DOCSLIB.ORG

Atypical Localization of Rheumatoid Nodule: Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Atypical Localization of Rheumatoid Nodule: Case Report CASO CLÍNICO Atypical localization of rheumatoid nodule: case report Bayram KB1, Guvendi EU1, Gurgan A1, Kocyigit H1, Askin A1, Rezanko T2 ACTA REUMATOL PORT. 2015;40:81-84 ABSTRACT between 45 and 88% in post-mortem studies4,5. Laryn- goscopic examination can demonstrate mucosal oede- Rheumatoid nodules can be seen in about 30% of pa- ma, hyperaemia, swelling of the arytenoids, intrinsic tients with rheumatoid arthritis. They are occasionally laryngeal muscle myositis, epiglottitis, crycoarytenoid localized subcutaneously, but they can rarely be seen in joint (CJ) involvement, reduction in mobility of the vo- visceral organs. Their appearance can be confused with cal cords and vocal cord rheumatoid nodules4-7. If an many clinical conditions when they have atypical lo- atypically localized space-occupying lesion detected in calizations. To exclude the presence of a malignancy, patients with complaints like throat ache, hoarseness; these lesions should always be investigated. We aimed primarily malignancy and benign laryngeal lesions are to discuss a patient with rheumatoid nodule localized considered, a rheumatoid nodule may not come to in close neighbourhood of hyoid bone, presumed as a mind8. This can cause confusion, misdiagnosis and ex- malignancy. posure of patients to unnecessary tests. In this case we aimed to discuss the case of a patient with a rheuma- Keywords: Hyoid bone; Malignancy; Rheumatoid no - toid nodule loca lized in close neighbourhood of the hy- dule; Mass. oid bone, that had presumed malignancy and to per- forme a review of the literature. INTRODUCTION CASE REPORT Rheumatoid arthritis (RA) is a chronic autoimmune di - sease with unknown aetiology, which is characterized Forty-nine years old female patient with a diagnosis of by peripheral symmetrical polyarthritis, typically with RA for 25 years, admitted to our clinic due to an in- joint and bone erosion that leads to deformity and des - crease in complaints of wide -spread joint pain and truction1. Most common extra-articular involvement in morning stiffness. After diagnosis, the patient had been patients with RA are subcutaneous rheumatoid no - treated with hydroxychloroquine, sulfasalazine, dules2. Subcutaneous nodules are usually seen on the leflunomide and corticosteroid during short periods. extensor surface of the proximal ulna and in areas She had not been receiving any treatment in last 2 years subjec ted to pressure such as sacrum, Achilles tendon, and had dificulties in performing everyday activities occipital area and hand tendons. Visceral rheumatoid due to the weakness, fatigue and pain. She referred dys- nodu les are detected in areas such as lung, heart, la - phagia in swallowing, sore throat and hoarseness for rynx and vocal cords3. four months. She did not describe mouth and eye dry- The prevalence of laryngeal involvement in RA ness, rashes, aphthous lesions, diarrhea, abdominal ranges from 13 to 75% in various clinical studies, and pain or an infection recently. She had no previous his- tory of surgery or major trauma and hadn’t been used any other drugs for a systemic di sease. 1. Physical Medicine and Rehabilitation, Katip Celebi University On physical examination the patient’s body tempera - Ataturk Training and Research Hospital; o 2. Pathology, Katip Celebi University Ataturk Training and ture was 36,1 C; blood pressure 120/70 mmHg; heart Research Hospital rate 80 beats per minute. Examination of locomotor ÓRGÃO OFICIAL DA SOCIEDADE PORTUGUESA DE REUMATOLOGIA 81 ATYPICAL LOCALIZATION OF RHEUMATOID NODULE: CASE REPORT gative. In neck MRI lingular tonsil volumes had increased. A tissue that had the same signal characteristics as thy- roid gland was discovered at the right of hyoid bone, between strep muscles. The patient was referred to the endocrinology clinic and an USG guided FNA biopsy was performed to the mass. The cytological exa - mination of the obtained smears revealed a large num- ber of isolated atypical cells with eosinophilic, vacuo- lated or clear cytoplasm, ‘’histiocytic’’ cells, some of them were suggestive for signet-ring cells, in a amor- phous eosinophilic material background (Figure 1). Mitotic figure and anisonucleosis was observed in some cells. A small number of multinucleated giant FIGURE 1. Hypercellular smear shows a predominantly isolated cell histiocytes were also seen. Cytomorphological single dispersed cell population. Cytoplasm is mostly finely findings were primarily considered as a neoplasm with vacuolated or ‘’ histiocyte-like’’. Some cells have eccentric nuclei and abundant eosinophilic cytoplasm, mitotic figure a cystic component and metastatic carcinomas (signet (arrow). Sparse multinucleated cells