Arthritis-dermatitis syndrome

Neisseria gonorrhoeae (gonococcus) Arthritis-dermatitis syndrome genital infections Ceftriaxone, cefixime, cefotaxime, or cefpodoxime. Ciprofloxacin or ofloxacin... 

L20. Ludvico, C. L., and Myers, A. R., Survey for immune complexes in disseminated gonococcal arthritis dermatitis syndrome. Arthritis Rheum. 22, 19-24 (1979). 

M3. Manicourt, D. H., and Orloff, S., Gonococcal arthritis-dermatitis syndrome. Study of serum and synovial fluid immune complex levels. Arthritis Rheum. 25, 574-578 (1982). 

The role of both T and B lymphocytes in a variety of disease states beyond transplantation has become increasingly important in the past decade. This is especially true of those diseases frequently referred to as autoimmune in their etiology, such as rheumatoid arthritis, nephrotic syndrome, systemic lupus erythematosus, inflammatory bowel disease, and so on. In addition, several other major diseases are also known to have a component of T- or B-cell-mediated pathogenesis, for example, atopic dermatitis, psoriasis, and asthma. Until very recently, the mainstay of therapy for these diseases was the corticosteroids, which were often less than satisfactory in efficacy and often associated with undesirable side effects, especially in growing children and the elderly. Thus, the search for new agents with different mechanisms of action and which did not have the same adverse event profile as conventional corticosteroids led to the subsequent evaluation of drugs such as tacrolimus and sirolimus to treat several of these diseases. 

All sulfonamides, including antimicrobial sulfas, diuretics, diazoxide, and the sulfonylurea hypoglycemic agents, have been considered to be partially cross-allergenic. Flowever, evidence for this is not extensive. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, < 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see below), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

Currently promoted uses of OEP include EFA deficiency mastalgia, fibrocystic breast disease, endometriosis, menopause, premenstrual syndrome (PMS), and the prevention of preeclampsia, diabetic neuropathy, psoriasis, eczema/dermatitis, rheumatoid arthritis, cardiovascular disease, gastrointestinal disorders, attention deficit disorder in children, and hypercholesterolemia (5,7). OEP is used topically as an ingredient in some soaps, cosmetics and medicinals. 

Adverse reactions to penicillins are rare diarrhoea can occur due to alteration in normal gastrointestinal bacteria. In fact, penicillins are probably the least toxic drugs known. Hypersensitivity reactions to penicillins occur in up to 10% of patients and vary from mild skin rashes to exfoliative dermatitis and Stevens-Johnson syndrome (immune vasculitis with arthritis, nephritis, central nervous system abnormalities and myocarditis) and from bronchoconstriction to life-threatening anaphylactic shock. 

Goid Saits Recent studies suggest that gold salts are ineffective for treating arthritis. They are still prescribed, however. Dermatitis, stomatitis, GI upset, nephrotic syndrome, cholestasis, hepatitis. Oral/IM preparations available. Accumulates in synovium and in phagocytic cells. 

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