Endothelial function is significantly impaired in adults with primary SNV, supporting the hypothesis that premature arteriosclerosis in chronic inflammatory rheumatic disorders results from endothelial dysfunction secondary to vasculitis. Normalization of endothelial function after the treatment of primary SNV suggests that early suppression of disease activity in chronic inflammatory rheumatic disorders may reduce long-term vascular damage. The role of inflammation in atheroma formation is increasingly appreciated; this work raises questions regarding the potential for anti-inflammatory therapy in atherosclerosis itself.
Seventy-five patients with rheumatoid arthritis have been studied in order to assess the relative contributions of bed rest and planned activity on the observed improvement in arthritis during hospitalization. The benefit of bed rest was less than expected; only a third of patients showed significant improvement. A similar number improved during planned activity and although bed rest was superior the advantages were small. The features of those patients who responded to bed rest or planned activity showed small but important differences indicating that more careful selection to one or other regimen may increase the number of patients benefiting from hospitalization.
Four patients with a previous inflammatory rheumatic disease developed a peripheral tuberculous (TB) arthritis in a joint apparently affected by a rheumatic disease. The single most important factor in the diagnosis of TB was the presence of past or present pulmonary TB or a family history on a background of steroid use. Clinical presentation, disease evolution, and routine laboratory tests were unhelpful. The most effective method of diagnosis was synovial biopsy.
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