DOCSLIB.ORG

10-Minute Consultation Polyarthralgia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
10-Minute Consultation Polyarthralgia Primary care 10-minute consultation BMJ: first published as 10.1136/bmj.326.7394.859 on 19 April 2003. Downloaded from Polyarthralgia Jo Samanta, Julia Kendall, Ash Samanta This is part of a A 45 year old woman says she has had joint pains in Useful reading her hands, knees, and hips for three months. Her series of symptoms have progressively worsened. Michael L Snaith, ed. ABC of rheumatology. 2nd ed. occasional London: BMJ Books, 1999 articles on What issues you should cover common Assessment—Is her joint pain simple arthralgia, Medendium Group. Guidelines: summarising clinical problems in degenerative joint disease, or an inflammatory guidelines for primary care. www.eguidelines.co.uk primary care arthropathy, or is it secondary to some other cause? (accessed 7 Jan 2003) History—Ask whether she has had any swelling Department of around the joints, morning stiffness, nocturnal pain or Rheumatology, Leicester Royal pain at rest, or recent viral or throat infection. Check x If the diagnosis is rheumatoid arthritis or a Infirmary, Leicester for systemic features such as fever, weight loss, or LE1 5WW fatigue. She may have bowel or bladder symptoms, and seronegative inflammatory arthropathy, explain the Jo Samanta nature of the condition and that referral to hospital for clinical research her eyes or skin may be affected. Is there a family assistant history of rheumatoid arthritis? Other features may be specialist assessment, education, and long term support would benefit. Give positive messages: several treatment Julia Kendall prolonged repetitive use of hands; mood changes, general practice altered sleep pattern, or lack of energy; and use of over modalities are available that can slow down disease pro- clinical assistant the counter drugs or complementary treatment. gression; chronic disability and “ending up in a Ash Samanta wheelchair” are now the exception rather than the consultant Examination—Which joints are affected? Check for rheumatologist symmetrical presentation and proximal interphalangeal norm. x Arrange early referral. Meanwhile consider start- Correspondence to: or metacarpophalangeal joint swelling (absence of A Samanta groove between knuckles on making a fist); inflamma- ing a disease modifying antirheumatic drug— ash.samanta@ uhl-tr.nhs.uk tion and range of movement of joints; hand function, sulfasalazine and methotrexate are the most common assessed by grip strength and ability to hold objects or first line treatments. (Chest radiography is advisable The series is edited before methotrexate treatment because of possible by general write; nodules around elbows or shins; nodes at distal practitioners Ann (Heberden’s nodes) or proximal (Bouchard’s nodes) pulmonary side effects.) Remember that these drugs McPherson and require regular haematological and biochemical Deborah Waller interphalangeal joints; and pitting of nails. Be alert to http://www.bmj.com/ monitoring. Liaise with local rheumatologists if in (ann.mcpherson@ risk factors such as overweight, sedentary lifestyle, heavy dphpc.ox.ac.uk) physical work, repetitive work, or previous joint injury, all doubt. x The BMJ welcomes of which might indicate osteoarthritis. Short term use (6-12 weeks) of low dose oral contributions from corticosteroid ( < 7.5 mg prednisolone a day) relieves general symptoms and may slow progression. practitioners to the series What you should do x Arrange follow up in four to six weeks for clinical x If there is no active inflammation, consider simple assessment, reinforcement of earlier advice, and evalu- BMJ 2003;326:859 arthralgia. Reassure her and advise her to take ation of home and social circumstances. simpleanalgesics or non-steroidal anti-inflammatory on 26 September 2021 by guest. Protected copyright. drugs (NSAIDs). Consider fibromyalgia if she has more generalised pain and signs of depression. Encourage positive lifestyle changes and ask her to return in four Polyarthralgia: signs and symptoms weeks. Simple arthralgia x If features indicate osteoarthritis, reassure her and Main symptom is pain; no clinical features of inflammation in the joints or explain the nature of the