were also observed. There ring or renal cell carcinoma) were also suspected. is an isonucleosis in some cells and a signet ring-like cell Clini cal, radiological examination and excision of mass (arrow, inset) (Hematoxylin&Eosin X200) for definitive diagnosis was recommended. The biopsy results were discussed at the Otolaryngolo gy, Urology and General Surgery clinics. system revealed tenderness in the joints of the hands There were no malignancy findings in gastroscopy and and feet, bilateral swelling of the 1st and 2nd meta - colonoscopy. No pathological findings were detected carpal joint and bilateral Z deformity of the thumb. In in computed tomography (CT) of all abdomen and neck palpation, a hard mobile 2x2 cm lymphade no - high-resolution CT of lung. Ear, nose and throat (ENT) pathy was discovered on the left side, about the level Clinic performed a biopsy with flexible laryngoscopy. of C3. Rheumatoid nodu l es were present on the right In pathological exa mination a cell organization that olecranon. No further changes were observed on exa - may accompany inflammatory cystic neoplasm was mination. observed. Total excision of the mass was recommend- The basic laboratory tests including complete blood ed. Pathological exa mination of the excisional biopsy count, erythrocyte sedimentation rate (ESR), blood showed features of a rheumatoid nodule (Figures 2 biochemistry findings, rheumatoid factor (RF), liver and 3). The patient’s medical treatment was planned function tests and urinary analysis were within nor- and scheduled a follow-up in our rheumatic diseases mal limits. Disease activity score (DAS-28) was calcu- clinic. lated as 4.41. Upon detection of thyroid-stimulating hormone (TSH): 5.65 uIU/ml (0.35-5.50), FT3: 2.24 pg/ml (2.3-4.2), FT4: 1.2 ng/dL (0.88-1.72) thyroid DISCUSSION ultrasonography (USG) and thyroid antibody tests were planned. In USG slight coarsening was observed Rheumatoid nodules are seen in approximately 30% of in the parenchyma of the thyroid gland but no nodules RA patients. They can be detected on the compression detected. A mass lesion about 13x9.33 mm was loca - exposed areas like elbows, forearms, fingers, tendons, ted posterior to the hyoid bone. The lesion was he - sacrum, heel bone and visceral organs (liver, kidney, terogeneous, hypoechoic and its borders were indis- lung, heart), larynx, pharynx, trachea, vocal cords, pe- tinguishable. In differential diagnosis necrotic lymph nis, vulva and breast3,7,9-13. Most nodules are node and complicated cystic lesion was considered. asymptoma tic, but those located under pressure areas Magnetic resonance imaging (MRI) examination, thy- such as periosteum or tendons, can be painful2,3. No - roid scintigraphy and fine-needle aspiration biopsy dules are more common in RA patients who have RF (FNA) was planned. Diffuse hyperplasia was found in and anti-cyclic citrullinated peptide (anti-CCP) posi- thyroid scintigraphy. Thyroid autoantibodies were ne - tivity, bone erosions and extra articular manifestations. ÓRGÃO OFICIAL DA SOCIEDADE PORTUGUESA DE REUMATOLOGIA 82 BAYRAM KB ET AL FIGURE 3. Rheumatoid nodule: nodular lesion infiltrating the striated muscle; fibrin deposition and necrobiosis is seen in centre of nodule surrounded by histiocytes, proliferated FIGURE 2. The mass-forming diffuse cellular infiltration vascular endothelial cells, lymphocytes, plasma cells and nearby hyoid bone and muscle tissue (Hematoxylin&Eosin occasional giant cells (Hematoxylin&Eosin X40, inset X100) X40) Larynx rheumatoid nodules may present with many No dules are gene rally seen in long-term disease3. Also, symptoms. Dyspnoea, stridor, hoarseness, fullness in increased rheumatoid nodule formation has been re- the throat and pain in swallowing are some of ported with methotrexate treatment14. them5,12,13. In patients with RA if one of these findings The pathogenesis of rheumatoid nodules is not suggesting larynx involvement are present, radio- clearly understood. However, has been hypothesized graphs may be used for showing most common in- that trauma to pressure points on the body, with sub- volvement erosive CJ arthritis. However CT is consi - sequent small haemorrhages, results in accumulation dered the method of choice. The main findings that of RF complexes at the site of the injury. RF comple - include CJ thickening or erosions, arytenoid subluxa- xes have a chemotactic role in immune response by tion and asymmetry of the glottis or aryepiglottic folds activating local monocytes and developing local vas- can be better displayed by CT4,16. We primarily exa - culitis. Involvement of T and B-lymphocytes increa ses mined our patient with a neck MRI, because of sus- the immune response15. This explains the formation of pected cystic or necrotic lymph node component of rheumatoid nodules also in the internal organs and in the mass lesion.
