ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Dermatomyositis (DM) is an idiopathic, inflammatory myopathy characterized by dermatologic changes, myopathy, some typical serologic findings, and frequent extramuscular involvement. Both children and adults may be affected, with certain features distinct to children. Dermatologic changes may occur without myositis in patients with amyopathic DM. DM has been reported to occur in patients undergoing treatment with certain therapeutic agents or with concomitant infections. DM may be associated with malignant disease in older patients. Newer serologic tests may identify subsets with different clinical patterns and prognoses. Magnetic resonance imaging is increasingly used to identify muscle involvement and to select sites for biopsies. Newer studies provide improving guidance for therapies in steroid nonresponders.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There are several major issues related to malignancy that are of importance to the practicing clinician caring for patients with rheumatoid arthritis. Although it has been clearly established that rheumatoid arthritis is associated with an increased risk of hematologic malignancies including non-Hodgkin's lymphoma and multiple myeloma, the absolute risk of developing a hematologic malignancy is less than 1%. In rheumatoid arthritis patients with secondary Sjogren's syndrome, Felty's syndrome, or paraproteinemia, the risks for developing hematologic malignancy are likely to be even higher. These risks are balanced by reduced rates of gastrointestinal cancers. There are no conclusive data that link the FDA-approved second line therapeutic agents with the subsequent development of malignancy. However, the renal transplant experience suggests that immunosuppression alone increases the risk of subsequent malignancy. This should be a guiding principle when obtaining informed consent as well as in planning future therapeutic approaches to rheumatoid arthritis. Alkylating agents markedly increase the risk of leukemia and skin, bladder, and hematologic malignancies when used to treat rheumatoid arthritis.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This brief review of musculoskeletal injuries in musicians serves as an introduction to performing arts medicine and to the role rheumatologists can play in managing injured musicians. This niche is an area of practice that the rheumatologist may find very gratifying that, at the same time, provides a valuable service to the community. Common problems include overuse syndromes, nerve entrapment, thoracic outlet syndrome, osteoarthritis, motor dysfunction, fibromyalgia, and complications of hypermobility. Important points in the history and physical examination of the injured musician must include details of practice and performance patterns. Treatment involves many techniques used in nonmusicians but also often important is direct contact with the musicians' teachers.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Nine patients with mechanical or osteoarthritic knee pain present for more than 6 weeks were evaluated by clinical examination, needle arthroscopy, and standard arthroscopy. Each knee was assessed for patellofemoral cartilage disruption, cartilage abnormalities in the tibiofemoral joints, meniscal tears, and synovitis. Needle arthroscopy was performed immediately before standard arthroscopy in the operating room under local anesthesia. Six of the nine patients had magnetic resonance imaging (MRI) scans before the arthroscopic procedures. The clinical examination was 100% sensitive for the detection of patellofemoral disease, 62% sensitive for medial meniscal tears, and 14% sensitive for lateral meniscal tears. Visualization of the femoral-tibial joint was significantly better with standard arthroscopy than with needle arthroscopy (p = 0.002). Percent visualization with the needle arthroscope was higher for the patellofemoral and the medical tibiofemoral cartilage compared to the lateral tibiofemoral cartilage and menisci (p < 0.05). The needle arthroscope and MRI scan were equivalent to the standard arthroscope in the detection of patellofemoral cartilage disruption of any depth and in the detection of meniscal tears. However, the standard arthroscope was better in detecting cartilage abnormalities in the medial and lateral joint spaces (p < 0.05 and p < 0.01, respectively). The costs for diagnostic standard arthroscopy, needle arthroscopy, and MRI of the knee in an academic center are $3900, $1650, and $900, respectively. These data suggest that the majority of reversible causes of knee pain are diagnosed by physical examination. Therefore, after a complete history and physical examination, if the physician thinks that the patient has an internal derangement of the knee and that surgical intervention is needed, we suggest that the patient go directly to standard arthroscopy, which offers both confirmation and therapy. The MRI scan or needle arthroscopy should be considered only if, after a history and physical examination, the diagnosis of the knee pain is unclear.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Recreational exercise programs, particularly running, remain popular for a variety of reasons. It has been estimated that as many as 20 to 30 million Americans exercise, and that this includes perhaps 5 to 15 million runners/joggers. Until recently, scant information was available regarding long-term effects, if any, of exercise on the musculoskeletal system. We, and others, therefore studied and reported our observations on the possible association of the development of lower extremity osteoarthritis (OA) in runners. This eight-year, follow-up study of our original 18 nonrunners and 17 runners obtained information on 16 runners (12 of whom were re-examined) and 13 nonrunners (10 of whom were re-examined) in 1992. One runner was deceased (cancer), 14/15 were exercising, 11/15 were running, and 3/15 were engaged in other recreational exercises. In 1992, as in 1984, pain, swelling, and range of motion of hips, knees, ankles, and feet were comparable for runners and nonrunners, and radiographic examinations (for osteophytes, cartilage thickness, and grade of OA) of hips, knees, ankles, and feet were without notable differences between groups. Thus, we did not find an increased prevalence of OA among our runners, now in their seventh decade. These observations support the suggestion that running need not be associated with predisposition to OA of the lower extremities.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Diabetic muscle infarction (DMI) is a rarely reported complication of diabetes mellitus and usually occurs in patients with poorly controlled diabetes and/or significant end-organ complications. It is not unusual for these patients to undergo extensive work-up and treatment for thrombophlebitis, myositis, or vasculitis when DMI is not initially considered. We report the use of magnetic resonance imaging (MRI) to diagnose DMI on three occasions in two patients. We believe MRI should be considered early in the evaluation of diabetic patients with unexplained localized complaints in an extremity. In compatible clinical situations, MRI may lead to a swift diagnosis of DMI while excluding conditions requiring specific therapy. In addition, when the presentation is atypical, MRI may help focus further evaluation, i.e., localize which muscle to biopsy.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Joint manifestations in patients with rheumatoid arthritis (RA) are usually caused by the rheumatoid disease or, less often, by secondary osteoarthritis or an infection. Effusions related to crystal deposits have been reported but are uncommon. We report on seven patients with quiescent RA who presented with incompletely explained, acute, mostly monoarticular, joint or bursal exacerbations that may have been caused by apatite or lipid crystals or by reactions to tissue and cell debris. In one of these patients, the joint symptoms were related to the development of pigmented villonodular synovitis. Whether or not our hypothesized mechanisms are correct, it is important to be aware that exacerbations in a single or a few sites out of proportion to the rest of the RA need not be because of activity of the RA or infection. This awareness can prevent inappropriate aggressive treatment of the rheumatoid disease or extensive antibiotic therapy. In our cases, careful analysis of the synovial fluid was helpful in ascertaining that active RA was less likely and in identifying some possible causes of the effusions.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Gonadal dysgenesis, or Turner's syndrome, is a common X chromosome genetic disorder with characteristic clinical and radiological features. Psoriasis is a common skin disorder that can be associated with arthritis. This report describes a 34-year-old woman with both diseases. Radiological features of Turner's syndrome are described with illustrations of how some changes might be confused with those of rheumatic disease. Although psoriatic arthritis has not been previously reported, other autoimmune diseases have been associated with Turner's syndrome.

ISSN:1076-1608    

出版商:OVID    

年代:1995

数据来源: OVID