Hand and digit pain are common presenting symptoms to primary care physicians, rheumatologists, physiatrists and neurologists. There are many causes, but quality and location of the pain can be important clues to the diagnosis. Glomus tumors, neurovascular hamartomas of the glomus body, are an uncommon cause of hand pain. The glomus unit itself is a…
Radiographic imaging showed circumferential soft tissue swelling of the ankle with a soft-tissue density seen in the tibiotalar and posterior subtalar joints, as well as a large, lobulated effusion. MRI of the left ankle shows cystic changes within the talus and first cuneiform bones, as well as a lobulated abnormal soft tissue density with low…
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.
Settling into room 501 at Maine Medical Center, Mrs. N was on her way to the bathroom when she felt it coming on. One moment she was okay; the next, her chest felt damp and cold, even as her face flushed and her temperature spiked. Her forehead glistened beads of warm sweat. She felt the…
SAN FRANCISCO—Evolving research into the pathogenesis of rheumatoid arthritis (RA) is increasingly showing that rather than a single causative dysfunctional pathway leading to disease, multiple pathways are involved, the study of which can shed additional light on what is occurring in a person’s body prior to developing symptoms of disease. Saying it another way, no…
A 47-year-old Caucasian woman presented to the rheumatology clinic with a one-year history of pain and swelling involving the wrists, hands, ankles and feet that progressively worsened. Her symptoms included generalized fatigue, morning stiffness in the hands and lower back lasting more than an hour, Raynaud’s phenomena (triphasic), photosensitivity, tightening of the skin of the…
SAN FRANCISCO—Research is revealing more clues about the environmental factors that likely play a role in triggering rheumatoid arthritis (RA) in patients who are susceptible—or that may even protect them from autoimmunity. Large-scale, lengthy population studies conducted at institutions worldwide provide in-depth data from which to identify potential triggers and protective factors for RA, from…
SAN FRANCISCO—The risk of stroke after herpes zoster (HZ) infection is elevated in the period immediately after infection in patients with autoimmune diseases, according to a study presented at the 2015 ACR/ARHP Annual Meeting.1 The findings were presented in a scientific session, called Discover 2015, that highlighted new research. In another study from the session,…
A recent study used MRI to show that tofacitinib reduces inflammation and inhibition of the progression of structural damage in adults with early RA…
Enthesitis is a central feature of spondyloarthritis (SpA). This review article summarizes the substantial progress that has been made in addressing the pathophysiology, molecular mechanisms, genetic associations, clinical features, diagnostic modalities and treatment of enthesitis. Further examination into the role of the inflammatory mediators, including IL-17, IL-22, and IL-23 as well as potentially others, in driving enthesitis and bone formation will be important to direct our attention toward future therapeutic targeted pathways in patients with SpA…