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85 Q&A related to Arthritis

Erythropoietin for anemia | Hematology | 06-2012
It s recommended that before giving erythropoietin EPO to a patient, you have to make sure that the patient is not iron, folate or B12 deficient. You have to correct ...

Hyperuricemia | Nephrology | 03-2012
Asymptomatic hyperuricemia can be found in as many as 1 in 10 adults but it isn t necessarily significant or indicative of pathology. It should, however, prompt a search for ...

First steps in proteinuria | Nephrology | 12-2011
Clinical history and physical examination are important initial steps in evaluating patients with asymptomatic proteinuria, especially the history of diabetes, hypertension, family history of kidney disease, history of collagen disorder, ...

Blood and iron | Geriatrics, Hematology | 10-2011
Geriatrician s answer The World Health Organization s 1968 criteria defined anemia in adults as a hemoglobin less than 12 g dL in women and less than 13 g dL ...

Many faces of psoriatic arthritis | Rheumatology | 08-2011
Psoriatic arthritis may manifest in multiple ways, from isolated DIP inflammatory arthritis, to lower limb oligo-asymmetric arthritis, to spondyloarthropathy asymmetric symptomatic or asymptomatic sacroilitis and spondylitis but with variable site ...

Psoriatic arthritis outside the joint | Rheumatology | 12-2010
The phrase non-articular psoriatic arthritis is a contradiction, since arthritis per se invokes joint inflamation i.e. arthritis. If you re referring to involvement of joint related structures, e.g. tendons as ...

Myth of the magic bracelet | Rheumatology | 12-2010
Zero, zilch, nada. Not a shred of evidence.

Tortoise beats hare in steroid races | Clinical Pharmacology | 12-2010
Depot preparations e.g. Depomedrol, Aristospan, Kenalog are preferable given the sustained action. The disadvantage is the potential for soft tissue atrophy if injected incorrectly not in the joint or bursa ...

Intolerant of statins? | Cardiology | 08-2010
I find that many patients who say they can t tolerate statins can in fact tolerate low doses, either halving the daily dose or taking their therapy 3 days a ...

Statins: safer than aspirin | Cardiology, Clinical Pharmacology | 01-2010
Cardiologist s response Sadly, in real life, arthritis and aches and pains are all too commonly present in the background of high-risk patients. But muscle ache shouldn t preclude statin ...

Tricky to treat | Rheumatology | 12-2009
Erosive OA is one of the most vexing problems in rheumatology. It often affects middle-aged women, can be very disabling, and there s no specific evidence-based intervention that s truly ...

High D-dimer need not signal thrombosis | Hematology | 08-2009
If by false positive you mean an elevated D-dimer that isn t associated with thrombosis or pulmonary embolism, there are many conditions that can cause this. D-dimer is the product ...

Strep A’s gentler cousins | Infectious Disease | 08-2009
Group C and G beta-hemolytic streptococci commonly colonize the pharynx and tonsils without causing symptoms, but may also occasionally cause an exudative tonsillopharyngitis. Although non-suppurative sequelae such as glomerulonephritis and ...

Steroids first in knee inflammation | Rheumatology | 03-2009
In the case described, the use of intraarticular steroids may be appropriate, and I rsquo d suggest doing this before considering the HA injection. This may reduce the inflammatory component, ...

Can colectomy resolve inflammation elsewhere in the body? | Gastroenterology | 12-2008
Some types of arthritis follow the clinical course of ulcerative colitis so- called peripheral arthropathy where the arthritis can even be migratory. Joint disease activity in these cases often parallel ...

DMARDs for psoriatic and inflammatory arthritis? | Rheumatology | 10-2008
The role of these meds is substantive and evidence-based, with demonstrable improvements in disease activity, functional status and joint damage. Suffice to say, the merits of various DMARDs specifically methotrexate, ...

Is chelation safe for chronic fatigue? | Hematology | 09-2008
You haven't indicated what kind of specialist your patient consulted. There's no medical condition that would need chelation therapy because of borderline high ferritin. The original unproven claim is that ...