problem (wear and tear). morning stiffness; history of intercurrent illness or viral infection Advise analgesics or NSAIDs (or both), offer lifestyle Osteoarthritis education, and encourage exercise and weight loss. Pain is usually in large, weight bearing joints, carpometacarpal joint of thumb, or distal interphalangeal joints of the fingers; presence of Refer her for physiotherapy if needed. Heberden’s nodes, crepitus; lifestyle factors such as overweight, sedentary x If swelling and features of inflammation are present, occupation, repetitive use of joints, and history of trauma to affected joints consider an inflammatory arthropathy (the common- may be relevant est cause is rheumatoid arthritis). Consider further Seronegative (non-rheumatoid) arthritis investigations such as a full blood count (for anaemia), Linked with psoriasis, bowel disease (ulcerative colitis, Crohn’s disease), markers of inflammation (erythrocyte sedimentation bladder symptoms, and anterior uveitis. May occur after infections rate, plasma viscosity, C reactive protein), rheumatoid (streptococcal throat infection, chlamydial urethritis, or bowel infection with factor, and radiography of the hands. yersinia, salmonella, shigella). Mainly asymmetrical, large joint oligoarticular involvement; possible spinal involvement (sacroiliitis) x In the absence of contraindications start treatment with NSAIDS. Long acting preparations usually offer Rheumatoid arthritis At least four of these signs or symptoms for six weeks: pain and swelling in more sustained control. Consider a cyclo-oxygenase-2 at least three joint areas; symmetrical presentation; early morning joint selective inhibitor, as long term treatment is likely to be stiffness for more than one hour; involvement of metacarpophalangeal needed. Advise her to rest affected joints when they are joints, proximal interphalangeal joints, and wrists; subcutaneous nodules; inflamed. Consider referring her to occupational positive rheumatoid factor; radiological evidence of erosions therapy for splinting and home aids. BMJ VOLUME 326 19 APRIL 2003 bmj.com 859.
Load more

Recommended publications
  • Inflammatory Back Pain in Patients Treated with Isotretinoin Although 3 NSAID Were Administered, Her Complaints Did Not Improve
    Inflammatory Back Pain in Patients Treated with Isotretinoin Although 3 NSAID were administered, her complaints did not improve. She discontinued isotretinoin in the third month. Over 20 days her com- To the Editor: plaints gradually resolved. Despite the positive effects of isotretinoin on a number of cancers and In the literature, there are reports of different mechanisms and path- severe skin conditions, several disorders of the musculoskeletal system ways indicating that isotretinoin causes immune dysfunction and leads to have been reported in patients who are treated with it. Reactive seronega- arthritis and vasculitis. Because of its detergent-like effects, isotretinoin tive arthritis and sacroiliitis are very rare side effects1,2,3. We describe 4 induces some alterations in the lysosomal membrane structure of the cells, cases of inflammatory back pain without sacroiliitis after a month of and this predisposes to a degeneration process in the synovial cells. It is isotretinoin therapy. We observed that after termination of the isotretinoin thought that isotretinoin treatment may render cells vulnerable to mild trau- therapy, patients’ complaints completely resolved. mas that normally would not cause injury4. Musculoskeletal system side effects reported from isotretinoin treat- Activation of an infection trigger by isotretinoin therapy is complicat- ment include skeletal hyperostosis, calcification of tendons and ligaments, ed5. According to the Naranjo Probability Scale, there is a potential rela- premature epiphyseal closure, decreases in bone mineral density, back tionship between isotretinoin therapy and bilateral sacroiliitis6. It is thought pain, myalgia and arthralgia, transient pain in the chest, arthritis, tendonitis, that patients who are HLA-B27-positive could be more prone to develop- other types of bone abnormalities, elevations of creatine phosphokinase, ing sacroiliitis and back pain after treatment with isotretinoin, or that and rare reports of rhabdomyolysis.
