Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
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Randomized Controlled Trial
Reduced pain of intraarticular hyaluronate injection with the reciprocating procedure device.
Greater than 50% of patients report significant pain with intraarticular injection of hyaluronate. The reciprocating procedure device (RPD), also known the reciprocating syringe, has 2 plungers that reciprocate with each other, permitting one-handed operation. The RPD increases physician control of the needle and is proposed to reduce patient pain during syringe procedures. ⋯ Patients have considerably more pain with intraarticular needle introduction and injectable hyaluronate therapy than physicians estimate. The RPD reduces patient pain, reduces procedure time, and improves needle introduction compared with the conventional syringe for hyaluronate injection therapy for the knee.
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Obesity is a risk factor for the development and progression of arthritis. Weight loss can provide symptomatic benefit for adults with arthritis. ⋯ Receiving advice was associated with a greater likelihood of trying to lose weight. Health care professionals should advise overweight and obese adults with arthritis about the potential benefits of weight loss and should provide the resources to assist these patients in losing weight.
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Clinical Trial
Sphygmomanometry-evoked allodynia--a simple bedside test indicative of fibromyalgia: a multicenter developmental study.
One of the 2 classification criteria for fibromyalgia (FM) is the presence of tender points on specific anatomic sites. It has been established that these tender points reflect a state of generalized allodynia (defined as pain resulting from a stimulus that does not normally provoke pain). Patients with FM often describe pain elicitation during blood pressure testing (sphygmomanometry). ⋯ In this developmental study of patients attending rheumatology clinics, the generation of pain during blood pressure testing was strongly associated with the diagnosis of FM. This robust linkage probably reflects a tautologic phenomenon. A sine qua nonelement for FM diagnosis is the presence of tender points in discrete anatomic sites. These tender points in turn reflect a state of generalized mechanical allodynia that can be locally elicited by the cuff pressure during blood pressure testing. Sphygmomanometry is a simple bedside test that may be useful in the recognition of patients with FM. Blood pressure testing is a universal procedure in all clinical environments. Based on our results, we suggest searching for FM features in any person who has sphygmomanometry-evoked allodynia.
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We report the case of a 28-year-old woman with systemic lupus erythematosus who, during a flare, suddenly developed febrile pancytopenia, hyperferritinemia, and abnormal liver function tests. Bone marrow aspiration confirmed hemophagocytic syndrome (HPS). ⋯ In febrile patients with lupus, pancytopenia together with very high ferritin levels should raise the suspicion of HPS and because this may be fatal, early bone marrow aspiration is mandatory for the diagnosis. The exclusion of concurrent infection as the cause of HPS is very important for the establishment of the right therapeutic strategy.
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Case Reports
Staphylococcal septic synovitis of the sternoclavicular joint with retrosternal extension.
Bacterial arthritis of the sternoclavicular joint is an uncommon disorder caused by a variety of microorganisms. Both Gram-positive and Gram-negative bacteria have been identified as etiologies of an acute suppurative arthritis, whereas a few other bacteria such as mycobacteria and treponemes have been incriminated in chronic disease of the sternoclavicular joint. We recently treated a patient with staphylococcal synovitis of the sternoclavicular joint, which is the 24th recorded in the literature. ⋯ He recovered after 6 weeks of nafcillin therapy without any residual infection. Six previous patients with extension into the substernal space and mediastinum have been described. Staphylococcal infection of the sternoclavicular joint, although usually confined to the joint, can be associated with sepsis and metastatic abscess formation as well as substernal extension even in immunocompetent individuals.