DOCSLIB.ORG

A Variant of Rheumatoid Arthritis Characterized by Recurrent Digital Pad Nodules and Palmar Fasciitis, Closely Resembling Palindromic Rheumatism

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Variant of Rheumatoid Arthritis Characterized by Recurrent Digital Pad Nodules and Palmar Fasciitis, Closely Resembling Palindromic Rheumatism Ann Rheum Dis: first published as 10.1136/ard.8.1.1 on 1 March 1949. Downloaded from A VARIANT OF RHEUMATOID ARTHRITIS CHARACTERIZED BY RECURRENT DIGITAL PAD NODULES AND PALMAR FASCIITIS, CLOSELY RESEMBLING PALINDROMIC RHEUMATISM BY E. G. L. BYWATERS From the Department of Medicine, Postgraduate Medical School of London, and the Special Unit for Juvenile Rheumatism, Canadian Red Cross Memorial Hospttal, Taplow, Buckinghamshire INDEX Page Page INTRODUCTION .. 1 Relation to lupus erythematosus . 26 CASE HISTORIEs (1-6) .. 2 Relation to lipoidosis 26 HISTOLOGY Relation to palindromic rheumatism 27 Synovial membrane 22 Relation to gout .. 28 Nodules .... 23 Relation to rheumatoid arthritis .29 DISCUSSION SUMMARY .. 29 copyright. Cutaneous nodules .. 23 REFERENCES .. ..t 29 Palmar and Digital contractures 24 Introduction (c) psoriatic arthritis, characterized by ter- Observations culninating in the work of Nichols minal interphalangeal joint involvement and http://ard.bmj.com/ and Richardson in 1909 clearly differentiated association of activity with skin exacerbations; rheumatoid arthritis from degenerative joint disease, (d) joint disorders associated with ulcerative a distinction which has been universally accepted colitis and other intestinal diseases (for example and has done more to clarify our ideas on chronic Whipple's syndrome), characterized by a rheumatism than any other single concept. Rheu- relatively mild course with remissions and matoid arthritis itself, however, has tended since exacerbations dependent on activity of the then to become an unwieldy nosological hotch- primary disease; on September 28, 2021 by guest. Protected potch, including almost any chronic joint affliction (e) spondylitis ankylopoietica or, as some which is not obviously exogenous (for example prefer to call it, rheumatoid arthritis of the traumatic or bacterial) in origin. Many 'have sug- spine, diffeiing in the earlier age and prepon- gested that the term includes a variety of diseases, derantly male incidence: its peripheral joint and attempts have been made to separate out such manifestations are different neither clinically clinical entities as: nor pathologically from those of rheumatoid (a) infective arthritis, characterized by the arthritis "proper "; involvement of a few large joihts and the (f) intermittent hydrarthrosis and palin- presence of a focus of infection, but no recover- dromic rheumatism (Hench) which are thought able metastatic organism and by a tendency by some, but not by Hench, to be variants to improve or even to heal following the removal of the rheumatoid arthritis syndrome; certainly of the focus; some cases of intermittent hydrarthrosis ulti- (b) classical rheumatoid arthritis, occurring mately develop the same type of permanent in middle-aged women and involving, charac- joint involvement as in rheumatoid arthritis: teristically, multiple finger joints; see later discussion; 2 Ann Rheum Dis: first published as 10.1136/ard.8.1.1 on 1 March 1949. Downloaded from 2- ANNALS OF THE RHEUMATIC DISEASES (g) Still's disease. This is rheumatoid arth- others do not-but to " account " for the variant ritis occurring in children and the so-called we postulate some extra factor, operative before or distinguishing features (for example late radio- after the onset of the main disease, either deter- logical involvement) are due only to the mined by it or actually determining the main increased cartilage protection of epiphyseal disease. bone at this age. Other features, such as A further characteristic of such variants is that a pericarditis, enlarged glands, and spleen, are gradation exists between the type and its variant. seen in adults as well; Thus we do not include rheumatic fever as a variant (h) arthritis associated with visceral dis- of rheumatoid arthritis because we do not see cases seminated lupus erythematosus (see later which are pathologically halfway between rheumatic discussion); fever and rheumatoid arthritis; our patients turn out (i) Felty's syndrome with arthritis, spleno- ultimately to have either permanent joint or per- megaly, anaemia, leukopenia, and pigmefltation manent heart disease or neither (in contra-distinc- of the skin is now generally agreed (for example tion to those of other clinics, for example, Talkov and others, 1942), to be rheumatoid Baggenstoss and Rosenberg, 1941; Bayles, 1943; arthritis, occasionally complicated by coincident Young and Schwedel, 1944). Thus, to prove a disease such as cirrhosis of the liver: in the syndrome to be a variant, it is necessary to establish classical rheumatoid case, any or rarely all of the existence of lesser and variable degrees of these extra signs may be present; variation from type, that is, transitionaf forms. (rheumatoid arthritis It is the object ofthis paper to detail such a variant. (j) Sjogren's syndrome A case will first be