    [Show full text]
  • Clinical Data Mining Reveals Analgesic Effects of Lapatinib in Cancer Patients
    www.nature.com/scientificreports OPEN Clinical data mining reveals analgesic efects of lapatinib in cancer patients Shuo Zhou1,2, Fang Zheng1,2* & Chang‑Guo Zhan1,2* Microsomal prostaglandin E2 synthase 1 (mPGES‑1) is recognized as a promising target for a next generation of anti‑infammatory drugs that are not expected to have the side efects of currently available anti‑infammatory drugs. Lapatinib, an FDA‑approved drug for cancer treatment, has recently been identifed as an mPGES‑1 inhibitor. But the efcacy of lapatinib as an analgesic remains to be evaluated. In the present clinical data mining (CDM) study, we have collected and analyzed all lapatinib‑related clinical data retrieved from clinicaltrials.gov. Our CDM utilized a meta‑analysis protocol, but the clinical data analyzed were not limited to the primary and secondary outcomes of clinical trials, unlike conventional meta‑analyses. All the pain‑related data were used to determine the numbers and odd ratios (ORs) of various forms of pain in cancer patients with lapatinib treatment. The ORs, 95% confdence intervals, and P values for the diferences in pain were calculated and the heterogeneous data across the trials were evaluated. For all forms of pain analyzed, the patients received lapatinib treatment have a reduced occurrence (OR 0.79; CI 0.70–0.89; P = 0.0002 for the overall efect). According to our CDM results, available clinical data for 12,765 patients enrolled in 20 randomized clinical trials indicate that lapatinib therapy is associated with a signifcant reduction in various forms of pain, including musculoskeletal pain, bone pain, headache, arthralgia, and pain in extremity, in cancer patients.
    [Show full text]
  • Polyarthralgia: Joint Pain & Fibromyalgia
    Polyarthralgia: Joint Pain & Fibromyalgia - Disabled World 07/23/2015 Skip to Content Accessibility HOME Disability ▼ Health ▼ Sports ▼ Products Videos ▼ About: Document Information A B C D E F G H I J K L M N O P Q • Author: Ian Langtree R S T U V W Y • Contact: Disabled World ★ Polyarthralgia: Joint Pain & Fibromyalgia • Published: 2009-04-22 (Revised: 2015-06-01) ▶ Health and Disability ▶ Bones & Joints - Conditions • Related Topics • Definition of Polyarthralgia Brief Synopsis: Information and • Cite This Document definition of Polyarthralgia usually used 3 Foods Cause Joint Pains to describe aches and pain affecting five • Add or Read Comments or more joints. medixselect.com • Print Page & Screen Readers The One Thing You Should Eat For Your Joints "Polyarthralgia is more common in Every Morning. -Video ▼ Awareness: Ribbons & Dates women and even more so with increasing age." 1 Trick to Fibromyalgia What is Polyarthralgia? Free Knee Pain Relief Kit • Awareness Ribbon Colors & Meaning Polyarthralgia is defined as aches in the • Awareness Days, Weeks & Months joints, joint pains, arthralgia of multiple Anterior Hip Replacement Today 07-23-2015 is: joints, and multiple joint pain. • World Sjogren's Day - Commemorates the Polyarthritis is the word usually used to describe pain affecting five or more joints, while a birthday of Henrik Sjogren, who first identified patient with 2 to 4 joints involved would be said to have oligoarticular disease. this disease in 1933, while bringing organizations across the world together to raise Polyarthralgia is more common in women and even more so with increasing age. awareness about Sjogren's. Polyarthralgia: Signs and Symptoms The initial symptoms, which usually appear in the third to fifth decade of life, include painless swelling or thickening of the skin of the hands and fingers, pain and stiffness of the joints Adrenal Fatigue (polyarthralgia), often mistaken for rheumatoid arthritis, and paroxysmal blanching and MDs cyanosis (becoming blue) of the fingers induced by exposure to cold (Raynaud syndrome).
    [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]
  • Arthritis and Joint Pain
    Fact Sheet News from the IBD Help Center ARTHRITIS AND JOINT PAIN Arthritis, or inflammation (pain with swelling) of the joints, is the most common extraintestinal complication of IBD. It may affect as many as 30% of people with Crohn’s disease or ulcerative colitis. Although arthritis is typically associated with advancing age, in IBD it often strikes younger patients as well. In addition to joint pain, arthritis also causes swelling of the joints and a reduction in flexibility. It is important to point out that people with arthritis may experience arthralgia, but many people with arthralgia may not have arthritis. Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back).
