Pyoderma gangrenosum: clinical and laboratory findings in 15 patients with special reference to polyarthritis.
Fifteen consecutive patients with PG have been studied during the period 1971-78. Systemic disease was found in 13 of the patients and preceded the skin disease in 10 patients by 1-25 years. Only two patients had ulcerative colitis. One patient had paroxysmal nocturnal hemoglobinuria and three patie...
| Publicado en: | Medicine Vol. 59; no. 2; pp. 114 - 134 |
|---|---|
| Autores principales: | , , , |
| Formato: | case study Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
1980 Mar
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104778462&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104778462 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00257974 2S6 jtl: Medicine issn: 00257974 maglogo: N pubinfo: dt: 1980 Mar vid: 59 iid: 2 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 104778462 104778462 2011137957 10.1097/00005792-198003000-00003 NLM7360040 104778462 ppf: 114 ppct: 20 formats: tig: atl: Pyoderma gangrenosum: clinical and laboratory findings in 15 patients with special reference to polyarthritis. aug: au: Holt, P J Davies, M G Saunders, K C Nuki, G sug: subj: Arthritis Diagnosis Pyoderma Diagnosis Skin Ulcer Diagnosis Adolescence Adult Aged Arthritis Immunology Arthritis, Rheumatoid Diagnosis Cell Physiology Colitis, Ulcerative Diagnosis Female Anemia, Hemolytic Diagnosis Immunity, Cellular Immunoglobulins Analysis Male Middle Age Neutrophils Immunology Paraproteinemias Diagnosis Pyoderma Complications Pyoderma Immunology Recurrence Skin Ulcer Complications Adolescent: 13-18 years Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Fifteen consecutive patients with PG have been studied during the period 1971-78. Systemic disease was found in 13 of the patients and preceded the skin disease in 10 patients by 1-25 years. Only two patients had ulcerative colitis. One patient had paroxysmal nocturnal hemoglobinuria and three patients had an IgA myeloma. Eight patients had polyarthritis; this was classical seropositive rheumatoid arthritis in two patients, and a seronegative inflammatory polyarthritis in six patients. Four patients had an unusual progressive erosive seronegative polyarthritis without evidence of granulomatous bowel disease, psoriasis, genital, urinary tract or eye disease. In three of these four patients the arthritis preceded the PG. Synovial fluid analysis showed depressed complement levels and in one patient deposits of immunoglobulins and complement were demonstrated in the synovial membrane. The course of the arthritis was progressive with development of disabling joint deformities and erosive destruction of joints, despite treatment with penicillamine, corticosteroids and nonsteroidal anti-inflammatory drugs. One other patient had severe degenerative joint disease and chondrocalcinosis in association with a seronegative inflammatory polyarthritis, and another patient had ulcerative proctitis and severe degenerative joint disease secondary to chronic seronegative inflammatory polyarthritis. None of the patients had colitic arthritis, but in view of the association between PG and ulcerative colitis, some patients previously reported with PG and joint disease may have been suffering from the arthritis of ulcerative colitis. PG developed at the site of skin trauma in six patients. The natural history of the skin disease ran one of two courses: an acute, progressive course in which the ulcers rapidly enlarged until arrested by treatment; and a chronic course in which the lesions extended slowly and which after a period of weeks began to show signs of spontaneous healing. In only the patients with ulcerative colitis was there any correlation between the activity of the associated disease and the onset and progression of the skin disease. Serum complement levels were normal and no circulating cryoprecipitable immune complexes were found. Skin histology showed no evidence of vasculitis and direct immunofluorescence examination of involved skin was negative for IgG, IgM, IgA and C3. No consistent abnormality of cell-mediated immunity or neutrophil function was found and no significantly increased prevalence of any HLA antigen type was noted. Twelve patients have been treated with systemic corticosteroids. Six of these patients developed serious steroid complications and four patients have died, all from complications of steroid therapy. pubtype: Academic Journal doctype: case study Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|