Rheumatology Commons^™

Primary Hypertrophic Osteoarthropathy: A Case Series, Varuni Pragya, Mahabaleshwar Mamadapur Dr, Rahul Bisaralli Dr, Deepak Benny Dr, Purna Bansal

Digital Journal of Clinical Medicine

Skeletal dysplasia encompasses a spectrum of over 400 rare inheritable skeletal abnormalities typically manifested early in childhood. Hypertrophic Osteoarthropathy is a clinical syndrome marked by abnormal skin and osseous tissue proliferation at the distal extremities. It is characterized by unique clinical features such as digital clubbing, periostosis of tubular bones, and synovial effusions.

We report three cases of HPOA for further understanding and insight into this infrequent cause of clubbing. Case 1 involved a 25-year-old male presenting with joint pain, primarily in wrists and knees, accompanied by progressive swelling in both lower limbs for the past 3 years. Case 2 …

Characteristics And Hospital Outcomes Of 1403 Patients Hospitalized At Community Hospitals With Ankylosing Spondylitis, Se Won Lee, Carol Elsakr, Jonathan Holt, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS).

Methods

We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home …

Biliary Dyskinesia In Stiff Person Syndrome: An Association Between Reduced Gaba Production And Gastroenteric Dysmotility, Scarlet Louis-Jean, Nirav Agrawal, Shire Chaudhry, Adrien Mazer

Journal of Community Hospital Internal Medicine Perspectives

Stiff person syndrome (SPS) and biliary dyskinesia are two rare but potentially debilitating conditions that can significantly impact quality of life. SPS is a rare neurological disorder characterized by muscle stiffness, rigidity, and muscle spasms that primarily affect the trunk and limbs and is associated with extra-axial manifestations involving the gastrointestinal tract. Biliary dyskinesia is a gastrointestinal disorder characterized by abnormal gallbladder emptying, leading to symptoms of intense abdominal pain, nausea, and vomiting. Despite their distinct clinical presentations, studies have suggested a possible connection between the two disorders. This link may be due to involvement of similar neurotransmitters and autoantibodies …

Treatment Of Knee Synovitis From Psoriatic Arthritis With Platelet Rich Plasma Injection, Nicolle Mazzei, Arielle Hall, Cody Clinton

Cooper Rowan Medical Journal

Psoriatic arthritis has been known to cause many inflammatory clinical features, including synovitis. In the past, synovitis has been primarily treated with NSAIDs, corticosteroid injections, and synovectomy when needed. This case report outlines a 49-year-old female with synovitis caused by psoriatic arthritis who did not respond to conventional treatment options and was apprehensive to surgery. She was offered a platelet rich plasma (PRP) injection as alternative therapy to a synovectomy. This case explores the use of PRP injections as a potential treatment modality for patients with synovitis caused by psoriatic arthritis. This patient was able to show improvement in her …

Hydroxychloroquine Induced Cardiomyopathy, Mohamed Salah Mohamed, Katrina Wojciechowski, Scott Feitell, Muhammad Osama, Anas Hashem, Jayesh Patel, Amir Mahmoud, Ali Abdelhay, Prakash Upreti, Soidjon Khodjaev

Advances in Clinical Medical Research and Healthcare Delivery

Hydroxychloroquine (HCQ) is one of the immunomodulatory medications used in treatment of autoimmune diseases. Rarely, HCQ can cause serious complications, such as cardiotoxicity. We present a rare case of HCQ-induced cardiomyopathy. 60-year-old female patient with a medical history of SLE on chronic HCQ therapy for 28 years, preexisting non-ischemic cardiomyopathy and heart failure with reduced ejection fraction for 7 years, and complete heart block status post pacemaker insertion presented with acute chest pain and severe weight loss. Patient underwent coronary angiogram that showed normal coronaries and right-sided heart catheterization that showed acute heart failure. Echocardiogram showed LVEF of 30% with …

Eosinophilic Granulomatosis With Polyangiitis (Churg Strauss Syndrome) – A Case Report, Rudrani Mukherjee, Bhanukumar M

Digital Journal of Clinical Medicine

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg Strauss syndrome, is a rare small vessel vasculitis characterized by asthma, eosinophilia, and systemic involvement. This case report presents a 51-year-old man with a history of asthma, who presented with neurological symptoms including blurring of vision, bilateral ptosis, and altered sensorium. The patient had a previous history of cervical and lumbar spine surgeries for symptoms attributed to spondylosis. Further examination revealed hyperpigmented lesions on the limbs, wasting of small muscles, and foot drop.

