Modern rheumatology
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Modern rheumatology · Jan 2009
Case ReportsExtreme efficacy of intravenous immunoglobulin therapy for severe burning pain in a patient with small fiber neuropathy associated with primary Sjögren's syndrome.
Neurological involvement occurs in approximately 20% of patients with primary Sjögren's syndrome. Although neurological symptoms can affect the peripheral nervous system and the central nervous system, the most frequent symptom is polyneuropathy. ⋯ We show here a patient with Sjögren's syndrome who developed SFN and was treated with intravenous immunoglobulin (IVIG) therapy, which was immediately and extremely effective. Because of the efficacy of IVIG therapy, we propose that direct immune-mediated mechanisms may be involved in the pathogenesis of SFN complicated by Sjögren's syndrome.
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Modern rheumatology · Jan 2008
Case ReportsRemitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome following spontaneous rupture of a gouty tophus.
A 70-year-old man with a 30-year history of gout presented with a ruptured gouty tophus over the right lateral malleolus. After the debridement of the tophus, bilateral arthralgia and pitting edema were observed in his extremities. ⋯ However, prednisolone therapy was highly effective, and the patient's symptoms were rapidly ameliorated. Thus, we presume that rupture of a gouty tophus or its surgical treatment might contribute to the occurrence of RS3PE syndrome; however, in our case, the etiology of the syndrome remained unknown.
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Modern rheumatology · Jan 2007
Case ReportsSevere subcutaneous generalized edema in a patient with dermatomyositis.
Subcutaneous generalized edema associated with dermatomyositis (DM)/polymyositis (PM) is extremely rare. Herein we report a case of severe subcutaneous generalized edema complicating DM. A 78-year-old woman was hospitalized in our department because of massive edema in the four limbs. ⋯ The absence of other diseases that could cause the symptoms indicated that massive edema was correlated with the pathophysiology of DM. Although myopathy and edema responded well to oral prednisolone, dysphagia persisted. We conclude that subcutaneous generalized edema can occur during the course of DM/PM, and subcutaneous vasculopathy may be involved in the pathogenesis of DM/PM.
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Modern rheumatology · Jan 2007
Review Case ReportsPulmonary-renal syndrome in systemic sclerosis: a report of three cases and review of the literature.
We describe three cases of acute renal failure with diffuse alveolar hemorrhage, which is designated pulmonary-renal syndrome (PRS), in systemic sclerosis (SSc) and review the literature to better define this rare but severe complication of SSc. The clinical course of three SSc patients with acute renal failure and concomitant diffuse alveolar hemorrhage are reported, and the literature published between 1967 and 2005 is reviewed following a PubMed search. Including our cases, a total of 19 SSc patients with acute renal failure and concomitant diffuse alveolar hemorrhage have been reported. ⋯ Pulmonary-renal syndrome is a fatal complication of SSc and results from different pathogenic processes. Prompt differential diagnosis between the subsets is critical, because therapeutic strategy may differ in the use of high-dose corticosteroid and plasma exchange between the subsets of PRS. Clinical courses of the patients with PRS with thrombotic microangiopathy suggest that high-dose corticosteroid therapy is a trigger of diffuse alveolar hemorrhage in patients with diffuse SSc with signs of thrombotic microangiopathy.
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Modern rheumatology · Jan 2007
Comparative Study Clinical TrialUltrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear.
The objectives of this study were to identify ultrasonographic (US) abnormalities and to compare physical examination with US findings, especially of rotator cuff abnormalities in patients with shoulder pain. A total of 120 patients with shoulder pain were prospectively studied. The physical examination of shoulders was performed as follows: (1) the area of tenderness; (2) the range of passive and active motion for abduction, forward flexion, external rotation, and internal rotation; (3) Neer and Hawkins's tests for shoulder impingement; and (4) maneuvers for determining the location of the tendon lesions. ⋯ Physical examination had low sensitivity and specificity for the detection of tendon tear. US examination leads to an anatomical diagnosis of shoulder pain in many patients. Whether the US examination of the painful shoulder improves its treatment should be investigated.