DOCSLIB.ORG

Serum Protein Changes in Caplan's Syndrome by J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Serum Protein Changes in Caplan's Syndrome by J Ann Rheum Dis: first published as 10.1136/ard.21.2.135 on 1 June 1962. Downloaded from Ann. rheum. Dis. (1962), 21, 135. SERUM PROTEIN CHANGES IN CAPLAN'S SYNDROME BY J. A. L. GORRINGE* From the Pneumoconiosis Research Unit, Llandough Hospital, Penarth, Glam. Since Caplan first described characteristic multiple, Johnston, Stradling, and Abdel-Wahab (1956> discrete, round opacities in the lungs of miners with indicated that tuberculosis caused quite consistent rheumatoid arthritis (Caplan, 1953), numerous changes in serum proteins, namely increased cx,- attempts have been made to determine the aetiology and y-globulins and reduced albumin. That similar- of these lesions. The association of the character- changes occur in coal-workers' pneumoconiosis and istic radiological opacities with rheumatoid arthritis silicosis associated with tuberculosis was confirmed (R.A.) was confirmed in the epidemiological studies by Christiaens, Balgairies, Claeys, and Lenoir (I954), of Miall, Caplan, Cochrane, Kilpatrick, and and by Rosenkranz (1957) respectively. Shaw Oldham (1953), and of Miall (1955), and in the (1956) claimed that especially large increases in latter a hereditary factor was clearly shown to be X2-globulin occurred in the presence of tuberculous implicated in the development of both "Caplan" pleural effusion, and Prignot (1956) stated that lesions and rheumatoid arthritis. The same factor a2-globulin reached its highest level in miners when seemed also to predispose to tuberculosis. cavitation of P.M.F. occurred. As the pulmonary Gough, Rivers, and Seal (1955), reporting on the component of Caplan's syndrome is an active pathology in sixteen cases of the syndrome coming and rapidly progressive one compared with P.M.F., to biopsy or autopsy, found evidence of past or giving rise to cavitation earlier and more often present tuberculosis in about 40 per cent., which is (Caplan, 1959) and being not infrequently associated copyright. a similar incidence to that found at autopsy in cases with pleurisy and pleural effusion, it seemed reason- of orthodox progressive massive fibrosis (P.M.F.) able to look for serum protein changes resembling (Rivers, James, Davies, and Thomson, 1957), but those found in tuberculosis. they described also areas of inflammation in some It was realized that rheumatoid arthritis itself lesions which did not resemble tuberculosis and causes serum protein changes very similar to those which are not found in P.M.F. The inflammation described in tuberculosis (Ropes, Perlmann, Kauf- was tentatively identified as the "rheumatoid man, and Bauer, 1954; Kuhns and Crittenden, 1955), component". but it was hoped that the effect of the pulmonary http://ard.bmj.com/ The identification of a-E-diaminopimelic acid disease would be large enough to be detected in spite (D.A.P.) in lesions showing no histological or of this. An investigation was therefore undertaken bacteriological evidence of tuberculosis (Consden of the serum proteins of patients with Caplan's and Glynn, 1955; Consden and Howard, 1957) was syndrome and to these were added for comparison interpreted as indicating that mycobacteria had at a small group of patients having characteristic lung one time been present, though this amino-acid lesions without arthritis and, at the other end of the could have been derived from a variety of other scale, a small group of miners with rheumatoid on October 1, 2021 by guest. Protected micro-organisms. Nethercott and Strawbridge, as arthritis who, in spite of significant dust exposure, an extension of their work with sarcoidosis (1956), had no radiological evidence of nodular pulmonary claimed to have identified mycolic acid in Caplan lesions. lesions (personal communication). This would Of fifty men admitted to the trial, five were later have greatly strengthened the tuberculous theory of excluded, two because of other diseases likely to their aetiology, but the identification of mycolic affect the serum proteins, two because of doubt as acid was disputed by Consden (1957) and Berg to the nature of lung lesions on the basis of which (1957). they were at first included, and one because of The investigation now reported was an attempt to doubt as to the diagnosis of rheumatoid arthritis. approach the problem of the aetiology of Caplan As a new electrophoretic technique was to be used lesions from a different angle. The work of Seibert, (Gorringe, 1957), a group of twelve normal subjects Seibert, Atno, and Campbell (1947), and of Gilliland, was also studied to provide evidence as to the values to be expected for the various protein fractions in * Present appointment: Director of Clinical Investigation, Parke Davis and Co., Staines Road, Hounslow, Middlesex. healthy individuals. 