Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily characterized by persistent synovitis, leading to joint destruction, deformities, and systemic involvement. Synovial cysts are rare extra-articular manifestations of RA, usually arising from inflamed synovial tissues. While most synovial cysts occur in typical locations like the knees and wrists, we present a unique case of RA manifesting as multiple large synovial cysts in uncommon locations. A 67-year-old female patient with a history of well-controlled RA presented with complaints of progressive swelling and discomfort in her upper arms and thighs, unresponsive to conventional RA management. Physical examination revealed large, fluctuant masses, which were non-tender but limited the range of motion in the affected limbs. Diagnostic imaging, including ultrasound and magnetic resonance imaging (MRI), confirmed the presence of multiple synovial cysts, each measuring over 5 cm in diameter, situated in atypical areas around the elbow, hip, and shoulder joints. Given the patient's history, these findings were initially unexpected, prompting further investigation to exclude differential diagnoses, such as lipomas, abscesses, and malignancies. Aspiration of the cysts revealed a synovial fluid consistent with RA pathology, confirming the diagnosis. This case highlights an unusual and rare presentation of RA. While synovial cysts are a known manifestation, their appearance in less typical locations emphasizes the importance of a comprehensive diagnostic approach. This case underscores the need for clinicians to consider atypical presentations when evaluating RA patients, particularly those with unusual swelling or masses that do not respond to standard treatments. Proper imaging and aspiration can facilitate accurate diagnosis, ensuring timely and appropriate management. Further research is needed to understand the mechanisms driving such atypical cyst formations and to optimize treatment strategies for similar cases.

Relapsing polychondritis (RP) is a rare autoimmune disease that affects cartilaginous tissues and proteoglycan-rich organs. Around 30% of cases have coexisting autoimmune inflammatory diseases. Palmoplantar pustulosis (PPP) is extremely uncommon in RP. We report a case of resistant RP, complicated with PPP. A 36-year-old female presented with fever, nose and earlobe chondritis, and symmetric arthritis. Infectious and connective tissue diseases were ruled out. The RP diagnosis was made, and she was treated with corticosteroids and methotrexate. Three years later, she experienced acute dyspnea due to tracheobronchial chondritis, and she was placed on induction treatment with 6 cyclophosphamide pulses, accompanied by maintenance therapy with mycophenolate mofetil (MMF). After 4 years, she presented with scleritis and panuveitis. The MMF was discontinued, and she was treated with tocilizumab (TCZ) 162 mg/week. Four months after the initiation of TCZ, the patient experienced erythematous papules and pustules on both palms and soles, suggestive of PPP. She received oral corticosteroids in addition to TCZ, with complete regression of symptoms.

Polymyositis with concomitant scleroderma is a rare, progressive condition with profound consequences if not addressed promptly. Severity and symptom presentation varies between patients, and much is unknown about how best to treat overlapping connective tissue diseases. This case discusses the rare presentation, medical evaluation, and successful treatment of a 46-year-old woman with excessive muscle atrophy, weakness, and tissue fibrosis, who was diagnosed with overlapping connective tissue disorder after extensive work up that included a muscle biopsy, skin punch biopsy, and autoantibody lab work. This patient recovered well with the use of mycophenolate mofetil demonstrating promising results for similar patients and offering insight into potential methods of evaluation and medical management. Studying cases like this one give providers more knowledge about overlapping connective tissue disease and how to best diagnose and manage them.

Background: Generalized Joint Hypermobility (GJH) is defined as a range of joint motion exceeding normal limits in multiple joints and is relatively common in children. Although often asymptomatic, GJH has been increasingly linked to psychological comorbidities, especially anxiety. While adult studies have highlighted these connections, pediatric-specific research remains limited.

Objectives: This study aimed to evaluate the association between GJH and the prevalence of anxiety disorders in school-aged children using validated clinical and psychological measures.