Load more

Recommended publications
  • Accuracy of Ontario Health Administrative Databases in Identifying Patients with Rheumatoid Arthritis
    ACCURACY OF ONTARIO HEALTH ADMINISTRATIVE DATABASES IN IDENTIFYING PATIENTS WITH RHEUMATOID ARTHRITIS by Jessica Widdifield A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy in Health Services Research Institute of Health Policy, Management & Evaluation University of Toronto © Copyright by Jessica Widdifield 2013 Accuracy of Ontario Health Administrative Databases in Identifying Patients with Rheumatoid Arthritis (RA): Creation of the Ontario RA administrative Database (ORAD) Jessica Widdifield Doctor of Philosophy Institute of Health Policy Management and Evaluation University of Toronto 2013 Abstract Rheumatoid arthritis (RA) is a chronic, destructive, inflammatory arthritis that places significant burden on the individual and society. This thesis represents the most comprehensive effort to date to determine the accuracy of administrative data for detecting RA patients; and describes the development and validation of an administrative data algorithm to establish a province-wide RA database. Beginning with a systematic review to guide the conduct of this research, two independent, multicentre, retrospective chart abstraction studies were performed amongst two random samples of patients from rheumatology and primary care family physician practices, respectively. While a diagnosis by a rheumatologist remains the gold standard for establishing a RA diagnosis, the high prevalence of RA in rheumatology clinics can falsely elevate positive predictive values. It was therefore important we also perform a validation study in a primary care setting where prevalence of RA would more closely approximate that observed in the general population. The algorithm of [1 hospitalization RA code] OR [3 physician RA diagnosis codes (claims) with !1 by a specialist in a 2 year period)] demonstrated a ii high degree of accuracy in terms of minimizing both the number of false positives (moderately good PPV; 78%) and true negatives (high specificity: 100%).
    [Show full text]
  • Rheumatoid Nodules Injected Area Six Times Daily; Nodules Differential Diagnosis and Immunological Appeared in 37 of 82 of Their Patients (450/O)
    Matters arising 83 3 Paolaggi J B, Chaouat D, Auquier L. An rheumatic fever, though arthritis or arthralgia but my efforts to reproduce them additional test for the diagnosis and is of a more prolonged nature appearing early experimentally failed miserably! monitoring of giant cell arteritis and after infection. polymyalgia rheumatica. Arth Rheum 1985; F DUDLEY HART Ann Rheum Dis: first published as 10.1136/ard.53.1.83 on 1 January 1994. Downloaded from 28: 837-8. Massell et al' reported in 1937 that nodules 24 Harnnont House, closely resembling those of rheumatic fever 20 Harley Street, could be produced by injecting 3 cc of a London WIN IAN, patient's blood subcutaneously into the soft United Kingdom tissue of an elbow followed by rubbing the 1 Veys E M, De Keyser F. Rheuamtoid nodules: Rheumatoid nodules injected area six times daily; nodules differential diagnosis and immunological appeared in 37 of 82 of their patients (450/o). findings. Ann Rheum Dis 1993; 52: 625-6. 2 Schlesinger B E. The public health aspects of The recent Leader on rheumatoid nodules by I was unable to confirm these findings5 in 40 heart disease in children. Lancet 1938; 1: Veys and De Keyser' gave a very interesting children with rheumatic fever in acute or 593-9, 649-54. and useful review of the subject. When I was convalescent stages, five children with 3 Fink C W. The role of the streptococcus in post- registrar with Dr chronic juvenile arthritis (Still's disease), and streptococcal reactive arthritis in childhood working as a medical polyarteritis nodosa.
