Cases reported "Rheumatic Diseases"

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1/13. Greater trochanter enthesopathy: an example of "short course retinoid enthesopathy": a case report.

    Irreversible skeletal changes have been described in patients with dermatologic disorders treated with isotretinoin (Accutane), a synthetic vitamin a derivative. Although retinoids were developed to avoid toxicity associated with vitamin a, skeletal lesions and rheumatologic consequences are possible hazards of isotretinoin treatment. Enthesopathy is one of the potential musculoskeletal sequelae and is characterized by pathologic, sometimes painful changes at the insertion sites (entheses) of tendons, ligaments, and articular capsules into bone. We report a patient who was referred secondary to an extended history of bilateral hip region pain. She was subsequently found to have a greater trochanteric enthesopathy. A detailed patient history revealed past use of Accutane for cystic acne. The subsequent treatment course, including medications, corticosteroid injections, physical therapy, and activity modifications, is described and the pertinent literature is reviewed. We believe that patients who are prescribed isotretinoin should be warned about this potential pathologic condition at the initiation of treatment and that physicians who are treating patients with a history of Accutane use should be suspicious of underlying enthesopathies as the etiology behind pain of musculoskeletal origin.
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ranking = 1
keywords = bone
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2/13. Serglycin expression in CD2 and CD14 cells from patients with various rheumatic diseases.

    The objective of the study was to look at the in vivo expression of serglycin in cells taken from patients with an inflammatory disease. The mRNA expression of the small proteoglycan serglycin was investigated in macrophages/monocytes and T-cells derived from the synovial fluid and blood of six patients with various rheumatic diseases and from the blood of two control subjects. Our results demonstrate higher Levels of expression in CD14 cetts taken from patients with chronic inflammatory diseases than in control subjects. This suggests that serglycin may play a role during the inflammatory process.
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ranking = 739.41521657315
keywords = macrophage
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3/13. Serious infections associated with anticytokine therapies in the rheumatic diseases.

    The ability to target and neutralize macrophage-derived inflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-alpha), has emerged in recent years as one of the most important advances in the treatment of rheumatoid arthritis, Crohn's disease, and several other systemic inflammatory diseases. In rheumatoid arthritis, for example, these biological agents rapidly reduce signs and symptoms of joint inflammation and profoundly slow the progression of joint damage. However, data that have emerged following food and Drug Administration approval of these agents have alerted clinicians to an increased likelihood of opportunistic infections in patients treated with these agents, particularly tuberculosis. The effect of TNF inhibition on the frequency of infection with more common bacterial pathogens is less clear. Animal models of tuberculosis and other opportunistic infections have demonstrated the importance of TNF-alpha in controlling and containing intracellular pathogens. The spectrum of infections reported to date in the setting of anti-TNF-alpha treatment is reviewed here. In addition, relevant animal data illustrating potential mechanistic roles for TNF-alpha in host responses to infection are also reviewed.
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ranking = 739.41521657315
keywords = macrophage
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4/13. 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.
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ranking = 11
keywords = bone
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5/13. Coexistence of IgA nephropathy and undifferentiated spondyloarthropathy in a female patient.

    We report a female patient with IgA nephropathy associated with undifferentiated spondyloarthropathy. The patient manifested proteinuria and microhematuria and was diagnosed as having IgA nephropathy based on the histopathologic findings of the renal biopsy. Two years later, the bone X-ray demonstrated syndesmophytes and multiple calcifications in the ligament and tendon insertions, suggestive of long-term enthesitis, but the patient had occasionally noticed mild lumbago up to the time she visited our hospital, with spontaneous pain in the bilateral shoulders and lower back. IgA nephropathy can be concomitant with a mild form of seronegative spondyloarthropathy in women. Possible association of this disorder should be carefully checked in patients with IgA nephropathy irrespective of clinical symptoms suggesting the arthropathy, particularly in women.
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ranking = 1
keywords = bone
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6/13. Mild phosphate diabetes in adults.

