Background:MSK (musculoskeletal) disorders (MSDs) significantly limit physical activity and the general quality of life of patients. Prison inmates have poor access to quality health care, which may hinder their rehabilitation journey. This study assessed the prevalence of MSDs among prison inmates. Methods:Electronic databases were searched from inception to July 2025. Studies were screened, and relevant data were extracted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted using a random-effects model to pool the prevalence of MSDs among inmates. The quality of studies was assessed using the Newcastle-Ottawa Scale, and bias was measured using the funnel plot, the Egger test, and leave-one-out sensitivity analysis. Results:A total of 16 studies were included from 1089 initially retrieved from database searches. A total of 21 536 prison inmates were included in these studies, of which 4016 had MSDs. Pooled prevalence of overall MSDs (diagnosed and self-reported) among prisoners was 25% (95% confidence interval [CI] = 18%-33%). Clinically diagnosed and self-reported MSDs had a prevalence of 18% (95% CI = 13%-24%) and 30% (95% CI = 20%-39%), respectively. The funnel plots and the Egger tests show no publication bias, with sensitivity analyses showing that no single research significantly influences the pooled effect sizes. Conclusions:Musculoskeletal disorders may affect 1 in 4 prison inmates, with associated debilitating effects on both physical and mental health. Given that this population has limited access to quality care and considering that the aim of incarceration is rehabilitation, it is essential to prioritize and address the health effects of MSK disorders among prison inmates.
Background:Non-specific low back pain (NSLBP) is a significant factor involved in the onset of sexual dysfunctions (SDs). However, studies demonstrating the correlation between these 2 conditions are rare. This study aimed to determine the prevalence and factors associated to SDs in patients suffering from NSLBP in Cameroon. Method:A cross-sectional study was conducted among patients suffering from NSLBP in the 3 main town (Yaoundé, Douala and Bafoussam) of Cameroon. Clinical characteristics and sexual activity of these patients were evaluated using validated questionnaires such as the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Male sexual Health-Questionnaire, and the Female Sexual Function Index. Results:Data from 409 patients (233 men and 176 women) were collected and included in this study. The overall prevalence of SDs related to NSLBP was 43%. The most affected sexual activity domains were desire (2.7 ± 1.4) and excitement (3.2 ± 1.4) in women. In men, desire (15.2 ± 5.7) and sexual satisfaction (15 ± 6.8) were most affected. Several associations were found between SD in NSLBP patients and some variables such as: overweight (odds ratio [OR] = 1.882, P = .005), female (OR = 1.518, P = .03), pain intensity (OR = 1.365, P = .0001), pain catastrophizing (OR = 1.076, P = .0003), hypoflexibility (OR = 1.029, P = .0009), reduced erector spinae (OR = 0.984, P = .0009), abdominal muscle strength (OR = 0.983, P = .016), depression (OR = 1.177, P < .0001), anxiety (adjusted odds ratio [aOR] = 1.168, P < .0001), and disability (OR = 1.165, P < .0001). Conclusion:The relatively high prevalence of SDs related to NSLBP highlights the close relationship between these 2 conditions and their associated factors in Cameroon. These results highlight many factors that must be taken into account in the management of SDs related to NSLBP.
Background:Knee osteoarthritis (KOA) is frequently accompanied by quadriceps weakness. Resistance training is recommended, but high-intensity resistance training (HIRT) may be poorly tolerated in some patients, whereas low-intensity resistance training (LIRT) may yield smaller strength gains. Low-intensity blood flow restriction training (LIBFR) has been proposed as a low-load strategy to stimulate muscle adaptations; however, the evidence base has been summarized in multiple systematic reviews with variable conclusions. Objective:To synthesize and appraise the evidence on the efficacy and safety of LIBFR in individuals with KOA through an overview of systematic reviews. Methods:We searched MEDLINE, EMBASE, Cochrane Database, Web of Science, CINAHL, SPORTDiscus, PEDro, Epistemonikos, and gray literature (ProQuest, Global ETD) for systematic reviews of randomized clinical trials comparing LIBFR with LIRT and/or HIRT. Reviews were eligible if they evaluated supervised exercise-based LIBFR delivered ⩾2 to 3 sessions/week for ⩾4 weeks. Two reviewers independently screened, extracted data, and assessed methodological quality (AMSTAR 2). Certainty of evidence was appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) based on KOA-specific quantitative syntheses, applying a hierarchical approach in the presence of overlap across reviews. Results:Eighteen systematic reviews (57 randomized trials; 5656 participants) were included. Compared with LIRT, LIBFR was associated with greater improvements in quadriceps strength (standardized mean difference [SMD] = 0.75; 95% confidence interval [CI] = [0.40 to 1.10]) and muscle hypertrophy (SMD = 0.81; 95% CI = [0.10 to 1.52]), although certainty of evidence was very low. Compared with HIRT, LIBFR was associated with fewer adverse events (risk ratio [RR] = 0.26; 95% CI = [0.09 to 0.72]).Across comparisons, effects on pain and functional outcomes were generally similar, and between-group differences were not consistently observed. Conclusions:The LIBFR may improve quadriceps strength and hypertrophy relative to LIRT and may have a more favorable adverse-event profile than HIRT, but confidence in these estimates is limited by low-/very low-certainty evidence and variability in protocols and reporting. Well-designed, longer-term randomized trials with standardized LIBFR parameters and robust safety reporting are needed to clarify patient-important outcomes.
Background:In recent years, musculoskeletal pain (MSP) has gained widespread attention globally and has become a significant public health issue affecting people of all ages, especially those affected by adolescence. Many musculoskeletal problems have a biomechanical origin, often linked to foot type and plantar pressure. Objectives:The aim of this study is to provide new insights into the multifactorial nature of MSP by exploring its associations with foot type, plantar pressure, physical activity, psychosocial factors, and daily living habits in adolescents. Design:A cross-sectional observational study was conducted among adolescents recruited from community and schools in Guangzhou, China. Methods:Chi-square tests and logistic regression analysis were employed to investigate the associations between the prevalence of musculoskeletal pain and various factors, including foot type, plantar pressure, physical activity levels, psychosocial factors, study pressure and daily living habits like sleep duration, sleep quality, and screen time. Given the high prevalence and clinical relevance, we further analyzed factors associated with neck, back, and foot pain. Results:This study included 216 adolescents (15.83 ± 1.05 years). The analysis revealed that physical activity, sleep duration, and study pressure significantly associated with the incidence of neck pain. Emotional symptoms at the threshold or abnormal and poor sleep quality both associated with low back pain. Foot type and plantar pressure did not show statistical significance in association with overall musculoskeletal pain. However, when specific pain sites were examined, foot pain was significantly associated with maximum plantar pressure ⩾ 1000 N/dm2, average plantar pressure ⩾ 180 N, and flatfoot or high-arched foot. Conclusions:Our study found that while foot type and plantar pressure were not associated with overall musculoskeletal pain, they were significantly associated with foot pain specifically. Low physical activity, insufficient sleep, and high study pressure were linked to neck pain, while poor sleep quality and emotional symptoms were associated with low back pain. These findings highlight the multifactorial nature of musculoskeletal pain and the need for comprehensive assessments in primary care. Clinical trial number:This study was registered at Chinese Clinical Trials Registry (http://www.chictr.org.cn/) on August 12, 2024. Clinical trial number: ChiCTR2400088109.
Ledderhose disease, or plantar fibromatosis, is a rare fibroproliferative disorder affecting the plantar fascia. Conservative management plays a crucial role in alleviating symptoms and maintaining function. This article explores the role of podiatric interventions, including custom orthotics, footwear modifications, manual therapy, and adjunctive modalities such as shockwave therapy. In addition, the role of regenerative medicine and the need for interdisciplinary rehabilitation strategies are discussed. Future research should focus on the efficacy of podiatric treatments and their integration into multidisciplinary care.
Background: Biologics have revolutionized the treatment of autoimmune rheumatologic diseases, but data on their real-world use and safety in resource-limited settings like Bihar, India, are scarce. Objectives: This study aimed to evaluate the prescription patterns and safety profile of biologic disease-modifying antirheumatic drugs (b-DMARDs) in patients with rheumatoid arthritis (RA) at a tertiary care hospital in Bihar. Design: A prospective, observational cohort study conducted over 12 months. Methods: A total of 120 adult patients with RA prescribed b-DMARDs were enrolled. Data on demographic, clinical characteristics, and treatment details were collected. Disease activity (DAS-28-CRP) and functional status (HAQ-DI) were assessed at baseline and 6months. Adverse events, particularly infections, were recorded and analysed using multivariable logistic regression to identify risk factors. Results: Biologicals were prescribed in 14.93% patients with RA. Adalimumab (49.17%) was the most prescribed b-DMARD, followed by etanercept (28.33%). Methotrexate was the most common concomitant conventional DMARD (85.83%). All b-DMARDs significantly improved DAS-28-CRP and HAQ-DI scores (P < .0001), with adalimumab showing the greatest improvement. Infliximab had the highest infection rate (53.33%), whereas etanercept had the lowest (14.70%). Regression analysis identified infliximab use (adjusted odds ratio [aOR]: 3.27), concomitant corticosteroid use (aOR: 2.74), and the presence of comorbidities (aOR: 2.13) as significant independent risk factors for infection. Conclusion: Biologic disease-modifying antirheumatic drugs are effective in RA, but infection risks vary. Adalimumab and etanercept demonstrated favourable efficacy and safety profiles, respectively. Treatment decisions should be personalized, considering drug-specific risks, corticosteroid co-therapy, and patient comorbidities, especially in resource-constrained settings.
Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organ systems, characterized by heterogeneous pathogenesis, diverse clinical manifestations, prolonged disease course, and substantial morbidity and mortality. Objectives:This study aimed to systematically evaluate the clinical value of 11 hematological indices derived from routine blood tests in assessing disease activity in patients with SLE. Design:This retrospective observational study analyzed the correlation between hematological biomarkers and clinical disease activity indicators in enrolled patients. Receiver-operating characteristic (ROC) curves were employed to evaluate the predictive efficacy of each indicator for disease activity, while binary logistic regression analysis was used to identify independent risk factors influencing disease activity. Methods:Clinical and laboratory data from 100 patients with SLE were retrospectively analyzed. Associations between blood routine-derived indices and disease activity were assessed. Receiver-operating characteristic curves were used to evaluate the predictive performance of these indices for SLE activity, and binary logistic regression analysis was conducted to identify independent risk factors. Results:Compared with healthy controls, patients with SLE exhibited significantly higher levels of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), aggregated inflammatory systemic index (AISI), derived neutrophil-to-lymphocyte ratio (dNLR), neutrophil-to-lymphocyte-platelet ratio (NLPR), monocyte-to-lymphocyte ratio (MLR), and RDW/PLT ratio (RPR) (all P < .05), whereas HGB/RDW ratio (HBR) was significantly lower. Disease activity was positively correlated with SIRI, SII, AISI, PLR, NLR, dNLR, NLPR, and MLR (P < .05 or P < .01), while mean platelet volume-to-platelet ratio (MPR) and RPR showed significant negative correlations with disease severity. The ROC analysis demonstrated that SIRI, SII, AISI, PLR, NLR, dNLR, NLPR, MLR, RPR, and a combined predictive model effectively discriminated active disease, with the combined model yielding the highest area under the curve (AUC). Among individual indices, SII and NLR showed the strongest predictive performance. Conclusion:Blood routine-derived inflammatory indices, particularly SII and NLR, are effective tools for evaluating disease activity in SLE. After adjustment for potential confounders, elevated SII was identified as an independent risk factor for increased disease activity, highlighting its potential clinical utility in routine assessment of patients with SLE.
Background:HTLV-1 infection has been demonstrated to induce both cellular and humoral immune responses, suggesting a probable role in the development and pathogenesis of autoimmune diseases. Objectives:The objective of the present study was to assess the prevalence of antibodies against HTLV-1 and its associated risk factors in patients diagnosed with rheumatoid arthritis who were referred to Allameh Bohlool Gonabadi Hospital in 2023. Design:This study is of a cross-sectional analytical nature. The study population comprised 107 patients diagnosed with rheumatoid arthritis. These patients were referred to the rheumatology clinic of Allameh Bohlool Gonabadi Hospital. The patients were selected for inclusion in the study on a random basis. Methods:The data collection instrument employed in this study was the demographic information checklist and the disease activity and severity questionnaire (Disease Activity Score 28 [DAS28]). A study was conducted to determine the prevalence of HTLV-1. Also, 2 mL of blood was collected from the research units, and then serum was isolated and stored at -20°C. The antibody levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Following the collection of the data, it was subjected to analysis using SPSS version 20 software, with the Fisher's exact and independent samples T-tests employed at a significance level of less than 5%. Results:The mean age of the research units was 55.30 ± 12.45 years, and 82.2% of the subjects were female. The activity and severity of the disease were found to be average in 38.3% and 70.1% of the research units, respectively. A total of 2 positive HTLV-1 cases (1.9%) were identified among the study population. The investigation revealed that HTLV-1 infection demonstrated no substantial correlation with disease activity, disease severity, gender, education, history of smoking and alcohol consumption, age, and body mass index (P > .05). Conclusion:The prevalence of HTLV-1 infection among patients diagnosed with rheumatoid arthritis is not significant. Also, in this study, the impact of HTLV-1 infection on the activity and severity of rheumatoid arthritis was not found.
Background: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder that is associated with reduced quality of life, physical and emotional distress, and financial strain on caregivers and health care systems. Although RA has been thoroughly researched, the psychological effects and lived experiences of patients and caregivers remain underexplored. Objectives: To evaluate the perspectives of patients with RA, caregivers, and health care professionals (HCPs) involved in RA management. Design: Online cross-sectional exploratory survey. Methods: The survey was conducted from December 20, 2024, to January 13, 2025, focusing on patients with RA, caregivers, and HCPs. Individualized questionnaires for each group collected data on disease impact, treatment experiences, mental well-being, and systemic deficiencies. Descriptive statistics were used to analyse and summarize the responses. Results: Out of 25 patient responders, majority were old females, with 60% reporting severe limitations in daily activities and 72% experiencing disrupted sleep and fatigue. Only 20% were satisfied with their treatment plans. Among 23 caregivers, 74% reported negative impacts on relationships and social lives, and 35% lacked adequate knowledge about RA. Of 13 HCPs, most prioritized patient education and identified treatment adherence, financial constraints, and communication gaps as major challenges. Only 46% routinely referred patients to support organizations. Conclusion: The study highlights areas related to patient-centred care, enhanced provider-patient communication, and improved caregiver support. The integration of psychosocial support and education into RA care strategies may support overall care approaches.
Background:Osteoarthritis (OA) is a degenerative joint disease characterized by a complex pathophysiology involving inflammatory biomarkers. Objectives:The current study aimed to investigate the correlation between interleukin-6 (IL-6) serum levels and joint space narrowing (JSN) in patients with knee OA. Design:A total of 46 patients clinically diagnosed with knee OA were included in this study. Methods:Joint space narrowing was measured using radiographic examinations, whereas blood serum levels of IL-6 were quantified using enzyme-linked immunosorbent assay. Statistical analysis was performed to determine the relationship between IL-6 and JSN. Results:The average level of IL-6 was 117.61 (67.05) ng/mL, with JSN measurement of 1.76 (1.31) mm. An inverse correlation found between IL-6 levels and the size of the gap joints in patients with knee OA (r = -.298; P = .044). Conclusion:An inverse correlation exists between IL-6 levels and joint impairment in knee OA, suggesting that inflammation plays a crucial role in the progression of the disease.
Background:Late-onset rheumatoid arthritis (LORA) poses a great challenge for physicians regarding diagnosis and treatment. The prognosis for LORA was better in some early research but worse in more recent trials. Objectives:The study aim was to compare the clinical, laboratory, and radiological characteristics assessed by musculoskeletal ultrasound (MSUS) of patients with LORA and early-onset rheumatoid arthritis (EORA) and to examine their associations with inflammation and treatment outcomes. Design:The study included 64 RA with EORA and 64 RA patients with LORA, fulfilling the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA. Methods:Medical history, Health Assessment Questionnaire Disability Index (HAQ-DI), DAS 28 score, laboratory investigations, and MSUS of both hands and wrist joints were done. Results:Female patients with EORA were more compared with those with LORA (89% vs 78.1%). Comorbidities were significantly more prevalent in the LORA group (28.12%) compared with the EORA group (10.9%) (P = .0143). A significant difference was also observed between the 2 groups regarding higher ESR values in LORA, with no significant difference detected in C-reactive protein (CRP) levels. Regarding joint involvement, shoulder, metatarsophalangeal (MTP), and knee joints were more frequently affected in LORA, with statistically significant differences (P < .0001, .0119, and .0285, respectively). The MSUS findings revealed higher gray-scale grades in patients with LORA, with significantly increased Doppler signal activity (P < .052), and a greater frequency of erosions compared with those with EORA. The mean HAQ-DI score was significantly higher in LORA than in EORA (P = .0004). Regarding treatment patterns, methotrexate (MTX) was more commonly prescribed in the EORA group (67.1%) compared with the LORA group (37.5%), whereas leflunomide was used more in LORA (68.75%) compared with EORA (46.8%), with statistically significant difference. Conclusions:Patients with LORA demonstrated more active synovitis and a higher frequency of erosions compared with those with EORA, despite the non-significant difference in DAS 28 scores. Moreover, patients with LORA exhibited a greater burden of comorbidities than those with EORA. Therefore, regular evaluation of inflammatory activity using MSUS, along with assessment of associated comorbid conditions, is recommended in patients with LORA.
Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that damages hand and wrist joints, leading to pain, disability, and reduced quality of life. Radiographic assessment plays a key role in diagnosis, but it is subjective and dependent on the clinician's experience. Deep learning-based systems offer the potential for faster, more objective, and more consistent evaluation. Objectives:This study aims to develop an attention-based deep learning model for the automated diagnosis of RA from hand and wrist radiographs and to demonstrate that high diagnostic performance can be achieved even with a limited data set. Design:Retrospective observational study evaluating an attention-based deep learning model for automated diagnosis of RA from hand and wrist radiographs. Methods:Radiographs from 311 RA patients and 259 healthy controls collected between September 2018 and September 2024 were analyzed. Individuals with other conditions causing hand deformities were excluded. The data set was divided into training (n = 325), validation (n = 142), and test (n = 50) sets. DenseNet121 and DenseNet169 architectures were combined with an attention mechanism to highlight RA-specific structural changes. Despite the relatively small data set, data augmentation and attention modeling were used to improve robustness. Results:The proposed model achieved 88% accuracy, 84% precision, and 91% recall, demonstrating strong diagnostic capability with limited training data. Initial clinical testing suggests that the model can support radiologists by providing consistent and objective assessments. Conclusion:This attention-based deep learning approach shows promise as an effective, reliable, and efficient tool for the automated diagnosis of RA. The ability to achieve high performance with limited data highlights its potential for real-world clinical adoption, particularly in resource-constrained environments.
Groin pain that worsens with coughing is most commonly attributed to intra-abdominal pressure changes associated with inguinal or femoral hernias. However, musculoskeletal (MSK) disorders can mimic hernia-related symptoms and are often overlooked, leading to misdiagnosis, unnecessary imaging, and delayed treatment. Recognition of these alternative causes is essential for accurate diagnosis and appropriate management. We report the case of a 42-year-old male office worker with chronic right-sided groin pain persisting for 6 months. The pain was localized without radiation, aggravated by palpation, but not influenced by coughing or the Valsalva maneuver. Imaging studies including MRI of the hip, lumbar spine, and pelvis were unremarkable. On physical examination, a hypersensitive trigger point was identified in the pectineus muscle, with a pain pressure threshold (PPT) of 1.8 kg/cm(2) compared to 3.4 kg/cm(2) on the unaffected side. A diagnosis of pectineus myofascial pain syndrome was made. Ultrasound-guided dry needling was applied in three sessions over 2 weeks, resulting in an improvement of PPT to 3.2 kg/cm(2) and a reduction of the Visual Analog Scale (VAS) score from 7/10 to 2/10. This case emphasizes that not all groin pain provoked by coughing is hernia-related. Pectineus myofascial pain syndrome, although underrecognized, should be considered in the differential diagnosis. Early recognition of this condition can prevent unnecessary surgical referrals and facilitate timely effective treatment.
Background:Behcet's disease (BD) is an immune-mediated disease with ocular involvement in ~70% cases. Clinical assessment of uveitis activity can be challenging in special situations. The Systemic Immune-Inflammation Index (SII), a novel biomarker, may aid assessment but remains unstudied in BD uveitis. Objective:To evaluate the levels of SII and other potential inflammatory biomarkers derived from full blood count (FBC) in patients with active uveitis in BD. Methods:This is a case-control study that included 3 groups; an active uveitis group with a confirmed diagnosis of BD, an inactive disease group with BD without any activity for at least 3 months, and a control group of age and sex-matched healthy adults. Full blood count was done for all participants from a venous sample. Neutrophil-lymphocyte ratio (NLR), Platelet-lymphocyte ratio (PLR), and SII (neutrophils × platelets/lymphocytes) were calculated and compared between the groups. Results:58 subjects were enrolled; 24 patients with BD and current active uveitis, 15 patients with inactive BD, and 19 healthy matched volunteers. The NLR and PLR were significantly higher in the active uveitis group than in the inactive group. SII was higher in the active uveitis group compared with the inactive group (P < .001) and the healthy controls (P .002). The cutoff value for SII was > 701.72 with 79.17% sensitivity and 100% specificity. SII levels were higher in bilateral uveitis (1232.47) compared with unilateral active uveitis (870); however, the difference was not statistically significant. Conclusion:SII was highest in BD patients with active uveitis, significantly differing from those with inactive disease and healthy controls, supporting its potential as a biomarker for uveitis activity. Further research is needed to explore its correlation with disease severity.