described (in full detail since it with kerato-conjunctivitis sicca). appears to be unique) which shows the variation Thus, we have a number of loosely conceived at a maximum, so much so that the correct diagnosis nosological entities of whose life course we know was not reached for nine years: following this, other as yet little and whose pathological changes, still ill- cases will be detailed rather more shortly, showing understood, appear superficially to resemble each transition to the more usual type of rheumatoid other very closely. These various syndromes are arthritis. copyright. statistically determined rather than true entities, Case Histories based on clinical or anatomical data rather than a knowledge of aetiology. The chief reason for CASE 1 distinguishing between them is the practical useful- E.P., a man aged 60, on his first admission (Feb. 2, ness ofsuch distinctions for prognosis and treatment. 1943) with no family history or relevant disease, had been in good health until the age of 51, except for a minor For scientific purposes, the resemblances between http://ard.bmj.com/ these various conditions are, from many angles, degree of silicosis contracted during service as a mining more important than their differences; it seems engineer inf South Africa, for which he was invalided at the age of 45. He had contracted no tropical' disease. probable that the basic (and unknown) pathological The present complaint started in 1934 at the age of 51* processes are, in all, similar in nature. This means following an exposure to damp and cold: the hands that these conditions may be considered as variants became swollen and painful in attacks lasting some two on a basic theme, or from a basic type. Such or three days. At this period he had perhaps two attacks variants fall into several possible categories. The every month, affecting only the hands and feet. These variation-producing factor may be constitutional are described as swellings and pain in the neighbourhood on September 28, 2021 by guest. Protected (for example, the congenital ductus arteriosus variant of the proximal interphalangeal joints, one or two being of subacute bacterial endocarditis); it may be age affected at each incident, and then perhaps others in of onset (for example, Still's disease); it may be succeeding incidents. These attacks continued to 1935, such as being always more frequent during the winter months, modification by environmental factors, but completely absent in a warm climate (South Africa nutritional state, etc., or it may be the presence of in December 1935 and January 1936) and returning some other disease producing a pseudovariant on the voyage home. (for example, cirrhosis ofliver complicating rheuma- In October 1935 the -patient saw Consultant I toid and producing Felty's syndrome). There might (Medicine) complaining at that time of " superficial be variation in original exogenous stimulus (for painful swellings on the toes, fingers, wrists, knees, and example, antigen)-or variation in the type or soles of feet, especially marked in cold weather". location of tissue originally stimulated. Of such * The patient's wife was medically qualified and kept a detailed vagaries we know very little-why some patients diary of her husband's condition and copies of the medical reports lesions and others from the numerous specialists whom he consulted; I sm much indebted with rheumatoid develop eye to her for allowing me to see and use these documents, as well as to the do not, why some psoriatics develop arthritis and consultants themselves. Ann Rheum Dis: first published as 10.1136/ard.8.1.1 on 1 March 1949. Downloaded from A VARIANT OF RHEUMATOID ARTHRITIS 3 Examination showed nothing abnormal except a small swelling arising in two to three hours, sometimes taking oedematous area appearing during examination between days to subside. This was brought on by cold weather the index and middle knuckles of the left hand, which but left no permanent change. A tentative diagnosis disappeared in a few minutes. In between these attacks of gout was made and the patient was treated with the patient was perfectly well. For example; aspirin and colchicum. No improvement having followed a holiday in Bermuda in April "Aug. 2.-Swelling of right little finger. 1937, he was sent Aug. 6.-Finger better. into a private clinic under the care of Consultant V Aug. 7-8.-Right wrist painful. (Gastro-enterology), where the-condition was thought to Aug. 9.-Wrist free of pain. Got slightly chilled: be gout. Blood uric acid was 3-6 and later. 3-2 mg. by evening the right index finger was considerably swollen per 100 c.cm. Atophan at first seemed to be helpful, with clear distal demarcation, swelling covering one inch causing the swellings to disappear for a few days, but above and below middle phalangeal joint; middle finger subsequently it had much less obvious effect. The also swollen. Left' hand: middle finger swollen and erythrocyte sedimentation rate was recorded as 62 mm, similar to right index. Feet: uncomfortable but not definitely swvollen. and 4 mm. per hour (Westergren) one month later. Aug. 10.-Swelling of fingers improved. Haemoglobin was 96 per cent., red cell count 4,900,000 Aug.
