1/30. Multicentric reticulohistiocytosis: a mimic of gout and rheumatoid arthritis.Multicentric reticulohistiocytosis is a rare cutaneous-articular disease that may mimic more common disorders such as rheumatoid arthritis or tophaceous gout. In one fourth of patients, it is a paraneoplastic process. This brief overview is aimed at physicians who care for patients with polyarthritis, to alert them to distinctive features that differentiate multicentric reticulohistiocytosis from the common arthritides.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/30. Why I would not recommend complementary or alternative therapies: a physician's perspective.The use of complementary or alternative therapies by patients with rheumatic diseases is widespread and under-reported by patient to physician. The most commonly used forms of therapy are herbal/nutrient supplements, chiropractic, homeopathy, and acupuncture. The use of these therapies for treatment of rheumatic disease is not substantiated by review of the available medical literature. Furthermore, these therapies are expensive and potentially toxic. Incorporation of these treatments into the therapeutic armamentarium of the rheumatologist cannot be recommended until they are shown to be effective, safe, and affordable.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
3/30. Evaluating patients with arthritis of recent onset: studies in pathogenesis and prognosis.Inflammatory synovitis of recent onset poses a diagnostic and prognostic challenge to primary care physicians and rheumatologists. A lack of understanding of the underlying etiologic and pathogenic processes limits the ability to distinguish forms of arthritis that follow a benign, self-limiting course from forms that proceed to an aggressive, erosive disease requiring intensive immunosuppressive therapy. It is estimated that between 30% and 40% of patients presenting with early synovitis have disease that remains unclassified. Using data from a cohort of patients with early synovitis and reviewing current literature, we discuss investigational approaches toward a new classification of patients with early synovitis. Although a lack of understanding of this heterogeneous clinical syndrome has led clinicians to take a largely empirical approach to treatment thus far, the evolving awareness of disease predisposition at a genetic level and the expanding ability to specifically manipulate biological pathways may ultimately change the approach to this clinical problem. JAMA. 2000;284:2368-2373.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/30. case management for patients with rheumatoid arthritis.Mary was in her mid-20s when a long day of shopping made her feet hurt so much that she sought the care of a podiatrist. Radiographs showed no abnormalities in her bones, so it was not until several months later, when her hands became swollen and painful, that she was diagnosed with rheumatoid arthritis (RA) by her primary care physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/30. Cancer polyarthritis resembling rheumatoid arthritis as a first sign of hidden neoplasms. Report of two cases and review of the literature.Recent onset arthritis reminiscent of rheumatoid arthritis (RA) may be an early manifestation of an occult malignancy. In this report, we present two patients with cancer-associated polyarthritis. Both suffered from symmetric polyarthritis when initially visiting their physicians and did not achieve relief when treated with non-steroidal anti-rheumatic drugs (NSAIDs). In both patients, subsequent work-up led to the diagnosis of an underlying malignancy. One patient suffered from small cell lung cancer (SCLC), while the other was diagnosed with adenocarcinoma of the colon. In both, the arthritis spontaneously disappeared after successful treatment of the malignancy, i.e. chemotherapy and tumor resection, respectively. We discuss these cases in view of the existing literature, since awareness of the entity of cancer polyarthritis is necessary for its timely treatment and may potentially be life-saving.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/30. Is it Crohn's disease? A severe systemic granulomatous reaction to sulfasalazine in patient with rheumatoid arthritis.BACKGROUND: sulfasalazine is a widely used anti-inflammatory agent in the treatment of inflammatory bowel disease and several rheumatological disorders. Although as many as 20% of treated patients may experience reversible, dose-dependent side effects, less frequent but potentially severe, systemic reactions have also been reported. CASE PRESENTATION: A severe systemic reaction to sulfasalazine developed in a 21-year old female with rheumatoid arthritis characterized by eosinophilia, granulomatous enteritis and myelotoxicity, cholestatic hepatitis, and seizures. The clinical course and management of this patient are presented as well as a review of the incidence and outcome of severe systemic reactions to sulfasalazine. CONCLUSIONS: Granulomatous myelotoxicity and enteritis developed in a 21 year old female within 3 weeks of initiating sulfasalazine for rheumatoid arthritis. Following a short course of corticosteroids, the patient had resolution