Proving that a picture can be worth at least a thousand words, this slide show with links to case studies offers a chance to review the basics of diagnosis and treatment.
In this first case, the patient was suffering his third episode of gout. The first metatarsophalangeal joint of his left foot was erythematous, hot, and tender, and the intense pain was resistant to treatment with colchicine.
Why are gout patients seeking treatment from their healthcare providers at three times the rate they were in the later 20th century? Researchers suggest that better disease awareness and an aging population may hold the answers. More »
ACR2013: Urate crystals turned up in dual-energy CT and pathology studies of OA patients never diagnosed with gout who came to the Mayo Clinic for knee replacement, raising intriguing questions. More »
Internists gain some guidance on identifying systemic lupus erythematosus (SLE) and why they should work with rheumatologists. Meanwhile, two UK studies outline paths to successful gout treatment and lower mortality rates after hip replacement surgery. Finally, the use of imaging, including... More »
Researchers have nailed the reason why several herbal nostrums for arthritis and gout cause malignancy, including hepatocellular cancer previously attributed to hepatitis C. Also in the non-rheumatology journals this week: News about comorbidities of psoriasis and antibody profiles for morphea. More »
PML and Rituximab: What Rheumatologists Should Know
The risk for progressive multifocal leukoencephalopathy among RA patients on rituximab is extremely low, about 5/100,000. For MS patients on long-term (>24 months) natalizumab and infected with relevant pathogen, the JC virus, it is cited as 1/100. . ..
Pharmacogenetics in Rheumatology: Disappointment, Success, and a Few Challenges
The enzyme that prevents toxic reactions to the lupus drug azathioprene has little or no activity in 0.3% of individuals and only intermediate activity in 10%. The test for this, advised on the label, is a rare example of effective pharmacogenetics in rheumatology. . ..
EMG is a very helpful to differentiate myositis from disorders of the brain, nerves, or spinal cord, but among children MRI is often used to avoid the morbidity associated with muscle biopsy and EMG. Absent skin manifestations, muscle biopsy is the gold standard. . ..
Systemic Lupus Erythematosus With Features of Castleman Disease
Lymphadenopathy, fever, anemia, elevated ESR, and hypergammaglobulinemia occur often in the plasma cell type of Castleman Disease. Unlike another cause in the differential, malignancy, these are completely reversible in Castleman Disease. . ..
All About Gout and Pseudogout: Meeting A Growing Challenge
Most patients with hyperuricemia do not go on to have gout, and it may be seen with any other cause of acute monoarthritis. On the other hand, serum uric acid levels may drop to normal values during an acute gout attack, due to an increase in renal excretion, so a normal value does not exclude this diagnosis. . ..
Joint Aspiration and Injection: A Look at the Basics
Cellulitis overlying a swollen joint is not a contraindication if it is the only portal for intra-articular access. The risk of introducing infection by aspirating through cellulitic skin is far less than the risk of unmanaged septic arthritis. . ..
Limited Joint Mobility in Diabetes Mellitus: The Clinical Implications
Take care not to be overenthusiastic about the prayer-sign test for limited joint mobility, for instance in patients with diabetes. One study found that 26% of healthy controls were not able to make complete contact of the palmar surfaces. . ..
Viral causes are implicated in potentially deadly A-DRESS SYNDROME (dermatitis, hepatitis, interstitial nephritis, and eosinophilia) among allopurinol users. Skin biopsy and a wide panel of viral titers are well advised. . ..
How Physicians Can Manage Unexpected Free Time Jennifer Frank, MD, October 22, 2013 Whether you have an unexpected patient no-show, or two hours before bed, figuring out how to spend spurts of free time can be a work-life balance stressor.