    [Show full text]
  • Rheumatoid Nodules Developing Under Methotrexate Treatment for Rheumatoid Arthritis
    Letters to the Editor 397 Rheumatoid Nodules Developing under Methotrexate Treatment for Rheumatoid Arthritis Sir, several punched-out radiolucencies and non-calcifying nodules Rheumatoid nodules have been reported to occur in about projecting in the soft parts surrounding the joints. 20% of patients with chronic rheumatoid polyarthritis (1, 2). In the recent literature, a correlation between treatment of rheumatoid arthritis with methotrexate and the development DISCUSSION or worsening of rheumatoid nodules has been suggested (2 ± 4). Methotrexate, a common drug for the treatment of rheuma- We describe here the explosive deterioration of rheumatoid toid arthritis, has been used successfully, but various side- nodules during the course of methotrexate treatment for effects have been reported. Among patients with rheumatoid rheumatoid polyarthritis in a 63-year-old woman and discuss arthritis under methotrexate therapy, the ones whose joint current aspects of possible pathogenetic mechanisms as well symptoms are improving due to administration of metho- as therapeutic options for methotrexate-induced rheumatoid trexate frequently develop subcutaneous nodules increasing in nodules. size and number (1 ± 3, 5). Nevertheless, only in rare cases the severity or the localization of the nodules, e.g. vascular, pulmonary or cardiac manifestation, necessitated discontinua- CASE REPORT tion of the drug (3). Cause and effect relationship between methotrexate treatment and the accelerated development of A 63-year-old woman presented to our department with a 15-year nodules is supported by the regression of the nodules after history of chronic rheumatoid polyarthritis affecting her ®ngers, discontinuation of the drug (2, 6). Although the predominant hand, elbow and knee joints. Ten years previously, she ®rst developed a few ®rm nodules on her ®ngers and feet.
    [Show full text]
  • Complicated Rheumatoid Nodules in Lung
    Hindawi Case Reports in Rheumatology Volume 2020, Article ID 6627244, 3 pages https://doi.org/10.1155/2020/6627244 Case Report Complicated Rheumatoid Nodules in Lung Geetha Wickrematilake Sirimavo Bandaranayake Specialized Childrens Hospital, Kandy, Sri Lanka Correspondence should be addressed to Geetha Wickrematilake; [email protected] Received 18 October 2020; Revised 20 November 2020; Accepted 24 November 2020; Published 3 December 2020 Academic Editor: Gregory J. Tsay Copyright © 2020 Geetha Wickrematilake. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 65-year-old nonsmoker lady carrying a diagnosis of seropositive erosive rheumatoid arthritis for nine years presented with acute shortness of breath, following a spontaneous pneumothorax while on combination therapy with methotrexate, leflunomide, and tocilizumab. Imaging studies revealed multiple cavitory lung nodules, and a transbronchial lung biopsy favoured a diagnosis of rheumatoid lung nodules. Her initial pathological samples were negative for any infectious cause. A follow-up computerized tomography scan (CT scan) confirmed enlargement of lung nodules with a positive antibody test for aspergillosis which needed antifungal therapy, and currently, her arthritis is managed well with rituximab therapy, sulfasalazine, and hydroxychloroquine. 1. Introduction ,e oxygen saturation was 98% while breathing room air, but
    [Show full text]
  • Actemra® (Tocilizumab) Injection for Intravenous Infusion
    UnitedHealthcare® Community Plan Medical Benefit Drug Policy Actemra® (Tocilizumab) Injection for Intravenous Infusion Policy Number: CS2021D0043T Effective Date: September 1, 2021 Instructions for Use Table of Contents Page Commercial Policy Application ..................................................................................... 1 • Actemra® (Tocilizumab) Injection for Intravenous Coverage Rationale ....................................................................... 1 Infusion Applicable Codes .......................................................................... 4 Background.................................................................................. 