Susan G. Perlman

Phenylpropanolamine (PPA) is the major ingredient in more than 70 over-the-counter preparations including diet pills, nasal decongestants, and the legal "look-alike" stimulants. Structurally and functionally similar to amphetamine and ephedrine, PPA has recently been associated with several neurological manifestations including psychosis, stroke, severe headache, seizures, and intracerebral hematoma. We report a case of intracerebral hematoma and subarachnoid hemorrhage in a young woman with angiographic and biopsy-proven vasculitis of the central nervous system (CNS) induced by PPA in her diet pills. From review of the literature, we distinguish drug-induced vasculitis as a separate entity from primary CNS vasculitis, both clinically and pathologically. This report should alert physicians, in general, to this potentially fatal side effect of PPA, a commonly used over-the-counter drug. Also, neurosurgeons in particular should consider the possibility of drug-induced vasculitis when faced with cases of intracerebral or subarachnoid hemorrhage without apparent cause.

Reported here are the results of the first effort to examine the effects of a dance-based aerobic exercise program for people with rheumatoid arthritis (RA). Forty-three subjects with RA completed a 16-week program that met twice weekly for 2 hours. One hour was devoted to exercise consisting of 15 to 20 minutes of warm-ups, 20 to 30 minutes of dance-based aerobic exercise, and 15 to 20 minutes of mat work for muscle strengthening and flexibility. The second hour was devoted to discussion that emphasized participant problem solving. The combined exercise/problem-solving discussion program was called EDUCIZE. Analyses of pretest to posttest changes indicated no deleterious effects on disease activity. In fact, physician-assessed articular pain and swelling decreased significantly, as did 50-foot walk time, pain, and depression. Participants reported significant improvement in lower extremity function. Changes in vigor and fatigue approached significance. Perceptions of general health as well as four of five quality of life indices improved significantly. This study adds to the as yet limited literature that indicates that weight-bearing vigorous exercise is beneficial for people with arthritis. Controlled studies to validate the findings of this study appear warranted. Also important for future research is investigation of the influence of the problem-solving discussion component on program effects.

We have studied the temporal relation between psoriasis and psoriatic arthritis in 27 patients receiving photochemotherapy for treatment of psoriasis. Patients were classified as either spondylitic or nonspondylitic. For spondylitic patients, psoriasis was difficult to control, arthritis did not improve, and skin and joint activity appeared to vary independently. In contrast, 67% of nonspondylitic patients receiving photochemotherapy treatment remained clear of psoriasis, with 49% mean improvement in articular index. There was an inverse relation between initial percentage of psoriasis and improvement in peripheral arthritis. These results suggest that aggressive management of psoriasis helps control synovitis in at least a subgroup of patients with psoriatic arthritis.

We performed human lymphocyte alloantigen determinations in patients with psoriatic arthritis (PsPA) who were clinically classified into arthritic subtypes and disease severity. The total PsPA group demonstrated elevations of HLA-BW38, CW6, DR4 when compared with controls (p less than 0.001). Severe arthritics have increased DR4 frequency when compared with less severe arthritics (p less than 0.02). Those with mild disease have increased A3, B7 frequency which was absent in patients with moderate or severe arthritis. Rheumatoid-like PsPA patients have increased DR4, B40 frequencies; those with spondylitis, B27, CW1. PsPA is associated with many genes in the major histocompatibility complex. Distinct groups of patients with PsPA as determined by type and severity are identifiable by the presence of specific human lymphocyte antigens.