of her cholestatic hepatitis, rash, eosinophilia, and gastrointestinal symptoms with no residual manifestations at 7 months follow-up. Although severe reactions to sulfasalazine are rare and unpredictable, practicing physicians should be aware of unusual clinical presentations of toxicity when prescribing sulfasalazine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/30. Rheumatoid arthritis of the cervical spine: current techniques for management.The incidence of rheumatoid arthritis in the European and North American population is significant. Rheumatoid arthritis can result in serious damage to the cervical spine and the central neuraxis, ranging from mild instability to myelopathy and death. Aggressive conservative care should be established early. The treating physician should not be lulled into a false sense of security by reports suggesting that cervical subluxations are typically asymptomatic [76-78]. Gradual spinal cord compression can result in severe neurologic deficits that may be irreversible despite appropriate surgical intervention when applied too late. [figure: see text] The treatment of rheumatoid disease in the cervical spine is challenging. Many details must be considered when diagnosing and attempting to institute a treatment plan, particularly surgical treatment. The pathomechanics may result in either instability or ankylosis. The superimposed deformities may be either fixed or mobile. The algorithm suggested by the authors can be used to navigate through the numerous details that must be considered to formulate a reasonable surgical plan. Although these patients are [figure: see text] frail, an "aggressive" surgical solution applied in a timely fashion yields better results than an incomplete or inappropriate surgical solution applied too late. When surgical intervention is anticipated, it should be performed before the development of severe myelopathy. patients who progress to a Ranawat III-B status have a much higher morbidity and mortality rate associated with surgical intervention than do patients who ambulate. Although considered aggressive by some, "prophylactic" stabilization and fusion of a [figure: see text] relatively flexible, moderately deformed spine before the onset of severe neurologic symptoms may be reasonable. This approach ultimately may serve the patient better than "observation" if the patient is slowly drifting into a severe spinal deformity or shows signs of early myelopathy or paraparesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/30. Celecoxib-related renal papillary necrosis.Selective cyclooxygenase 2 (COX-2) inhibitors are known to affect renal prostaglandins (epoprostenol and dinoprostone), which are at least in part COX-2 dependent. Consequently, adverse events including hypertension, peripheral edema, hypercalemia, hyponatremia, and acute renal failure have been reported to occur with the new COX-2-specific inhibitors. This case report posits celecoxib as a likely cause of renal papillary necrosis and alerts physicians to the possibility of this additional renal complication with COX-2-specific inhibitors.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/30. pyoderma gangrenosum treated with hyperbaric oxygen therapy.The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones, or immunosuppressants, either alone or in combination. Inconsistent response to therapy is a source of frustration to both patient and physician. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our patient, a woman with severe rheumatoid arthritis and diabetes mellitus, hyperbaric oxygen therapy not only promoted healing of pyoderma gangrenosum but permitted reduction of systemic corticosteroids.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/30. Normal pressure hydrocephalus found after anesthesia--a case report.Normal pressure hydrocephalus (NPH) is characterized by insidious onset and gradual development of the triad of gait disturbance, dementia, and urinary incontinence. nausea, vomiting, and signs of increased intracranial pressure do not occur. A 71-year-old male patient was scheduled for total knee replacement due to osteoarthritis of right knee joint. No neurological symptoms and signs except mild forgetfulness were detected during physical examination following admission. Due to operational mistakes, the anesthesiologist was informed that the surgery was cancelled just after completion of induction of general anesthesia. The patient was allowed to emerge from anesthesia. Unfortunately, his consciousness became drowsy the next morning. After a series of examinations, he was at last diagnosed as a case of NPH principally by the brain computed tomography scan. So he was scheduled again but this time for vetriculoperitoneal (V-P) shunt. The patient regained consciousness after V-P shunt. From this case, we learned that NPH may remain in concealment in the patients we contacted in our daily practice. A vigilant physician should keep in mind that the presentation of gait disturbance, dementia, and urinary incontinence in a patient may indicate the likelihood of NPH.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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