International Journal of Clinical Rheumatology最新文献

{"title":"Fever of unknown origin and mesenteric mass: a case of kikuchi fujimoto disease and systemic lupus erythematosus","authors":"S. Sharif, Kristaq Koci, Z. Chaudhry, A. Baqir, Naureen Kabani Olga Dvorkina","doi":"10.37532/1758-4272.2021.16(2).121","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).121","url":null,"abstract":"Background: Kikuchi Fujimoto Disease (KFD) is a rare autoimmune disorder manifesting with prolonged fevers and lymphadenitis. It is proposed to be triggered by infectious agents in genetically susceptible patients. Diagnosis is confirmed with lymph node biopsy. In most patients, symptoms resolve spontaneously but rarely glucocorticoids are required for remission. Clinical Summary: This is a unique case of KFD with mesenteric lymphadenitis leading to a new diagnosis of Systemic Lupus Erythematosus (SLE) in a 24-year-old African American male presenting with two weeks of epigastric pain and fever. Initial CT abdomen showed a heterogeneous soft tissue mass followed by CT guided core biopsy of mesenteric lymph nodes revealing necrotic lymphadenopathy. He was empirically treated for intraabdominal infection with antibiotics and then discharged home. A week later he was re-admitted for similar complaints. He was febrile and tachycardic. Labs showed neutropenia and elevated inflammatory markers. Infectious work up was negative. Autoimmune panel was positive for an Anti-Nucleic Acid (ANA), Ribonucleoprotein (RNP), Smooth Muscle (SM) Antibodies and Urine Protein: Creatinine Ratio (UPCR) of 0.5 gr and 1.2 gron two separate occasions. He was treated empirically with IV antibiotics followed by filgrastim. Mesenteric lymph node open biopsy demonstrated large areas of necrosis and characteristic absence of neutrophils. Thus, KFD and SLE were diagnosed based on SLICC criterion of SLE diagnosis. Treatment with Solumedrol 40 mg IV Q12 resulted in clinical improvement and discharge from hospital. Hydroxychloroquine 200 BID was added with steroid taper as patient continued to improve during outpatient follow ups. Conclusion: It is the first reported case of KFD with mesenteric lymphadenitis as the initial manifestation in a young African American male. This rare presentation masquerades the diagnosis leading to unnecessary procedures and empiric treatments. It warrants further research on the underlying pathophysiology and the need for a standardized diagnostic criterion and treatment guidelines of the disease.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91166615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment patterns and costs ofpatients with ankylosing spondylitisinitiating biologic therapy in taiwan ??? apopulation-based analysis","authors":"Ko-Jen Li, C. Tang, W. Furnback, Masayo Sato, Ching-Yun Wei, Bruce Cm Wang Chia-Fang Lee","doi":"10.37532/1758-4272.2021.16(5).161","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(5).161","url":null,"abstract":"Objective: To evaluate the real-world treatment patterns and costs of patients initiating their first biologic therapy for the treatment of Ankylosing Spondylitis (AS) in Taiwan. Methods: Taiwan’s National Health Insurance claims data between 1/1/2014 and 12/31/2017 was used to identify and follow patients with AS initiating their first biologic therapy in 2015. Patients > 18 years of age, with AS (ICD-9-CM: 720.0), a claim for a biologic therapy in 2015, continuous enrollment for at least one year following index, and no claims for biologics in the previous year were indexed into the study. A matched cohort of non-biologic patients with AS receiving antiinflammatory drugs was derived. Patients were followed from their index date (first biologic claim) through the end of the study period, death, or they were lost to follow-up. Results: There were 430 as patients included in the biologic-initiators cohort (Adalimumab = 191; Etanercept = 122; Golimumab = 177). PRE-index utilization rates were significantly higher for biologic-initiators compared to the matched cohort for corticosteroids, opioids, and csDMARDs (all p<0.0001). utilization rates of NSAIDs and csDMARDs were lower for biologic initiators and higher for the matched cohort during the follow-up period compared to the pre-index period. mean total healthcare costs were higher and average non-medication costs were lower for biologic-initiators compared to the matched cohort during the two years post-index. Conclusions: Patients initiating their first biologic therapy for as had high rates of as-related medication utilization during the pre-index period followed by a decrease in utilization rates after biologic initiation.