International Journal of Clinical Rheumatology最新文献

{"title":"Hemodialysis Induced Amyloid Arthropathy Presenting As Septic Arthritis : a case report","authors":"S. Boussaid","doi":"10.37532/1758-4272.2021.16(6).183","DOIUrl":"https://doi.org/10.37532/1758-4272.2021.16(6).183","url":null,"abstract":"Dialysis-Related Amyloidosis (DRA) is a unique type of amyloidosis affecting patients undergoing long-term hemodialysis. It is defined by the deposition of the insoluble protein 2 microglobulin (B2M) in a variety of organs, but with high affinity for the osteo-articular system. The presentation may be subclinical and only apparent when a tissue biopsy is carried out. Gemellahaemolysans (G. haemolysans) is an opportunistic pathogen reported to infect immune-compromised patients and rarely observed in bone infections. We report the first case of septic arthritis due to G. haemolysans of a native knee and revealing an associated multi focal DRA.","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":"89241691","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":"Post covid-19 reactive arthritis: An emerging existence in the spectrum of musculoskeletal complications of SARSCoV-2 infection","authors":"M. I. Ghauri, M. Mukarram, KhizraIshaq Syeda Urooj Riaz","doi":"10.37532/1758-4272.2020.15(S1).198-200","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(S1).198-200","url":null,"abstract":"Reactive arthritis is commonly preceded by a gastrointestinal or a sexually transmitted infection. However, its association with different viral infections has also been reported. Herein, we report a case of a 34 year old male who developed Reactive arthritis few days after the severe acute respiratory syndrome corona virus 2 infection (SARS-CoV-2). The patient was positive for COVID-19 infection from nasopharyngeal swab specimen. He was advised self-isolation/quarantine, considering his mild form of disease, along with medication. Ten days later he developed severe pain and tenderness in his right knee joint. His MRI of the affected joint revealed mild effusion (secondary to inflammation) in the patella-femoral compartment. Patient was diagnosed with Reactive arthritis and was prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Intra articular glucocorticoid was injected, to which he responded dramatically. His symptoms completely resolved in next ten days.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72866325","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":"An autoimmune storm: A case based literature review of successful management of lupus-polymyositis overlap syndrome complicated by multiple organ failure","authors":"A. Ali, I. Kang, Kamalmeet Kaur, O. Molokwu, Sajad Adhami, C. AnnaKazaryan, ice Reyes Yuvienco","doi":"10.37532/1758-4272.2020.15(3).48-59","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(3).48-59","url":null,"abstract":"Overlap syndromes of Connective tissues diseases is a rare and under-studied disorder. This syndrome can be complicated by multiple life-threatening complications like hepatitis, pancreatitis, macrophage activation syndrome and Acute Respiratory Distress syndrome. We report a 22-year-old Hispanic male with no remarkable past medical history who presented to the hospital with abdominal pain, myalgia, arthralgia, and persistent fever for two weeks and was found to have tachycardia, pancytopenia, transaminitis and an elevated lipase. The patient was initially evaluated for acute pancreatitis and hepatitis due to binge drinking and presumptive viral infection. Infectious work up was unrevealing, and the patient continued to deteriorate. The autoimmune panel came back significant for highly elevated Antinuclear Antibody (ANA) and Anti Double Stranded DNA antibody (dsDNA), low complement, high inflammatory markers, ferritin, elevated Creatine Kinase (CK), positive Anti Mi 2 antibody, low Natural Killer (NK) cell activity and elevated CD25. Patient was subsequently diagnosed with Lupus- Polymyositis overlap syndrome. Acute lupus flare was considered as the trigger for pancreatitis and hepatitis. The hospital course was complicated by Acute Respiratory Distress Syndrome (ARDS) due to Lupus pneumonitis, encephalopathy, and Macrophage Activation Syndrome (MAS). Patient was treated successfully with steroid pulse therapy, Cyclophosphamide, plasmapheresis, artificial ventilation, and extracorporeal membrane oxygenation (ECMO). We believe that this case is unique as it represented a diagnostic challenge as the Lupus-Polymyositis overlap syndrome is a rare entity, and it initially manifested in an extensively complicated pattern which is unusual. Moreover, this case was not only a diagnostic challenge but also a treatment conundrum due to multiple life-threatening complications the patient had during this hospitalization. In this review, we intend to discuss the management of this challenging and rarely reported connective tissue disease overlap syndrome.