Re: AOSD - Part 2

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Okay everyone, here is the last bit of the article I

promised you. Please excuse any typing errors.

LABORATORY, RADIOGRAPHIC AND PATHOLOGIC FEATURES

Nonspecific abnormalities are evident in laboratory

studies. The erythrocyte sedimentation rate is

elevated, often above 100 mm/hr. Peripheral

neutrophilic leukocytosis, usually over 15,000

cells/mm(3) has been reported in most patients. A

leukemoid reaction also may be seen as well as

persistent and progressive normocytic, normochromic

anemia in the absence of hemolysis or gastrointestinal

bleeding. Elevation of serum hepatocellular enzymes

can be seen with active disease alone and as a result

of administration of nonsteroidal antinflammatory

drugs (NSAIDs).

High serum ferritin levels, up to 10 times the upper

limit of normal are often seen and usually correlate

with disease activity. The ferritin level may be

useful to support the clinical diagnosis and to

monitor the effects of therapy. Characteristically,

antinuclear antibodies and rheumatoid factor tests are

negative, although in some series a few patients with

low positive titers have been reported.

Antistreptolysin 0 titers may be elevated as well but

on serial testing the titers remain constant.

Associations with leukocyte histocompatibility

antigens have been reported for the loci of HLA-B8,

Bw35, B44, DR4, DR5,and DR7. These studies are not

helpful in supporting a clinical diagnosis or in

predicting the outcome of visceral or articular

manifestations or drug side effects. A few patients

have been described with rising titers of antibodies

against mumps, rubella viruses and Yersinia

enterocolitica, although no viruses or bacteria have

been isolated from inflamed articular tissues.

Periarticular demineralization can be the only

radiographic finding. Bone erosions and subluxation

are uncommon. There is a peculiar tenndency for

fusion of the carpometacarpal and intercarpal joints

that is considered characteristic of the disease.

Involvement of the upper cervical apophyseal joints,

tarsal and temporomandibular joints and teriminal

phalangeal joints can be seen in up to 50% of the

patients who have been followed for more than 10

years.

Examination of synovial fluid reveals a high leukocyte

count and predominance of polymorphonuclear cells.

The synovium shows signs of mild, chronic, nonspecific

synovitis with moderate synovial cell proliferation,

variable degree of vascular engorgement and scattered

or diffuse infiltrates with lymphocytes and plasma

cells. The histopatholic findings in skin and

visceral lesions are nonspoecific.

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You might find this a difficult read but just imagine

trying to type it!!! LOL

Hope you enjoyed it.

Marilyn

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