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75230882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and misconceptions towards osteoporosis among patients with musculoskeletal health problems","authors":"A. Moshrif, Hany M Ali Hamid Khalifa","doi":"10.37532/1758-4272.2021.16(2).045","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).045","url":null,"abstract":"Purpose/Introduction:To determine the level of awareness and knowledge about osteoporosis among a sample of patients with musculoskeletal diseases. Methods: Through a cross-sectional study on patients with musculoskeletal disorders either degenerative or inflammatory (aged 18-62 years), 1200 participants were interviewed and responded to a prepared validated questionnaire about the knowledge and attitude towards Osteoporosis (OP) and its potential complications as fragility fractures and kyphosis. Results: Seventy eight percent (936) of the studied subjects know osteoporosis (of them only 930 agreed to complete the study) while 22% did not know a disease called osteoporosis and did not complete the remaining questions. A positive effect was found for educational level, occupation, and residence on knowledge of osteoporosis (P=0.000, P=0.001, P=00.002 respectively). Among those who completed the questionnaire, the majority (72.2% and 82%)were found to have the misconceptions that OP can lead to joint deformities and bone pain which reflected that their knowledge about the disease lacks the required in-depth awareness. Conclusion: There are variable degrees of knowledge and attitudes towards patients with musculoskeletal disorders which are affected by multiple factors including educational level, occupation, residence and marital status. However, the in-depth awareness about the disease is highly limited and efforts should be done to overcome this point as a first step to prevent the disease. Summary: Awareness and knowledge about Osteoporosis (OP) and its risk factors is highly limited and efforts should be done to overcome this point as a first step to prevent the disease.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83096969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of refractory immune-mediated necrotizing myopathy with abatacept and tacrolimus: A case-based review","authors":"Camargo Macias Kathlyn, B. Karan, Chawla Ambreesh Bhanusali Neha","doi":"10.37532/1758-4272.2021.16(2).060","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).060","url":null,"abstract":"Idiopathic inflammatory myopathies are characterized by muscle weakness, elevation in serum muscle enzyme levels, electromyography abnormalities, presence of Myositis Specific Autoantibodies (MSAs) and findings of inflammation on muscle biopsy. Immune-mediated necrotizing myopathy (IMNM) is a subset of IIM that is often resistant to standard immunosuppressive therapy, requiring multiple combinations of therapeutic agents. We present a case of a middle-aged man with positive anti-Signal Recognition Particle (SRP) IMNM who responded to abatacept and tacrolimus after failing standard of care treatment.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76547719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet rich plasma therapy forshoulder tendinopathy: a systematicreview","authors":"Pooja Pithadia, Sharmila S.Tulpule, M. P. Surya","doi":"10.37532/1758-4272.2021.16(5).149","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(5).149","url":null,"abstract":"Background: There is afascinating interest inplatelet-rich plasma (PRP)injection as a treatment for shoulder tendinopathy. Objective: To determine the efficacy of platelet-rich plasma (PRP) injections for shoulder tendinopathycompared with other existing conventional methods. Design: Systematic review Data Sources: PubMed, Scopus, EMBASE, and Cochrane Librarypublished up to October 15, 2020 Study Eligibility Criteria:Randomized controlled trials, single-arm interventional study, and a prospective open-label study comparing PRP with conventional methods (saline, sham injection, dry needling, corticosteroid. non-steroidal anti-inflammatory drugs, physiotherapy, and hyaluronic acid) in patients with shoulder tendinopathy. The search included only in vivo studies and excludednon-human studies. Study Appraisal and Synthesis Methods: A systematic review was carried out in accordance with the PRISMA statement. The authors reviewed and tabulated data according to the year of study and journal, study type and level of evidence, study population, intervention, outcomes, and interpretation. Results: Among the 228 records screened, 11 studies were included in the systematic review study. The selected studies focused on the application of PRP in the treatment of shoulder tendinopathy. Among 11 studies, 9 studies demonstrated favourable outcomes such as improved pain and functional scoresafter the PRP application for shoulder tendinopathy. In two studies, no statistically significant differences were seen regarding clinical outcomes. Conclusions: Injection of PRP is more efficacious than control injections in patients with shoulder tendinopathy.