Robert B. Buckingham

Palmar fasciitis and arthritis with malignant neoplasms: A paraneoplastic syndrome

VARIETY of musculoskeletal syndromes have been associated with malignancy.’ Among these, hypertrophic pulmonary osteoarthropathy, dermatomyositis, and carcinomatous polyarthritis are the most frequently recognized.‘** Shoulder-hand syndrome, a variant of reflex sympathetic dystrophy, is another rheumatic disorder that has occasionally been associated with malignant neoplasms.3-‘5 Although brain and lung malignancies are the tumors most frequently associated with this syndrome,6*7,9-‘3 carcinoma of the bladder,8*14 uterus,15 breast,‘*” and esophagus, ‘*I4 have also been reported. Recently, a syndrome that has been termed “palmar fasciitis and arthritis” has been reported to occur in association with ovarian adenocarcinoma.3 This disorder differs from the usual case of shoulder-hand syndrome in that the progression and extent of rheumatic disease are much more dramatic. Specifically, the fasciitis is more severe, the arthritis more inflammatory, and both are more rapidly progressive than generally seen in shoulder-hand syndrome. Com

Sjögren's syndrome in progressive systemic sclerosis.

Thirty-five consecutive patients with progressive systemic sclerosis were prospectively evaluated for evidence of Sjögrens syndrome. Six of the 35 (17%) were judged to have the disorder. This is a higher prevalence than in most reports, but much lower than that recently reportedly by Alarcón-Segovia and associates (7). An additional 17 of the 35 patients (48%) had significant fibrosis in the absence of sufficient mononuclear cell infiltrates to confirm the diagnosis of Sjögrens syndrome. This group had particularly aggressive scleroderma with serious visceral features, and five died after a short duration of illness. No significant abnormalities were found in biopsies from six patients with the mixed connective tissue disease syndrome, five with Raynauds phenomenon alone, or in 29 autopsy control subjects who had no evidence of connective tissue disease. Fibrosis in the absence of mononuclear infiltration in minor salivary glands of patients with progressive systemic sclerosis indicates a poor prognosis.

Cerebrospinal fluid immune complexes in systemic lupus erythematosus involving the central nervous system

C ENTRAL nervous system (CNS) involvement in systemic lupus erythematosus (SLE) is a commonly encountered situation in which diagnostic certainty is lacking.‘,’ The clinical manifestations are diverse, ranging from mild affective disorders to profound encephalopathy, transverse myelopathy, and stroke.3’4 Other conditions capable of causing neuropsychiatric disease, such as hypertension and corticosteroidinduced mental syndromes, frequently coexist in patients with SLE. Furthermore, no laboratory test has been reported that is both sensitive and specific in establishing the diagnosis of CNS lupus.*~5~’ Immunoglobulin abnormalities of cerebrospinal fluid (CSF) are found in several neurologic diseases where immune mechanisms are thought to be involved in pathogenesis.‘-” Recent advances in the technology of zone electrophoresis, particularly the adoption of agarose gel as a separation medium,” have led to the description of specific qualitative immunoglobulin abnormalities, including oligoclonal patterns (i.e., two or more homogeneous restricted bands of protein, each representing intact immunoglobulin secreted by individual clones of phlsma cells)‘2m’4 and more recently, identification of immune complexes.‘5 The present study applied this method to the search for immunoglobulins and immune complexes in the CSF tif patients with systemic lupus erythematosus involving the central nervous system.