1/19. Multiple epidermal inclusion cysts in a patient with rheumatoid arthritis: a case report.A construction worker with rheumatoid arthritis presented with multiple soft tissue masses on the volar surface of the palm and digits. A misdiagnosis of rheumatoid nodules was made secondary to the patient's history of rheumatoid arthritis. Subsequent excision confirmed multiple epidermal inclusion cysts, which was not entertained in the preoperative differential diagnosis. Follow-up evaluation 3 years later revealed no evidence of local recurrence. Based on our literature review, multiple epidermal inclusion cysts is a rare entity and has not been reported in a patient with rheumatoid arthritis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/19. Palmar shelf arthroplasty, the next generation: distraction/interposition for rheumatoid arthritis of the wrist.Rheumatoid arthritis affects approximately 1 percent of the adult population. Bilateral symmetric involvement of the wrist occurs in 85 percent of these patients, with recurrent flares and relentless progression. Anatomic changes consist of radiocarpal, intercarpal, and radioulnar subluxation and joint destruction. For advanced disease, both wrist arthrodesis and arthroplasty have been recommended. arthrodesis has been successful for pain relief at the expense of motion. Implant arthroplasty has been unreliable, with failure rates of 25 to 50 percent at 2 to 9 years. Palmar shelf arthroplasty was introduced in 1970 as a resectional fibrous arthroplasty. The results were good but the series was small. Subsequent reports of this procedure have been inconsistent. In 1990, I initiated and have since followed a series of patients treated with the palmar shelf arthroplasty. To the basic procedure, I added joint distraction by external fixator, collagen/bone wax interposition, scapholunate stabilization, and increased immobilization time. Fourteen consecutive patients were enrolled in this study. Each carried a diagnosis of rheumatoid or psoriatic arthritis of the wrist. There were 11 women and 3 men. Age ranged from 28 to 56 years. Follow-up ranged from 2 to 7 years (average 4.2). The patients were interviewed, examined, and x-rayed. A questionnaire using an analog scale as well as the Hospital for Special Surgery scoring system was completed to assess the clinical outcome of the wrist postoperatively compared with its preoperative status and with the contralateral wrist. No patient has requested or required a revision procedure. All patients experienced improvement with both pain and function; no wrist spontaneously fused. patient satisfaction was high. patients with ipsilateral arthroplasty and contralateral arthrodesis preferred the arthroplasty. Hospital for Special Surgery score increased from 53 to 91 out of 100 points (p < 0.001). Range of motion averaged 50 degrees flexion, 30 degrees extension. Palmar shelf arthroplasty remains a viable option for severe rheumatoid disease of the wrist. Ideally, the procedure is performed on the dominant wrist of a patient with bilateral wrist involvement in the setting of inflammatory arthritis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/19. Allergic contact dermatitis due to benzalkonium chloride in plaster of paris.Plaster of paris (POP) bandages are extensively used for splinting and casting injured or surgically repaired body parts. Allergic contact dermatitis caused by POP has been reported only rarely in the medical literature. An 81-year-old woman developed multiple large, tense, haemorrhagic bullae on the palm, and an acute vesicular eczematous eruption on the forearm, after the application of a POP splint. Subsequent patch testing revealed positive reactions to both the POP bandage used and to benzalkonium chloride, a component of the POP formulation. patch tests to two other POP products without benzalkonium chloride were negative. These results confirm those of previous studies which have implicated the quaternary ammonium compound benzalkonium chloride as the allergen responsible for POP-induced allergic contact dermatitis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
4/19. Palmar rheumatoid nodulosis associated with local pressure.Rheumatoid nodulosis is a term used to describe adult patients with rheumatoid arthritis with little or no clinical joint inflammation who have numerous subcutaneous nodules indistinguishable from those of patients with active rheumatoid arthritis. This paper reports the case of a woman with quiescent rheumatoid arthritis who developed palmar nodulosis three weeks after the strenuous activity of painting her apartment. This case illustrates the direct association between the appearance of nodulosis and physical pressure despite inactive disease.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/19. erythema multiforme-like drug eruption with oral involvement after intake of leflunomide.Leflunomide is an antirheumatic agent of the type of a 'disease-modifying antirheumatic drug'. In rare cases, severe skin reactions up to the extreme expression of toxic epidermal necrolysis have been observed. A female patient with rheumatoid arthritis had been treated with systemic steroids and methotrexate for 2 years. Five weeks prior to admission to our hospital methotrexate was replaced by leflunomide. Three weeks after initiation of leflunomide therapy a progressive generalized erythema with blistering formation occurred accompanied by increase of body temperature, chills and erosive lesions on the lips and oral mucosa. The palmar and plantar surfaces revealed edema, erythema and pulpitis with epidermolysis. On histologic examination necrotic keratinocytes and epidermal spongiosis were observed. After administration of high-dose prednisolone and topical treatment the patient recovered within 14 days. This is one of the few cases of severe drug reaction after intake of leflunomide. Therefore, the indication of this relatively new drug should be considered carefully.