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80763817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression in adults with idiopathic inflammatory myopathy during the COVID-19 pandemic: A prospective cohort study","authors":"Haiting Wang, Jinju Chen, Liping Qian, Wanlong Wu, Chunhua Li","doi":"10.37532/1758-4272.2021.16(2).108","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).108","url":null,"abstract":"Purpose The COVID-19 outbreak has profoundly changed daily life and how patients access medical care. Idiopathic inflammatory myopathy (IIM) patients, who frequently develop chronic interstitial lung disease (ILD), are at high risk for respiratory infection and are also susceptible to psychological disorders. This study explored depression, anxiety, and compliance among IIM-ILD patients and the association of these factors with disease status during the COVID-19 outbreak in China. Methods A total of 94 IIM-ILD patients were included in the analysis. Baseline demographic and disease-related information was collected using the medical records system. The following questionnaires were used: Beck Depression Inventory-II (BDI-II), Compliance-Questionnaire- Rheumatology (CQR), Multidimensional Scale of Perceived Social Support (MSPSS), and the State-Trait Anxiety Inventory (STAI). The questionnaires were administered before, during, and after the COVID-19 outbreak in China by a rheumatology nurse through We-Chat. Results: During the COVID-19 outbreak, a significantly deteriorated depression status and reduced treatment compliance were found among these patients. Female gender and a dosage of greater than 15 mg of glucocorticoid per day were independently associated with depression, while social support was found to be negatively correlated with depression. Clinical follow-up revealed an overall disease flare rate of 17% (16/94). Patients with depression during the COVID-19 outbreak had a significantly higher disease flare rate than those without depression. Conclusion: Because depression negatively impacts patient quality of life and recovery from primary disease, patients with rheumatic disease should receive an early evaluation, appropriate treatment, and long-term monitoring for depression.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82057472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankylosing spondylitis: Diagnosis in sub-saharan african setting","authors":"Y. Mezgebu, Alula Abebe, T. Tadesse","doi":"10.37532/1758-4272.2021.16(1).037","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(1).037","url":null,"abstract":"Background: Ankylosing spondylitis is a subset of spondyloarthritis, characterized by chronic inflammatory back pain in adolescents or young adults. ‘Imaging arm’ of ASAS classification criteria established ankylosing spondylitis as radiographic sacroiliitis. Case presentation: A 29-year-old man presented to university of Gondar hospital, Northwest Ethiopia with inflammatory back pain of 15 years duration. Radiographic imaging revealed grade 3 sacroiliitis (left sacroiliac joint ankylosis and contralateral joint space narrowing and erosions). Other supporting clinical findings were peripheral arthritis, anterior uveitis, elevated ESR, and family history of inflammatory back pain.In sum, ‘imaging arm’ of ASAS classification criteria established radiographic axial spondyloarthritis and modified New York diagnostic criteria diagnosed ankylosing spondylitis.He had physical disability with BASFI score of 5/10 on initial evaluation. He was treated with topical steroid eye drops for uveitis and oral NSAIDs for spondyloarthritis. Physical therapy was initiated as rehabilitative measure. He got symptomatic benefit with above therapeutic regimen. He waslinked to Chronic Illness Care Clinicand Ophthalmology Clinic of the hospital for follow-up. Conclusion: Ankylosing spondylitis had significant impact on physical function and quality of life in African setting.Possible reasons could be late diagnosis due todelayed radiographic evidences and limited access to magnetic resonance imaging, inadequate therapy with available NSAIDs and unavailability of biologic DMARDs.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91183356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic, clinical, and serological features of Iraqi patients with rheumatoid arthritis: evaluation of 470 patients","authors":"A. Mathkhor, Abdulnasser H. Abdullah Amer S. Khoudhairy","doi":"10.37532/1758-4272.2021.16(2).099","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).099","url":null,"abstract":"Aim: To evaluate the demographic, clinical, serological, and radiological characteristics of patients with Rheumatoid Arthritis (RA). Methods: This was a cross-sectional, descriptive study conducted on a population of patients with RA in the rheumatology outpatient clinic in the three main teaching hospitals in Basrah province between January 2018 and July 2020. Four hundred seventy patients with RA were recruited for this study. All patients were examined and diagnosed by a rheumatologist. Laboratory and radiology tests were also performed for all patients. Results: Three hundred eighty-five (81.9%) women and 85 (18.1%) men with RA were enrolled for the study. The mean age, disease duration, and body mass index were 49.9 ± 11.9, 14.7 ± 6.8 years, and 27.1 ± 4.7, respectively. 