Rheumatology Commons^™

Giant Cell Arteritis: A Case Study And Review Of Treatment, Andrew Di Mattina Od, Jeffrey Sterling Od, Heather Whyte Od

Optometric Clinical Practice

Background: Giant cell arteritis (GCA) is the most common vasculitis affecting individuals over 50, and frequently leads to severe ischemic complications, most notably irreversible vision loss. Early diagnosis and prompt, aggressive treatment with corticosteroids is paramount to protect the fellow eye. The multifaceted clinical presentation of GCA, sometimes with atypical or sequential ocular involvement, can pose significant diagnostic challenges. This paper reviews current understanding of GCA pathophysiology, diagnosis, and current management strategies.

Case Report: A 70‑year‑old man presented with “cracked glass” vision in his right eye and was diagnosed with a branch retinal artery occlusion (BRAO). Two weeks later he …

Adult-Onset Iga Vasculitis Initially Attributed To A Cutaneous Drug Reaction And Diverticulitis, Leila C. Tou, Catherine Grace P. Hobayan, Shane Devine, Sarah Koraym

Journal of Community Hospital Internal Medicine Perspectives

Immunoglobulin A vasculitis (IgAV), formerly Henoch–Schönlein purpura, is a small-vessel vasculitis characterized by palpable purpura, arthralgias, gastrointestinal involvement, and renal disease. Although IgAV is common in children, adult-onset disease is rare and may be associated with more severe manifestations, particularly renal involvement. In adults, IgAV may be difficult to recognize because of overlap with more common gastrointestinal, infectious, or medication-related conditions. We present a case of adult-onset IgAV initially attributed to presumed diverticulitis and later to a drug eruption following antibiotic exposure. This case highlights diagnostic pitfalls and the importance of early recognition and renal surveillance.

Koeksistensi Spondiloartritis Perifer Dan Fokal Segmental Glomerulosklerosis: Sebuah Laporan Kasus Jarang, Zakiya Zulaifah, Florentina Carolin Puspita Hapsari, Virly Nanda Muzellina

Jurnal Penyakit Dalam Indonesia

Spondyloarthritis is a group of inflammatory rheumatic diseases characterized by shared clinical features, genetic predispositions, and pathogenic mechanisms. Without appropriate management, it carries a risk of various complications. We report the case of a young male patient with a one-year history of nephrotic syndrome prior to admission, presenting with chronic polyarthritis. Initially, systemic lupus erythematosus (SLE) with renal and musculoskeletal involvement was suspected, although SLE is relatively uncommon in young males. However, based on the clinical presentation of arthritis, imaging findings of sacroiliitis, and the absence of diagnostic criteria supporting SLE, the patient was subsequently diagnosed with peripheral spondyloarthritis and …

Prevalensi Covid-19 Derajat Berat Dan Kritis Saat Admisi Pada Pasien Penyakit Reumatik Autoimun Dan Faktor-Faktor Yang Berhubungan, Mulia Destini, Anna Ariane, Mira Yulianti, Aulia Rizka, Ikhwan Rinaldi, Arif Mansjoer, Hasan Maulahela, Syahidatul Wafa

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with autoimmune rheumatic diseases are known to be more vulnerable to severe and critical infections, including COVID-19. Although it is no longer classified as a pandemic, SARS- CoV-2 infection still persists, and several surges of cases have been reported, including in Indonesia. To date, no data are available regarding the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases in Indonesia and the associated factors. This study aimed to determine the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases at Dr. Cipto Mangunkusumo National General Hospital, …

Successful Rituximab Therapy In Igg4-Related Sclerosing Mesenteritis, Sanjana L. Thimmannagari, Shiamak Cooper, Annie H. Yang, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly common autoimmune, multiorgan fibro-inflammatory disorder. Its involvement of organs like the pancreas, lacrimal glands, salivary glands and kidneys is well known but IgG4RD presenting as sclerosing mesenteritis is a rare entity. On imaging, it presents as a mesenteric mass and biopsy is the gold standard for confirmation as elevated serum IgG4 levels are unreliable to establish the diagnosis. Here we report a previously healthy 33-year-old African American female who presented with one week history of generalized abdominal pain. Imaging studies revealed a mass within the mesentery and post-operative biopsy of the mass confirmed …

Family Mental Health – A Case Report, Vikrant Arora, Medha Kosireddy, Mathumitha Ananth, Kishor M. Manohar Rao

Digital Journal of Clinical Medicine

Psychiatric illness in India is estimated to be 15% as per National Mental Health Survey 2015-16.  Mental health challenges within families, especially depression, anxiety disorders that are not common and when unaddressed exert cascading effects on all members, disrupting emotional cohesion, relational functioning, and socioeconomic stability. There are few case reports on entire family presenting to psychiatry department.

With informed consent a city-based middle-class family of non-consanguineous origin, where the 40-year-old female, presented with intractable limb pains and health anxiety, she had multiple consultation in last few months and her 48-year-old husband also had with episodic pains, irritability and her …

Accidental Daily Dosing: Severe Methotrexate Toxicity In A Patient With Rheumatoid Arthritis, Sidra Memon, Kavitha Vemuri, Syed Uzair Mahmood, Darshit Patel

Advances in Clinical Medical Research and Healthcare Delivery

This case highlights a crucial complication of oral methotrexate therapy: toxicity due to dosing errors. A patient’s daily dosing regimen, instead of the intended weekly schedule, led to a significantly excessive cumulative dose of methotrexate over a short period, resulting in severe hematologic and mucosal toxicity. This underscores the importance of clear patient education and vigilant prescription practices to prevent such errors.