135 Ann Rheum Dis: first published as 10.1136/ard.21.2.135 on 1 June 1962. Downloaded from 136 ANNALS OF THE RHEUMATIC DISEASES Method of Investigation gravity method (Phillips, Van Slyke, Dole, Emerson, The patients were investigated in the following seven Hamilton, and Archibald, 1944, 1945), but there seemed ways: no object in expressing protein fractions in absolute (1) Industrial history to establish exposure to a real concentrations since this practice tends to obscure dust hazard. differences by making all the values numerically small. (2) Medical history, including family history. No relationship was found between total protein values (3) Clinical examination. and severity of disease so that the percentage values havrz (4) Erythrocyte sedimentation rate (mm. in 1 hr the same validity as the absolute values. Westergren). (5) Sheep Cell Agglutination Test (S.C.A.T.) by the Diagnosis and Grading method of Ball (1950). (6) Serum electrophoresis by the method previously (A) Rheumatoid Arthritis described (Gorringe, 1957). (7) Postero-anterior chest x ray supplemented by In order to include mild and inactive cases of lateral x rays and tomograms when thought R.A. in the study, the strict diagnostic criteria of necessary. Miall (1955) and of Kellgren and Lawrence (1956) The first four investigations were done on the same had to be relaxed to some extent, but all except day in every case and blood for electrophoresis and two of the more severe cases (Grade 2 and above: S.C.A.T. was obtained at the same time. The serum see below) had two or more of their three criteria- was separated and stored, frozen solid, until required. history of characteristic polyarthritis plus character- Chest x rays of all out-patients were taken on the same istic radiological joint changes and/or a positive day and those of in-patients on admission. The remain- sheep cell agglutination test (S.C.A.T.). It was felt ing investigations of the in-patients were usually done in several days later. that the clinical diagnosis was sufficiently certain Haematological investigations were performed on all the case of the two exceptions to justify their in-patients, but on out-patients only when there was inclusion. clinical evidence of anaemia. Joints were x-rayed in the Clinical diagnosis was based on: majority of cases, but the x rays were used in diagnosis (1) A history of past or present polyarthritiscopyright. only when other investigations left this in doubt. with morning stiffness, pain in and/or The stained electrophoresis strips, when dry, were swelling of joints affected; rendered translucent with the clearing fluid described by (2) The examination of all joints, especially Rees and Laurence (1955) and scanned in a recording densitometer (Laurence, 1954), using a compound filter those of the hands and feet for tenderness, consisting of one thickness of Ilford No. 205 gelatin and limitation of movement, crepitus, swelling, one thickness of Chance heat-resisting glass. The redness, heat, effusions, muscle wasting, and clearing fluid was then removed by washing the strip in deformity; three changes of ether. The trace produced was used (3) Examination of the skin for palmarhttp://ard.bmj.com/ as a template for dividing the stained strip reproducibly erythema, hyperhydrosis, pigmentation, into five segments corresponding to the five protein rheumatoid nodules, psoriasis, or other skin fractions. This was done by completing the curves, disease; dropping perpendiculars through the points of inter- (4) Examination for enlargement of liver, section on to the baseline, and then transferring these and lymph nodes. lines on to the stained strip, which was positioned over the spleen, trace by means of a pencil line drawn on the strip beyond All patients in whom R.A. was diagnosed were the albumin band before scanning and so represented on first graded as Active or Inactive (the latter are the trace by a sharp peak (Fig. 1, opposite). Each subsequently designated "R" for "Remission"). on October 1, 2021 by guest. Protected stained strip was then divided longitudinally into equal Remission was inferred when a patient had not halves by another pencil line and cut up into ten segments. more than one sign or symptom in each of the The five segments in each half paper corresponding to following groups: the five protein fractions were eluted separately and 1. Joints estimated in a spectrophotometer at 640 m[i. The two Group sets of optical densities obtained were compared and, if Morning stiffness of one or more joints. compatible, added together. The value for each fraction Pain and/or tenderness in one or more joints. was then expressed as a percentage of the total. The Swelling of one or more joints. object of eluting each paper in two halves was two-fold; Functional disability not attributable to in the first place it was necessary to keep the highest residual deformity. optical density within the accurate range of the spectro- photometer. This could have been achieved by using Group 2. Systemic twice the quantity of eluting fluid or thinner cuvettes, Rheumatoid nodules. but it was felt that duplicate estimations would con- Abnormal fatigue and lassitude. stitute a useful check against gross error. Hyperhydrosis. Total protein estimations were done by the specific Palmar erythema.