322(68.5%) of the patients were have insidious disease onsets. There were 425 (96.2%) patients on Methotrexate (MTX), 247(52.6%), and 180(38.3%) patients on etanercept and prednisolone, respectively. The wrist was the most frequently involved joint, and the hip was the least frequently affected joint (100% and 5.1%), respectively. Anemia was the most extra-articular manifestation in our sample in a ratio of 18.7%. Anti-CCP and rheumatoid factor were present in 81.9% and 77%, respectively. Ulnar deviation was complicated 19.4% of the patients. Diabetes mellitus was the most abundant comorbidity presented in 43.6% of patients. One hundred sixty (34.0%) of the patients were completed their secondary education. Conclusion: Clinical and serological features of rheumatoid arthritis in Basrah province were similar to those found in some national and international studies. We observed higher female preponderance.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75695734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors: Impact on trabecular bone score and bone mineral density in primary fibromyalgia","authors":"H. Hamoud, Mohamed M. Ghait, Muhammad M Harb Yasser A Elmotaleb Elsayed","doi":"10.37532/1758-4272.2021.16(2).064","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(2).064","url":null,"abstract":"Background: Fibromyalgia is a chronic musculoskeletal pain disorder characterized by widespread pain at multiple tender points, sleep disturbance and fatigue, which subsequently affect quality of life.The aim of our study is to determine the correlation between consumption of SSRIs and SNRIs in patients with primary fibromyalgia, and BMD and TBS. Methods and Findings: A cross-sectional study carried out on 150 Egyptian participants. Patients were divided into 2 main groups: treatment group including 100 patients (50 on SSRI, and 50 on SNRI) diagnosed with primary myelofibrosis, and control group including 50 age-matched subjects (25 healthy individual, and 25 with primary myelofibrosis but receiving medications other than SSRI and SNRI).BMD and TBS were significantly low in SSRI and SNRI treatment groups compared to healthy control. In older population, lumbar spine (L1-L4) BMD and TBS decreased significantly in SSRI group. Also, control patients with primary fibromyalgia showed low BMD. Conclusion: Our study showed that patients with primary myelofibrosis, especially old population, whose treatment involved SSRIs or SNRIs had low BMD and low TBS. Additionally, patients with primary fibromyalgia who neither received SSRI nor SNRI also experienced low BMD. Thus, primary myelofibrosis could be considered as a contributing factor for low BMD.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83915409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strontium ranelate as new modality in treatment of primary knee osteoarthritis","authors":"Y. M. Sarhan, R. Shaat, Abdelkhalek Am Shabana Aa","doi":"10.37532/1758-4272.2021.16(1).018","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(1).018","url":null,"abstract":"Background: Osteoarthritis is a degenerative disease that has an effect on the whole joint structure which includes the synovial layer, cartilage, subchondral bone, ligaments and muscle groups across the joint. Objective: to evaluate effectiveness of strontium ranelate in treatment of patients with primary knee osteoarthritis (KOA). Methods: This randomized clinical trial was done on 30 patients with bilateral Knee osteoarthritis, they were divided into 2 groups. Group 1: 15 patients received strontium ranelate 2 gram and physiotherapy programme. Group 2:15 patients received physiotherapy programme only. All patients were assessed using visual analogue scale for pain (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee MRI. Results: This study included 45 patients with Knee osteoarthritis, 15 patients were excluded based on exclusion criteria, only 30 patients were randomized into 2 groups, 1 patient in group 1 and 2 patients in group 2 didn't complete follow up duration, and statistical data were done only on 27 patients. At the beginning of the study no significant difference was found between both groups in all parameters. A significant improvement in VAS and WOMAC score was found in group 1(p=0.034,p=0.004) in comparison to group 2 after 6 months follow up. There was statistically significant improvement in group 1 in synovitis/effusion detected by MRI in comparison to group 2 after 6 months of treatment. Conclusion: Strontium ranelate (SrR) has great role in reducing pain, synovitis, improving function in primary knee osteoarthritis and could be considered a disease modifying osteoarthritis drug.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77726296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}