CHICAGO—A 49-year-old woman has had RA for eight years. She has a rheumatoid factor reading of 35, an aCCP reading of 160, erythrocyte sedimentation rate of 42, plus erosions. She has been on methotrexate. She tried etanercept for six months, but then it stopped working. She was on 40 mg of adalimumab weekly, but it…
NEW YORK (Reuters Health)—Inspiratory muscle training can help improve aerobic capacity and pulmonary function in patients with ankylosing spondylitis (AS), according to new findings presented at the European League Against Rheumatism Annual Congress. “Inspiratory muscle training as a stand-alone therapy improves inspiratory muscle function (strength and endurance), decreases symptoms of dyspnea and improves exercise capacity,”…
It has been nearly 35 years since the original descriptions of what now is recognized as AIDS (the acquired immune deficiency syndrome), an advanced form of infection secondary to the human immunodeficiency virus (HIV). The epidemic of HIV infection remains the singular most dramatic epidemic of our generation and will likely remain with us for…
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…
Lyme disease is often considered a cause of chronic fatigue, pain and other incapacitating symptoms. This assumption stems from analyses of patients who seek retreatment for Lyme disease. However, a new study suggests that Lyme disease is not life altering in the long term for most patients. Specifically, patients with culture-confirmed Lyme disease have similar…
Dr. Sheffield is an adult rheumatologist who received the following referral request from a family doctor: “Please see this 22-year-old male with a history of juvenile arthritis for ongoing care. I have only seen him once, and have no previous medical records.” Dr. Sheffield meets with Paul, who reports that he has had arthritis since…
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,…
Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in Southeast Asia and northern Australia.1 In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare, but well-recognized, manifestation of melioidosis. Case Report A 49-year-old woman with known diabetes was admitted elsewhere with uncontrolled diabetes and fever. She was found to…
As the literature on comorbidities linked to psoriatic arthritis (PsA) expands, it’s becoming more difficult for clinicians to keep up with what comorbidities should be assessed and how these comorbidities affect treatment selection. Given this, rheumatologists at the Perelman School of Medicine at University of Pennsylvania, Cleveland Clinic and Hospital for Special Surgery in New…
The Case A 68-year-old woman with a past medical history of Charcot-Marie-Tooth presents with thickening of the skin on her trunk and extremities, which she has had for the past seven months (see Figures 1 and 2). Her symptoms first began with swelling of her bilateral upper and lower extremities. She is now having difficulty…