Load more

Recommended publications
  • Acute < 6 Weeks Subacute ~ 6 Weeks Chronic >
    Pain Articular Non-articular Localized Generalized . Regional Pain Disorders . Myalgias without Weakness Soft Tissue Rheumatism (ex., fibromyalgia, polymyalgia (ex., soft tissue rheumatism rheumatica) tendonitis, tenosynovitis, bursitis, fasciitis) . Myalgia with Weakness (ex., Inflammatory muscle disease) Clinical Features of Arthritis Monoarthritis Oligoarthritis Polyarthritis (one joint) (two to five joints) (> five joints) Acute < 6 weeks Subacute ~ 6 weeks Chronic > 6 weeks Inflammatory Noninflammatory Differential Diagnosis of Arthritis Differential Diagnosis of Arthritis Acute Monarthritis Acute Polyarthritis Inflammatory Inflammatory . Infection . Viral - gonococcal (GC) - hepatitis - nonGC - parvovirus . Crystal deposition - HIV - gout . Rheumatic fever - calcium . GC - pyrophosphate dihydrate (CPPD) . CTD (connective tissue diseases) - hydroxylapatite (HA) - RA . Spondyloarthropathies - systemic lupus erythematosus (SLE) - reactive . Sarcoidosis - psoriatic . - inflammatory bowel disease (IBD) Spondyloarthropathies - reactive - Reiters . - psoriatic Early RA - IBD - Reiters Non-inflammatory . Subacute bacterial endocarditis (SBE) . Trauma . Hemophilia Non-inflammatory . Avascular Necrosis . Hypertrophic osteoarthropathy . Internal derangement Chronic Monarthritis Chronic Polyarthritis Inflammatory Inflammatory . Chronic Infection . Bony erosions - fungal, - RA/Juvenile rheumatoid arthritis (JRA ) - tuberculosis (TB) - Crystal deposition . Rheumatoid arthritis (RA) - Infection (15%) - Erosive OA (rare) Non-inflammatory - Spondyloarthropathies
    [Show full text]
  • Approach to Polyarthritis for the Primary Care Physician
    24 Osteopathic Family Physician (2018) 24 - 31 Osteopathic Family Physician | Volume 10, No. 5 | September / October, 2018 REVIEW ARTICLE Approach to Polyarthritis for the Primary Care Physician Arielle Freilich, DO, PGY2 & Helaine Larsen, DO Good Samaritan Hospital Medical Center, West Islip, New York KEYWORDS: Complaints of joint pain are commonly seen in clinical practice. Primary care physicians are frequently the frst practitioners to work up these complaints. Polyarthritis can be seen in a multitude of diseases. It Polyarthritis can be a challenging diagnostic process. In this article, we review the approach to diagnosing polyarthritis Synovitis joint pain in the primary care setting. Starting with history and physical, we outline the defning characteristics of various causes of arthralgia. We discuss the use of certain laboratory studies including Joint Pain sedimentation rate, antinuclear antibody, and rheumatoid factor. Aspiration of synovial fuid is often required for diagnosis, and we discuss the interpretation of possible results. Primary care physicians can Rheumatic Disease initiate the evaluation of polyarthralgia, and this article outlines a diagnostic approach. Rheumatology INTRODUCTION PATIENT HISTORY Polyarticular joint pain is a common complaint seen Although laboratory studies can shed much light on a possible diagnosis, a in primary care practices. The diferential diagnosis detailed history and physical examination remain crucial in the evaluation is extensive, thus making the diagnostic process of polyarticular symptoms. The vast diferential for polyarticular pain can difcult. A comprehensive history and physical exam be greatly narrowed using a thorough history. can help point towards the more likely etiology of the complaint. The physician must frst ensure that there are no symptoms pointing towards a more serious Emergencies diagnosis, which may require urgent management or During the initial evaluation, the physician must frst exclude any life- referral.