14 Clinical Evidence ......................................................................... 14 U.S. Food and Drug Administration ........................................... 18 References ................................................................................... 18 Policy History/Revision Information ........................................... 19 Instructions for Use ..................................................................... 19 Application This Medical Benefit Drug Policy does not apply to the states listed below; refer to the state-specific policy/guideline, if noted: State Policy/Guideline Indiana Immunomodulators for Inflammatory Conditions (for Indiana Only) Kansas Refer to the state’s Medicaid clinical policy ® Kentucky Actemra (Tocilizumab) Injection for Intravenous Infusion (for Kentucky Only) Louisiana Refer to the state’s Medicaid clinical
    [Show full text]
  • Non-Bacterial Thrombotic Endocarditis in a Patient With
    Case Report http://dx.doi.org/10.4070/kcj.2016.46.3.425 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal Non-Bacterial Thrombotic Endocarditis in a Patient with Rheumatoid Arthritis Jung-Hye Choi, MD1, Jeong-Eun Park, MD1, Jang-Young Kim, MD2, and Taeyoung Kang, MD1 1Department of Rheumatology, 2Department of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment. (Korean Circ J 2016;46(3):425-428) KEY WORDS: Endocarditis, non-infective; Arthritis, rheumatoid; Mitral valve. Introduction of life. Although RA patients have an increased risk of cardiovascular events such as myocardial infarction, stroke, cardiac death and Nonbacterial thrombotic endocarditis (NBTE), a very rare condition thromboembolism compared with the general population,2)3) there that refers to a spectrum of noninfectious endocarditis of the has been no report of mitral valvular NBTE in a patient with RA.
    [Show full text]
  • SUPPLEMENTARY APPENDIX 4: Search Strategies Syntax Guide For
    SUPPLEMENTARY APPENDIX 4: Search Strategies Pubmed, Embase Perioperative Management - PubMed Search Strategy – March 6, 2016 Syntax Guide for PubMed [MH] = Medical Subject Heading, also [TW] = Includes all words and numbers in known as MeSH the title, abstract, other abstract, MeSH terms, MeSH Subheadings, Publication Types, Substance Names, Personal Name as Subject, Corporate Author, Secondary Source, Comment/Correction Notes, and Other Terms - typically non-MeSH subject terms (keywords)…assigned by an organization other than NLM [SH] = a Medical Subject Heading [TIAB] = Includes words in the title and subheading, e.g. drug therapy abstracts [MH:NOEXP] = a command to retrieve the results of the Medical Subject Heading specified, but not narrower Medical Subject Heading terms Boolean Operators OR = retrieves results that include at least AND = retrieves results that include all the one of the search terms search terms NOT = excludes the retrieval of terms from the search Perioperative Management PubMed Search Strategy – March 6, 2016 Search Query #1 ((((ARTHROPLASTY, REPLACEMENT, HIP[MH] OR HIP PROSTHES*[TW] OR HIP REPLACEMENT*[TIAB] OR HIP ARTHROPLAST*[TIAB] OR HIP TOTAL REPLACEMENT*[TIAB] OR FEMORAL HEAD PROSTHES*[TIAB]) OR (ARTHROPLASTY, REPLACEMENT, KNEE[MH] OR KNEE PROSTHES*[TW] OR KNEE REPLACEMENT*[TW] OR KNEE ARTHROPLAST*[TW] OR KNEE TOTAL REPLACEMENT*[TIAB]) OR (ARTHROPLAST*[TW] AND (HIP[TIAB] OR HIPS[TIAB] OR KNEE*[TIAB])) AND (("1980/01/01"[PDAT] : "2016/03/06"[PDAT]) AND ENGLISH[LANG])) NOT (((("ADOLESCENT"[MESH]) OR "CHILD"[MESH])
    [Show full text]
  • CONCOMITANT GOUT and RHEUMATOID ARTHRITIS - a CASE Presented with Multiple Nodular Swellings on REPORT Feet, Hands, Wrists and Elbows