Investigations showed eosinophilia and thrombocytosis on blood analysis, with bone marrow aspiration revealing eosinophilic and megakaryocytic hyperplasia. The …

Extrinsic Allergic Alveolitis: A Systematic Review Of Hla-Dr In Pigeon Breeder’S Disease, Dylan Thibaut, Ryan A. Witcher, Anitha Kunnath, James Toldi

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Introduction: Pigeon Breeder’s Pneumonitis (PBP) results due to a complex pathophysiology that includes exposure to avian antigens. Susceptibility has been linked to human leukocyte antigen (HLA) class II, though consensus has not been reached. The goal of this systematic review is to further elucidate the association between PBP and HLA-DR subtypes.

Methods: Databases utilized included PubMed, Google Scholar, ScienceDirect, and Cochrane Library. Inclusion required a minimum of three studies in English presenting HLA-DR alleles of PBP and control subgroups. Exclusion was due to insufficient data or non-feasible control groups. Forest plots were created for HLA-DR subtypes’ association …

Graves' Disease And Major Histocompatibility Complex Class Ii: A Meta-Analysis Of Hla-Dq And Hla-Drb1, Dylan Thibaut, Connor Sweeney, Shannon South, Mohamed Hussein

Advances in Clinical Medical Research and Healthcare Delivery

Background: Human leukocyte antigen (HLA) class II has shown potential in determining prognosis, understanding medication reactions, and predicting onset of Graves’ disease. The aim of this study is to further investigate the association between Graves’ disease and HLA class II, specifically HLA-DQ and HLA-DR, via meta-analysis to find HLAs that can be further examined for prognostic reasons.

Methods: Statistical analysis was performed to determine if variants of HLA-DQA1, HLA-DQB1, or HLA-DRB1 were associated with significantly altered odds of Graves’ disease. A minimum of three studies pertaining to a particular HLA was required for inclusion. Studies were excluded if …

Rheumatoid Vasculitis Presenting With Incidental Renal Infarcts: Case Report And Literature Review, Fatima Halilu, Howard Hauptman

Journal of Community Hospital Internal Medicine Perspectives

Rheumatoid vasculitis is a rare and late complication of rheumatoid arthritis, affecting small to medium sized vessels. Inflammation in the vessel wall produces an occlusive vasculopathy with downstream infarction. We present the case of a 70-year-old female with long standing stable RA status post recent COVID-19 vaccination admitted with community acquired Legionnaires disease found to have an incidental renal infarct on chest imaging without a clear etiology. She improved from a respiratory standpoint but then had a fever spike with repeat imaging showing a second renal infarct and CT angiography showing extensive beading with aneurysmal dilation in the bilateral hepatic …

Lupus Enteritis In The Absence Of A Lupus Flare. A Case Report And Review Of Literature, Fatima Halilu, Anum Qureshi, Brenton Nash

Journal of Community Hospital Internal Medicine Perspectives

Lupus enteritis is a rare manifestation seen in systemic lupus erythematosus (SLE). Its diagnosis can be challenging as symptoms frequently overlap many gastrointestinal disorders, imaging findings are not specific, and endoscopic features are infrequently diagnostic. Moreover, enteritis can occur in isolation without other systemic manifestations or even elevated inflammatory markers (1). Here is presented the case of a 22-year-old female with known SLE manifested by lupus nephritis complicated by end-stage renal disease who presented with abdominal pain. She had leukocytosis with thickened bowel loops, ascites, “target sign”, “comb sign” and patent abdominal vessels on CT imaging. The differential diagnoses considered …

Evidence-Based Role Of Aspirin In Giant Cell Arteritis: A Literature Review, Anum Qureshi, Fatima Halilu, Sam W. Serafi, Howard Hauptman, Tristan Flack

Journal of Community Hospital Internal Medicine Perspectives

Giant cell arteritis (GCA), or temporal arteritis, is a medium to large vessel vasculitis seen in the elderly. Its presentation varies from fever of unknown origin to cranial ischemic complications including complete vision loss. The early initiation of steroids is key to preventing complications of GCA. Here we discuss the role of aspirin in the treatment of GCA, both as an antithrombotic agent and its increasingly utilized antiinflammatory properties. The aim of this review article is to examine the evidence behind the rationale of aspirin use as an adjunct to steroids for the prevention of cranial ischemic complications.