    [Show full text]
  • Pachydermoperiostosis As a Rare Cause of Blepharoptosis Nadir Bir Blefaroptozis Nedeni Pakidermoperiostozis
    DOI: 10.4274/tjo.55707 Case Report / Olgu Sunumu Pachydermoperiostosis as a Rare Cause of Blepharoptosis Nadir Bir Blefaroptozis Nedeni Pakidermoperiostozis Özlem Yalçın Tök*, Levent Tök*, M. Necati Demir**, Sabite Kaçar***, Elif Nisa Ünlü****, Firdevs Örnek***** *Süleyman Demirel University Faculty of Medicine, Department of Ophthalmology, Isparta, Turkey **Yıldırım Beyazıt University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey ***Türkiye Yüksek İhtisas Education and Research Hospital, Department of Gastroenterology, Ankara, Turkey ****Süleyman Demirel University Faculty of Medicine, Department of Radiology, Isparta, Turkey *****Ankara Training and Research Hospital, Ministry of Health, Department of Ophthalmology, Ankara, Turkey Summary A 37-year-old male patient diagnosed with pachydermoperiostosis at another center came to our clinic to rectify his blepharoptosis. The physical examination of the patient revealed skeleton and skin symptoms typical for pachydermoperiostosis. There was thickening and extending horizontal length of the eyelids, an S-shaped deformity on the edges of the eyelids, and symmetric bilateral mechanical blepharoptosis. In order to treat the blepharoptosis, excision of the thickened skin and the orbicular muscle as well as levator aponeurosis surgery was performed. The esthetic result was satisfactory. Pachydermoperiostosis is a rare cause of blepharoptosis. Meibomius gland hyperplasia, increase of collagen substance in the dermis, mucin accumulation are reasons of thickening the eyelid and
    [Show full text]
  • Differential Diagnosis of Juvenile Idiopathic Arthritis
    pISSN: 2093-940X, eISSN: 2233-4718 Journal of Rheumatic Diseases Vol. 24, No. 3, June, 2017 https://doi.org/10.4078/jrd.2017.24.3.131 Review Article Differential Diagnosis of Juvenile Idiopathic Arthritis Young Dae Kim1, Alan V Job2, Woojin Cho2,3 1Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea, 2Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 3Department of Orthopaedic Surgery, Montefiore Medical Center, New York, USA Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into sev- en subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and with- out rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise sub- type is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA. (J Rheum Dis 2017;24:131-137) Key Words.
    [Show full text]
  • Caplan's Syndrome
    Int J Clin Exp Med 2016;9(11):22600-22604 www.ijcem.com /ISSN:1940-5901/IJCEM0036089 Case Report Rheumatoid pneumoconiosis (Caplan’s syndrome): a case report Wei-Li Gu, Li-Yan Chen, Nuo-Fu Zhang Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respi- ratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Received July 18, 2016; Accepted September 10, 2016; Epub November 15, 2016; Published November 30, 2016 Abstract: Caplan’s syndrome, also referred to as rheumatoid pneumoconiosis (RP), is specific to rheumatoid arthri- tis (RA) and presents with multiple, well-defined necrotic nodules in workers exposed to dust. Here we report one case with a typical pulmonary presentation, confirmed through computed tomography (CT) and histopathological studies. A 58-year-old male patient with a diagnosis of RA, complained pain of multiple joints and mild dyspnea on exertion. He was an active smoker (40 pack-years) and worked as a shepherd for 35 years exposed to dust. High- resolution CT (HRCT) of the chest revealed bilateral, round, well-delimited nodules with peripheral distribution. After one month of treatment with corticosteroids and tripterygiumwilfordii, the patient’s pain and dyspnea improved. In the meantime, pulmonary nodules grew down gradually. The case demonstrates the clinical presentation, radiologi- cal and pathological features of Caplan’s syndrome. The effective treatment for Caplan’s syndrome is corticoste- roids and tripterygiumwilfordii. Keywords: Pneumoconiosis, rheumatoid arthritis, Caplan’s syndrome, silicosis Introduction in the lung for two years with no other initial signs of rheumatoid disease. He complained Caplan’s syndrome, also referred to as rheuma- pain of multiple joints eight months later.