    [Show full text]
  • Treatment of Taxane Acute Pain Syndrome (TAPS) in Cancer Patients Receiving Taxane-Based Chemotherapy—A Systematic Review
    Support Care Cancer (2016) 24:1583–1594 DOI 10.1007/s00520-015-2941-0 ORIGINAL ARTICLE Treatment of taxane acute pain syndrome (TAPS) in cancer patients receiving taxane-based chemotherapy—a systematic review Ricardo Fernandes1 & Sasha Mazzarello2 & Habeeb Majeed3 & Stephanie Smith 2 & Risa Shorr4 & Brian Hutton5 & Mohammed FK Ibrahim1 & Carmel Jacobs1 & Michael Ong1 & Mark Clemons1,2,6 Received: 21 May 2015 /Accepted: 3 September 2015 /Published online: 19 September 2015 # Springer-Verlag Berlin Heidelberg 2015 Abstract randomized open-label trials 76 patients), and one was a ret- Background Taxane acute pain syndrome (TAPS) is charac- rospective study (10 patients). The agents investigated includ- terized by myalgias and arthralgias starting 1–3 days and last- ed gabapentin, amifostine, glutathione, and glutamine. Study ing 5–7 days after taxane-based chemotherapy. Despite nega- sizes ranged from 10 to 185 patients. Given the heterogeneity tively impacting patient’s quality of life, little is known about of study designs, a narrative synthesis of results was per- the optimal TAPS management. A systematic review of treat- formed. Neither glutathione (QoL, p = 0.30, no 95 % CI re- ment strategies for TAPS across all tumor sites was performed. ported) nor glutamine (mean improvement in average pain Methods Embase, Ovid MEDLINE(R), and the Cochrane was 0.8 in both treatment arms, p = 0.84, no 95 % CI reported) Central Register of Controlled Trials were searched from were superior to placebo. Response to amifostine (pain re- 1946 to October 2014 for trials reporting the effectiveness of sponse) and gabapentin (reduction in taxane-induced arthral- different treatments of TAPS in cancer patients receiving gias and myalgias) was 36 % (95 % CI, 16–61 %) and 90 % taxane-based chemotherapy.
    [Show full text]
  • Therapeutic Optimization of Aromatase Inhibitor–Associated Arthralgia
    Review Therapeutic optimization of aromatase inhibitor–associated arthralgia: etiology, onset, resolution, and symptom management in early breast cancer Cheryl Jones, MD,1 James Gilmore, PharmD,1 Mansoor Saleh, MD,1 Bruce Feinberg, DO,1 Michelle Kissner, RPh, PharmD,2 and Stacey J. Simmons, MD2 1Georgia Cancer Specialists, Macon, GA; 2Pfizer Inc., New York, NY Third-generation aromatase inhibitors (AIs) used in the treatment of hormone-responsive breast cancer are associated with arthralgia, which is the most common reason for treatment discontinuation. This review characterizes the observed arthralgia and describes its variable definitions in key clinical trials; its typical onset and duration; symptom management strategies; and symptom resolution. The symptomatic manifestations of AI-associated arthralgia are highly variable, with typical onset occurring 2-6 months after treatment initiation. Aromatase inhibitor-associated arthralgia is most often bilateral and symmetrical, involving hands and wrists. Other common locations include knees, hips, lower back, shoulders, and feet. To improve standardization of care as well as patient quality of life, we propose a diagnostic algorithm for the management of patients who receive AIs and who develop arthralgia or worsening symptoms from preexisting joint pain. We conclude that although arthralgia is often associated with AI therapy, prompt diagnosis and management of musculoskeletal symptoms may ensure continued AI treatment and improve quality of life. he use of third-generation aromatase in-
    [Show full text]
  • Joint Pain and Sjögren’S Syndrome
