J Rheumatol
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Neither pneumothorax or mediastinal emphysema are well recognized pulmonary manifestations of systemic lupus erythematosus (SLE). We describe a 41-year-old woman with severe lupus pneumonitis complicated by recurrent pneumothoraces and mediastinal emphysema. Other features of SLE were minimal. ⋯ Both pneumothoraces and mediastinal emphysema occurred during a course of corticosteroid therapy. The course of her illness was unaffected by treatments that included high dose corticosteroids, immunosuppressives and plasmapheresis. Better medical treatment for these lupus complications should be sought in addition to surgery.
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Case Reports
Cyclophosphamide treatment of interstitial pulmonary fibrosis in polymyositis/dermatomyositis.
Interstitial pulmonary fibrosis is a serious complication of inflammatory muscle disease associated with significant morbidity and mortality. We describe 3 consecutive cases complicating dermatomyositis (1 case, anti-Jo-1 antibody negative) and polymyositis (2 cases, anti-Jo-1 antibody positive) in which cyclophosphamide was added to prednisone therapy with favorable outcomes.
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Pulmonary hypertension due to vasculitis is a rare complication of rheumatoid arthritis (RA). We describe 2 patients with RA and pulmonary hypertension who died with a clinical diagnosis of idiopathic pulmonary hypertension. ⋯ Pulmonary vasculitis must be included in the differential diagnosis of pulmonary hypertension associated with RA. Open lung biopsy should be considered in this clinical setting in an attempt to identify this potentially treatable cause of pulmonary hypertension.
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Comment Letter Case Reports
Abscess formation in sternoclavicular joint septic arthritis.
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Visual analogue scales (VAS) for overall and individual joint pain at rest and on movement were completed by 105 patients with polyarthritis as part of a study of the relationship between overall pain and pain in individual joints. Not all subjects recorded pain on a conventional VAS although all had at least 2 painful joints on movement. At best only 25% of the variance in overall pain was explained by pain in individual joints. Our findings suggest that conventional overall measures of pain in arthritis may neglect aspects of pain experience which relate to individual joints and to pain on movement.