    [Show full text]
  • A Rheumatologist Needs to Know About the Adult with Juvenile Idiopathic Arthritis
    A Rheumatologist Needs to Know About the Adult With Juvenile Idiopathic Arthritis Juvenile idiopathic arthritis (JIA) encompasses a range of distinct phenotypes. By definition, JIA includes all forms of arthritis of unknown cause that start before the 16th birthday. The most common form is oligoarticular JIA, typically starting in early childhood (before age 6) and affecting only a few large joints. Polyarticular JIA, affecting 5 joints or more, can occur at any age; older children may develop seropositive arthritis indistinguishable from adult rheumatoid arthritis. Systemic JIA (sJIA) is characterized by fevers and rash at onset of disease, though it may evolve into an afebrile chronic polyarthritis that can be resistant to therapy. Patients with sJIA, like those with adult onset Still’s disease (AOSD), are susceptible to macrophage activation syndrome, a “cytokine storm” characterized by fever, disseminated intravascular coagulation, and end organ dysfunction. Other forms of arthritis in children include psoriatic JIA and so-called “enthesitis related arthritis,” encompassing the non-psoriatic spondyloarthropathies. Approximately 50% of JIA patients will have active disease into adulthood. JIA can be accompanied by destructive chronic uveitis. In addition to joints, JIA can involve the eyes, resulting in a form of chronic scarring uveitis not seen in adult arthritis. Patients at particularly high risk are those with oligoarticular or polyarticular arthritis beginning before the age of 6 years, especially if accompanied by positive ANA at any titer. In thehighest risk group, up to 30% of children may be affected. Patients who did not develop uveitis in childhood are very unlikely to do so as adults.
    [Show full text]
  • Spondyloarthropathies and Reactive Arthritis
    RHEUMATOLOGY SPONDYLOARTHRITIS ROBERT L. DIGIOVANNI, DO, FACOI PROGRAM DIRECTOR LMC RHEUMATOLOGY FELLOWSHIP [email protected] DISCLOSURES •NONE SERONEGATIVE SPONDYLOARTHROPATHIES SLIDES PREPARED BY GENE JALBERT, DO SENIOR RHEUMATOLOGY FELLOW THE SPONDYLOARTHROPATHIES: • Ankylosing Spondylitis (A.S.) • Non-radiographic Axial spondyloarthropathies (nr-axSpA) • Psoriatic Arthritis (PsA) • Inflammatory Bowel Disease Associated (Enteropathic) • Crohn and Ulcerative Colitis • +/- Microscopic colitis • Reactive Arthritis (ReA) • Juvenile-Onset SpA • Others: Bechet’s dz, Celiac, Whipples, pouchitis. THE FAMOUS VENN DIAGRAM: SPONDYLOARTHROPATHY: • First case of Axial SpA was reported in 1691 however some believe Ramses II has A.S. • 2.4 million adults in the United States have Seronegative SpA • Compare with RA, which affects about 1.3 million Americans • Prevalence variation for A.S.: Europe (0.12-1%), Asia (0.17%), Latin America (0.1%), Africa (0.07%), USA (0.34%). • Pathophysiology in general: • Responsible Interleukins: IL-12, IL17, IL-22, and IL23. SPONDYLOARTHROPATHY: • Axial SpA: • Radiographic (Sacroiliitis seen on X- ray) • No Radiographic features non- radiographic SpA (nr-SpA) • Nr-SpA was formally known as undifferentiated SpA • Peripheral SpA: • Enthesitis, dactylitis and arthritis • Eventually evolves into a specific diagnosis A.S., PsA, etc. • Can be a/w IBD, HLA-B27 positivity, uveitis SHARED CLINICAL FEATURES: • Axial joint disease (especially SI joints) • Asymmetrical Oligoarthritis (2-4 joints). • Dactylitis (Sausage
    [Show full text]
  • Pachydermoperiostosis and an Eyelid Ptosis Associated with Spiky Keratoderma–An Unusual Presentation
