When a young patient arrives at a clinic complaining of knee pain with clicking or popping, a meniscal tear is often the culprit. “In young [people], there’s a pretty classic presentation of meniscal tear, with clicking and other mechanical symptoms, because the tear rubs up against different tissues,” says Jeffrey Katz, MD, MSc, a rheumatologist…
The Presentation A pale, quiet woman—her mother—wheeled the girl into my clinic. It was a blistering Florida day, and the girl was shivering. She glanced up at me when I said hello and asked her name. “Hi,” she said, giving me a broad smile. Her smile was the only broad thing about her. Her elbows…
It’s one thing for a developing country to lack physicians due to a scarcity of training. It’s quite another for such a vacuum to exist because the physicians were executed. In Cambodia in the 1970s, genocide perpetrated by the Khmer Rouge spared few of the educated class. If they were spared, chances were they lost…
A number of autoinflammatory syndromes that result from genetic mutations have been described recently. The vast majority occur in children. However, three periodic fever syndromes are important for rheumatologists who treat adults to know about. The goal of this review is to provide a concise description of each condition, and to help the clinician understand…
Necrotizing autoimmune myopathy (NAM) is a relatively recently discovered subgroup of inflammatory myopathies. NAM is characterized by predominant muscle fiber necrosis and regeneration with little or no inflammation.1 One subgroup of NAM is 3-hydroxy-3-methylglutaryl-CoA reductase antibody (HMGCR Ab)-related immune-mediated necrotizing myopathy (IMNM), which occurs (rarely) after statin exposure, with a rough incidence of two per…
Mysterious Ways The juxtaposition of the old and the new was readily evident that busy Wednesday morning. My first patient, a 94-year-old gentleman, Hal, arrived with a precise request. His rheumatologist for the past 40 years had just retired, and he was searching for a doctor with expertise in the use of gold sodium aurothioglucose,…
Anemia is common in patients with systemic rheumatic disease, yet it may not get the attention it deserves. Anemia can result from chronic inflammation, treatment side effects or other disease factors, or it may signal an unrelated condition. Although diagnosis and treatment of anemia are sometimes challenging, clinicians must do their utmost to rigorously investigate…
Tubulointerstitial nephritis and uveitis (TINU) syndrome, also known as Dobrin syndrome, is a rare oculo-renal inflammatory disease. It was first described in 1975 by American physician Robert Dobrin, MD.1 It manifests as acute interstitial nephritis and bilateral uveitis. In addition, patients often experience nonspecific systemic findings, such as fever, weight loss, malaise, myalgia and arthralgia. TINU…
A 57-year-old Ghanaian woman was referred to our rheumatology practice with acute, left elbow swelling and pain. The referring oncologist suspected gout, because the patient had hyperuricemia. Six months before, the patient was diagnosed with stage IV human T-lymphotropic virus type 1 (HTLV-1)-associated adult T cell lymphoma (ATLL). Her initial oncologic manifestations included multiple thoracic,…
Limited data exist on the clinical presentation of Muckle–Wells syndrome (MWS) during pregnancy. The purpose of this case report is to highlight the diagnosis of MWS in a pregnant woman. Many rheumatic diseases affect women of childbearing age, and their management during pregnancy can be challenging. Case A 33-year-old, 18-weeks’ pregnant woman was hospitalized for…