Positive serology for Lyme -- now what? | Infectious Disease | 06-2008
A diagnosis of Lyme disease is usually done on the basis of characteristic clinical features, history of exposure to an endemic area, and positive serology to Borrelia burgdorferi. Clinical manifestations ...

How to manage palindromic arthritis | Rheumatology | 05-2008
Palindromic rheumatism is a syndrome of transient inflammatory oligoarticular symptoms that recur or relapse. By most definitions, pains last for less than 24-72 hours from onset to complete resolution. Both ...

When to consider uric acid-lowering therapy | Nephrology | 05-2008
Asymptomatic hyperuricemia is common and may occur in up to 10 of adults. It doesn't necessarily represent a disease state, however, and it's often a coincidental laboratory finding. When serum ...

Should we prescribe glucosamine? | Rheumatology | 04-2008
Not at all. Recent controlled clinical trials Clegg DO et al. NEJM 2006 354 8 795-808 as well as meta-analyses have shown no clear-cut benefit over placebo. In my clinical ...

Learn to identify the acromion types | Imaging | 03-2008
Plain x-rays of the shoulder joint can be very helpful in assessing local joint pathology and determining the origin of symptoms. Apart from obvious findings such as arthritis, fracture, subluxation ...

Rheumatoid arthritis: to be med-free | Rheumatology | 01-2008
This question sums up the challenges faced by rheumatologists and their patients in the era of biologic therapy. It's easy to start medications harder to stop. The goal of long-term ...

Hot houses of the elderly | Geriatrics | 11-2007
Temperature dysregulation -- as part of altered homeostatic mechanisms -- becomes increasingly common in old age. Hypo- and hyperthermia are predominantly disorders of the elderly and mortality can be high, ...

Why does arthritis spare paralyzed limbs? | Rheumatology | 09-2007
The issue of sparing as described above has been ascribed to neurogenic modulators of inflammation, in particular the role of neuropeptides such as substance P, gastrin-related peptides and bombesin. Sparing ...

Can laser lick musculoskeletal aches? | Rheumatology | 08-2007
Many claims are made in both the scientific and the lay literature for the efficacy of these modalities, but a careful review finds that little consistent high quality evidence is ...

Can hepatitis vaccines trigger lupus? | Allergy | 06-2007
Certain vaccines, particularly the flu shot, have been associated in case reports as triggering exacerbations of autoimmune conditions, such as lupus and Guillain-Barr syndrome. A variety of other autoimmune disease ...

Is glyconutrient supplementation worthwhile? | Clinical Pharmacology, Nutrition | 06-2007
Glyconutrients are a group of sugars that are purportedly important in the formation of glycoproteins. Some animal work supports glyconutrient supplementation, but despite claims of efficacy for conditions as varied ...

Can a hot diet cool cancer? | Clinical Pharmacology, Nutrition | 03-2007
Capsaicin, the major spice in red peppers, is a compound that's been used for some time as an analgesic and as a topical irritant. It's been a flavouring agent for ...

Should statins stop in the presence of myalgia? | Cardiology | 08-2006
Unfortunately, myalgias and arthritis are common, especially as we age. Many patients and pharmacists are quick to blame statins for these muscular complaints. Before starting anyone on a medication to ...

Is elevated ESR due to osteoarthritis? | Hematology | 03-2006
A very high ESR is generally seen in inflammatory arthritis, e.g. rheumatoid arthritis, but not in pure osteoarthritis OA . Many conditions can increase the ESR. Consequently, it's not unusual ...

Revisiting the risks of vasectomy | Urology | 02-2006
There's no increased risk for infarction, prostate cancer, arthritis or any other health problem after a vasectomy, despite scare stories that were suggested earlier on. Vasectomy has stood the test ...

Are inflammatory disorders tied to CVD? | Cardiology | 01-2006
You're obviously well read. Currently, atherosclerosis and inflammation are correlated. It's now believed that many disease processes that cause inflammation, such as rheumatoid arthritis, are associated with a higher incidence ...