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]
  • Rotator Cuff Tendon Ruptures and Degeneration As the First Manifestation of Polymyalgia Rheumatica Disease - a Case Report
    Open Access Austin Journal of Clinical Case Reports Case Report Rotator Cuff Tendon Ruptures and Degeneration as the First Manifestation of Polymyalgia Rheumatica Disease - A Case Report Bazoukis G1*, Michelongona P2, Papadatos SS1, Pagkalidou E1, Grigoropoulou P1, Fragkou A1 and Abstract Yalouris A1 Polymyalgia Rheumatica (PMR) is a common rheumatic disease of the 1Department of Internal Medicine, General Hospital of elderly. Although it is a well-established disease, its causes and pathophysiology Athens “Elpis”, Greece remain unclear. In our case report we present an 83-year-old female presented 2Department of Internal Medicine, General Hospital of at the emergency department because of fever and diarrhea. Her medical Korinthos, Greece history included a recent orthopedic surgery because of tendons rupture of the *Corresponding author: George Bazoukis, rotator cuff. Her blood exams showed increased inflammatory markers and a Department of Internal Medicine, General Hospital of three-digit ESR. The diagnosis of PMR was set after the exclusion of infectious Athens “Elpis”, Greece and other diseases that mimic PMR symptoms. To the best of our knowledge, it is the first time that rotator cuff tendons rupture and degeneration is the first Received: June 05, 2016; Accepted: August 02, 2016; manifestation of PMR disease. Clinicians should be aware of the degeneration Published: September 08, 2016 of the shoulder and hip extra-articular structures in PMR and they should keep in mind that it can be the first manifestation of the disease. Keywords: Polymyalgia rheumatica; Rotator cuff denegeration; Tendon rupture Introduction and infraspinatus muscles as well as significant tendinopathy of the subscapularis and long head of biceps muscles.
    [Show full text]
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Single Injection May Quell Chronic Plantar Fasciitis
    March 2006 • www.rheumatologynews.com Lupus/CT Diseases 27 Single Injection May Quell Chronic Plantar Fasciitis BY BRUCE JANCIN lief in nine such patients treated in open- try botulinum toxin A because of pub- greater than 4 on a 0-10 visual analog Denver Bureau label fashion. Based upon these highly en- lished reports citing its general analgesic scale. At week 2 this score was halved. At couraging results, a randomized, double- effect and inhibition of inflammatory pain. week 6 it was quartered. The same pattern V IENNA — Botulinum toxin A injection blind, and placebo-controlled clinical trial The nine patients selected for botu- of improvement was noted for maximum shows promise as a novel therapeutic op- is now planned, according to Dr. Placzek linum toxin A injection averaged age 55 pain during the previous 48 hours. tion for chronic plantar fasciitis patients of Charité Hospital, Berlin. years, with a 14-month history of plantar No muscle weakness or other adverse unresponsive to conventional treatments, Most patients with chronic plantar fasci- fasciitis refractory to all standard mea- events were observed, he noted at the Dr. Richard Placzek reported at the annual itis respond to physical therapy, cortico- sures. Follow-up evaluations were con- meeting sponsored by the European European Congress of Rheumatology. steroid injections, orthotics, acupuncture, ducted 2 weeks postinjection and every 1- League Against Rheumatism. Patients in- A single 200-unit injection into the and/or high-energy ultrasound extracor- 3 months thereafter up to 52 weeks. dicated they were satisfied with the pain painful region at the origin of the plantar poreal shock wave therapy.
