Musculoskeletal Disorders

Note that some lesions occur within the outer ear, quite typical for the diagnosis of discoid lupus.

Elevated serum uric acid level is pathognomonic for gout. Untreated gout may lead to tophi, nephropathy, and uric acid nephrolithiasis.

The location (pretibial surface) of this ulcer, its visibly rolled undermined border, and severe pain are all typical of pyoderma gangrenosum, which is typically associated with inflammatory bowel disease, rheumatoid arthritis, and hematologic malignancies.

A definitive gout diagnosis is based on demonstration of monosodium urate crystals on aspiration of an affected joint or tophus.

Purine-rich foods have now been fingered as perpetrating acute gout attacks as well as chronic gout. A pair of French rheumatologists propose that we may be focusing on the wrong dietary component.

Psoriatic arthritis can be treated with the new TNF-alpha inhibitor biologic drugs, etanercept, adalimumab, or infliximab.

Red face. Roseacea? Lupus? Sunburn? No, it's seborrheic dermatitis. Here's how to tell.

Joint hypermobility; “cigarette-paper” skin; keloid scars; and pectus and scoliosis: to what common diagnosis do these disparate findings in 3 different patients point? Click here for more details.

A 58-year-old man presents for evaluation of a facial rash. He is convinced, from internet research, that he has systemic lupus erythematosus.

Unfortunately, the growing epidemics of hypertension and gout are often a package deal. Recent data demonstrate that 74% of people with gout are also hypertensive.

A 33-year-old man seeks attention for his abnormal toenails, having already failed full treatment courses of both terbinafine and itraconazole.

Gout, once considered a disease of kings, is now a common and equal opportunity disease that affects as many as 3 million people in the US. Gouty arthritis has now become a serious problem in organ transplant recipients; in diuretic users; and in patients with CKD, hypertension, metabolic syndrome, heart failure, plus more.

What physical and radiologic clues suggest that surgical replacement of the knee may be indicated? Here, Dr. Bill Walter, an orthopaedic surgeon who specializes in hip and knee replacement, walks you through the details.

A 59-year-old woman had aphasia and right-sided weakness after a routine total knee replacement. CT and MRI scans revealed a large left middle cerebral artery infarct. A CT angiogram showed no significant disease of the cerebrovascular arteries. Test results for the lupus anticoagulant were positive. A venous study of the legs showed no deep venous thrombosis. She was treated with warfarin and aspirin and discharged. After speech and physical therapy, she had mild residual aphasia.

A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.

Twenty years ago, the American College of Rheumatology (ACR) introduced the following clinical criteria for the diagnosis of fibromyalgia (FM) . . .

During the past year, a 48-year-old man has had joint pain as well as this worsening rash on his hands. He is a construction worker, and he attributes the symptoms to his occupational exposure.

Are persons with asthma at risk for other proinflammatory disorders? Yes, say researchers from the Mayo Clinic and Olmsted Medical Center in Rochester, Minn, who found that asthma is associated with the development of diabetes mellitus and coronary artery disease. However, there was no association between asthma and rheumatoid arthritis or inflammatory bowel disease.

A 48-year-old woman was hospitalized for acute-onset abdominal pain. She had a history of adult-onset Still disease and severe osteoarthritis. She had been taking 650 mg of aspirin every 4 hours to relieve her arthritis pain and fevers.

About 70% of patients with gout are treated exclusively in the primary care setting. Because the prevalence of gout is rising, particularly among older patients, you are increasingly likely to encounter this disease in your practice.

Here, a simple option to help relieve a painful symptom.

In the third podcast in this 3-part series, Dr Lieberman describes the options for treatment of an acute flare and for long-term urate-lowering therapy. The first step is lifestyle modification, and he discusses the challenges of motivating patients to institute and adhere to dietary changes.

The gold standard for diagnosis is joint aspiration and synovial fluid analysis; however, compensated polarized light microscopy is not available in most primary care practices. In part 2 of his 3-part podcast, Dr Lieberman discusses the diagnosis of gout in real-world practice.

Gout is a primary care disease. About 70% of patients with gout are treated exclusively in the primary care setting. And because the prevalence of gout is increasing, particularly in older patients, you are increasingly likely to encounter this disease in your practice.

For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).

How effective is antimalarial therapy in patients with lupus?

How effective is antibiotic therapy for long-standing reactive arthritis?

Along with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.

More than half of patients with rheumatoid arthritis who were treated with a biologic discontinued treatment, and another 12% switched to at least 1 other biologic within a 2-year treatment period, according to a study led by Chureen Carter, PharmD, of Centocor Ortho Biotech Services.

A study of Humana members enrolled in commercial and Medicare Advantage plans showed that patients with fibromyalgia have higher health care utilization and costs than those without the disease.1 This is because of higher use of office visits, testing, and procedures as well as pain-related medications.