1/9. polymyalgia rheumatica and temporal arthritis.polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions that affect different cellular targets in genetically predisposed persons. Compared with temporal arteritis, polymyalgla rheumatica is much more common, affecting one in 200 persons older than 50 years. Temporal arteritis, however, is more dangerous and can lead to sudden blindness. The diagnosis of polymyalgia rheumatica is based on the presence of a clinical syndrome consisting of fever, nonspecific somatic complaints, pain and stiffness in the shoulder and pelvic girdles, and an elevated erythrocyte sedimentation rate. Temporal arteritis typically presents with many of the same findings as polymyalgia rheumatica, but patients also have headaches and tenderness to palpation over the involved artery. Arterial biopsy usually confirms the diagnosis of temporal arteritis. early diagnosis and treatment of polymyalgia rheumatica or temporal arteritis can dramatically improve patients' lives and return them to previous functional status. Corticosteroid therapy provides rapid and dramatic improvement of the clinical features of both conditions. Therapy is generally continued for six to 24 months. Throughout treatment, clinical condition is assessed periodically. patients are instructed to see their physician immediately if symptoms recur or they develop new headache, jaw claudication or visual problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Heeding clues to giant cell arteritis. Prompt response can prevent vision loss.To return to the case vignette, the new onset of headache in a 74-year-old woman with anemia and a markedly elevated ESR should alert the physician to the strong possibility of giant cell arteritis. Vision loss is the most significant potential early complication. Temporal artery biopsy is indicated, and treatment with corticosteroids should be started immediately. Close monitoring of the patient's symptoms and laboratory parameters is critical, as is surveillance for potential late complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Steroid dementia: an overlooked diagnosis?The authors studied a 72-year-old man with polymyalgia rheumatica who, after taking 100 mg of prednisone for 3 months, developed a psychosis followed by dementia. It was initially considered that the dementia was a separate neurodegenerative condition, probably of Alzheimer type, but when steroids were discontinued, he rapidly returned to his previous level of functioning. Reviewing the literature regarding the effects of steroids on cerebral function, the authors found that such cases of "reversible dementia" are not uncommon, although rarely given the emphasis they deserve. The authors believe, given the extensive use of steroids in medical practice, that physicians should be more aware of this important cause of reversible dementia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. osteoarthritis as a misdiagnosis in elderly patients.Musculoskeletal disorders are very common in the elderly, and x-ray evidence of irreversible damage due to osteoarthritis is found in probably all older people. Thus, when confronted by various pain symptoms in an older patient, the physician must always include osteoarthritis in the differential diagnosis. However, potentially reversible causes for the problem are too often ignored, and a misdiagnosis of osteoarthritis prevents or delays effective treatment of the actual underlying problem, with potentially serious consequences. Six case studies are offered illustrating this problem and pointers in differential diagnosis are suggested.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Musculoskeletal syndromes associated with malignancy.Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/9. polymyalgia rheumatica and giant cell arteritis in emergency department patients.Elderly patients with undiagnosed polymyalgia rheumatica and giant cell arteritis are not uncommon, and they may present to the emergency department with nonspecific physical complaints. We describe the cases of two patients who had the "typical" constellation of symptoms. It is important that emergency physicians consider the diagnosis and provide appropriate testing, therapy, and follow-up.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. incidence of autoimmune disease in patients after breast reconstruction with silicone gel implants versus autogenous tissue: a preliminary report.OBJECTIVE: To test the hypothesis that there is a higher incidence of autoimmune disorders in patients who have undergone breast reconstruction with silicone gel implants rather than autogenous tissue. DESIGN: Prospective study. SETTING: Tertiary referral center dealing exclusively with cancer. patients: All female breast cancer patients who underwent breast reconstruction between January 1986 and March 1992. patients were nonrandomly assigned to breast reconstruction with one of the following four methods: (1) silicone gel implant only, (2) latissimus dorsi flap with implant, (3) latissimus dorsi flap without implant, and (4) transverse rectus abdominis flap. The first two groups made up the implant cohort and the last two groups the autogenous tissue cohort. Selection of reconstructive method was made on clinical grounds and was based on both physician and patient preference. MAIN OUTCOME MEASURES: Documented diagnosis of autoimmune disorder by Board-certified rheumatologist. Results: Three hundred eight implants were used in 250 patients, and 408 reconstructions with tissue were performed on 353 patients. The two groups were similar in age and tumor stage. The two groups contributed 615.8 and 663.4 person-years of follow-up, respectively. One patient from each group (< 0.5%) had a documented occurrence of an autoimmune syndrome requiring therapy. Both cases were considered mild, and after initial low-dose steroid therapy, both patients are now off steroids. CONCLUSION: The incidence of autoimmune disease in mastectomy patients receiving silicone gel implants is not different than in patients who had reconstruction with autogenous tissue.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. giant cell arteritis and polymyalgia rheumatica: clues to early diagnosis.giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related disorders found predominantly in older patients. These disorders, which are being recognized more frequently, are more common in women, in Caucasians, and in various geographic locations. Early recognition and treatment may prevent possible catastrophic consequences of GCA, such as blindness, stroke, or dissection of the aorta. Although diagnosis is fairly easy with the classic presentation, it may be missed when the patient presents with nonspecific constitutional symptoms. An increased awareness among primary care physicians will aid in the prevention of much of the morbidity and mortality related to these diseases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. A 24-year-old man with symptoms and signs of polymyalgia rheumatica.Most physicians regard polymyalgia rheumatica (PMR) as a disease that affects only the elderly. This case report of a 24-year-old man with proximal limb girdle muscle pain, stiffness, tenderness, weakness, and an elevated erythrocyte sedimentation rate, who had a dramatic response to steroids, supports the premise that PMR may affect a wider range of our population. Increased physician awareness that this illness does occur in patients younger than 50 may prevent delays in diagnosis, and decrease the needless suffering and incapacitation of younger patients with this disorder.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |