Check for updatesThis case series reports two cases of paraneoplastic rheumatic syndrome of systemic sclerosis presentation and underscores the importance of early recognition and treatment of the underlying malignancy for the successful management of these conditions.To identify and manage paraneoplastic syndromes, it is critical that rheumatologists, oncologists, and primary care practitioners collaborate effectively. Case Presentation Patient No.1The patient was a 63-year-old woman of Asian descent who was a non-smoker and non-alcoholic with underlying diabetes mellitus, hypertension, dyslipidemia, and hyperthyroidism.She worked as a chef and was on chronic prescriptions of the following medications: metformin 1g twice daily, biphasic insulin subcutaneous injection 20 units in the morning, then 14 units in the evening, perindopril 8 mg once daily, simvastatin 40 mg once daily and carbimazole 5 mg once daily.Her family history was notable for lymphoma and hepatocellular carcinoma among her first-degree relatives.She presented with a 3-month history of bilateral symmetrical polyarthritis involving small
Erythrodermic psoriasis is a rare and life-threatening variant of psoriasis. Multiple triggering factors have been described, including emotional stress, alcohol consumption, medications, infections, less common phototherapy, photo chemotherapy, application of topical irritants, Sars-Cov 2 vaccine, HIV and hypocalcemia.
At baseline, within-group comparisons in all groups found statistically significant differences (SSD; p < 0.001) only between the endmost RPs (‘A’ vs. ‘H’), for all CPs, LPs and BMD values in the absence of SSD in mJSW. During the observation, for all groups, SSDs (p < 0.05) were detected between all RPs (‘H’ vs. ‘I’ vs. ‘A’), for all assessed indicators, but at different time points according to applied treatment. Furthermore, between groups comparisons found SSD at М12 in JSN for both stages K/L-II (p = 0.004) /K/L-III (p = 0.003), in all RPs of MMW-HA vs. NS. These findings were accompanied by similar changes in mJSW (p < 0.001) found at M36 and in times to conversions to total hip replacement (tTHR) - MMW-HA vs. NS (p < 0.001).
Paediatric systemic lupus erythematosus (pSLE) is an autoimmune disease with multiple manifestations resulting in inflammation & damage to several organs. We report a case of young boy presented to us with features of meningoencephalitis with multisystem involvement (phenotype-constitutional symptoms, neuropsychiatric involvement, mucocutaneous involvement, serositis, renal affection, hematological manifestations). Detailed clinical examination with laboratory & imaging studies clinched the diagnosis of paediatric SLE. Patient showed remarkable response to steroid & immunosuppressive therapy.
Sjögren's Syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function. SS occurs in a primary form not associated with other disease and in a secondary form that complicates other rheumatic conditions. The most common disease associated with secondary SS is rheumatoid arthritis. In primary or secondary SS, decreased exocrine gland function leads to the sicca complex, a condition of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) [1].
Calcium pyrophosphate deposition (CPPD) disease is caused by calcium pyrophosphate (CPP) crystal deposition in the fibrocartilage. It usually presents as monoarticular deposition but can deposit in multiple joints presenting as chronic polyarticular disease mimicking rheumatoid arthritis (RA), known as pseudo-rheumatoid arthritis, making it very challenging for the correct diagnosis.
Herein is a case of systemic lupus erythematosus (SLE) who developed myasthenia gravis (MG) and presented with proximal muscle weakness and easy fatiguability. Although inflammatory polymyositis is a common cause of muscle weakness in SLE, MG is not frequently reported in SLE. The diagnosis was established by positive Antibodies to acetylcholine receptors, Electroneuromyography (ENMG).
Introduction:The aim of this study is to describe the clinical characteristics and outcomes of Systemic lupus erythematosus (SLE) patients with central nervous system (CNS) involvement in our population. Methods:We conducted a retrospective review of the medical records of patients diagnosed with neuropsychiatric lupus (NPSLE) in Singapore General Hospital between Jan 2007 and Oct 2017. Results:The records of eighteen patients were analysed retrospectively.The median age of diagnosis of NPSLE was 33.5 years.The median duration of SLE at the time of the neuropsychiatric manifestations was 4.5 months.Thirty-three percent had NPSLE as the first presentation of SLE.The most frequent clinical presentation was acute confusional state (30.8%) followed by cerebrovascular disease (23.1%) and seizures (19.2%).Seven patients (38.9%) had more than one neuropsychiatric syndrome.The commonest Magnetic Resonance Imaging (MRI) brain abnormality was white matter hyperintensities (61.1%), followed by acute infarcts (33.3%) and cerebral hemorrhage (22.2%).Multi-vessel involvement (3 or more vessels) (55.6%) was observed on magnetic resonance angiography (MRA).Majority of the patients (72.2%) received intravenous methylprednisolone, 66.7% had intravenous cyclophosphamide and 22.2% had rituximab.Twelve patients (66.7%) had clinical improvement and three patients (16.7%) had relapsing courses.There were three deaths from diffuse alveolar hemorrhage and ischaemic heart disease. Conclusion:Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) manifests in a variety of clinical presentations, with NPSLE syndromes being the first presentation of SLE in one third of the patients.Prompt diagnosis and management is essential to improve clinical outcomes.
