A 58-year-old African American woman with a past medical history of hypertension (HTN), hyperlipidemia, severe gastroesophageal reflux disease (GERD) and limited cutaneous systemic sclerosis (lcSSc) presented to the emergency department with shortness of breath (SOB) and progressive bilateral lower extremity swelling for three weeks. She denied any chest pain, but endorsed generalized fatigue and dyspnea…
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New Rheumatology Disease Research & Advice
SAN DIEGO—Top researchers gathered for a review course at the start of the 2017 ACR/ARHP Annual Meeting in November to describe new research, their own treatment strategies and new ways of thinking about an array of rheumatic diseases. Here are the highlights: Raynaud’s & Other Digit Problems When a patient walks into your clinic with…
Case Review: Lupus Patient with Acute Disseminating Encephalomyelitis
Systemic lupus erythematosus (SLE) is an autoimmune-mediated rheumatic disease characterized by multisystem involvement that can cause significant morbidity and mortality. Acute disseminated encephalomyelitis (ADEM) is a rare, fulminant, autoimmune-mediated, demyelinating disease involving the white matter of the central nervous system (CNS), and is considered a manifestation of neuropsychiatric lupus. Few reported cases involve SLE and…
Rheumatology Case Report: Deep Vein Thrombosis Detected by Point-of-Care Ultrasound
Case A 46-year-old Caucasian female presented to the outpatient rheumatology clinic where she had been followed for several years. Her chief complaint was pain in her right knee, posterior right thigh and right hip that had begun gradually over the previous three weeks. Her past medical history was significant for rheumatoid arthritis (RA), obesity and…
Diagnosed by Artificial Intelligence?
“To err is human.” —Alexander Pope (1688–1744) The Wisest Minds in Medicine At some point during our careers, we have the privilege of meeting a physician so talented that everyone else pales in comparison. These are those gifted clinicians whose astonishing mastery of medicine makes everyone in their midst feel like inept, babbling fools. They…
Medical Paradoxes in Clinic, Lab Should Encourage Physicians to Reappraise Ideas about Health and Disease
Wash your hands. This most basic tenet of proper hygiene has been drummed into our heads for years. It’s an obvious infection prevention activity, yet for years, compliance among physicians and other caregivers has been lackluster. To rectify this matter, regulatory agencies began auditing hospital staff adherence to this axiom of infection prevention. Not only…
How to Manage Patients with Giant Cell Arteritis and Polymyalgia Rheumatica
WASHINGTON, D.C.—From diagnosis questions to infection risk to treatment decisions, handling giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) comes with a range of challenges for clinicians. Speaking in the ACR Review Course at the 2016 ACR/ARHP Annual Meeting, an expert—Rebecca Manno, MD, MHS, assistant professor of medicine in rheumatology at Johns Hopkins, as well…
Heparin Fails to Prevent Leg, Lung Clots After Arthroscopy, Casting
NEW YORK (Reuters Health)—Low-molecular-weight heparin failed to prevent symptomatic venous thromboemboli in people receiving knee arthroscopy or a lower leg cast, according to a pair of studies conducted in the Netherlands. The treatment is controversial because there is little clear evidence that heparin wards off clots in such instances. The research team, led by Dr. Raymond…
Rheumatology Case Report: Concomitant Lupus with Features of Scleroderma, Castleman Disease
We report a case of a 27-year-old woman who was initially diagnosed with systemic lupus erythematosus (SLE), had features of scleroderma and was subsequently found to have lymph node biopsy consistent with multicentric Castleman disease (MCD). She also had serologic evidence of acute Epstein-Barr virus (EBV) infection (vs. reactivation of EBV). The occurrence of MCD…
Trying to Parse True Meaning of Pain Can Be Challenging for Rheumatologists
Discussing aching joints, sore muscles and tender limbs is all in our day’s work. We are rheumatologists; we deal in misery. But trying to parse the true meaning of these terms is among the most vexing of clinical challenges.