Gout is the most common type of inflammatory arthritis in adults, and it typically occurs in men over the age of 50. When gout presents in younger patients or in women, this should warrant consideration of secondary causes. We describe an unusual genetic cause of tophaceous gout in a young, premenopausal woman. Case Report In… [Read More]
Dermatomyositis is an uncommon autoimmune condition involving skeletal muscle characterized by subacute onset of progressive weakness, intramuscular inflammatory infiltrates and the presence of myositis-specific autoantibodies.1 Immune-mediated myopathies may exert some pathogenic effects on the muscle tissue by targeting the microvasculature.1 Capillary inflammation, fragility and loss may contribute to heightened bleeding events in these patients. Here,… [Read More]
A 61-year-old Caucasian woman with a history of seropositive rheumatoid arthritis (RA) was hospitalized for a several-month history of progressively worsening left ankle pain and swelling. She had been unable to bear weight on her left leg for several days and did not notice improvement in symptoms with 20 mg of prednisone daily, which she… [Read More]
For most rheumatologists, the key elements of the physical exam—inspection, palpation, percussion and auscultation—have long been second nature, but a fifth modality has grown in importance with respect to making the correct diagnosis: ultrasound. From evaluating for Doppler signal and additional findings indicative of synovitis to identifying bony erosions, chondrocalcinosis, tophi and other articular and… [Read More]
A 59-year-old woman presented to our rheumatology clinic with a six-month history of a symmetric polyarthritis. She initially experienced pain in both knees. As time progressed, she began to notice pain in her ankles, hips, shoulders, hands and feet. She experienced joint stiffness lasting for more than 30 minutes every morning. She also described worsening… [Read More]
A 65-year-old woman was referred by an orthopedist to a rheumatologist for left knee pain. Previously, in 2014, she underwent left total knee arthroplasty (TKA) for severe osteoarthritis in a different institution. Following the procedure, she experienced severe chronic anterolateral knee pain at rest, exacerbated by walking. Because she was rendered wheelchair bound and required… [Read More]
Juvenile idiopathic arthritis (JIA) can affect all joints, including the temporomandibular joints (TMJs). For a long time, the TMJ was a “forgotten” joint in pediatric rheumatology, although Sir Frederick Still did comment on a small mandible in his first case series on juvenile arthritis in 1897. In recent years, more attention has been given to… [Read More]
ATLANTA—Two ways to investigate injuries to the upper extremities are by in-depth physical examinations and ultrasound. In a Clinical Practice session at the 2019 ACR/ARP Annual Meeting, Anatomy: Correlating Physical Exam and Ultrasound in Common Sports Injuries of the Upper Extremity, Carlin Senter, MD, FACP, associate professor of primary care sports medicine at the University… [Read More]
Immune checkpoint inhibitors (ICIs) targeting the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) or programmed cell death protein 1 (PD-1) axes have revolutionized therapy and improved survival in advanced cancers. However, these immune system modulators also lead to immune-related adverse events (IRAEs).1,2 In clinical trials, IRAEs mainly involved the gastrointestinal tract, skin, endocrine glands, liver and lung,… [Read More]
A 54-year-old African American man arrived at the emergency department with the acute onset of a tender mass on the left side of his neck. It had been getting progressively larger for the preceding two days. History & Examination His history included chronic right hip osteoarthritis with two surgeries performed five years prior. At his… [Read More]