Are inflammatory disorders tied to CVD? | Rheumatology | 01-2006
The association of increased cardiovascular morbidity and mortality with chronic inflammatory disorders such as rheumatoid arthritis has been known for some time. The use of CRP levels to help determine ...

The low-down on piriformis muscle injury | Rheumatology | 01-2006
The piriformis syndrome may be the result of either overuse or direct muscle injury. This muscle group acts as an external rotator of the hip, but its location at the ...

When to verify bone density | Obstetrics Gynecology | 10-2005
Bone mineral density is the best predictor of fracture. The BMD test should be performed on all postmenopausal women with one major or two minor risk factors for low bone ...

Is long-term use of TNF-a inhibitors risky? | Oncology | 08-2005
Excellent question There is an interaction between TNF-a inhibitors and malignancies, and depending on how you interpret the scientific papers, you initially wonder if the risk is increased or decreased. ...

Can vaccinations cause lupus to flare? | Allergy | 04-2005
There are case reports of infections and immunizations causing flares of lupus and other connective tissue diseases. The risks of withholding a vaccine, however, have to be weighed against the ...

Latent lymphadenopathy workup | Oncology | 09-2004
What you're telling me is that it sounds benign because there's been no change in size or consistency and health status for many years. Generally, lymphadenopathy for the vast majority ...

Mixing NSAIDs and ASA | Hematology | 02-2004
This isn't a simple question and there's no simple answer. Platelets and vascular endothelial cells process prostaglandin PG H subscript 2 to produce thromboxane TX A subscript 2 and PGI ...

Investigating axillary lumps | Imaging | 02-2004
Unilateral or asymmetrical axillary adenopathy is very common. The causes are often benign in nature, including reactive changes in the lymph nodes from regional infection lymphoid hyperplasia or those due ...

Can treating depression help arthritis? | Psychiatry | 02-2004
Epidemiologic studies have found associations between depression and chronic inflammatory conditions, such as asthma and rheumatoid arthritis. It's been shown that administering substances that increase the production of inflammatory cytokines ...

Does stroke prevent rheumatoid arthritis? | Rheumatology | 02-2004
amp quot Never amp quot is perhaps too definitive a term, but there's certainly a significant drop in the clinical manifestations of rheumatoid arthritis. Some have attributed this to a ...

Red-faced patient: acne rosacea or lupus? | Dermatology | 10-2003
Assessing a patient with a red face is a common challenge for physicians. The main differential is between rosacea and other photosensitive conditions, like lupus erythematosus. It can be difficult ...

Which DMARD is also useful in IBD? | Gastroenterology | 09-2003
Etanercept, a recombinant form of the tumour necrosis factor TNF receptor that competitively inhibits TNF, is beneficial in arthropathy and is used by rheumatologists for difficult cases of rheumatoid arthritis. ...

How are D-dimer tests interpreted? | Hematology | 09-2003
I don't think you really want to know all the conditions giving false-positive or false-negative D-dimer results. You're probably more interested in which conditions other than venous thromboembolism VTE can ...

Approaches for stubborn gout | Rheumatology | 09-2003
First, it's important to determine whether the MTP irritation is secondary to gouty arthritis or some other cause. Has the foot been x-rayed Is there evidence of osteoarthritis, calcification or ...

HIV-associated arthritic disorders | Rheumatology | 01-2003
HIV-infected patients may develop a variety of arthritic disorders, most commonly a psoriatic arthritis or Reiter's-like syndrome. HIV infection may also exacerbate pre-existent joint problems, specifically the seronegative spondyloarthropathies. Given ...

Back-and-forth on palindromic rheumatism | Rheumatology | 11-2002
Palindromic rheumatism is characterized by recurrent short-lived less than 24-72 hours generally episodes of acute joint inflammation, for which no other etiology can be determined. A subset of such patients ...

INVESTIGATING A HIGH PLATELET COUNT | Hematology | 09-2002
I assume that, by saying a platelet count is amp quot greater than 100,000, amp quot you actually mean greater than 100,000 mm superscript 3 or greater than 1,000 x ...

