Health Questions and Answers

Archive for April, 2008

Question: Which drugs are commonly associated with the development of a clinical syndrome of lupus and a positive ANA?

Tuesday, April 29th, 2008

Answer:
Historically, a clinical syndrome of arthritis, fever, rash, and positive ANA was seen in some patients after initiating antihypertensive treatment with hydralazine. Since then, the development of circulating ANA or clinical symptoms has been demonstrated with many drugs, including procainamide, diphenylhydantoin, isoniazid, chlorpromazine, d-penicillamine, sulfasalazine, methyldopa, and quinidine. So-called slow acetylators more commonly develop clinical [...]

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Question: Why is it helpful to know which specific ANA is present in a given patient?

Tuesday, April 29th, 2008

Answer:
Although no laboratory test is absolutely diagnostic for a rheumatic disease, the presence of certain autoantibodies in the appropriate clinical setting can be helpful. Some common disease associations include:
Ro/SSA
DS DNA
Sm
Jo-1
Centromere
SCL-70
SLE, neonatal lupus syndrome, subacute lupus, Sjögren’s syndrome, RA
SLE
SLE
Polymyositis with pulmonary involvement
CREST syndrome
Systemic sclerosis 
Reference: Craft J, et al: Antinuclear antibodies. In Kelly WN, et al (eds): [...]

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Question: Do ANA staining patterns detect specific ANAs? What is their clinical relevance?

Tuesday, April 29th, 2008

Answer:
The fluorescence test for ANA is performed by incubating the patient’s serum with a fixed monolayer of human larynx epithelioma cancer (HEp-2) cell lines. If ANAs are present in the serum, they bind to the nuclear component of the substrate. Next, fluorescent anti-Ig is added, which binds to antibodies (if present) in the test serum. [...]

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Question: What are the common causes for death in patients with SLE?

Tuesday, April 29th, 2008

Answer:
Cause of death may be related to active disease, toxicity of medications, or other causes. Death early in the course of disease is usually related to the disease itself. Nephritis and CNS disease are the most ominous prognostic factors. Of the causes of death not directly related to active disease, infection is singly most common [...]

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Question: What are the pulmonary manifestations of lupus?

Tuesday, April 29th, 2008

Answer:
Pulmonary involvement is fairly common in lupus and usually takes the form of pleurisy or pleural effusion. Up to 60% of patients may have pleuritic pain over the course of their illness. 
Effusions can be either transudative or exudative and in rare cases are the presenting feature. The so-called shrinking lung syndrome describes dyspnea associated with [...]

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Question: What are the neuropsychiatric manifestations of SLE?

Tuesday, April 29th, 2008

Answer:
Because of the difficulty in establishing an unequivocal diagnosis, rates of CNS features cross a broad range. Neuropsychiatric manifestations of lupus may occur in around 70% of patients. Examples include psychosis (5%); cranial, autonomic, and peripheral neuropathies; migraine headaches; seizure; aseptic meningitis; pseudotumor cerebri; chorea; and cerebral infarction. Rarely, transverse myelitis has been observed. Organic [...]

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Question: What is the most common pathologic abnormality in patients with lupus CNS disease?

Thursday, April 24th, 2008

Answer:
Small infarcts and hemorrhages are more commonly the source for the neuropsychiatric features of lupus than vasculitis. In fact, vasculitis, as suggested by such commonly used designations as “lupus cerebritis,” occur in < 15% of patients.
KEY POINTS: SPECIFIC RHEUMATOLOGIC DISEASES

RA increases mortality.
Mixed connective tissue disease is a specific diagnosis with features of SLE and [...]

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