1/22. Drug-induced lung disease.Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/22. Delay in diagnosis: indeterminate leprosy presenting with rheumatic manifestations.BACKGROUND: Rheumatic complications are common in leprosy (Hansen's disease) and can be the primary complaint delaying accurate diagnosis. OBJECTIVE: Such a case is reported here: a 61-year-old woman with indeterminate leprosy presented with symmetric arthritis and purpura. Despite biopsy and evaluation by several physicians, leprosy was not suspected. After 2 years of progressive symptoms, a second biopsy revealed lepromatous leprosy. CONCLUSION: In this case, lack of clinical suspicion and unfamiliarity with the histology of indeterminate leprosy delayed diagnosis and treatment. leprosy should be considered in the differential diagnosis of patients presenting with unusual rheumatic and persistent cutaneous manifestations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/22. 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) |
4/22. Cactus thorn arthritis: case report and review of the literature.synovitis secondary to penetrating plant thorn injuries is an infrequently reported event. Despite its wide geographic distribution, thorns from the prickly pear cactus (Optunia ficusindica) are a rare source of this type of inflammatory arthritis. We hereby present an unusual case of an individual who developed an acute monoarthritis of the knee shortly after sustaining a penetrating cactus thorn injury. The clinical and pathophysiologic features of cactus thorn arthritis are reviewed and the unusual features present in this individual are highlighted. Treatment options, with an emphasis on rapid diagnosis and therapeutic interventions, are discussed. Increased physician awareness and recognition of this unusual but not rare entity are essential as a means of improving clinical outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/22. 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) |
6/22. Hashimoto's thyroiditis presenting as bilateral knee arthropathy.Hashimoto's thyroiditis is an autoimmune disease associated with antimicrosomal antibodies. Thyroid failure from any cause can lead to hypothyroidism which has numerous manifestations, including rheumatic. Rheumatic or musculoskeletal symptoms may be the initial presentation of hypothyroidism. A case is described in which knee pain was the presenting symptom in a patient with Hashimoto's thyroiditis without any other sign or symptom of hypothyroidism. synovial fluid was non-inflammatory and lab tests were consistent with hypothyroidism secondary to Hashimoto's thyroiditis. The non-inflammatory arthralgia and arthritis, stiffness and musculoskeletal signs of hypothyroidism were completely reversible with adequate thyroid replacement hormone. knee effusions are a common sign in hypothyroidism with a sluggish bulge sign, which is due to highly viscous synovial fluid. Purpose of this case is early diagnosis and treatment of hypothyroidism by primary care physicians, which can probably prevent many patients from developing polyarthritis associated with hypothyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/22. Behcet's disease: a case report.While Behcet's disease is an uncommon presentation to a podiatric clinical setting, it is nonetheless a fascinating and poorly understood disease as demonstrated by the current and historical research available about the topic. Much debate remains about the disease cause, course and treatment goals. Only through further research into the specific components of this multisystem disease will medicine be more fully able to address the needs of the patient. This discussion should offer the podiatric physician an overview of the disease as well as available treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/22. lead poisoning caused by Indian ethnic remedies in italy.BACKGROUND: Complementary or alternative medicine has become widespread in Western Countries and since the remedies are "natural" they are believed to be free of toxic effects and health risks. Ethnic remedies may contain lead, other metals and toxic substances. OBJECTIVES: To show how lead poisoning as a result of using ethnic remedies may be severe enough to cause serious damage to health, and to increase awareness among family doctors and occupational physicians of the risks associated with ethnic remedies. methods AND RESULTS: Description of ethnic remedy-related lead poisoning in 2 native Italian adults, with clinical, laboratory and toxicological data. CONCLUSIONS: When metal poisoning is diagnosed, ethnic remedies should be included among the putative sources so as to avoid erroneous attribution to workplace exposure and application of unneeded preventive measures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/22. Human parvovirus B-19: not just a pediatric problem.Parvoviruses have long been associated with disabling and even fatal illnesses in animals. The discovery of the human parvovirus B-19 in 1975 (1) and subsequent studies of its effects in humans identified this virus as the causative agent of erythema infectiosum ("fifth disease") in children. (2). erythema infectiosum (EI) is a common, self-limited infectious disorder in children, easily recognized by the classic "slapped cheek" facial erythema and fine reticular rash. Only in the 1980s have further investigations linked HPV B-19 infection with more significant clinical syndromes, among which is an adult polyarthropathy. This presentation in adults is more common than is currently understood and is easily confused with other symmetric polyarthropathies. Recognition and conservative treatment of this disorder are important for the emergency physician, to whom these patients may present.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/22. Rofecoxib-induced hepatotoxicity: a forgotten complication of the coxibs.Rofecoxib is a member of the coxib family of nonsteroidal anti-inflammatory drugs that selectively inhibit cyclooxygenase-2. Although the coxibs are generally well-tolerated, rofecoxib was recently withdrawn from the market due to concerns regarding cardiovascular safety. Rare cases of hepatic injury attributable to the coxibs have been reported. In the present study, two additional cases of severe hepatotoxicity are described in patients with cholestatic symptoms and abnormal liver biochemistry, shortly following the initiation of rofecoxib for arthritic complaints. In both cases, liver histology was compatible with drug-induced hepatotoxicity, and rapid clinical and biochemical improvements were observed following rofecoxib discontinuation. With new coxibs and expanding indications on the horizon, physicians in all areas of practice must be aware of this disorder and consider it in any patient who develops hepatic dysfunction after taking a coxib.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |