ROME, Italy—Even with classification criteria that have been updated and refined over time, rheumatoid arthritis is still a diagnosis that ultimately has to be made with clinical judgment, said Ronald van Vollenhoven, MD, PhD, professor of medicine and chief of clinical therapy research in inflammatory diseases at the Karolinska University in Sweden. His remarks came…
Antiphospholipid syndrome (APS) is an autoimmune condition characterized by hypercoagulability often manifested as recurrent thrombosis or pregnancy complications, with persistently circulating antiphospholipid (aPL) antibodies or lupus anticoagulant. Catastrophic APS (CAPS), also known as Asherson syndrome, occurs in less than 1% of cases of APS and involves occlusive microangiopathy in at least three organ systems.1 Case…
Telling a patient that he or she has been diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis, fibromyalgia or another debilitating, painful and/or chronic condition can be upsetting for a patient to hear and difficult for a rheumatologist to convey. Given this, it’s important to prepare for the appointment. “Take a few minutes beforehand to contemplate…
In late February 2011, a 68-year-old woman visited the rheumatology outpatient clinic. She had been congenitally healthy and had been a field athlete in her early days. Beginning in early January 2011, she became aware of pain in her neck and both shoulders, with pain spreading to her lower back and thighs. She also became…
CHICAGO—David Daikh, MD, PhD, professor of medicine at the University of California San Francisco and chief of the Rheumatology Division at the San Francisco VA Medical Center, said the overlap between malignant disease and rheumatic disease means rheumatologists should stay aware that more may be going on than just a rheumatic disorder. He made his…
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 A 56-year-old man with end-stage renal disease on peritoneal dialysis presents…
View the question. Findings/Diagnosis The AP radiograph of the left shoulder (see Figure 1) shows erosions of the proximal humeral and glenoid articular surfaces (black arrows) without joint-space narrowing. There is a well-defined marginal erosion with overhanging edge at the junction of the proximal humeral articular surface and rotator cuff insertion on the greater tuberosity (ellipse)….
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…
In late March 2012, I awoke with pain in my left hand. I had difficulty moving my metacarpophalangeal (MCP) joints. They did not move smoothly, but clunked. As I repeatedly attempted to open and close my hand, I realized that I had morning stiffness. As the pain and stiffness gradually improved over the next hour,…
Without reliable diagnostic tests or evidence-based treatment guidelines, patient symptoms critical to diagnosing disease