J Rheumatol
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We studied the influence of disturbed sleep physiology on morning symptoms in 15 patients with classical rheumatoid arthritis (RA) who were experiencing an acute flare. All were found to have an alpha frequency (7 to 11.5 Hz) EEG sleep anomaly, an overnight increase in tenderness in their peripheral joints and in "fibrositic" regions, as well as increased weakness and diminished energy. One patient experienced remission in symptoms and improvement in sleep physiology. The morning symptoms may relate to a nonrestorative sleep disorder associated with the alpha EEG sleep anomaly.
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Manubriosternal joint involvement in rheumatoid arthritis is not rare and may be evidenced by erosion, reactive sclerosis and ankylosis. Frequent reports of such involvements appear in the radiological literature but only 3 cases where this had been associated with clinically evident subluxation of the joint have been reported previously. ⋯ Chronic or recurrent chest infections have been incriminated in the production of this deformity. However, the evidence seen in our series suggests rather, that this deformity is closely associated with severe cervicodorsal spinal erosion and deformity and that its presence should alert clinicians to potential problems of cervical cord compression.
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Antimalarial therapy in psoriatic arthritis was felt to be contraindicated traditionally due to frequent exacerbation of psoriatic skin disease. Interest in hydroxychloroquine treatment of psoriatic arthritis has been revived because of recent series found no exacerbation of psoriatic skin lesions in 50 psoriatic arthropathy patients treated with hydroxychloroquine. A psoriatic arthropathy patient whose skin lesions were markedly exacerbated by hydroxychloroquine is reported. The literature on antimalarial effects on psoriatic skin lesions is briefly discussed.
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We reviewed 11 patients with rheumatoid subcutaneous bursitis involving the olecranon bursa in 10 and an adventitious bursa in 1. All patients had a positive latex fixation test for rheumatoid factors. ⋯ Cholesterol crystals were present in 5 of 6 nodular bursae, and in none of the 5 non-nodular bursae (p less than 0.05). Two patients had acicular cholesterol crystals that had previously led to an erroneous diagnosis of gout.