HTLV-1 OR -II INFECTION: WHAT'S THE SIGNIFICANCE? | Infection | 08-2002
The HTLV viruses are retroviruses. To date, we've identified two types in humans. HTLV-I is present in widely scattered populations and probably infects 10-20 million people globally. Rates of seropositivity ...

HTLV SCREENING IN BLOOD DONORS | Hematology | 07-2002
It's been demonstrated that HTLV can be transmitted through blood transfusion. Most HTLV carriers are asymptomatic, but about 1-5 develop adult T cell leukemia lymphoma and a smaller number get ...

Is it cellulitis, gout or a septic joint? | Rheumatology | 04-2002
By definition, cellulitis shouldn't affect the range of joint movement, although in some cases the degree of swelling may impair some aspects of range. Besides, joint line tenderness isn't a ...

ENTHESOPATHY AND RHEUMATOLOGIC DISORDERS | Rheumatology | 02-2002
If the enthesopathy has an inflammatory basis, it may turn out to be a feature of a seronegative arthropathy like psoriatic arthritis, ankylosing spondylitis or Reiter's syndrome. Other conditions may ...

MYSTERIOUS MONOCYTOSIS | Hematology | 01-2002
It's very difficult to give any advice in this case without knowing the detailed history, physical examination, and the type of nonspecific red cell changes. When you say amp quot ...

ANY FOLLOW-UP FOR HTLV-1 CARRIERS? | Hematology | 10-2001
HTLV-1-associated infection has the highest prevalence in the southwestern district of Japan. It's also endemic in the Caribbean basin, parts of Africa, Latin America, the Middle East and the Pacific ...

INTERPRETING BONE DENSITY SCANS IN TEENS | Imaging | 09-2001
A number of disease processes may directly or indirectly affect the bone mineral content in children and young adults. These include juvenile rheumatoid arthritis, cystic fibrosis, inflammatory bowel disease, renal ...

GLUCOSAMINE FOR OA GETS RESPECT | Rheumatology | 09-2001
A recent well-designed placebo-controlled long-term three-year study of glucosamine demonstrated that progression of joint space narrowing at the knee appeared to slow down and symptoms improved, using the Western Ontario ...

CLUES TO CHLAMYDIA IN HEART DISEASE | Infection | 06-2001
A number of microbes have been linked to rheumatoid arthritis and neurologic diseases but, as far as I know, Chlamydia pneumoniae has only been associated with atherosclerosis aside from its ...

ANTIBACS FOR ARTHRITIS? | Rheumatology | 03-2001
If the arthritis is based on a bacterial infection, then absolutely. But more than likely, you're asking about non-infectious i.e. inflammatory arthropathies and here, its beneficial use depends on the ...

Complications from the fountain of youth | Endocrinology | 01-2001
Patients receiving growth hormone treatment should be followed carefully by someone experienced in growth hormone replacement. In Canada, it's indicated for use in children or adults who are deficient in ...

HIGH FERRITIN: WHAT'S BEHIND THE RISE? | Hematology | 12-2000
With the exception of iron deficient or hypothyroid anemia, many chronic and longstanding anemias are linked to high serum ferritin. The most common -- chronic disease anemia -- is associated ...

DRUG-INDUCED MENINGITIS IN RHEUMATOLOGY | Rheumatology | 10-2000
DIAM is an uncommon reaction to a variety of agents that may be caused by a hypersensitivity-induced response, either Type III immune complex or IV cellular , or direct thecal ...

ANTIBIOTIC PROPHYLAXIS FOR A CAT BITE | Infection | 09-2000
Although cat bite-related infections are often polymicrobial in nature, one organism, namely Pasteurella multocida, tends to predominate. P. multocida is very adept at causing significant soft tissue infections including those ...

INVESTIGATING OSTEOMYELITIS: IS MRI BEST? | Imaging | 05-2000
There are three accepted imaging routes to follow when attempting to diagnose acute osteomyelitis three-phase technetium-99m Tc-99m nuclear medicine bone scan combined with a gallium-67 scan three-phase bone scan combined ...