    349 350 INDIAN JOURNAL OF MEDICAL SCIENCES CASE REPORT consulted various practitioners and took allopathic and indigenous medications but to no relief. Two months prior to admission he CONCOMITANT GOUT AND RHEUMATOID ARTHRITIS - A CASE presented with multiple nodular swellings on REPORT feet, hands, wrists and elbows. Patient’s past medical history is significant for hypertension, POOJA KHOSLA*, ATUL GOGIA**, P. K. AGARWAL***, AMIT PAHUJA**, SUNIL JAIN***, K. K. SAXENA# diabetes mellitus, chronic ethanolism and renal stones for which he underwent left nephrectomy about 25 years ago. Family Abstract history is non-contributory. Figure 1: Multiple nodules present on metatarsal joints of both feet (Gouty Tophi) We report a case of definite rheumatoid arthritis and co-existing gout. Although gout On examination multiple nodules were present and rheumatoid arthritis are relatively common entities individually, the co-existence on metatarsal joints of both feet, Achilles of these two conditions is rare. tendon bilaterally, left prepatellar bursa, bilateral metacarpophalangeal joint, right KEY WORDS: Gout, Rheumatoid Arthritis olecranon process. There was swelling and tenderness of PIP and MCP joints of both feet. (Figure 1) Laboratory data revealed INTRODUCTION metatarsophalangeal joint. He had hemoglobin - 8.9gm/dl, ESR 124 mm at the asymmetrical joint pains and swelling at end of first hour, leucocyte count 7400/cmm Gout and rheumatoid arthritis rarely co-exist in irregular intervals with exacerbations and with normal differential count. Random blood the same patient. As separate disease entities remissions. The symptoms subsided in sugar was 139 mg/dl, Creatinine- 1.6 mg/dl; they are relatively common. Rheumatoid between but there was no period when patient serum uric acid level was 10.9 mg/dl.
    [Show full text]
  • Acr23274 Am.Pdf
    Page 1 of 63 Arthritis Care & Research Key Words: Please choose key words for your manuscript. Choosing the best match of the journal’s keywords to your Arthroplasty, Rheumatoid Arthritis, Disease-Modifying Antirheumatic Drugs work will likely result in better (Dmards), Spondyloarthritis, Systemic lupus erythematosus (SLE) match to reviewers with expertise in your interest area. It may also help to speed the review process.: Optional Terms: You have the option to add additional key words that are not on the Perioperative Management, Complications, Prosthetic Infection, Biologic journal's list to more Response Modifiers specifically categorize your submission.: Accepted Article This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version record. Please cite this article as doi:10.1002/acr.23274. This article is protected by copyright. All rights reserved. Arthritis Care & Research Page 2 of 63 1 Words- 5517 Required 3880 2016 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Anti-rheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty 1* 2* 3 4 Susan M. Goodman, MD , Bryan Springer, MD , Gordon Guyatt, MD , Matthew P. Abdel, MD , Vinod Dasa, MD 5, Michael George, MD 6, Ora Gewurz-Singer, MD 7, Jon T. Giles, MD, MPH 8, Beverly Johnson, MD 9, Steve Lee, DO 10 , Lisa A. Mandl, MD, MPH 1, Michael A. Mont, MD 11 , Peter Sculco, MD 1, Scott Sporer, MD 12 , Louis Stryker, MD 13 , Marat Turgunbaev, MD, MPH 14 , Barry Brause, MD 1, Antonia F.
    [Show full text]
  • The Giant Rheumatoid Nodule: a Case Report
    icine: O ed pe M n l A a r c e c e n s e s G Gupta et al., Gen Med (Los Angeles) 2017, 5:3 General Medicine: Open Access DOI: 10.4172/2327-5146.1000291 ISSN: 2327-5146 Case Report Open Access The Giant Rheumatoid Nodule: A Case Report Sushilkumar Satish Gupta, Ankur Sinha and Vinod Namana* Maimonides Medical Center, Ny, United States Corresponding author: Vinod Namana, Cardiovascular Disease Fellow, Maimonides Medical Center, Brooklyn, NY 11219, Tel: 917-445-7267; E-mail: [email protected] Rec date: May 04, 2017; Acc date: June 5, 2017; Pub date: June 9, 2017 Copyright: © 2017 Namana V. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Rheumatoid arthritis is one of the most common debilitating rheumatological disorders. A subcutaneous rheumatoid nodule usually occurs in advanced cases of rheumatoid arthritis and is also a hallmark of the chronicity of the disease. They are also the most common extra-articular manifestation of rheumatoid arthritis. We present a case of a giant rheumatoid nodule, developed on the left elbow. Keywords: Rheumatoid nodule; Pain; Arthritis The nodule was pale in color, had doughy consistency, approximately 8 cm in diameter, and there was no signs of infections Case Report or ulcerations. She denied pain at the site of the nodule, but did complain of decreased range of motion. She had tried intra nodular An 87-year-old female presented to our hospital for pain and corticosteroid injections in the past without significant relief.