Baffling Case Of A Patient With History Of Lupus In A Covid-19 Pandemic, Anum Qureshi, Kia Persaud, Fatima Halilu, Ji Hyun Rhee

Journal of Community Hospital Internal Medicine Perspectives

Systemic lupus erythematosus (SLE) is an autoimmune disease with a myriad of clinical presentations and periodic flares. We present a case of a young lady with a history of SLE who presented with constitutional symptoms 1 week after starting Isoniazid and Rifampin for treatment of latent TB. Her presentation shared similarities with several diseases including TB lymphadenitis, SLE flare, Kikuchi-Fujimoto Disease (KFD) and hemophagocytic lymphohistiocytosis (HLH) posing a diagnostic dilemma. Additionally, she presented not long after the onset of the global COVID-19 pandemic, further expanding the differential diagnosis. She was ultimately diagnosed with a severe SLE flare caused by rifampin …

Copper Intrauterine Device Is An Appropriate Method Of Contraception For A Patient With A History Of Systemic Lupus Erythematosus, Sydney E. Daviskiba

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Sánchez-Guerrero J, Uribe AG, Jiménez-Santana L, et al. A Trial of Contraceptive Methods in Women with Systemic Lupus Erythematosus. N Engl J Med. 2005;353(24):2539-2588. https:/doi.org/10.1056/nejmoa050817

for a patient with systemic lupus erythematosus choosing a method of contraception.

At-Home Aerobic Exercise Improves Functional Ability Of Patients With Rheumatoid Arthritis With Limited Exercise Options, Daniel Harris

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Neuberger GB, Aaronson LS, Gajewski B, et al. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Arthritis Rheum. 2007;57(6):943-952. https://doi.org/10.1002/art.22903

and its application for a patient with rheumatoid arthritis.

Gout: Current Considerations, Alexandria Fappiano, Wilson Crone

Internet Journal of Allied Health Sciences and Practice

Gout is a treatable chronic inflammatory condition that can cause severe joint pain and disfigurement. Commonly, it affects the first metatarsophalangeal (MTP) joint as a monoarticular process. It is typically caused by hyperuricemia and genetic mutations of the uricase gene. Gout is definitively diagnosed with the presence of negative birefringent needle-shaped crystals in the synovial fluid of the affected joint. Classically, seafood and alcohol are risk factors for developing gout. However, given current population trends, obesity is another major risk factor. While weight loss is the best conservative management, medications can also be used to manage gout. The treatment is …

Nonbacterial Thrombotic Mitral Valve Endocarditis Presenting As Embolic Stroke In A Young Patient With Lupus And Anti-Phospholipid Syndrome, Andrew Mccuen, Muhammad Saad, Erin Jm Terpstra, Adam T. Stys

Aesculapius Journal (Health Sciences & Medicine)

A 37-year-old man on systemic immunosuppression for clinically and biochemically quiescent lupus nephritis, presented with left hemiparesis. Brain MRI was concerning for right sided embolic stroke. Workup was negative for atrial fibrillation, deep venous thrombosis, and heart failure. Transesophageal echocardiogram was remarkable for fixed mitral valve leaflet echodensities. In the absence of bacteremia and systemic signs of infection, and with a history of lupus, small vegetations on atrial and ventricular sides of mitral valve leaflets are suggestive of nonbacterial thrombotic endocarditis. Nonbacterial thrombotic vegetations are composed of fibrin deposits on otherwise-healthy valves. Mainstay of treatment is therapeutic anticoagulation with clinical …

Localization Of Hand And Wrist Anatomic Structures Among Physical Medicine And Rehabilitation Residents: Implication Of Ultrasonography In Palpation Skill Verification, Se Won Lee, Phuong Uyen Le, Craig Van Dien, Stefanie Lai, Eric Aguila

HCA Healthcare Journal of Medicine

Objective

The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification.

Methods

PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.

Results

Overall palpation accuracy for 16 joint line and soft tissue structures was …

Multi-Digit Auto-Amputation In Setting Of Mixed Connective Tissue Disease, Kishan P. Patel, Jennifer L. Medlin, Michelene Hearth-Holmes

Graduate Medical Education Research Journal

Raynaud’s disease is a cutaneous manifestation often present in various connective tissue and vascular diseases. Depending on the age of onset and acuity of symptoms, the phenomenon can provide clinicians with some insight as to the severity of underlying disease, including the distinction between primary and secondary Raynaud’s. However, this diagnostic approach seems to have its limitations regarding efficacy and timing of treatment. Traditionally, treatment of Raynaud’s has focused on reestablishing blood perfusion to affected tissue, which has previously been achieved with vasodilatory medications and site-specific surgical intervention. In lieu of the severe sequelae of Raynaud’s in the setting of …

Il-1 Inhibitor Anakinra Is An Effective Alternative To Standard Treatments For Reducing Pain Due To Acute Gout Flare, Cheryl Craig

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Janssen CA, Voshaar MAHO, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019;58(8):1344-1352. https://doi.org/10.1093/rheumatology/key402 for a patient with an acute gouty attack refractory to standard treatment.

Evaluation Of Sodium Valproate Low Dose Efficacy In Radicular Pain Management And It’S Relation With Pharmacokinetics Parameters, Mona Ghasemian, Mohammad Bagher Owlia, Mohammad Hossein Mosaddegh, Masoud Nakhaie Nejad, Seyed Mojtaba Sohrevardi

BioMedicine

Background: Radiculopathy due to lumbar or cervical disc disease is the most common chronic neuropathic pain in adults. The aim of present study was evaluation of low dose of sodium valproate on radicular pain and determining VPA pharmacokinetics.

Materials and Methods: In this double blind randomized placebo control clinical study, 80 patients with established lumbar or cervical radicular pain, have been randomly allocated into two study groups: 40 have received sodium valproate 200 mg/day and Celecoxib 100 mg/day and acetaminophen 500 mg PRN as rescue medication, and second group has received placebo, Celecoxib and acetaminophen. Quantitative assessment of pain was …

Multifocal Bone Pain, Recurrent Fevers And Anemia In A 15-Year-Old, Anna M. Martens, Catherine Ezzio, Amanda Goddard, Leah Mallory

Journal of Maine Medical Center

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that primarily affects children with recurrent episodes of sterile osteomyelitis in one or more bones. Patients usually present with recurrent bone pain, though it is often a diagnosis of exclusion with most patients undergoing extensive work-up to arrive at a diagnosis.

Clinical Findings: This 15-year-old female presented with months of progressive multifocal bone pain, 22-pound weight loss and recurrent fevers. Work-up as an outpatient included a positive screening assay and IgM Western blot Panel positive for Lyme disease, treated with a 28-day course doxycycline without resolution of the symptoms, …

When Treating Sick Joints Harms Lungs, Ixekizumab Induced Pleural Effusion, Rami Batarseh, Kyle Smith, Mohammed Al-Ourani, Amro K. Al-Astal

Marshall Journal of Medicine

Immunological therapies have provided a multitude of new and effective treatment strategies for various disease states. While monoclonal antibody therapy benefits many patients, side effects are widely variable. here we present a case of pleural effusion complicating psoriatic arthritis treatment.

Macrophage Activation Syndrome As A Complication Of Systemic Lupus Erythematosus In An Adult Male, Rajesh Gopalarathinam, Vamsee Chirumamilla, Balachandran Vaidyanathan

Marshall Journal of Medicine

Macrophage activation syndrome (MAS) is a rare life-threatening complication that sometimes occurs in patients with systemic lupus erythematosus (SLE) and other connective tissue diseases. This syndrome is universally fatal without treatment, and therefore, prompt diagnosis and initiation of treatment is of vital importance.