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78799936","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":"Towards stratified treatment of rheumatoid arthritis","authors":"N. Luurssen-Masurel, Angelique Elisabeth Adriana, Maria Weel, Johanna Maria, Wilhelmina Hazes, Pascal, Hendrik Pieter de Jong","doi":"10.37532/1758-4272.2020.15(3).73-82","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(3).73-82","url":null,"abstract":"Background: To compare the clinical efficacy of different initial treatment strategies in autoantibodynegative rheumatoid arthritis(RA) patients. Methods and findings: Data of the tREACH trial, a stratified single-blinded randomized clinical trial with a treat-to-target strategy, were used. For this analysis, we selected all autoantibodynegative RA patients, defined as fulfillment of 2010-criteria and absence of both rheumatoid factor and anti-citrullinated protein antibody, within the intermediate probability stratum. We compared the following initial treatment strategies in our autoantibody-negative RA population: 25mg methotrexate(iMTX) per week, 400mg hydroxychloroquine(iHCQ) daily or 15mg glucocorticoids(iGCs) orally in a 10-week tapering scheme without any DMARDs. Primary outcome was the proportion of patients with active disease, defined as a disease activity score(DAS)≥2.4, after 3 months of treatment. Secondary outcomes were DAS and functional ability(HAQ) over time using a linear mixed model(LMM), in which we respectively corrected for baseline DAS and HAQ. 116 patients were included and started with iMTX(n=44), iHCQ(n=35) or iGCs(n=37). After 3 months 34%, 34% and 76% of patients respectively treated with iMTX, iHCQ and iGCs had an active disease(p<.0005 for iHCQ and iMTX versus iGCs). Our corrected LMM showed no significant difference in DAS and HAQ over time between the different initial treatment strategies. Conclusions: Initial GCs without csDMARDs are also not indicated for autoantibody-negative RA patients. However, iHCQ and iMTX show similar (early) treatment responses in this subgroup of patients, which suggests that initial treatment can be stratified for autoantibody-negative and autoantibody-positive RA, but validation is needed.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86193560","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":"The clinical efficacy of artificial saliva using four point ordinal scale and visual analogue scale in patients of sjogrens syndrome with xerostomia","authors":"S. Samreen, B. Salim, H. Nasim","doi":"10.37532/1758-4272.2020.15(5).134-139","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(5).134-139","url":null,"abstract":"Objective: To evaluate the efficacy of artificial saliva for relief of xerostomia in patients with Sjogrens syndrome. Place/duration of study: This is a quasi-experimental trial of 6 months’ duration from 1st October 2019 till 30th march 2020 conducted at Fauji Foundation Hospital, Rawalpindi. Patients and methods: We enrolled 50 patients with xerostomia due to Sjogrens syndrome. The clinical efficacy of Xerostomia was evaluated by means of a patient reported score on a 10-point visual analog scale (VAS) and assessment of the oral tissue condition by means of a 4-point ordinal scale at 0, 2, 4 and 6 weeks. Mean ± standard deviation of quantitative variables was calculated and level of significance was determined using paired-t-test. An improvement in xerostomia was measured by comparing patient reported VAS and a physician recorded 4-point ordinal score at baseline, 2nd, 4th and 6th week. Results: All of the patients were female with a mean age (years ± SD) of 48.48 ± 10.8.Four-point ordinal score at screening visit was 25.30 ± 5.21(mean ± SD) whereas patient VAS was 57.92 ± 12.03 (mean ± SD). The mean change in both four-point ordinal score and patients VAS was statistically significant at 2 weeks, 4 weeks and 6 weeks (p value 0.000 in each). It was well tolerated in most of the patients (only 7 patients discontinued ;5 due to mucositis ,1 due to respiratory tract infection and one had mouth bleed due to dental issues). Conclusions: Artificial saliva is a safe and efficacious option for patients with xerostomia.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88975458","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":"Therapeutic management of chronic inflammatory rheumatic diseases in times of pandemic COVID 19","authors":"R. Dhahri, S. Boussaid, M. Slouma, S. Jemmali, E. Cheour, H. Sahli, S. Rekik, L. Metoui, Imen Elleuch","doi":"10.37532/1758-4272.2020.15(S1).164-174","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(S1).164-174","url":null,"abstract":"Conoravirus 2019 or Covid-19 disease (acronym for COronaVirus Infectious Disease 2019) is an emerging highly contagious infection caused by the coronavirus strain SARS-CoV-2. In March 2020 it has been declared a pandemic by the World Health Organization (WHO). The rheumatologist is therefore faced with a challenge: an optimal management of COVID patients who are immunosuppressed not only by the disease but also by the immunosuppressive treatments they take. In fact, some of these drugs seem , oddly, to have antagonist effects on viral response and therefore are investigated in COVID treatment. Severe COVID-19 originates from a cytokine storm caused by increased levels of a number of cytokines and chemokines resulting in a multiorgan failure. The management of this cytokine storm is one of the major challenges regarding COVID-19 infection. Several pathways are investigated including drugs known to be efficient on rheumatology field (especially NSAIDs, corticosteroids, Disease Modifying Anti Rheumatic diseases (DMARDs): biological or synthetic ones such as methotrexate, salazopyrine, leflunomide and Hydroxychloroquine). Given these facts, this review aimed to summarize the existing data that may support the therapeuting decision making of rheumatologists in this pandemic context. Glucocorticoids should be used at its lowest necessary dose regardless of exposure or infection status if needed to controlee underlying disease. They should never be stopped precipitously . Stable patients with no COVID 19 infection or exposure should continue their treatment either NSAIDs or immunosuppressants (CsDMARDs, TsDMARDs or bDMARDs) with no modification or dose reduction in case of life threatening organ lesion. Anti malarial drugs is to not discontinue them, considering the antiviral efficacy and the immunomodulatory rather than immunosuppressive effect. The anti Il 6 is also not to be stopped given their action on the inflammatory reaction caused by COVID19. In case of confirmed COVID 19 infection it is recommended to temporarily stop other immunosuppressive treatments. That guidance does not replace clinical judgment of the rheumatologist based on clinical severity of the infection or the ARD. Mostly guideline panel recommends underlying general preventive measures, e.g., social distancing and hand hygiene, reducing exposure of patients with minimizing health encounters.