This study was carried out at the Rheumatology department in Benghazi University, follow up study Ninety-six (96) patients were diagnosed of Psoriasis arthritis (PsA), those patients were assessment clinically of skin psoriasis and nail involvement were assessed by the Psoriasis Area Severity Index (PASI). The Joint disease activity was measured by clinical diagnosis activity index (CDAI).
Radiologic findings are important for the diagnosis and treatment of inflammatory joint disease. Current classification criteria utilize different serological findings, such as anti-citrullinated-peptide antibodies (ACPA) and rheumatoid factor (RF), as well as clinical findings, for diagnosis of rheumatoid arthritis (RA). The presence of erosions allows diagnosis, even if serological criteria are not fulfilled. However, the pertinent erosions are not clearly defined. Previous studies have shown different patterns of radiographic changes in RA patients, possibly representing different mechanisms of damage. The association between different damage patterns and serological findings is not known. This study explores the association between serological factors and radiographic findings in patients with a clinical diagnosis of RA, RF-/ACPA-positive and negative, and spondylarthropathy, from a single centre. Anonymized radiographs were evaluated blindly, assessing presence of osteopenia, marginal and subchondral erosions, peri-erosional sclerosis, joint surface crumbling, and joint fusion. Radiological diagnosis was then correlated with serological findings. 193 patients were studied (RA/spondylarthropathy 151/42). Age and disease duration did not differ significantly between the groups. Subchondral and wrist erosions were significantly more common in clinically-diagnosed RA patients. RF, but not ACPA, was associated with metacarpal-carpal and metatarsal-tarsal erosions. Generally, no serological or clinical parameter could reliably predict radiological changes in patients with peripheral arthritis, neither those findings associated with RA, nor those rather associated with spondylarthropathy. This study suggests that serology alone is unable to predict the mode of radiological damage in patients with peripheral inflammatory joint disease. To prevent confounding, further studies into arthritis pathophysiology should therefore take both radiological and serological findings into account.
Comorbidities are common in psoriatic arthritis patients, including mood disorders. We aimed to study the prevalence of anxiety and depression in psoriatic arthritis patients from Brazil and its association with epidemiological, clinical and treatment data.
32-year-old male presented to our department with pain and swelling of his right knee. There was no other joint pain, extra-articular manifestation or co morbid illness. His blood tests showed elevated inflammatory markers and negative autoantibodies. MRI showed effusion and extensive synovial hypertrophy. Arthroscopic synovial biopsy was done and histopathological examination was confirmative of rheumatoid arthritis. Patient was started on DMARDS and showed dramatic improvement.
Citation: Rothschild B (2020) Antiphospholipid Antibody-Related Problems, the Orphan Child of Medicine. J Rheum Dis Treat 6:085. doi.org/10.23937/2469-5726/1510085 Accepted: August 27, 2020: Published: August 29, 2020 Copyright: © 2020 Rothschild B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PURPOSE: A 30-year old Filipino female initially presented with thromboembolic symptoms (massive pulmonary embolism, recurrent pregnancy losses and deep venous thrombosis) and a positive test for antiphospholipid antibodies with negative findings for Systemic Lupus Erythematosus (SLE). She developed joint pains, alopecia and myalgia accompanied with thrombocytopenia, neutropenia and hemolytic anemia 8 years later which resulted in a diagnosis of a SLE with secondary APS. The development of a previously diagnosed primary APS with no clinical and diagnostic evidence of other autoimmune diseases followed by (SLE) is a rare occurrence. SLE may develop years after the onset of the primary APS. METHODS: She was initially treated with Warfarin but was shifted to Dabigatran due to problems in monitoring. During the succeeding years, there were recurrent episodes of pulmonary embolism despite medical management, which resulted to the development of chronic thromboembolic pulmonary hypertension (CTEPH). the patient was also treated for SLE immediately after its diagnosis. The patient continued with her anticoagulation and underwent pulmonary endarterectomy. RESULTS: There was marked improvement of the patient's symptoms post operatively and echocardiography revealed a decrease in pulmonary pressure. Biopsy of the resected segment was consistent with a thrombus. CONCLUSIONS: The mainstay of treatment for thromboembolism in APS requires anticoagulation with warfarin or heparin and aspirin but other alternatives such as direct oral anticoagulants (DOACs) should be considered especially in extenuating circumstances. CLINICAL IMPLICATIONS: The complexity of the diagnosis and management of the patient may contribute to the understanding of APS in association with SLE, which made the this reportable.
In the analysis of the data, significant difference between remission and moderate-high disease activity was observed in morning stiffness, presence of deformity, presence of nodule, osteoporosis and exertional dyspnea; whereas statistically significant difference between low and moderate-high disease activity was observed in osteoporosis and dyspnea at rest (p < 0.05).
A 20-year-old female with recurrent childhood ear infections, and reported history of recurrent oral, genital ulcerations and UTIs, presented as transfer from outside hospital with concern for Behcet syndrome. The patient initially had a 3-4-month history of fever, oral and genital ulcerations and worsening respiratory symptoms. She was initially treated at urgent care with antivirals and nitrofurantoin.
