Clinical course of anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and systemic vasculitis

Article Abstract:

In autoimmune diseases, the body makes antibodies against its own proteins and other molecules. Many autoimmune diseases result in vasculitis (inflammation of blood vessels) and kidney disease, including glomerulonephritis (inflammation of the kidney blood vessels and kidney filtering apparatus). Systemic vasculitis (SV) and glomerulonephritis (GN) have been difficult to study because affected patients are a heterogeneous group. However, a group of antibodies that recognize intracellular molecules in neutrophils (a type of white blood cell) have been identified, thus allowing patients with SV and GN to be classified into a closely related group. A group of 70 patients with anti-neutrophil cytoplasmic autoantibodies (ANCA) and GN were studied. Most patients also had SV. The onset of disease, extent of extrarenal (non-kidney) disease, and outcome of three treatment regimens were evaluated. All but 6 percent of patients had suffered a flu-like illness days or weeks before the onset of disease, which most often occurred in winter and least often in summer. Thirty-seven patients had pulmonary (lung) disease; 12 of these and 7 others had upper respiratory tract infection, particularly sinusitis. Neurologic disease was found in 9 patients, skin disease in 16 patients, and joint disease in 29 patients. Eighteen patients had renal-limited disease, 15 had nonpulmonary extrarenal disease similar to polyarteritis nodosa, and 37 had pulmonary disease similar to Wegener granulomatosis. There was no difference in mortality among these groups, and survival was 75 percent at 24 months. The blood level of creatinine (a marker of kidney function) at time of diagnosis was the only factor predictive of outcome, although massive pulmonary hemorrhage was strongly associated with death. There were few differences in survival or kidney function in the patients who were treated with steroids or cyclophosphamide. Blood levels of autoantibodies correlated with disease activity and response to treatment. The findings indicate that patients with ANCA have a wide variation in disease manifestations. Further study of ANCA-associated GN and SV is needed, including analyses of the effectiveness of treatment regimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Prognosis, Autoimmune diseases, Neutrophils, Glomerulonephritis

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Patterns of ordering diagnostic tests for patients with acute low back pain

Article Abstract:

Patients and doctors with certain characteristics appear to be more likely to respectively receive or order imaging tests to identify the source of lower back pain. Researchers interviewed 1,580 patients with low back pain and polled their doctors regarding the use of imaging techniques during the management of their patients' and hypothetical patients' care. Patients with pain radiating downward, white patients, and those with poor physical or mental function were more likely to receive imaging tests. Orthopedic surgeons, chiropractors, and doctors in a solo private practice were more likely to order imaging tests.

Usage, Diagnosis, Backache, Back pain, Diagnostic imaging

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Small-vessel vasculitis

Article Abstract:

Small-vessel vasculitis is the inflammation of small blood vessel walls and characterizes a number of complex clinical syndromes. Signs and symptoms can include skin lesions, pain, malaise, respiratory and neurologic problems, kidney disease and immunologic abnormalities. Accurate diagnosis may require examination of affected tissues, evaluation of immunologic markers, and comprehensive clinical and laboratory assessment, and is critical in guiding therapy. Some syndromes have fatal complications, and a number of drug treatments including corticosteroids and immunosuppressants are available.

Care and treatment, Schonlein-Henoch purpura, Allergic purpura

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