The Journal of the Association of Physicians of India
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Rheumatoid arthritis (RA) is a chronic progressive disease of the joints associated with significant morbidity, deformity, and impaired quality of life. A satisfactory remission of disease is seldom achieved, so therapy is aimed at controlling joint damage and pain with preservation of joint mobility. Until recently, NSAIDs, followed by DMARDs, was considered the treatment of choice. ⋯ In light of limitations of cost and lack of long-term safety and efficacy data, newer agents for the time being are used as second- or third-line agents in patients with active RA. The dilemma is that which patients with RA are most suitable for such therapy, since it is still not possible to accurately predict which patient with RA will develop severe disease. One alternative approach may be to limit the use in patients who can afford it, and who are at high risk of radiographic progression and disability.
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Upper extremity deep vein thrombosis (UEDVT) is a rare thrombotic disorder (1-4% or all DVT), but it has a potential for considerable morbidity in the form of pulmonary embolism, persistent upper extremity pain and swelling, superior vena cava syndrome and loss of vascular access. Newer non-invasive methods such as duplex ultrasound and magnetic resonance angiography facilitate early diagnosis. Early catheter directed thrombolysis followed by anticoagulation prevent long-term sequalae.