    [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]
  • The Painful Heel Comparative Study in Rheumatoid Arthritis, Ankylosing Spondylitis, Reiter's Syndrome, and Generalized Osteoarthrosis
    Ann Rheum Dis: first published as 10.1136/ard.36.4.343 on 1 August 1977. Downloaded from Annals of the Rheumatic Diseases, 1977, 36, 343-348 The painful heel Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis J. C. GERSTER, T. L. VISCHER, A. BENNANI, AND G. H. FALLET From the Department of Medicine, Division of Rheumatology, University Hospital, Geneva, Switzerland SUMMARY This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus. copyright. A 'painful heel' syndrome occurs at times in patients psoriasis, urethritis, conjunctivitis, or enterocolitis. with inflammatory rheumatic disease or osteo- The antigen HLA B27 was present in 29 patients arthrosis, causing significant clinical problems. Very (80%O). few studies have investigated the frequency and characteristics of this syndrome. Therefore we have RS 16 PATIENTS studied unselected groups of patients with rheuma- All of our patients had the complete triad (non- toid arthritis (RA), ankylosing spondylitis (AS), gonococcal urethritis, arthritis, and conjunctivitis).
    [Show full text]
  • The Pathomechanics of Plantar Fasciitis
    Sports Med 2006; 36 (7): 585-611 REVIEW ARTICLE 0112-1642/06/0007-0585/$39.95/0 2006 Adis Data Information BV. All rights reserved. The Pathomechanics of Plantar Fasciitis Scott C. Wearing,1 James E. Smeathers,1 Stephen R. Urry,1 Ewald M. Hennig2 and Andrew P. Hills1 1 Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia 2 Biomechanik Labor, University Duisburg-Essen, Essen, Germany Contents Abstract ....................................................................................585 1. Anatomy of the Plantar Fascia ............................................................586 1.1 Gross Anatomy of the Plantar Fascia...................................................586 1.2 Histological Anatomy of the Plantar Fascia .............................................589 1.2.1 Neuroanatomy ................................................................590 1.2.2 Microcirculation ...............................................................590 1.2.3 The Enthesis ...................................................................590 2. Mechanical Properties of the Plantar Fascia ................................................592 2.1 Structural Properties ..................................................................593 2.2 Material Properties ...................................................................593 3. Mechanical Function of the Plantar Fascia .................................................594 3.1 Quasistatic Models of Plantar Fascial Function ..........................................594
    [Show full text]
  • REPETITIVE STRAIN INJURY AWARENESS Tenosynovitis
    REPETITIVE STRAIN INJURY RSIA AWARENESS Tenosynovitis RSI Conditions The term Repetitive Strain Injury is an umbrella term used to describe a number of specific musculoskeletal conditions, including tenosynovitis, as well as ‘diffuse RSI’, which is more difficult to define but which recent research attributes to nerve damage. These conditions are often occupational in origin. Lack of adequate diagnosis or access to appropriate treatment can exacerbate the condition and sometimes leads to job loss and economic hardship. What is Tenosynovitis? Tenosynovitis is the tender swelling of the rope or cord like structures (tendons) which connect muscles to the bones in order to work the joints of the body, and inflammation of the lining of the protective synovial sheath that covers these tendons. Areas most frequently affected are the hand, wrist or arms, although it may occur at any tendon site. De Quervain’s or Stenosing Tenosynovitis results from inflammation or constriction of the tendons on the thumb side of the wrist. A localised swelling affecting the flexor tendons of the hand is known as Trigger Finger. The Symptoms When the gliding surfaces of the tendon and sheath become roughened and inflamed from overuse, tenosynovitis will present as aching, tenderness and swelling of the affected area. There may also be also stiffness of the joint, shooting pains up the arm and creaking tendons (crepitus). The ability to grip can be lost. A localised swelling at the base of the thumb may indicate De Quervain’s. Tenosynovitis can just last a few days, but in some cases may go on for many weeks or even months.
