Clinical rheumatology
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Clinical rheumatology · May 2013
Review Case ReportsAntisynthetase antibody syndrome: case report and review of the literature.
Antisynthetase antibody syndrome is a rare autoimmune disease that may present with variable systemic manifestations, mainly polymyositis, interstitial lung disease, skin lesions, and Raynaud's phenomenon. This diagnosis should always come to mind in patients that present with signs of myositis, dermatomyositis, or polymyositis associated with interstitial lung disease. ⋯ A diagnosis of antisynthetase antibody syndrome was made and the patient showed good response to treatment with corticoids and methotrexate. Finally, we present a short review of the literature.
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Clinical rheumatology · May 2013
ReviewFoot tendinopathies in rheumatic diseases: etiopathogenesis, clinical manifestations and therapeutic options.
Damage to the mutual and delicate articular relationships of the foot may lead to functional failure. A painful foot can be the heralding sign of inflammatory, metabolic or degenerative rheumatic disease that may cause severe disability if left untreated. Healthy tendons are brilliant white in colour, are fibroelastic in texture and can withstand huge mechanical loads. ⋯ Pain is the most common presenting symptom in the inflammatory rheumatic diseases of the ankle and the foot and usually precedes ultrasound or radiographic changes; pain results from inflammatory changes of the synovia and soft tissue structures including bursae, tendons, fascias and peripheral nerves. The management of tendinopathies in inflammatory and non-inflammatory rheumatic patients includes "articular economy," pharmacological treatment, foot orthotics, cryotherapy, instrumental physiotherapy, rehabilitation and physical. This review highlights the differences between tendinopathies occurring in non-inflammatory rheumatic disorders compared to those appearing in the course of inflammatory rheumatic disorders and defines a conservative management framework that non-rheumatologists (orthopaedic surgeons) and rheumatologists could adhere for the management of foot tendinopathies.
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Clinical rheumatology · May 2013
Review Case ReportsCrowned dens syndrome: a rare cause of acute neck pain.
Crowned dens syndrome (CDS) is a rare but underrecognized cause of severe neck pain in older adults. It is characterized by acute onset pain and stiffness of the cervical spine. Accompanying fever and elevated inflammatory markers often lead to misdiagnosis. ⋯ Periodontoid calcification is seen on cervical computed tomography (CT) scan but is not typically visible on plain radiographs, making CT scanning invaluable in diagnosis. We describe a case of CDS in a 59-year-old woman, who presented with severe neck pain, elevated inflammatory markers, and progressive evolution in the appearance of her CT scans. The pathophysiology, clinical and radiographic findings, and dramatic response to corticosteroid therapy are reviewed.
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Compared to elite athletes, elite performers, especially musicians and dancers, invariably lack expert medical backup even though their needs are just as great as the sportspeople. In some countries, this is now being realised and addressed. It is hoped that a new MSc in Performing Arts Medicine, recently introduced in the UK, will go some way towards correcting this, and its syllabus has provided the catalyst for this themed issue.
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This overview is based on the over 30 years of performing arts medicine experience of the author, an orthopaedic surgeon who devoted his professional life entirely to the prevention, diagnostics, and treatment of dancers' and musicians' injuries. After a short introduction on the specific demands of professional dance and music making, it describes some general principles of orthopaedic dance medicine and causes of injuries in dancers. The relation of dance injuries with compensatory mechanisms for insufficient external rotation in the hips is explained, as well as hypermobility and the importance of 'core-stability'. ⋯ In overuse injuries, relative rest supported by 'mental practice' is effective. The specific orthopaedic musicians' medicine section deals with some common injuries of the neck and upper extremities, like (posture related) cervicobrachialgia, and thoracic outlet syndrome. An important group of causes of musicians' injuries form the entrapment neuropathies (especially ulnaropathy), osteoarthritis of the hands and hypermobility.