Secondary analysis of the PRECISION Trial Forum 2012. http://www.lerner.ccf.org/qhs/software/lib/ premature cardiovascular events in rheumatologic condi- stddiff.pdf (20 September 2017, date last accessed). tions. Eur Heart J 2015;36:4829c. 13 Schoenfeld D. Partial residuals for the proportional haz- 16 Catella-Lawson F, Reilly M, Kapoor SC et al. ards regression model. Biometika 1982;69:23941. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. New Engl J Med 2001;345:180917. 14 Patrono C, Garcia Rodriguez LA, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. 17 Kent DM, Rothwell PM, Ioannidis JP, Altman DG, N Engl J Med 2005;353:237383. Hayward RA. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials 15 Mason JC, Libby P. Cardiovascular disease in patients 2010;11:85. with chronic inflammation: mechanisms underlying Rheumatology 2018;57:1369 doi:10.1093/rheumatology/key078 Clinical vignette Advance Access publication 21 March 2018 Strawberry gingivitis in granulomatosis with due to serous otitis media. Laboratory evaluation revealed polyangiitis elevated acute phase reactants together with positive im- munofluorescence for c-ANCA and enzyme immunoassay A 22-year-old man complained of persistent gingival for anti-PR3 antibodies. A CT scan of the chest showed hyperplasia and bleeding with rhinitis. Physical examin- some nodules. The diagnosis of granulomatosis with poly- ation showed hyperplastic gingivitis with red purple angiitis was made and the patient was given a high dose oedematous interdental papillae diffusely covered of corticosteroids and monthly i.v. CYC. A complete re- with petechiae. The lesion displayed the typical mission was observed after 6 months when CYC was pebbly appearance of strawberry gingivitis (Fig. 1A). replaced by AZA. Clinicians should keep in mind that Histopatological examination of the gingival tissue ob- strawberry gingivitis may be the initial manifestation of tained by biopsy showed a granulomatous inflammation granulomatosis with polyangiitis. containing lymphocytes, plasma cells, histiocytes and multinucleated giant cells together with haemorrhagic Acknowledgements areas and numerous neutrophilic debris coalescing in microabscesses (Fig. 1B, haematoxylin and eosin Thanks go to Professor Ignazio Olivieri for having con- stained). Similar features were observed in a nasal speci- veyed to us the importance of honesty and humility. men. In the following weeks the patient developed an Funding: There was no financial support. ulcerative skin lesion on the left flank and hearing loss Disclosure statement: All authors have declared no FIG.1 Hyperplastic gingivitis with red purple edematous conflicts of interest. interdental papillae diffusely covered with petechiae. (A) Lymphocytes, plasma cells, histiocytes and multinu- 1 2 Pietro Leccese , Carlo Palazzi , cleated giant cells together with haemorrhagic areas and 1 1 Salvatore D’Angelo and Angela Anna Padula numerous neutrophilic debris coalescing in microabs- Rheumatology Institute of Lucania (IReL) and the cesses ( 10) (B) Rheumatology Department of Lucania, San Carlo Hospital, Potenza and Rheumatology Institute of Lucania (IReL) and the Rheumatology Department of Lucania, Madonna delle Grazie Hospital, Matera, Italy Correspondence to: Pietro Leccese, Via Potito Petrone, 1, Potenza, 85100, Italy. E-mail: email@example.com ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: firstname.lastname@example.org https://academic.oup.com/rheumatology 1369 Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/8/1369/4948681 by Ed 'DeepDyve' Gillespie user on 24 July 2018
Rheumatology – Oxford University Press
Published: Mar 21, 2018
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