    [Show full text]
  • August-Infammatory-Arthritis.Pdf
    Disclaimer The information provided is intended to assist with support for the documentation accuracy of the diagnoses codes reported to Highmark and not intended to influence clinical or coding judgement. Information regarding any law or regulation does not constitute legal or tax advice and is subject to change based upon the issuance of new guidance and/or change in laws or regulations. Providers should still reference official ICD-10-CM coding guidelines and coding manuals or electronic coding software for accurate reporting of compliant diagnosis codes. Highmark Inc. CONFIDENTIAL AND PROPRIETARY Agenda 1. Identify types of arthritis 2. Discuss documentation requirements 3. Review related treatments Highmark Inc. CONFIDENTIAL AND PROPRIETARY Types of Arthritis Types of Arthritis • Non-Inflammatory • Osteoarthritis • Inflammatory • Ankylosing Spondylitis • Gout • Juvenile Idiopathic Arthritis • Psoriatic Arthritis • Rheumatoid arthritis Highmark Inc. CONFIDENTIAL AND PROPRIETARY Differences Rheumatoid arthritis Osteoarthritis Age of onset May begin at any time in life Usually begins later in life Relatively rapid, over weeks to Speed of onset months Slow, over years Joint symptoms Pain, swelling, stiffness Achiness and tenderness, but little or no swelling Often affects small and large joints Often begins on one side of the body and may spread on both sides of the body to the other side. Symptoms begin gradually and are Pattern of joints (symmetrical), such as both hands, often limited to one set of joints, usually the finger affected both wrists or elbows, or balls of joints closest to the fingernails or thumbs, large both feet weight-bearing joints (hips, knees) or the spine. Duration of morning Less than one hour – returns at the end of the day stiffness Longer than one hour or after periods of activity Presence of symptoms affecting Frequent fatigue and a general feeling the whole body of being ill Whole body symptoms are not present (systemic) Highmark Inc.
    [Show full text]
  • STILL's DISEASE and RHEUMATOID NODULE of the SCLERA*T by A
    Br J Ophthalmol: first published as 10.1136/bjo.52.11.853 on 1 November 1968. Downloaded from Brit. J. Ophthal. (1968) 52, 853 STILL'S DISEASE AND RHEUMATOID NODULE OF THE SCLERA*t BY A. J. LYNE and E. S. ROSEN From the Manchester Royal Eye Hospital THE following report concerns a patient suffering from Still's disease who developed a rheumatoid nodule of the sclera and subsequent scleral thinning of the right eye, a finding not previously recorded in the literature. Case Report A woman aged 31 years first developed joint symptoms at the age of 11 years. Stiffness and pain in the joints increased, until within 9 months all her joints were affected. She has undergone numerous orthopaedic operations, including arthroplasty of both elbow joints at the age of 13 years, a right transtrochanteric osteotomy at the age of 15 years, bilateral mandibular condylec- tomies at the age of 16 years, and further arthroplasties of the elbows at the age of 18 years. At present there is gross deformity with limitation of movement in the hands, elbows, shoulders, hips, knees, and ankles. She is undersized and underweight. Nodules are present on the fingers, copyright. elbows, and knees. A nodule removed from the scalp proved histologically to be a rheumatoid nodule. There is no lymphadenopathy and no skin rash and the liver and spleen are not palpable. She has been treated with prednisolone for the past 12 years in doses varying from 5 to 12-5 mg. daily. Investigations.-Hb varies between 9-6 and 12-8 g.
    [Show full text]