    Vol. 12, No. 1, 2014 Case Report Pachydermoperiostosis And An Eyelid Ptosis Associated With Spiky KeratodermaAn Unusual Presentation Chakraborty S1, Sarkar NS2, Das S3 1RMO, Department of Dermatology, NRS Medical Abstract College and Hospital, Kolkata; 2Assistant Professor, Pachydermoperiostosis, (PDP), a rare hereditary disorder that is Department of Ophthalmology, NRS Medical characterized by digital clubbing, pachydermia, subperiosteal new College and Hospital, Kolkata; 3Associate Professor, bone formation, associated with pain, polyarthritis, cutis verticis Department of Dermatology, NRS Medical College gyrata, seborrhoea and hyperhidrosis. It mainly presents due to and Hospital, Kolkata disfiguring facial features, widening of the limbs and bone and joint pain. It affects male population predominantly and transmitted as an Address for correspondence autosomal dominant trait. There are many constant features associated with it as well as rarer features. Increased proliferation of the fibroblast Dr. Sudip Das and dysregulation of matrix protein play a central role in the pathogenesis of the disease. They are diagnosed primarily on clinical Assosciate Professor, Department of Dermatology and radiological grounds. Histopathology plays a supportive role in NRS Medical College and Hospital, Kolkata, India the diagnosis. Such a case has to be differentiated from several other Email: [email protected] conditions like acromegaly, neurofibroma, myxedema, primary systemic amyloidosis as well as from other causes of digital clubbing. Citation The case which is described here is a complete form of PDP which is a rare disease reported in Indian context and that too with the a Chakraborty S, Sarkar NS, Das S. rarer presentation of spiky palmoplanter keratoderma and severe Pachydermoperiostosis and an eyelid ptosis mechanical ptosis leading to severe visual impairment which was associated with spiky keratoderma-an unusual corrected after surgical manipulation of the ptosis.
    [Show full text]
  • Adult Onset Still's Disease Is a Rare Rheumatic Condition
    Adult onset Still’s disease Author: Doctor Bruno Fautrel1 Creation Date: March 2001 Update: December 2001 January 2004 Scientific Editor: Professor Xavier MARIETTE 1Groupe hospitalier Pitié Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. [email protected] Abstract Keywords Name of the disease and synonyms Definition/Diagnostic criteria Juvenile form Comments on the differential diagnosis Incidence Clinical description Method of biological diagnosis Evolution Frequency of episodes of the disease Management/Treatments Etiology Genetic counseling References Abstract Adult onset Still's disease is a rare rheumatic condition. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peaks, joint or muscle pain, lymph node hypertrophy, increase of white blood cells (especially polymorphonuclear neutrophils) and abnormalities of liver metabolism. Other symptoms may also be present. None of these signs is sufficient to establish the diagnosis, and several other diseases (notably infectious or neoplastic diseases) may produce similar symptoms. Thus, adult onset Still's disease often corresponds to a « diagnosis of exclusion », meaning that the diagnosis is retained when the other possible diagnoses have been completely ruled out. The evolution of the disease is difficult to predict; it may be limited to only one flare or may recur over a period of several months or years. Sometimes, joint erosions may happen (roughly 1 patient out of 3). Treatments have 2 objectives : - To limit the intensity of the symptoms of the disease. Aspirin and NSAIDs are the most common drugs for that purpose, and are usable at the beginning of the disease, even if the diagnosis is not completely ascertained.
