1/194. Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. methods: review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. Arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean c-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.- - - - - - - - - - ranking = 1keywords = back pain, pain, back (Clic here for more details about this article) |
2/194. Systemic amyloidosis and sacroiliitis in a patient with systemic lupus erythematosus.We report a case of a 25-year-old female with juvenile onset systemic lupus erythematosus who developed systemic secondary amyloidosis with renal and gastrointestinal involvement. She has also had radiological signs of bilateral asymptomatic sacroiliitis without lower back pain or hla-b27 antigen.- - - - - - - - - - ranking = 0.72142095814144keywords = back pain, pain, back (Clic here for more details about this article) |
3/194. "Ankylosing spondylitis" without sacroiliitis in a woman without the HLA B27 antigen.An elderly woman with otherwise typical ankylosing spondylitis for 45 years lacked radiologic evidence of sacroiliitis and the HLA B27 antigen. The illness was complicated by renal tuberculosis requiring a left nephrectomy 23 years after the onset of low back pain, and 20 years after an episode of severe iritis. After the eradication of the tuberculosis by surgery and chemotherapy, she has continued to have symptomatic spondylitis. The case seems to be an exception to the rule that sacroiliitis is a sine qua non for ankylosing spondylitis. women with ankylosing spondylitis tend to have milder disease with an apparently lower frequency of roentgenographic changes in sacroiliac joints.- - - - - - - - - - ranking = 0.72142095814144keywords = back pain, pain, back (Clic here for more details about this article) |
4/194. Fatal fulminant hepatitis associated with bromfenac use.OBJECTIVE: To report a case of fulminant hepatic failure associated with the use of bromfenac, a new analog of the phenyl acetate class of nonsteroidal antiinflammatory drugs. CASE SUMMARY: A 60-year-old white woman with liver failure who had no known history of chronic liver disease was transferred to the liver transplant unit for evaluation. For three months preceding her illness, the patient was treated with bromfenac 25 mg po qid for arthritic pain. Prior to the initiation of bromfenac, her liver function test results were normal. Etiologic evaluation at presentation was unremarkable. The patient's condition continued to deteriorate, with the development of hepatic encephalopathy and worsening liver function test results while awaiting liver transplantation. Progressive hepatic and renal dysfunction along with respiratory decompensation ensued, and the patient died 48 days after initial presentation. CONCLUSIONS: Fulminant hepatic failure associated with the prolonged use of bromfenac appears to be an idiosyncratic response consistent with experience with other agents of its class. This case along with other cases of serious hepatotoxicity associated with the use of this agent ultimately resulted in bromfenac's removal from the market.- - - - - - - - - - ranking = 0.27857904185856keywords = pain (Clic here for more details about this article) |
5/194. chiropractic care and ochronotic arthropathy.OBJECTIVE: To discuss the case of a patient with ochronotic arthropathy whose symptoms were treated with chiropractic care. An emphasis is placed on this condition's radiographic features. CLINICAL FEATURES: A 59-year-old woman with pain in her low back, right knee, and left ankle sought chiropractic evaluation. Black pigmentation was found in the sclera of both eyes, and homogentisic acid was present in the urine. Orthopedic evaluation revealed uncomplicated, nonspecific joint pain, and radiographs demonstrated characteristic spinal changes. INTERVENTION AND OUTCOME: The patient was treated with chiropractic manipulation, physiotherapy modalities, bracing, and exercises. This type of therapy was successful in reducing the symptoms and helped decrease the severity and frequency of acute exacerbations. CONCLUSION: Ochronotic arthropathY is a rare metabolic disorder that can be diagnosed from spinal radiographs. chiropractic care is an appropriate tool for reducing its symptomatology.- - - - - - - - - - ranking = 0.58835628396319keywords = pain, back (Clic here for more details about this article) |
6/194. A technical solution for secondary arthritis due to chronic proximal tibiofibular joint instability.Chronic instability of the proximal tibiofibular joint is an uncommon diagnosis and not frequently reported in the literature. The management options of this joint instability, complicated with secondary arthritis, have rarely been discussed and consist mainly of fibular head resection or arthrodesis of this joint. We describe a new technical procedure for addressing both the instability and the joint secondary arthritis. Stability of the joint is achieved by ligament reconstruction using a biceps femoris split passed through the tibial metaphysis and fixated back to the fibular head using bone anchors. The arthritic changes are addressed by interposition of a vascularized fascia lata strip. The described procedure offers a firm stabilization with no need for postoperative restrictions and an alternative to the inadvisable joint arthrodesis or resection.- - - - - - - - - - ranking = 0.031198200246072keywords = back (Clic here for more details about this article) |