    Joint Pain and Sjögren’s Syndrome Alan N. Baer, MD, FACP Alan N. Baer, MD, FACP Associate Professor of Medicine Division of Rheumatology Johns Hopkins University School of Medicine Director, Jerome Greene Sjogren's Syndrome Clinic 5200 Eastern Avenue Mason F. Lord Bldg. Center Tower Suite 4100, Room 413 Baltimore MD 21224 Phone (410) 550-1887 Fax (410) 550-6255 In 1930, Henrik Sjögren, a Swedish ophthalmologist, examined a woman with rheumatoid arthritis who had extreme dryness of her eyes and mouth and filamentary keratitis, an eye condition related to her lack of tears (1). He became fascinated by this unusual debilitating condition and subsequently evaluated 18 additional women with the same combination of findings. He described this new syndrome as “keratoconjunctivitis sicca” in his postdoctoral thesis. Thirteen of the 19 women had chronic inflammatory arthritis. We would now classify these 13 women as having secondary Sjögren’s syndrome (SS), occurring in the context of rheumatoid arthritis. However, joint pain constitutes one of the most common symptoms of the primary form of SS, defined as SS occurring in the absence of an underlying rheumatic disease. In a recent survey of SS patients belonging to the French Sjögren’s Syndrome Society (Association Française du Gougerot-Sjögren et des Syndromes Secs), 81% reported significant joint and muscle pain (2). In this article, the joint manifestations of primary SS will be reviewed. A few definitions are needed for the reader. Although the term “arthritis” was originally applied to conditions causing joint inflammation, it now includes disorders in which the joint has become damaged by degenerative, metabolic, or traumatic processes.
    [Show full text]
  • Adult-Onset Still's Disease As the First Manifestation of Cerebral Infarction: a Case Report
    02 Brain Neurorehabil. 2018 Sep;11(2):e13 https://doi.org/10.12786/bn.2018.11.e13 pISSN 1976-8753·eISSN 2383-9910 Brain & NeuroRehabilitation Case Report Adult-onset Still's Disease as the First Manifestation of Cerebral Infarction: a Case Report Jong Kyoung Choi, Yu Jin Seo, Dae Yul Kim Received: Feb 27, 2018 HIGHLIGHTS Revised: Jun 19, 2018 Accepted: Jun 29, 2018 • Adult-onset Still’s disease (AOSD) is a rare systemic febrile disorder of unknown etiology. Correspondence to • Cerebral infarction as the first manifestation of AOSD has not been reported. DaeYul Kim • This case report is the first report cerebral infarction as the first manifestation of AOSD in Department of Rehabilitation Medicine, Asan a young stroke patient during rehabilitation period. Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. E-mail: [email protected] Copyright © 2018. Korea Society for Neurorehabilitation i 02 Brain Neurorehabil. 2018 Sep;11(2):e13 https://doi.org/10.12786/bn.2018.11.e13 pISSN 1976-8753·eISSN 2383-9910 Brain & NeuroRehabilitation Case Report Adult-onset Still's Disease as the First Manifestation of Cerebral Infarction: a Case Report Jong Kyoung Choi ,1,* Yu Jin Seo ,2 Dae Yul Kim 2 1Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea 2Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Received: Feb 27, 2018 ABSTRACT Revised: Jun 19, 2018 Accepted: Jun 29, 2018 Adult-onset Still's disease (AOSD) is a rare systemic febrile disorder of unknown etiology.
    [Show full text]
  • Cervical Spine Dysfunction Signs and Symptoms in Individuals with Temporomandibular Disorder
    Original Article Cervical spine dysfunction signs and symptoms in Artigo Original individuals with temporomandibular disorder Priscila Weber1 Frequência de sinais e sintomas de disfunção cervical em Eliane Castilhos Rodrigues Corrêa2 Fabiana dos Santos Ferreira1 indivíduos com disfunção temporomandibular Juliana Corrêa Soares1 Geovana de Paula Bolzan3 Ana Maria Toniolo da Silva2 Keywords ABSTRACT Facial pain Purpose: To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with Neck pain and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD Craniomandibular disorders and CCD coexistence. Methods: Participants were 71 women (19 to 35 years), assessed about TMD presence; Posture 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated Cephalometry through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned Signs and symptoms about cervical pain. Craniocervical posture was assessed by cephalometric analysis. Results: There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). Conclusion: Cra- niocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.
