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Rash Questions for Rheumatologists
May 17, 2013
Is it a form of lupus, myositis, or a drug reaction? Check your knowledge of skin eruptions and the associated rheumatologic conditions in this brief photo essay.
Pregnant Woman With Aching Pain, Muscle Fatigue, and Rash
Case study by Philip N. Velderman MD, Leslie A. Bruch MD, and George V. Lawry MD
, May 1, 2013
A 39-year-old woman, in her eighth week of pregnancy, experienced aching pain that worsened with activity. Weakness and fatigue set in three days later in her thigh and proximal arm muscle. Then a mildly pruritic rash developed across the forehead, nose, and forearms.
Lumbar MRIs and Baby Boomers: What Are We Looking For?
By John Cowdery MD
, April 16, 2013
The ACR's new list of probably unnecessary procedures set this emeritus rheumatologist wondering about another procedure that might be unwarranted: MRI for low back pain or sciatica in an older patient with no red flags. What does it accomplish beyond satisfying curiosity? Read the author's challenge to rheumatologists, and see what some readers think. Do you agree that an MRI may help some patients even if it only offers the last word on the subject?
| Rheumatology Tip of the Day |  | Understanding Allopurinol-Induced DRESS Syndrome
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. . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Latent Tuberculosis Infection in RA: The Disease and the Diagnosis
Although tuberculosis is common in RA even in the absence of treatment, false-negative tuberculin skin test results are frequent because of either immunosuppressive treatment or a natural waning of immunity. . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Doomed Arthritic Knees Rotate More and Never Rest
The quads and hamstrings of OA patients who later have knee replacement seem to be firing continuously, according to new biomechanics research. Training with the Alexander technique may offer relief. . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Lupus: The Role of the Primary Care Physician. Part 1: Diagnosis
Lesser-known presenting symptoms of lupus: • Cognitive dysfunction (difficulty focusing, memory loss, and depression) • Headaches • Anemia • Pleurisy and/or pericarditis • Abnormal blood clotting • Seizures • Ulcers of the mouth and/or nose . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Recognizing and Managing Posterior Cruciate Ligament Injuries
Gradually increasing mild pain in the back of the knee, stiffness, and pain with squatting or kneeling may be the only signs of PCL injury, arising long past the acute period after a seemingly trivial inciting event. . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Recognizing Rheumatologic Aspects of Cocaine Abuse
Cocaine and its contaminants, primarily levamisole, can cause lesions of the earlobes and cheeks, midline granulomatous lesions, and a mimic of vasculitis. . ..
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Is There Truly A Therapeutic "Window of Opportunity" in RA?
Combined studies of more than 6,000 patients agree: To lessen joint damage and achieve remission, treat rheumatoid arthritis at least during the first 12 weeks after diagnosis.. . .
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Eosinophilic Fasciitis: A Difficult Diagnosis
Raynaud's phenomenon is usually absent from eosinophilic fasciitis, which may be difficult to differentiate from scleroderma. Nearly all scleroderma patients have Raynaud's, usually early on. . .
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Obese Woman With Fibromyalgia and Increasing Back Pain
Clues to spinal epidural abscess as a cause of back pain (a potentially disabling condition and thus a diagnostic "great save"):
1. Usually insidious onset
2. Usually thoracic (most back pain is cervical or lumbar)
3. Major red flag: fever (though often absent, especially early in the course). . .
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Managing Systemic Sclerosis and Its Complications
Use ACE inhibitors with great care in systemic sclerosis. ACE inhibitors given before the onset of scleroderma renal crisis worsen later outcomes. . .
Learn More | | » See the entire Tip of the Day collection. | | Rheumatology Tip of the Day |  | Woman With Sarcoidosis, Lymphoma, and Shoulder Pain
As many as 40% of sarcoidosis patients show an acute, self-limiting polyarthritis, but chronic arthritis and muscular symptoms are very rare. . .
Learn More | | » See the entire Tip of the Day collection. |
No Evidence Backs Intra-articular Glucocorticoids for Acute Gout
May 15, 2013
They may be supported by guidelines and commonly used in practice, but joint injections with glucocorticoids for acute gout are not backed by any randomized controlled clinical trials, according to a new Cochrane report. However, the report backs away from saying they should not be used.
Why Fibromyalgia Belongs in Primary Care
May 13, 2013
New in the non-rheumatology journals, much about pain: A review based on 2012 fibromyalgia guidelines from Canada, a viewpoint on safe use of opioids, the evidence to back spinal pain interventions. Also: fast-track arthroplasty, and more newfound genes.
Pregnant Woman With Aching Pain, Muscle Fatigue, and Rash
May 1, 2013
A 39-year-old woman, in her eighth week of pregnancy, experienced aching pain that worsened with activity. Weakness and fatigue set in three days later in her thigh and proximal arm muscle. Then a mildly pruritic rash developed across the forehead, nose, and forearms.
Obese Woman With Fibromyalgia and Increasing Back Pain
April 11, 2013
 An obese woman in her thirties with a history of fibromyalgia syndrome, depression, polycystic ovarian syndrome, and diabetes presents with midline back pain that has gradually worsened over the past week.
Woman With Sarcoidosis, Lymphoma, and Shoulder Pain
April 2, 2013
A 56-year-old woman presents with a history of intermittent shoulder pain for the past six months. Early signs point to bursitis, but the plot thickens: She also has sarcoidosis and lymphoma. How would you proceed?
Skin Eruption in Taiwanese Immigrant
March 6, 2013
A 44-year-old nonsmoking immigrant from Taiwan sought help from a dermatologist for this longstanding skin eruption, lately complicated by weight loss and fatigue.
Diagnostic Champions’ Challenge on Musculoskeletal Network Designed to test the knowledge and medical diagnostic skills of physicians and other healthcare professionals, Musculoskeletal Network's Diagnostic Champions' Challenge was created to educate and entertain. Can you recognize and determine the appropriate treatment for a patient's malady quickly and correctly? Test your clinical knowledge and diagnostic skills by playing in previous rounds and see how your score matches up with other players! Read More»
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Roy D. Altman, MD
Professor, Department of Rheumatology, Ronald Reagan UCLA Medical Center, Los Angeles
Marcy Bolster, MD
Director, Rheumatology Fellowship Program, Massachusetts General Hospital; Lecturer, Harvard University Medical School, Boston
John S. Cowdery, MD
Chief of Staff, VA Iowa City Health Care System; Professor of Rheumatology, University of Iowa Carver College of Medicine, Iowa City
Christopher E. Collins, MD
Assistant Professor of Medicine, Georgetown University Medical Center and Program Director, Rheumatology Fellowship Program, Washington Hospital Center, Washington DC
Nancy E. Lane, MD
Director and Endowed Professor Aging Center, Medicine and Rheumatology, University of California at Davis Medical Center, Sacramento
Stephen A. Paget, MD
Joseph P. Routh Professor of Rheumatic Diseases in Medicine, Weill Medical College of Cornell University, New York; Former Chairman, Division of Rheumatology and Physician-in-Chief, Hospital for Special Surgery, New York
Previous articles from Musculoskeletal Network and the Journal of Musculoskeletal Medicine are available in the online archive. For previous articles on a particular topic, click the Search box at the upper right of the screen. You can optimize your search for either relevance or date.
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A discovery that patients with fibromyalgia showed signs of small fiber impairment not present in depressed patients or controls may point to the first objectively measurable alteration of the peripheral nervous system in this disorder.
A 36-year-old male weight lifter complained of a dull-achy pain in his right shoulder. He reported no injury or trauma.
