developed CIN, as did 8 patients (20.0%) in group II and 11 patients (27.5%) in group III (P = 0.72). Changes in mean Cr level from baseline to day 2 were not statistically significant in all groups. However, we detected a statistically significant increase in mean Cr levels at day 5 compared with baseline levels in group I and group III (from 1.42 ± 0.13 to 1.52 ± 0.26, p2 = 0.02; and from 1.43 ± 0.14 to 1.55 ± 0.30, p2 = 0.01, respectively). Although an increase was detected in mean Cr level from baseline to the 5‐day Cr level in group II, this did not reach statistical significance (from 1.40 ± 0.12 to 1.48 ± 0.23, P = 0.06).

Conclusions:

Pretreatment with nebivolol is protective against nephrotoxic effects of contrast media. © 2012 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis

Severe primary central nervous system (CNS) involvement such as vasculitis and pachymeningitis can rarely occur in rheumatoid arthritis (RA) even in the absence of systemic disease activation. The authors illustrate a female patient with well-controlled RA who presented with headaches, encephalopathy, seizures and relapsing focal neurological deficits. Primary rheumatoid cerebral vasculitis and pachymeningitis were diagnosed based on suggestive brain magnetic resonance (MR) imaging, MR angiography, cerebrospinal fluid analysis and cerebral angiography. MR showed abnormal leptomeningeal enhancement and hyperintense FLAIR signal in the cortical subarachnoid spaces consistent with pachymeningitis. Cerebral angiography findings were consistent with vasculitis. Aggressive treatment resulted in significant clinicoradiological resolution. Cerebral vasculitis is a rare but certain manifestation of RA. This complication can be diagnosed in the presence of suggestive angiographic and CSF findings. The condition may be steroid resistant, and needs to be treated more aggressively.     

Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient

Hepatic hydrothorax is a complication of cirrhosis that is uncommon and difficult to treat. Diuretic therapy, thoracentesis, transjugular intrahepatic portosystemic shunt and liver transplantation are the main therapeutic options. Here, we report on a 47-year-old man with decompensated liver cirrhosis related to hepatitis B and D virus infections and who had complications of hepatic hydrothorax and hepatorenal syndrome. In this case, the hepatic hydrothorax, which was refractory to thoracic tube drainage and octreotide treatment, could be controlled with 5 days of terlipressin therapy associated with albumin. Terlipressin administration resulted in both improvement in renal function and successful resolution of hepatic hydrothorax. Splanchnic vasoconstrictor agents that reduce splanchnic blood flow, increase both central volume and effective renal blood flow. Thus they improve renal function. In our case, terlipressin, known to be beneficial in hepatorenal syndrome, was also effective in the treatment of hepatic hydrothorax probably by similar mechanisms. This is the first case in the literature.