Articles related to Rheumatology

The case involves a 73-year-old patient, Ms. B, who had a history of rheumatoid arthritis and was taking prednisone for adrenal insufficiency caused by a pituitary tumor. She was treated by an internist, Dr. R, for various ailments over a period of four years. In November 2016, Ms. B was diagnosed with severe community-acquired pneumonia and admitted to the hospital, where she was treated with levofloxacin. After being discharged, she continued taking levofloxacin and suffered an acute rupture of the gluteus medius tendon, resulting in significant disabilities. Ms. B filed a lawsuit against Dr. R, alleging negligence and failure to inform her about the risks and contraindications of the medication. Dr. R sought a summary judgment to have the case dismissed but was denied by the court. The court ruled that a Boxed Warning on a medication, such as the one associated with levofloxacin, can create a triable issue of fact regarding a physician’s departure from accepted medical practice. Dr. R claimed he was unaware of the risks and relied on the hospitalists’ choice of medication, but the court found that he should have been knowledgeable about the specific risks and suitability of the medication for his patient. The case […]

A 37-year-old man presented with persistent swelling, limited range of motion, and loss of hand dexterity in both hands. He had a history of IV drug use, including opiates and methamphetamine. The examination showed diffuse swelling without joint inflammation. Lab tests were normal, and imaging revealed soft-tissue swelling. The diagnosis was puffy hand syndrome, a common complication of IV drug use. Treatment options are mainly symptomatic, including discontinuation of IV drug use and the use of low-stretch bandages and compression gloves. Puffy hand syndrome, often unrecognized by general practitioners, should be considered in patients with swelling and limited hand function who have a history of IV drug use. The syndrome involves progressive fibrosis of subcutaneous tissues due to repeated injection-induced vascular and dermal sclerosis. Diagnosis is based on clinical presentation, history, and evaluation ruling out other conditions. Treatment focuses on symptomatic relief and cessation of IV drug use.

Researchers discovered that inhibiting the activity of the fumarate hydratase enzyme in macrophages (a type of immune cell that plays a key role in inflammatory disorders) increased the cells’ production of interferon-beta. They also discovered that lupus patients’ macrophages have abnormally low levels of fumarate hydratase. These findings suggest that dysregulation of this enzyme may be a factor in the development of lupus, and that fumarate hydratase could be a potential therapeutic target.

Experiments have confirmed a connection between rheumatoid arthritis flare-ups and periodontitis.

The researchers discovered that 11 of the participants had likely somatic variants at known pathogenic UBA1 positions, and all 11 had clinical symptoms consistent with VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome. Five people (45 percent) did not meet the criteria for previous rheumatologic and/or hematologic diagnoses associated with VEXAS syndrome, but all 11 had anemia, which was macrocytic in 10 people and had concomitant thrombocytopenia in 10 people. One male patient had a pathogenic variant identified prior to the onset of VEXAS-related signs or symptoms, and two female patients had disease caused by heterozygous variants. A previously unreported UBA1 variant was found in one symptomatic patient, with in vitro data supporting a catalytic defect and pathogenicity. Disease-causing UBA1 variants were found in one of 13,591 unrelated individuals, as well as in one of 4,269 men and one in 26,238 women over the age of 50.

The patient’s ankylosing spondylitis is poorly controlled. He has avoided biologics and is on naproxen only. Now his course is complicated by persistent lower extremity edema. Other than hypertension, his vitals are normal. His spine is kyphotic with reduced mobility. He has 2+ swelling in both legs. After reviewing the labs, suggest your diagnosis.