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/19. skin reaction to adalimumab.The tumor necrosis factor alpha (TNFalpha) inhibitors etanercept and infliximab have shown good clinical results in the treatment of rheumatoid arthritis and other autoimmune disorders. With these novel fusion proteins, immune-mediated side effects, among them various cutaneous reactions, have been encountered. We report herein the case of an erythema multiforme-like skin reaction to treatment with the monoclonal anti-TNFalpha antibody adalimumab in a patient with rheumatoid arthritis. The reaction occurred after the sixth injection and affected the palms and soles as well as the injection site. Discontinuation of the adalimumab therapy resulted in rapid improvement of the condition. Although this patient was receiving concomitant immunomodulatory therapy with methotrexate and leflunomide, these medications were not discontinued when the reaction developed, and no other potential pathogenetic mechanisms were identified. We believe the reaction is most likely attributable to adalimumab.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/19. Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting.BACKGROUND: Wounds with exposed bones caused by rheumatic diseases commonly result in amputation despite progress in our understanding of wound-healing mechanisms. OBJECTIVES: To determine whether an experimental therapy of bone marrow exposure, an occlusive dressing and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation in patients with rheumatic diseases. methods: Fifteen patients, including those with rheumatoid arthritis or systemic sclerosis, who had wounds with exposed bones were treated either with the standard procedure, consisting of local wound care, debridement with a scalpel, bed rest and parenteral antibiotics (n = 8), or with a newly developed experimental procedure (n = 7). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until bleeding was observed from the exposed bone. The lesions were immediately covered with an occlusive dressing, and were eventually treated with epidermal grafts obtained from suction blisters. RESULTS: A comparison with standard therapy demonstrated that the time needed for wound healing was similar, but that the newly developed combination therapy reduced the risk of amputation (P = 0.020). No skin ulcers or erosions were observed for at least 1 year in five of seven patients (72%) due to the adoption of stable palmoplantar-type characteristics in grafts derived from the trunk epidermis. CONCLUSIONS: Our study indicates that exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers at least partly through the preparation of a healthy well-granulated wound bed and that subsequent epidermal grafting achieves site-specific differentiation through epithelial-mesenchymal interactions.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/19. psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction.Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial in a variety of chronic inflammatory conditions, including psoriasis. We describe 5 patients in whom psoriasiform skin lesions developed 6-9 months after the initiation of anti-TNF therapy for longstanding, seropositive rheumatoid arthritis (etanercept or adalimumab), typical ankylosing spondylitis (infliximab), and Adamantiades-Behcet's disease (infliximab). In all 5 patients, the underlying disease had responded well to anti-TNF therapy. Four patients developed a striking pustular eruption on the palms and/or soles accompanied by plaque-type psoriasis at other skin sites, while 1 patient developed thick erythematous scaly plaques localized to the scalp. In 3 patients there was nail involvement with onycholysis, yellow discoloration, and subungual keratosis. Histologic findings from skin biopsies were consistent with psoriasis. None of these patients had a personal or family history of psoriasis. In all patients, skin lesions subsided either with topical treatment alone, or after discontinuation of the responsible anti-TNF agent. The interpretation of this paradoxical side effect of anti-TNF therapy remains unclear but may relate to altered immunity induced by the inhibition of TNF activity in predisposed individuals.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/19. Absence of ulnar drift in a rheumatoid hand with partial amputation of the digits.A patient suffered partial amputation of all the fingers of her left hand. One year later, she developed rheumatoid arthritis. She was subsequently spared the deformities of ulnar drift and palmar subluxation in the mutilated left hand. The possible causes of ulnar drift are discussed in relation to this patient.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/19. hand splint for rheumatoid arthritis patients during gait training after joint replacement in lower extremity.Rheumatoid arthritis patients have multiple joint problems, often making it difficult to use gait aids after a joint replacement in the leg. To address this problem, we designed a hand splint with a hook on the palmar side for use with parallel bars. patients put these splints on both hands and they can walk holding the bars with the hooks. Best suited for using this splint are rheumatoid arthritis patients who are unable to hold parallel bars without marked pain in the hands or fingers, contracture of the wrist joint, or dislocation of finger joints. Several patients have tried this splint, which worked safely and satisfactorily during exercise.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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