Methods: A case-control study was conducted among 3920 children aged 8 to 15 years in Isfahan, Iran (2021-2023). The Beighton scoring was used to identify children with GJH (score ⩾ 6), yielding 634 cases. An age- and sex-matched control group of 650 children without GJH was selected. Anxiety was assessed using the validated Spence Children Anxiety Scale (SCAS), covering separation anxiety, social phobia, panic/agoraphobia, specific phobia, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and generalized anxiety disorder (GAD). Logistic regression assessed associations between GJH and anxiety outcomes.

Results: Children with GJH had significantly higher odds of separation anxiety (odds ratio [OR] = 4.49; confidence interval [CI]: 2.39-8.43), social phobia (OR = 4.32; CI = 2.40-7.75), panic disorder/agoraphobia (OR = 3.46; CI = 1.30-9.21), and GAD (OR = 2.87; CI = 1.10-7.47). ADHD, specific phobia, and OCD showed no significant differences between groups (P > .05).

Conclusion: This study suggests a strong association between GJH and specific anxiety disorders in children. Given the ease of identifying GJH, psychological screening in this population may be a valuable preventive strategy.

Background: Anterior shoulder instability is prevalent among young, active individuals, especially athletes. The optimal surgical intervention remains debated between Arthroscopic Bankart repair and Open Latarjet procedure.

Objectives: The Open Latarjet procedure results in lower recurrence rates and better functional outcomes compared with the Arthroscopic Bankart repair in patients with recurrent anterior shoulder instability, particularly those with significant glenoid bone loss and multiple preoperative dislocations.

Design: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Methods: Databases searched included PubMed, Google Scholar, and the Cochrane Library. Inclusion criteria encompassed studies comparing Arthroscopic Bankart repair with Open Latarjet procedure, reporting on recurrence rates, functional outcomes, and complications. Data extraction and risk of bias assessment were performed independently by 3 reviewers.

Results: 15 studies with 1636 patients were included. The Open Latarjet group exhibited significantly lower recurrence rates (4.2%) compared with the Arthroscopic Bankart group (11.8%). Functional scores (Rowe, WOSI, and ASES) were higher in the Latarjet group. Complication rates were similar, but the Bankart group had higher rates of redislocation and revision surgeries. Subgroup analyses revealed that patients with significant glenoid bone loss and multiple preoperative dislocations benefited more from the Latarjet procedure.

Conclusion: The Open Latarjet procedure offers superior outcomes for patients with recurrent anterior shoulder instability, especially those with significant bone loss and multiple dislocations. Surgical decision-making should be individualized, considering patient-specific factors.

Scleroderma is an autoimmune disease traditionally affecting middle-aged females. Its occurrence in elderly males is uncommon and often associated with severe manifestations such as interstitial lung disease, cardiac involvement, and renal crises. This study aims to highlight the clinical features, diagnostic challenges, and outcomes of new-onset scleroderma in elderly males. In this case series-based review of new-onset scleroderma among elderly males, we describe the clinical manifestations and outcomes of 4 patients under our care, and review the epidemiology, clinical presentations, and prognosis of this specific group. The case series included 4 men aged 68 to 87 years. All patients presented with various atypical presentations and organ involvement. Laboratory tests revealed high titers of anti-nuclear antibodies in all patients. Either anti-RNA polymerase III or anti-SCL70 antibodies were positive in 3 patients, with the fourth positive with anti-Ro52 antibodies. Imaging and biopsies confirmed organ involvement in 3, with the fourth lost to follow-up. The time to diagnosis ranged from months to years. Two patients died from sudden cardiac death, reflecting a poor prognosis in this subpopulation. Classically, scleroderma is considered a disease affecting middle-aged women. In this case-based review, we highlight a rare and presumably underdiagnosed cohort of scleroderma patients. Multisystemic conditions usually attributed to old age may reflect clinical manifestations of scleroderma. This case series-based highlights what may be the tip of an iceberg regarding elderly males with scleroderma; the review underscores the necessity for heightened clinical vigilance and tailored management strategies for elderly males with suspected scleroderma.