7/194. Comparison of first carpometacarpal joint arthrodesis with contralateral excision arthroplasty in a patient with bilateral saddle joint arthritis: a case report.A post-menopausal patient with bilateral primary osteoarthritis of the first carpometacarpal joint (CMCJ) was treated by 2 different surgical techniques. The non-dominant left CMCJ was arthrodesed in 1992 while excision of trapezium and tendon suspensionplasty was done for the dominant right side in 1997. She reported good pain relief with both procedures and she was able to fully oppose both thumbs at 6 years after arthrodesis and 1 year after arthroplasty. The grip and pinch strength was stronger on the arthrodesed side while hand function tests revealed the arthroplasty side to be more dexterous. Subjectively, she preferred the right thumb. Radiographs showed no peritrapezial arthritis in the arthrodesed CMCJ and no proximal migration of the metacarpal on the reconstructed side. Both procedures offered excellent relief of symptoms and she was able to return to work as a machine operator.- - - - - - - - - - ranking = 0.27857904185856keywords = pain (Clic here for more details about this article) |
8/194. Protracted familial mediterranean fever arthritis.familial mediterranean fever (FMF) is an inherited disorder characterized by recurrent attacks of fever and abdominal, chest, and articular pain. The articular attack of FMF is typically an acute, self-limited, large joint monoarthritis most often affecting the knee or hip. Rarely, a more protracted arthritis may occur. We describe two unusual cases of long-standing FMF arthritis with excellent response to synovectomy.- - - - - - - - - - ranking = 0.28137195581573keywords = pain, chest (Clic here for more details about this article) |
9/194. Secondary hypertrophic osteoarthropathy. An unusual cause of arthritis in childhood.Although an uncommon occurrence in childhood, hypertrophic osteoarthropathy secondary to tumors- most commonly to osteogenic sarcoma with pulmonary metastasis-may cause severe join pain and swelling. The syndrome should be considered in the differential diagnosis of acute arthritis in childhood- - - - - - - - - - ranking = 0.27857904185856keywords = pain (Clic here for more details about this article) |
10/194. Nimesulide-induced hepatitis and acute liver failure.BACKGROUND: Nimesulide is a relatively new non-steroidal anti-inflammatory drug that is gaining popularity in many countries because it is a selective cyclooxygenase 2 inhibitor. Occasionally, treatment is associated with mild elevation of liver enzymes, which return to normal upon discontinuation of the drug. Several cases of nimesulide-induced symptomatic hepatitis were also recently reported, but these patients all recovered. OBJECTIVES: To report the characteristics of liver injury induced by nimesulide. patients AND methods: We report retrospectively six patients, five of them females with a median age of 59 years, whose aminotransferase levels rose after they took nimesulide for joint pains. In all patients nimesulide was discontinued, laboratory tests for viral and autoimmune causes of hepatitis were performed, and sufficient follow-up was available. RESULTS: One patient remained asymptomatic. Four patients presented with symptoms, including fatigue, nausea and vomiting, which had developed several weeks after they began taking nimesulide (median 10 weeks, range 2-13). Hepatocellular injury was observed with median peak serum alanine aminotransferase 15 times the upper limit of normal (range 4-35), reversing to normal 2-4 months after discontinuation of the drug. The remaining patient developed symptoms, but continued taking the drug for another 2 weeks. She subsequently developed acute hepatic failure with encephalopathy and hepatorenal syndrome and died 6 weeks after hospitalization. In none of the cases did serological tests for hepatitis a, B and C, Epstein-Barr virus and cytomegalovirus, as well as autoimmune hepatitis reveal findings. CONCLUSIONS: Nimesulide may cause liver damage. The clinical presentation may vary from abnormal liver enzyme levels with no symptoms, to fatal hepatic failure. Therefore, monitoring liver enzymes after initiating therapy with nimesulide seems prudent.- - - - - - - - - - ranking = 0.28028655013641keywords = pain, upper (Clic here for more details about this article) |
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