    Phosphate diabetes has been considered as rare and to occur almost exclusively in children. Upon examination of adult patients with rheumatic or kidney diseases it has, however, been found that the combination of hypophosphataemia and hyperphosphaturia is not so rare. This paper deals with 24 adult patients of this type, whom we have found during 6 months. Their mean serum phosphorus concentration was 0.7 mmol/l (range 0.5--0.8). Mean phosphate clearance was 31 ml/min/1.73 m2 (range 16--51). The diagnoses were myalgia, dorsalgia (n = 7), papillitis calcificans (n = 5), prostatitis or prostate accretions (n = 4), dizziness (n = 2), kidney stones, tubular defect, interstitial nephritis, medullary sponge kidney (1 case each), two patients had transplanted kidneys. asthenia was a common additional diagnosis. The patients' complaints have been pain in the muscles, joints, bones (18 cases), tiredness (10 cases), dizziness (8 cases), shakyness, numbness, burning sensation (7 cases), tenderness in the muscles and bones ("the princess-on-the-pea syndrome") (7 cases). The most common findings upon examination were bone tenderness (13 cases), reduced manual power (8 cases), positive Romberg test (3 cases), slight muscle atrophy (2 cases), waddling gait (2 cases). The most common findings encountered in the laboratory, besides hypophosphataemia and hyperphosphaturia, were high pH in the urine, hyperaminoaciduria, and phosphate crystals in dried urine.
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ranking = 3
keywords = bone
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7/13. Sarcoid dactylitis.

    Dactylitis is a rare rheumatological complication of sarcoidosis. It may be accompanied by underlying bone changes, and management is often difficult. We report these 4 cases of dactylitis in which there have been significant bone changes and associated management problems. One case is further complicated by biopsy-proved sarcoid synovitis, uncommon in a British resident, and 2 cases show destructive bone changes, which have rarely been reported in sarcoidosis.
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ranking = 3
keywords = bone
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8/13. Malignant myositis ossificans: occult gastric carcinoma presenting as an acute rheumatic disorder.

    A patient developed ossifying skeletal muscle metastases from a primary gastric mucin-producing adenocarcinoma. The unusual nature of skeletal muscle metastases and the inflammatory-like syndrome associated with heterotopic ossification is reviewed. It is suggested that this case of 'neoplasm-induced post-traumatic myositis ossificans' may be caused by the interaction of local haemorrhage and thrombosis, mucin-producing tumour implants, and the presence of large quantities of gamma-carboxyglutamic acid, an amino acid associated with the calcification of bone matrix formation.
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ranking = 1
keywords = bone
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9/13. Rheumatic manifestations in patients with myelodysplastic and myeloproliferative diseases.

    OBJECTIVE. To evaluate the rheumatic complications in patients with myelodysplastic and myeloproliferative diseases. methods. A retrospective chart review of patients with a rheumatic disease and either a myelodysplastic or myeloproliferative disorder diagnosed on bone marrow examination. RESULTS. Nine patients were identified, 5 with myelodysplastic and 4 with myeloproliferative disorders. Polyarthritis was the most common rheumatic presentation, occurring in 6 patients with a positive rheumatoid factor in 4. Necrotizing vasculitis complicated the course in 3 patients. autoantibodies and hypergammaglobulinemia were present in the majority of patients. CONCLUSION. There is an association between hematologic disorders caused by proliferation of bone marrow derived pluripotent stem cells and rheumatic disorders.
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ranking = 2
keywords = bone
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10/13. methotrexate osteopathy in rheumatic disease.

    OBJECTIVE--To determine whether two adults with stress fractures receiving low weekly doses of methotrexate had methotrexate osteopathy. case reports--Two adult patients developed features consistent with methotrexate osteopathy while receiving low weekly doses of methotrexate. methods--Iliac crest biopsy samples were taken and bone histomorphometry carried out. RESULTS--Symptoms resolved when the methotrexate was discontinued. Bone histology showed changes consistent with osteoblast inhibition by methotrexate. CONCLUSIONS--When given in low doses for prolonged periods, methotrexate may have adverse effects on bone, particularly in post-menopausal women.
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ranking = 2
keywords = bone
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