Giant Cell Arteritis After Mrna Covid Vaccines: Concerning Or A False Alarm?-A Retrospective Cohort Study, Syed M. F. Zabiullah, Rutwik Pradeep Sharma, Roshan Subedi, Viqarunnisa Faaiza Zahid, Yasir Loai, Sarathlal Mannumbethlal, Aatifa Aatifa

Advances in Clinical Medical Research and Healthcare Delivery

Background: The coronavirus disease (COVID-19) pandemic led to the first large-scale rapid deployment of novel messenger RNA (mRNA) vaccines. Although the effectiveness and safety of these vaccines were rigorously studied, post-vaccination adverse events such as giant cell arteritis (GCA) continue to be reported. More than two hundred and sixty three cases of new-onset GCA occurring after mRNA vaccine administration are listed in the Vaccine Adverse Events Reporting System as of October 2024. We aimed to explore the incidence of GCA after mRNA vaccines among patients in our health system and study their characteristics and outcomes.

Methods: We conducted a …

A Comparative Analysis Of The Accuracy Of Retrieval Augmented Generation Versus Large Language Models For Gout-Related Queries, Samikchhya Keshary Bhandari, Himal Kharel, Zeni Kharel, Prajjwol Bhatta, Mouna Reghis, Ali Mohamed, Eduardo Avalos Sugastti, Chengu Niu

Advances in Clinical Medical Research and Healthcare Delivery

Importance: To better understand ways to improve the answers from large language models by feeding them disease specific guidelines which can potentially act as a clinical decision support tool in the future Objective: To demonstrate the effect of retrieval augmentation on answers related to gout in terms of accuracy, conciseness and unambiguity. Design: Observational. Setting: Virtual experimental setting. Participants: ChatGPT 3.5 and Retrieval augmented generation powered ChatGPT. Exposure: Nine questions derived from the 2020 American College of Rheumatology guidelines on gout. Main outcomes: A zero to two subjective scale to measure the accuracy, conciseness, …

Polmacoxib: A Drug Review, Sakeer Hussain, Dr. Subramanian Ramaswamy , Professor, Mahabaleshwar Mamadapur Assistant Professor, Ananthu Ajikumar

International Journal of Health and Allied Sciences

Polmacoxib, a novel nonsteroidal anti-inflammatory drug (NSAID), has shown a promised therapeutic option for the management of osteoarthritis and other inflammatory conditions. This drug review mainly aims to provide a comprehensive overview of polmacoxib, focusing on its pharmacological properties, clinical efficacy, safety profile, and potential therapeutic applications. Polmacoxib is a notable drug due to its dual mechanism of action, combining selective COX-2 inhibition with inhibition of carbonic anhydrase, which may contribute to its enhanced anti-inflammatory and analgesic effects. Being a selective COX-2 inhibitor, it helps minimize gastrointestinal side effects typically caused by conventional nonselective NSAIDs. Data from clinical studies suggest …

Idiopathic Granulomatous Lobular Mastitis: A Case Report, Wendy M. Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas

HCA Healthcare Journal of Medicine

Introduction

Idiopathic granulomatous mastitis (IGM), also known as nonpuerperal mastitis or granulomatous lobular mastitis, is a rare, benign, chronic inflammatory breast disease first characterized in 1972. IGM is characterized by sterile noncaseating lobulocentric granulomatous inflammation, usually affecting parous premenopausal women with a history of lactation.

Case Presentation

We present a 38-year-old African American woman presenting to our continuity clinic complaining of a painful right breast mass discovered during a self-breast examination. An initial right breast ultrasound demonstrated an area of concern with asymmetry, architectural distortion, and a questionable mass correlating to a 5.1 cm hypoechoic mass at the 12:30 position. …

Steroid-Dependent Recurrent Iga Vasculitis In A 19-Year-Old Woman, Hannah Berrett, Shivangi Gohil, Rebecca Kurian, Patricia Neyman

HCA Healthcare Journal of Medicine

Background

Immunoglobulin A (IgA) vasculitis is common in children and typically resolves spontaneously. However, when presenting in adults, it is more likely to be severe and recurrent.

Case Presentation

We present the case of a 19-year-old female patient with recurrent steroid-dependent IgA vasculitis. She had a history of a prolonged episode of IgA vasculitis in childhood. She presented to our hospital with proteinuria and a painful, palpable purpuric rash on her bilateral lower extremities. She was treated with high-dose intravenous steroids. When steroids were tapered, the patient had a recurrence of her painful rash. Over several months, she developed steroid-induced …

A Case Series Of Unusual Iga Vasculitis, Jared Bradley, Ian Whitaker, Brittany Lyons, Amy Mangla

HCA Healthcare Journal of Medicine

Introduction

Immunoglobulin A vasculitis (IgA)is a rare condition characterized by palpable purpura, often involving the skin, gastrointestinal tract, joints, and kidneys. Presentation is usually acute and is more common in children and adolescents of Southeast Asian and European descent. In the adult population, it is less common and therapies are not as well-established.

Case Presentation

Disease prevalence of IgA vasculitis outside Southeast Asian and European populations is not well-documented. In this case series, we present 2 cases of IgA vasculitis in 2 older adult males, one of Native American descent and one of African American descent.

Conclusion

IgA vasculitis must …

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 …