    [Show full text]
  • Rheumatological Manifestations of Infective Endocarditis
    Ann Rheum Dis: first published as 10.1136/ard.43.5.716 on 1 October 1984. Downloaded from Annals of the Rheumatic Diseases, 1984, 43, 716-720 Rheumatological manifestations of infective endocarditis Ph. THOMAS,' J. ALLAL,2 D. BONTOUX,' F. ROSSI,3 J. Y. POUPET,3 J. P. PETITALOT,2 AND B. BECQ-GIRAUDON4 From the Departments of 'Rheumatology, 2Cardiology A, 3Internal Medicine, 4Infectious Diseases, CHU La Miletrie, 86000 Poitiers, France SUMMARY A retrospective study showed musculoskeletal manifestations in 32 of 108 patients treated for infective endocarditis in several departments at the Poitiers CHU. Such manifesta- tions included articular pain or aseptic arthritis, typically involving the major joints, as well as vertebral osteomyelitis, low back pain (inflammatory or non-inflammatory), and myalgia. Patients showing such signs were generally younger than those without musculoskeletal involvement, diagnosis was made later, and prognosis was worse; streptococcus D was more often involved, and microscopic haematuria was more common. With the exception of vertebral osteomyelitis, the pathogenesis was not clear. Key words: bacterial endocarditis, rheumatology, arthritis, arthralgia, low back pain, vertebral osteomyelitis. copyright. Musculoskeletal manifestations of infective en- increase in organic murmur. Echocardiographic, docarditis (IE) are particularly hard to diagnose, surgical, or necropsy reports confirmed the diagno- and until recently their frequency has been under- sis in all cases where they were available. estimated. Reviewing 108 cases of patients admitted Assay of circulating immune complexes (CIC) to hospital for IE at the Poitiers CHU we sought to was carried out by a modified polyethylene glycol http://ard.bmj.com/ determine: (a) the type and frequency of rheumato- (PEG)-precipitation technique.' C4 precipitated by logical manifestations of IE; (b) the clinical and PEG was expressed as a function of serum C4 laboratory characteristics of IE with or without such concentration, with assay carried out by nephel- manifestations.
    [Show full text]
  • Chikungunya Annual Report 2017
    Chikungunya Annual Report 2017 Chikungunya Chikungunya is a class B disease. Class B diseases or conditions shall be reported to the Office of Public Health by the end of the next business day after the existence of a case, a suspected case, or a positive la- boratory result is known Chikungunya is caused by a mosquito-borne alphavirus indigenous to tropical Africa and Asia, where it causes endemic and epidemic chikungunya fever. Chikungunya is a Makonde word (one of the local lan- guages in Tanzania) meaning ‘that which bends up’, and describes the symptoms caused by the severe joint pains that usually accompany the infection. Diseases range from silent asymptomatic infections to undifferentiated febrile illness and to devastating encephalitis. Deaths are rare. Fatal cases have not been documented conclusively. Chikungunya belongs to the Arbovirus group; it is transmitted by Aedes mosquitoes. The virus multiplies in a mosquito within eight to ten days; the mosquito remains infective for life. Viremic humans are the main reservoir for the virus. The mosquito becomes infected by feeding on viremic patients from one day before, to the last day of the febrile period. The virus is transmitted during probing and blood feeding. There is no person-to-person transmission. Vertical transmission from mother to fetus is rare; transplacental chikungunya transmission and severe congenital chikungunya has been described. In Africa, the virus is maintained in the sylvatic cycle between wild primates and forest-dwelling Aedes. Serological studies have found antibodies in humans and wild primates in the moist forests and semi- arid savannas of Africa. There are 27 alphaviruses able to infect vertebrates (humans, rodents, birds, horses) larger mammals and invertebrates.
    [Show full text]