It has been nearly 35 years since the original descriptions of what now is recognized as AIDS (the acquired immune deficiency syndrome), an advanced form of infection secondary to the human immunodeficiency virus (HIV). The epidemic of HIV infection remains the singular most dramatic epidemic of our generation and will likely remain with us for…
Clinical Vignette A 45-year-old woman with long-standing asthma and chronic sinusitis has new-onset peripheral neuropathy, arthralgias, fatigue, progressive dyspnea and a nonproductive cough. She has never smoked and has no environmental exposures. Her medications include an albuterol metered-dose inhaler (which she uses daily); an inhaled corticosteroid, montelukast; and ibuprofen (which she takes occasionally). She is…
A single injection daily of zoledronic acid may improve bone mineral density (BMD) in frail elderly women in long-term care facilities, a new randomized controlled trial shows. However, the clinical importance of the improvement, observed over a two-year period, remains unclear, Dr. Neil M. Resnick, of the University of Pittsburgh, told Reuters Health in a…
Patients with systemic lupus erythematosus (SLE) are characterized by high-titer, highly specific, isotype-switched antibodies against DNA and RNA. Patients have both CD4+ T helper (Th) cell- dependent as well as Th cell-independent autoantibody production. Two mouse models of lupus demonstrate T-cell–independent autoantibody production: the pristane model of lupus, as well as in the MRL/lpr mouse…
It seems to have begun in Norway, the international pressure to switch patients from well-known brand biologic agents, such as Remicade (infliximab), to biosimilar agents, due to a significant cost advantage.1 This biosimilar came with a 39% price markdown last year compared with the brand, and when Norway called for bids, the discount went to…
Although compelling data exist to support a link between periodontal disease (PD) and the development of rheumatoid arthritis (RA), cementing the association will require extensive investigative work.1 However, in reviewing the literature of the past 10 years, Elliot D. Rosenstein, MD, director, Institute for Rheumatic and Autoimmune Diseases at Overlook Medical Center, Summit, N.J., and…
Rheumatologists have growing concerns about how we manage rheumatoid arthritis (RA) and the disease outcomes we are achieving.1 Over the past two years, clinician rheumatologists have begun working together to address these problems through the Rheumatoid Arthritis Practice Performance (RAPP) Project, a nationwide clinical quality-improvement initiative. The RAPP Project has now grown to 168 participants…
Chronic insomnia is a common complaint for patients with rheumatic diseases and conditions. In fact, sleep disturbances are among the most common symptoms of both fibromyalgia and rheumatoid arthritis (RA), with more than 50% of chronic pain patients reporting sleep disturbances. Pain combined with insomnia can lead to a vicious cycle, says Ruth Gentry, PhD,…
View the question. Findings/Diagnosis The radiographs demonstrate diffuse sheetlike and tumefactive calcifications throughout the subcutaneous tissues, muscle and fascia of the pelvis and right hand. The underlying bones and joint spaces appear normal. The differential diagnosis for soft tissue calcification is extensive and includes metabolic disturbances (particularly of calcium and phosphate), trauma (e.g., injection sites,…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History These radiographic images are of a 25-year-old woman with a known…