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73460017","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":"A challenging differential diagnosis: Granulomatosis with polyangiitis and tuberculosis","authors":"M. Restrepo, J. Mir, M. Franco","doi":"10.37532/1758-4272.2020.15(4).88-92","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(4).88-92","url":null,"abstract":"This article reviews the case of a patient with a headache, palpable purpura, chronic otomastoiditis, renal involvement, and pulmonary granulomatous disease, with the concurrence of granulomatosis with polyangiitis and tuberculosis. The association between both diseases and the challenge in the differential diagnosis are discussed.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82020537","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":"Reconciling treat-to-target with clinical practice: The challenge and how to meet it","authors":"P. Falzer","doi":"10.37532/1758-4272.2020.15(4).83-87","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(4).83-87","url":null,"abstract":"Treat-to-Target (T2T) has become the standard treatment approach for rheumatoid arthritis. In concept, T2T is a straightforward 2-stage procedure: Evaluate progress, then escalate treatment if a scale score exceeds a threshold. However, guidelines require T2T to be implemented collaboratively and with discretion. Studies have raised concerns about its feasibility for clinical practice and identified differences between how patients and providers evaluate progress as an impediment. Unfortunately, most studies fail to appreciate that progress assessment is a distinct process and not compatible with selection-based decision models. This brief report identifies 5 ways that progress and selection decisions differ. Having more appropriate methods and models will enable investigators, educators, and practitioners to focus on how commonalities between patients and providers are established and maintained, and how disagreements are overcome.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82391891","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":"A ‘crowning’ diagnosis: Fever, neck pain, and diffuse polyarthritis as a fulminant first presentation of pseudogout","authors":"Samuel Gaine Maximilian F. Konig","doi":"10.37532/1758-4272.2020.15(1).1-5","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(1).1-5","url":null,"abstract":"Background: Calcium Pyrophosphate Deposition Disease (CPPD) rarely presents as a diffuse polyarthritis with systemic features. Case presentation: A 75-year-old man with no prior history of rheumatic disease presented with acuteonset diffuse polyarthritis and severe neck pain, accompanied by fevers, leucocytosis, and elevated acute phase reactants. After excluding infectious aetiologies, a synovial fluid aspirate revealed a highly neutrophilic inflammatory infiltrate and rare calcium pyrophosphate dihydrate crystals. Cervical CT confirmed periodontoid calcium deposits consistent with the crowned dens syndrome. The patient was diagnosed with acute CPPD, and his joint and neck pain improved rapidly with colchicine and glucocorticoids. Conclusion: In addition to arthrocentesis and microscopic crystal analysis, cervical CT can lend support to a diagnosis of pseudogout complicated by CDS. In patients presenting with fever and neck pain, recognition that CDS can be a prominent or isolated feature of acute CPPD facilitates diagnosis, limits unnecessary procedures, and allows for early initiation of appropriate therapy.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88643609","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 outcome of primary Fibromyalgia Syndrome (FMS) using Duloxetine versus Pregabalin & Nortriptyline- An observational study","authors":"Mushtaq Ahmad, BilalRather, Fayaz sofi ZahoorAhmad","doi":"10.37532/1758-4272.2020.15(4).119-122","DOIUrl":"https://doi.org/10.37532/1758-4272.2020.15(4).119-122","url":null,"abstract":"Introduction: The prevalence of FMS is about 2% as per ACR 2010 criteria. It is 5 times more common in women than in men. The etiology of FMS is presumptive and not clearly known as yet. Non-Pharmacological [Cognitive Behavioral Therapy (CBT)] and Pharmacological therapy is provided for mitigating somatic & psychological manifestations of FMS. Aim of study: To know the effectiveness of Duloxetine and Pregabalin+Nortriptyline on FMS for Kashmiri patients and compare their magnitude of effectiveness. Material and methods: It was 2 years observational study from July 2016 to June 2018. 50 patients fulfilling 2010 ACR classification criteria for FMS received the treatment. 26 patients received Duloxetine [Dose 20 mg-60 mg], 24 patients received Pregabalin [Dose 75 mg-150 mg] and Nortriptyline [Dose 25mg]. Results: Most of the parameters of FMS improved more in the Pregabalin+Nortriptyline group. However sadness improved more in the Duloxetine group. Conclusion: In addition to CBT [Cognitive Behavioral Therapy], Pharmaco Therapy is helpful in mitigating various parameters of Fibromyalgia syndrome to improve the quality of life of FMS patients.","PeriodicalId":13740,"journal":{"name":"International Journal of Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89934237","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}