Does Patient-Provider Race/Ethnicity Concordance Impact Outcomes For Adults With Lupus?, Pamela C. Delis Phd, Rn, Cne, Inge B. Corless Phd, Rn, Fnap, Faan, Indigo Young Ms, Ccc-Slp, Mary W. Hildebrand Otd,Otr/L, Jessica G. Bell Ms, Amanda Tarbet Mslis

Journal of Health Disparities Research and Practice

Background: Health disparities exist among the 1.5 million Americans with lupus, with women of color bearing higher disease rates and burden. Complex reasons include genetics, comorbidities, and socioeconomics. These factors may lead to differences in health-related outcomes in lupus.

Aim: To determine if patient-provider racial/ethnic concordance plays a role in outcomes for adults with lupus.

Method: For this scoping review, the authors searched PubMed Medline and CINAHL using keywords and subject headings for lupus, race or ethnicity, and patient-health professional concordance.

Results: Despite an intentionally broadened search of literature, the authors identified a lack of studies examining the topic.

Conclusions: …

How Rare Is Isolated Rheumatic Tricuspid Valve Disease?, Edme R. Mustafa, Octavian Istrătoaie, Roxana Mandia, Georgică C. Târtea, Cristina Florescu

Journal of Mind and Medical Sciences

The incidence of rheumatic fever (RF) has markedly decreased in Europe since the beginning of the 20th century due to improved living conditions, early antibiotic therapy in streptococcal pharyngitis, and changes in serotypes of circulating streptococci. Isolated outbreaks of RF are still found in various parts of the world and the disease has changed its presentation with milder joint symptoms and subclinical carditis that make the correct diagnosis more difficult. Patients can present many years later with severe valve disease and significant disability. This article presents a case of isolated rheumatic tricuspid valve disease that presented with signs and symptoms …

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.

The Effect Of Glucosamine, Chondroitin And Harpagophytum Procumbens On Femoral Hyaline Cartilage Thickness In Patients With Knee Osteoarthritis– An Mri Versus Ultrasonography Study, Florentin Ananu Vreju, Paulina Lucia Ciurea, Anca Rosu, Beatrice Andreea Chisalau, Cristina Dorina Parvanescu, Sineta Cristina Firulescu, Adina Turcu Stiolica, Andreea Lili Barbulescu, Stefan Cristian Dinescu, Cristiana Iulia Dumitrescu, Roxana Mihaela Dumitrascu, Cristina Criveanu, Lucretiu Radu, Mihai Tusaliu, Daniela Dumitrescu

Journal of Mind and Medical Sciences

Background: the evaluation of cartilage thickness has become possible with new techniques such as musculoskeletal ultrasonography (US) and magnetic resonance imagining (MRI), making the evaluation of the treatment response and the progression of the disease more accurate. Objective: to evaluate the efficacy of a Symptomatic Slow Acting Drug for Osteoarthritis using both US and MRI for measuring cartilage thickness at baseline and after 1 year. Methods: The study included the clinical evaluation of 20 patients at baseline, at 6 and 12 months as well as imaging exams (US and MRI) at baseline and after 1 year. Measurements …

The Importance Of Early Arthritis In Patients With Rheumatoid Arthritis, Georgiana Iftimie, Ana Maria Alexandra Stanescu, Mihaela A. Iancu, Anca Pantea Stoian, Razvan Hainarosie, Bogdan Socea, Gheorghita Isvoranu, Dragos Marcu, Tiberiu P. Neagu, Camelia C. Diaconu

Journal of Mind and Medical Sciences

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time.

The management of early arthritis has changed considerably in the past few years, under the …

A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, Md, Lily Ackermann, Md

The Medicine Forum

INTRODUCTION

Eosinophilic granulomatosis with polyangiitis (eGPA) is a small- and medium-sized-vessel vasculitis with multi-organ manifestations. Given the rarity of eGPA, patients are often misdiagnosed for decades and may initially present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its associated signs and symptoms. This case report serves to describe a classic presentation of a patient with eGPA, as well as to delineate the diagnostic workup, acute management, and early outpatient follow-up required.

KEY POINTS

Given the life-threatening complications of this rare condition, it is important to raise awareness about eGPA. This …

Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju

Journal of Mind and Medical Sciences

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established.

We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation.

The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and …