Background:Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are interrelated inflammatory conditions, and evidence suggests that infection and vaccination might act as a trigger for these conditions. This descriptive systematic review summarizes the published case reports and case series on new-onset PMR and GCA following COVID-19 vaccination, highlighting their clinical features, diagnostic findings, and treatment outcomes. Objectives:To do a systematic analysis of available literature regarding the association between COVID-19 vaccination and the first onset or flare of PMR and/or GCA. Design:Systematic review of case reports and case series. Data sources and methods:A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, ScienceDirect, and Google Scholar. Data on patient demographics, clinical features, outcomes, and latency periods were extracted and analyzed. Quality assessment of included studies was performed using the Joanna Briggs Institute Critical Appraisal Tool. Results:A total of 32 articles, documenting 50 new-onset cases (30 PMR and 20 GCA), were identified for inclusion. The mean age for patients with PMR was 71.06 years, and 72.85 years for GCA. A slight female predominance was observed (60%) for both PMR and GCA. Pfizer-BioNTech (48%) and AstraZeneca (38%) vaccines were most frequently associated with disease onset. The mean latency period from vaccination to symptom onset was 11.03 days for PMR and 5.3 days for GCA, indicating a temporal relationship. Most of these studies originated from North America and Europe mimicking the global scale of vaccination. Most patients responded well to symptomatic treatment with corticosteroids. Conclusions:There exists a temporal association between COVID-19 mRNA or viral vector-based vaccines and the onset of PMR and GCA. While causality is not proven, this review underscores the need for clinicians to be aware of this potential association to ensure timely diagnosis and treatment, particularly as booster vaccinations continue to be administered. Larger epidemiological studies with long-term follow-up are essential to further explore this association.
Takayasu arteritis (TA) is a rare, chronic inflammatory disease that primarily affects large arteries, and in childhood (c-TA), it often presents with diverse and delayed manifestations that complicate diagnosis. We describe 2 pediatric cases that highlight the importance of early recognition and intervention. The first was a 3-month-old girl who presented with fever, respiratory distress, and peripheral cyanosis. Laboratory investigations revealed leukocytosis, anemia, elevated inflammatory markers, and hypercoagulability, while Doppler ultrasound and computed tomography angiography (CTA) demonstrated extensive vascular involvement with arterial occlusions and aneurysms. She was diagnosed with c-TA based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria and responded favorably to high-dose corticosteroids, infliximab, methotrexate, and antiplatelet therapy. The second case was a 17-year-old female with a history of hypertensive encephalopathy who presented with chest pain, arm numbness, and exertional dyspnea. Examination showed absent pulses and significant blood pressure discrepancies in the upper limbs, while laboratory tests revealed elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and positive antinuclear antibody (ANA). The CTA confirmed severe stenosis and occlusions in multiple arteries, fulfilling the diagnostic criteria for TA. Despite treatment with sarilumab, corticosteroids, methotrexate, and antiplatelet therapy, she continued to experience symptoms and required further intervention. These cases underscore the need to consider TA in pediatric patients with hypertension, absent or diminished pulses, blood pressure discrepancies, limb claudication, chest pain, or unexplained systemic inflammatory symptoms. Early recognition and aggressive immunosuppressive therapy are essential to prevent irreversible vascular damage and improve long-term outcomes.
Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily characterized by persistent synovitis, leading to joint destruction, deformities, and systemic involvement. Synovial cysts are rare extra-articular manifestations of RA, usually arising from inflamed synovial tissues. While most synovial cysts occur in typical locations like the knees and wrists, we present a unique case of RA manifesting as multiple large synovial cysts in uncommon locations. A 67-year-old female patient with a history of well-controlled RA presented with complaints of progressive swelling and discomfort in her upper arms and thighs, unresponsive to conventional RA management. Physical examination revealed large, fluctuant masses, which were non-tender but limited the range of motion in the affected limbs. Diagnostic imaging, including ultrasound and magnetic resonance imaging (MRI), confirmed the presence of multiple synovial cysts, each measuring over 5 cm in diameter, situated in atypical areas around the elbow, hip, and shoulder joints. Given the patient's history, these findings were initially unexpected, prompting further investigation to exclude differential diagnoses, such as lipomas, abscesses, and malignancies. Aspiration of the cysts revealed a synovial fluid consistent with RA pathology, confirming the diagnosis. This case highlights an unusual and rare presentation of RA. While synovial cysts are a known manifestation, their appearance in less typical locations emphasizes the importance of a comprehensive diagnostic approach. This case underscores the need for clinicians to consider atypical presentations when evaluating RA patients, particularly those with unusual swelling or masses that do not respond to standard treatments. Proper imaging and aspiration can facilitate accurate diagnosis, ensuring timely and appropriate management. Further research is needed to understand the mechanisms driving such atypical cyst formations and to optimize treatment strategies for similar cases.
Relapsing polychondritis (RP) is a rare autoimmune disease that affects cartilaginous tissues and proteoglycan-rich organs. Around 30% of cases have coexisting autoimmune inflammatory diseases. Palmoplantar pustulosis (PPP) is extremely uncommon in RP. We report a case of resistant RP, complicated with PPP. A 36-year-old female presented with fever, nose and earlobe chondritis, and symmetric arthritis. Infectious and connective tissue diseases were ruled out. The RP diagnosis was made, and she was treated with corticosteroids and methotrexate. Three years later, she experienced acute dyspnea due to tracheobronchial chondritis, and she was placed on induction treatment with 6 cyclophosphamide pulses, accompanied by maintenance therapy with mycophenolate mofetil (MMF). After 4 years, she presented with scleritis and panuveitis. The MMF was discontinued, and she was treated with tocilizumab (TCZ) 162 mg/week. Four months after the initiation of TCZ, the patient experienced erythematous papules and pustules on both palms and soles, suggestive of PPP. She received oral corticosteroids in addition to TCZ, with complete regression of symptoms.
Polymyositis with concomitant scleroderma is a rare, progressive condition with profound consequences if not addressed promptly. Severity and symptom presentation varies between patients, and much is unknown about how best to treat overlapping connective tissue diseases. This case discusses the rare presentation, medical evaluation, and successful treatment of a 46-year-old woman with excessive muscle atrophy, weakness, and tissue fibrosis, who was diagnosed with overlapping connective tissue disorder after extensive work up that included a muscle biopsy, skin punch biopsy, and autoantibody lab work. This patient recovered well with the use of mycophenolate mofetil demonstrating promising results for similar patients and offering insight into potential methods of evaluation and medical management. Studying cases like this one give providers more knowledge about overlapping connective tissue disease and how to best diagnose and manage them.
Background:Generalized Joint Hypermobility (GJH) is defined as a range of joint motion exceeding normal limits in multiple joints and is relatively common in children. Although often asymptomatic, GJH has been increasingly linked to psychological comorbidities, especially anxiety. While adult studies have highlighted these connections, pediatric-specific research remains limited. Objectives:This study aimed to evaluate the association between GJH and the prevalence of anxiety disorders in school-aged children using validated clinical and psychological measures. Methods:A case-control study was conducted among 3920 children aged 8 to 15 years in Isfahan, Iran (2021-2023). The Beighton scoring was used to identify children with GJH (score ⩾ 6), yielding 634 cases. An age- and sex-matched control group of 650 children without GJH was selected. Anxiety was assessed using the validated Spence Children Anxiety Scale (SCAS), covering separation anxiety, social phobia, panic/agoraphobia, specific phobia, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and generalized anxiety disorder (GAD). Logistic regression assessed associations between GJH and anxiety outcomes. Results:Children with GJH had significantly higher odds of separation anxiety (odds ratio [OR] = 4.49; confidence interval [CI]: 2.39-8.43), social phobia (OR = 4.32; CI = 2.40-7.75), panic disorder/agoraphobia (OR = 3.46; CI = 1.30-9.21), and GAD (OR = 2.87; CI = 1.10-7.47). ADHD, specific phobia, and OCD showed no significant differences between groups (P > .05). Conclusion:This study suggests a strong association between GJH and specific anxiety disorders in children. Given the ease of identifying GJH, psychological screening in this population may be a valuable preventive strategy.