    [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]
  • Palindromic Rheumatism Or When Do You Decide to Treat an Asymptomatic Seropositive RA Patient? What Is This?
    Palindromic Rheumatism or When do you decide to treat an asymptomatic seropositive RA patient? What Is This? • 11.15.15 • 56 yo man comes for 2nd opinion for bouts of severe large joint monoarthritis lasting 24 hours or longer. • Vague about duration “10-15 years.” Had wrist synovectomy 2005 after “trauma.” • Saw rheumatologist 2012: ACPA>500, RF 60. • Loss of shoulder motion in all planes. • At the conclusion of this presentation, the participant should be able to: – Appreciate the relationship of Palindromic Rheumatism (PR) and progression to RA – Understand the biology of intercritical PR – Define the utility of prevention strategies – Comprehend the yield of imaging in PR and how it informs PR pathophysiology • Should we try to prevent? How? Annual transition to RA is greater than 15% in which of the following ACPA+ pts? A. Arthralgia B. Arthralgia + Imaging + CRP C. Palindromic Rheumatism D. Asymptomatic Twin E. Interstitial Lung Disease Rheumatoid Arthritis Pathogenesis Tolerance broken-AutoAb appear Adaptive Immune Response Locus and Trigger? Systemic Nature? “Amplification” Synovial Targeting with variable kinetics? Innate vs Adaptive Immunity? Joint Targeting ACPA-IC deposit or are formed de novo in joint? Or something else? Tissue Injury Rheumatoid Arthritis Persistence of the Systemic Trigger? Systemic autoimmunity & inflammation T cells/B Cells Immune Complexes TNF, IL-6, GM-CSF No treatment shown to eliminate systemic process Where does MTX work? Joint Inflammation MF, FLS, Cartilage, Bone RA Centers in Synovium, Destroying All Around It? Why Is Palindromic Rheumatism Palindromic? Systemic inflammation Followed by resolution? e.g. like gout? Why does it resolve? Why does it stop resolving? Single Joint Inflammation Palindromic Rheumatism (PR) • How frequent is PR as an initial presentation of RA? • What is the mechanism of PR? • Is synovitis present during its intercritical phase? • What is the frequency of progression to RA in 5 years? Treatment? Is Palindromic Rheumatism a Common Presentation? Frequency relative to new onset RA is: A.
    [Show full text]
  • Conditions Related to Inflammatory Arthritis
    Conditions Related to Inflammatory Arthritis There are many conditions related to inflammatory arthritis. Some exhibit symptoms similar to those of inflammatory arthritis, some are autoimmune disorders that result from inflammatory arthritis, and some occur in conjunction with inflammatory arthritis. Related conditions are listed for information purposes only. • Adhesive capsulitis – also known as “frozen shoulder,” the connective tissue surrounding the joint becomes stiff and inflamed causing extreme pain and greatly restricting movement. • Adult onset Still’s disease – a form of arthritis characterized by high spiking fevers and a salmon- colored rash. Still’s disease is more common in children. • Caplan’s syndrome – an inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust, as in a mine. • Celiac disease – an autoimmune disorder of the small intestine that causes malabsorption of nutrients and can eventually cause osteopenia or osteoporosis. • Dermatomyositis – a connective tissue disease characterized by inflammation of the muscles and the skin. The condition is believed to be caused either by viral infection or an autoimmune reaction. • Diabetic finger sclerosis – a complication of diabetes, causing a hardening of the skin and connective tissue in the fingers, thus causing stiffness. • Duchenne muscular dystrophy – one of the most prevalent types of muscular dystrophy, characterized by rapid muscle degeneration. • Dupuytren’s contracture – an abnormal thickening of tissues in the palm and fingers that can cause the fingers to curl. • Eosinophilic fasciitis (Shulman’s syndrome) – a condition in which the muscle tissue underneath the skin becomes swollen and thick. People with eosinophilic fasciitis have a buildup of eosinophils—a type of white blood cell—in the affected tissue.
    [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]