We report a case of calcium pyrophosphate dihydrate crystal deposition (CPPD) disease presenting as acute arthritis of the left wrist. A 66-year-old woman with no significant family history was admitted with a 7-day history of swelling, persistent pain, and limitation of motion in her left wrist. She reported no recent trauma, surgery, or severe illness, and had no known comorbidities other than mild hypertension treated with low-dose thiazide diuretics. She was not on chronic glucocorticoids or other immunosuppressive drugs. Plain radiographs of her wrist, obtained during the initial days of arthritis, showed chondrocalcinosis in her left wrist. A diagnosis of pseudogout was made. After 30 days, a repeat X-ray demonstrated the disappearance of the chondrocalcinosis border in the left wrist; however, follow-up radiography revealed chondrocalcinosis in asymptomatic joint areas, such as the pubic symphysis and knees. With this case report, we highlight the important role of radiographs in the early diagnosis of CPPD disease. Radiographic detection of crystal deposition can occasionally be transient, and its disappearance may lead to diagnostic confusion. Identifying such changes early can help avoid misdiagnosis and inappropriate management.

Introduction: Internet and social media are widely available tools for several purposes, including search of health information. This study aims to describe the usage patterns, the trust generated, and the influence of such information on decision-making by patients diagnosed with systemic lupus erythematosus and rheumatoid arthritis.

Methods: A cross-sectional study was conducted, administering a survey to patients with rheumatic diseases at multiple centers in Latin America, virtually or on paper. Three domains were evaluated: access/patterns of use, perception, and confidence generated by the health information found. Subgroup analysis based on key characteristics was performed.

Results: In total, 244 surveys were analyzed, identifying 96.7 % respondents as regular internet users, mainly through smartphones (79.5%). About 86.5% used social media regularly, around 15.2 % used it for finding health information. YouTube was the most frequently used (67.6%). 64.3 % perceive searching information as straightforward and 65.6% as not frustrating; academic institutions were the most and "influencers" were the least trusted. Most expressed high confidence in the ability to use information and perceive it as beneficial. Different patterns of use, perception, and confidence were identified according to disease, age, educational level, country of origin and survey method of collection.

Conclusions: This study illustrates the high prevalence of Internet and social media access in Latin America, primarily through mobile devices, which represents an opportunity to develop educational strategies for the population that have access to these tools. These strategies can be tailored according to specific use patterns and differential characteristics of distinct subgroups of patients.

Objective: The objective was to determine whether oral non-steroidal anti-inflammatory drugs (NSAIDs) affect the efficacy of dextrose prolotherapy (DPT) in patients with knee osteoarthritis, and if the combination of these treatments is safe and well-tolerated.

Methods: Five patients with symptomatic knee osteoarthritis were included in this prospective case series. Participants underwent a series of three DPT injections at four-week intervals in their symptomatic knee(s) and were immediately prescribed a seven-day course of Ibuprofen after each injection. The main outcome measures included changes in the Knee Injury in Osteoarthritis (KOOS) questionnaire subscales (pain, symptoms, quality of life, sports and recreation function, and activities of daily living) and the Numeric Pain Rating Scale (NPRS).

Results: There was a statistically significant improvement in the KOOS subscales of pain (P < 0.0001), Symptoms (P = 0.01), and Quality of Life (P = 0.001) after 12 weeks. The KOOS subscales for Sports and Recreation function (P = 0.06) and Activities of Daily Living (P = 0.10) showed numerical improvement over time that fell short of statistical significance. There was a statistically significant improvement in the NPRS scores compared with baseline NPRS scores after 12 weeks (P < 0.0001). In addition, NPRS scores were significantly lower at one-week follow-up after each DPT injection (P = 0.01); (P = 0.025); (P < 0.0001). There were no reported adverse events.

Conclusions: Concomitant use of NSAIDS with dextrose prolotherapy injections is safe and well-tolerated with no adverse events and results in improvements in pain, symptoms, and overall quality of life associated with chronic knee OA. Controlled trials of this treatment are warranted.