    [Show full text]
  • Adult-Onset Still's Disease
    Journal of Clinical Medicine Review Adult-Onset Still’s Disease: Clinical Aspects and Therapeutic Approach Stylianos Tomaras 1,* , Carl Christoph Goetzke 2,3,4 , Tilmann Kallinich 2,3,4 and Eugen Feist 1 1 Department of Rheumatology, Helios Clinic Vogelsang-Gommern, 39245 Gommern, Germany; [email protected] 2 Department of Pediatrics, Division of Pulmonology, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), 10117 Berlin, Germany; [email protected] (C.C.G.); [email protected] (T.K.) 3 German Rheumatism Research Center (DRFZ), Leibniz Association, 10117 Berlin, Germany 4 Berlin Institute of Health, 10178 Berlin, Germany * Correspondence: [email protected] Abstract: Adult-onset Still’s disease (AoSD) is a rare systemic autoinflammatory disease charac- terized by arthritis, spiking fever, skin rash and elevated ferritin levels. The reason behind the nomenclature of this condition is that AoSD shares certain symptoms with Still’s disease in children, currently named systemic-onset juvenile idiopathic arthritis. Immune dysregulation plays a central role in AoSD and is characterized by pathogenic involvement of both arms of the immune system. Furthermore, the past two decades have seen a large body of immunological research on cytokines, which has attributed to both a better understanding of AoSD and revolutionary advances in treatment. Additionally, recent studies have introduced a new approach by grouping patients with AoSD into only two phenotypes: one with predominantly systemic features and one with a chronic articular Citation: Tomaras, S.; Goetzke, C.C.; disease course.
    [Show full text]
  • Approach to the Patient with Arthritis Articular Vs
    Approach to the Patient with Arthritis Articular Vs. Periarticular Clinical feature Articular Periarticular Anatomic Synovium, Tendon, bursa, structure cartilage, ligament, capsule muscle, bone Painful site Diffuse, deep Focal “point” Pain on Active/passive, Active, in few movement all planes planes Swelling Common Uncommon Inflammatory versus Noninflammatory Arthritis Inflammatory Arthritis Noninflammatory Arthritis • Pain and stiffness typically are • Pain that worsens with worse in the morning or after periods of inactivity (the so- activity and improves with called "gel phenomenon") and rest. Stiffness is generally improve with mild to mild moderate activity. • Elevated erythrocyte • The ESR and CRP are usually sedimentation rate (ESR) and a normal. high C-reactive protein (CRP) level • The synovial fluid WBC • The synovial fluid WBC count count is is <2000/mm3 in is >2000/mm3 in inflammatory noninflammatory arthritis arthritis. Constitutional Symptoms Active infection Not due to active infection 1. Septic arthritis 1. Systemic lupus erythematosus 2. Disseminated gonococcal 2. Drug-induced lupus infection 3. Still disease 4. Gout/ Pseudogout 3. Endocarditis 5. Reactive arthritis (particularly in 4. Acute viral infections its early phases) 6. Acute rheumatic fever and 5. Mycobacterial poststreptococcal arthritis 6. Fungal 7. Inflammatory bowel disease 8. Acute sarcoidosis 9. Systemic vasculitis 10. Familial Mediterranean fever and other inherited periodic fever syndromes 11. Paraneoplastic arthritis Skin Lesions Useful in Diagnosis
    [Show full text]
  • Differential Diagnosis of Polyarticular Arthritis GEORGE G.A
    Differential Diagnosis of Polyarticular Arthritis GEORGE G.A. PUJALTE, MD, Mayo Clinic Health System, Waycross, Georgia SHIRLEY A. ALBANO-ALUQUIN, MD, Pennsylvania State University College of Medicine, Hershey, Pennsylvania Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. The first step is to distinguish between true articular pain and nonarticular or periarticular conditions by recognizing clinical patterns through the history and physical examination. Once pain within a joint or joints is confirmed, the next step is to clas- sify the pain as noninflammatory or inflammatory in origin. Noninflammatory arthritis, which is mostly related to osteoarthritis, has a variable onset and severity and does not have inflammatory features, such as warm or swollen joints. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. A review of systems is usually negative for rashes, oral ulcers, or other internal organ involvement. In contrast, inflammatory arthritis generally causes warm, swollen joints; prolonged morning stiffness; and positive findings on a review of systems. Once inflammatory arthritis is suspected, possible diagnoses are sorted by the pattern of joint involvement, which includes number and type of joints involved, symmetry, and onset. The suspicion for inflammatory arthritis should be confirmed by the appropriate serologic/tissue and/or imaging studies in the clinical setting or in consultation with a subspecialist. (Am Fam Physician. 2015;92(1):35-41. Copyright © 2015 American Academy of Family Physicians.) CME This clinical content hen a patient presents with considered chronic after two weeks. The conforms to AAFP criteria pain in multiple joints, the pattern of chronic symptoms should be for continuing medical pain can originate from the classified as intermittent or constant (fluctu- education (CME).
    [Show full text]