Zeitschrift für Rheumatologie
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A 71-year-old woman developed progressive spreading of bitemporal scalp necrosis within 4 weeks accompanied by headaches, myalgia of the shoulder girdle and muscle weakness that had started a few months previously. No additional diseases were reported. ⋯ Recovery of the scalp necrosis emerged following second intention healing and split-skin transplantation of necrotic areas after successful wound conditioning. The case study demonstrates a rare and serious complication of temporal arteritis which is often accompanied by a poor prognosis.
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Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. ⋯ In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.
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Low back pain is a frequent health problem and causes substantial costs. Between 2007 and 2010 a panel of interdisciplinary experts in Germany developed evidence-based national guidelines for the management of nonspecific low back pain. ⋯ Education and patient information, maintenance of routine daily physical activities and pain therapy as needed are the cornerstones of acute nonspecific low back pain therapy. In order to prevent the development of chronic back pain in patients with acute nonspecific back pain, the early identification of parameters predictive of a high risk of chronicity (yellow flags) is of particular importance even in primary care.