Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
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This study aimed to estimate rates of cancer or opportunistic infection in patients with psoriatic arthritis (PsA) compared with patients without PsA. ⋯ The rates of solid and nonmelanoma skin cancers were similar in patients with PsA compared with patients without PsA, but the rates of hematologic cancer and opportunistic infections were higher in patients with PsA. In patients with PsA, rates of all outcomes were higher among those who received prescriptions for systemic PsA therapy.
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Joint range of motion (ROM) refers to the extent of movement of the joint, recorded using standard goniometers. Joint hypermobility (JHM) is a condition in which most of the synovial joints move beyond the "normal" limits. Joint hypermobility is recognized as a feature of heritable disorders of the connective tissue and can be identified mostly by the Beighton scale. Data on the possible relationship between JHM and joint ROM are lacking in the literature. The main objective of the present study was to evaluate the relationship between JHM and joint ROM in the different lower-extremity joints in young dancers. ⋯ (1) Joint ROM and JHM are associated one with the other; (2) the relationship between joint ROM and JHM is age dependent; and (3) JHM is common among young nonprofessional dancers compared with control subjects. The main clinical implications of the current study are to try and reduce the risk of injuries among JHM dancers by developing proprioceptive trainings to improve the correct alignment of the hyperextended joints, to increase their muscle strength for better stabilization of the hypermobile joints, and to provide them additional balancing and stabilizing exercises for their supporting muscles.
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Case Reports
Eculizumab Induces Sustained Remission in a Patient With Refractory Primary Catastrophic Antiphospholipid Syndrome.
Catastrophic antiphospholipid syndrome (CAPS) is fatal in approximately 44% of patients in whom the diagnosis is made, thus demonstrating the inadequacy of current medical therapy. In this report, we discuss a 47-year-old man with a known history of primary antiphospholipid syndrome, who presented with CAPS after undergoing cholecystectomy and a treatment-refractory early relapse after development of colitis. ⋯ He has remained in remission for over 16 months of follow-up while on eculizumab. In conclusion, this case represents successful use of eculizumab for the treatment of primary CAPS.
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Ultrasound (US) is a cost-effective, noninvasive, and accessible imaging modality that clinicians use at the point of care to assess disease activity and therapeutic efficacy in different rheumatic conditions. It can play a relevant role in invasive procedures performed by the rheumatologist, potentially ensuring a higher degree of accuracy. However, US-guided injections are still underused, and the conventional blind injection the most commonly adopted approach. In this article, we analyze the current evidence supporting the use of US-guided procedures, emphasizing comparative studies between conventional and US-guided procedures and their benefits in the daily rheumatological practice.
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Case Reports
Atlantoaxial subluxation and nasopharyngeal necrosis complicating suspected granulomatosis with polyangiitis.
Granulomatosis polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. The 2 established methods to confirm a suspicion of GPA are the antineutrophil cytoplasmic antibody (ANCA) test and biopsy. However, ANCA-negative cases have been known to occur, and it can be difficult to find biopsy evidence of granulomatous disease. ⋯ With a negative ANCA and no histological evidence, our diagnosis was founded on the exclusion of other diagnoses and the response to cyclophosphamide therapy. This case is unique because the patient's lesion resulted in atlantoaxial instability, which required a posterior spinal fusion at C1-C2. This is the first reported case of suspected GPA producing damage to the cervical spine and threatening the spinal cord.