A 59-year-old woman with rheumatoid arthritis (RA) presented to our pulmonary clinic for progressively worsening dyspnea of five years’ duration. She described progressively worsening dyspnea after a few minutes of walking on level ground. In addition, she noted worsening pain and morning stiffness of the wrists, knees and metacarpophalangeal (MCP) joints, with subcutaneous nodules. She…
A 14-year-old girl is referred to your office for fatigue and arthralgias. While you’re obtaining her past medical history, she divulges that she has had four episodes of bilateral parotitis, each lasting two weeks. An otolaryngologist evaluated her. She lacked sicca symptoms, had a normal complete blood count (CBC), normal inflammatory markers and a negative…
A 42-year-old man with a history of ulcerative colitis (UC), primary sclerosing cholangitis (PSC) and chronic sinusitis was referred to a rheumatologist to evaluate for a possible diagnosis of systemic vasculitis. This patient had developed new skin lesions, gingival hypertrophy and ulcerating tracheobronchitis, concerning for possible granulomatosis with polyangiitis (GPA). Since 1994, the patient had…
The idiopathic inflammatory myopathies (IIM) encompass eight categories: 1) dermatomyositis (DM) in adults, 2) juvenile dermatomyositis, 3) amyopathic DM, 4) cancer-associated DM, 5) polymyositis, 6) immune-mediated necrotizing myopathy, 7) inclusion body myositis, and 8) overlap myositis.1 These categories help classify the myopathies based on clinical and histologic features. The incidence of IIM is estimated at…
Hair dye products are commonly used by both men and women to enhance youth and beauty and to follow fashion trends. As reported in the medical literature, hair dyes and their ingredients are associated with allergic contact dermatitis. A possible association with joint inflammation has also been recognized. There is literature to support that para-phenylenediamine…
The patient medical history is far more prominent in clinical decisions for rheumatology than for many common chronic diseases in which a gold standard biomarker, such as blood pressure or serum glucose, is applicable to diagnosis and management of all individual patients.1 Components of a subjective patient history may be recorded as structured, quantitative, standard,…
A recent study indicates that depression in patients with ankylosing spondylitis is a result of both contextual and disease-related factors. Researchers found a patient’s mastery—the perception they have control over things in their lives—plays a key role in the development of depression in this patient population…
ATLANTA—The authors of the new draft ACR treatment guideline for the management of gout presented the draft guideline on Nov. 13 at the 2019 ACR/ARP Annual Meeting. Based on evidence from more than 130 published studies, there are 42 recommendations, of which 16 were strong, including 27 for urate-lowering therapy (ULT) management, 13 of which…
Case Presentation A 45-year-old man with crystal-proven gout, poorly controlled diabetes and chronic kidney disease was lost to follow-up for six years and presented back to the VA clinic in the midst of a gout flare. He stated he had continued taking 100 mg of allopurinol daily, but his serum urate level was 13.8 mg/dL….
ATLANTA—At the 2019 ACR/ARP Annual Meeting in November, the ACR and the ARP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education and patient care. This month, The Rheumatologist speaks with the winners of the ARP Merit Awards about their individual contributions to advancing rheumatology. You’ll also find a…