WHEN SHOULD HIGH URIC ACID BE TREATED? | Rheumatology | 10-1999
An elevated uric acid level alone doesn't absolutely require treatment -- but you'll need to perform further clinical and laboratory assessments to understand this finding. Since there's joint pain in ...

RHEUMATOID ARTHRITIS TX PROS AND CONS | Rheumatology | 09-1999
The risk-benefit ratio for methotrexate MTX in a patient with active rheumatoid arthritis RA -- presumably the reason that the consultant rheumatologist has suggested initiating this therapy -- is more ...

CAN ANTIBIOTICS HELP IN RHEUMATOID ARTHRITIS? | Rheumatology | 07-1999
Over the years, many efforts have been made to identify an infectious cause for rheumatoid arthritis RA -- but no bacteria or virus has ever been confirmed as the etiologic ...

WHO'S AT RISK FOR OSTEOPOROSIS? | Imaging | 06-1999
Growing awareness of the impact of osteoporosis, and the availability of new treatments to prevent fractures, have highlighted the importance of diagnosis. Right now, dual x-ray absorptiometry DXA is still ...

D-DIMER DOESN'T DIAGNOSE | Respirology | 06-1999
Actually, the specificity of a positive D-Dimer test is poor. Since lots of things can cause a positive test, such as recent surgery or inflammation for any reason e.g. infection, ...

WHO'S AT RISK FOR OSTEOPOROSIS? | Rheumatology | 06-1999
Growing awareness of the impact of osteoporosis, and the availability of new treatments to prevent fractures, have highlighted the importance of diagnosis. Right now, dual x-ray absorptiometry DXA is still ...

FLU SHOTS VS POSSIBLE RA FLARE-UPS | Rheumatology | 03-1999
The concern raised is reasonable that is, could the administration of flu vaccine trigger a flare-up of this patient's arthritis Conversely, you also have to consider whether a patient under ...

UPDATE ON METHOTREXATE GUIDELINES | Rheumatology | 06-1998
The American College of Rheumatology has issued guidelines for monitoring methotrexate therapy in rheumatoid arthritis Arthritis Rheum 1996 39 723-33 . The guidelines include getting baseline CBC, chest x-ray, liver ...

HIGH URIC ACID: DOES HE NEED ALLOPURINOL? | Rheumatology | 04-1997
An elevated serum uric acid is not in itself an indication for treatment with allopurinol. The specific indications include the following recurrent attacks of gouty arthritis more than three per ...

FOOT PAIN IN CHILD CALLS FOR TESTS | Pediatrics | 02-1997
An elevated erythrocyte sedimentation rate ESR is a very non- specific laboratory finding. It often produces more unnecessary parental anxiety than useful information. In this case, the combination of foot ...

RA AND ANTIBIOTICS: DO THEY HELP? | Rheumatology | 01-1997
The role of antibiotics in RA has been examined in a number of large scale randomized controlled trials and most recently the minocycoline trials in the United States. While there ...

DATA DISPROVES VASECTOMY HEALTH RISKS | Urology | 01-1997
Adverse consequences, like increased risk for coronary heart disease, arthritis and impotence, have all been disproved. About four to five percent of patients report lingering discomfort from increased fluid pressure ...

NO STOUT WITH GOUT | Rheumatology | 06-1995
There are no specific dietary restrictions that reduce the risk of a gouty attack. Although alcohol has been suggested as a potential precipitant of gouty arthritis, it is more likely ...

METHOTREXATE AND BLEEDING ULCER | Rheumatology | 04-1995
Methotrexate is an effective anti-inflammatory that has been used in treating a variety of chronic inflammatory arthrites, whether they are the result of rheumatoid or seronegative disorders. It certainly has ...

NSAIDS DURING PREGNANCY: ARE THEY SAFE? | Rheumatology | 04-1995
NSAIDs are generally safe to use during the first two trimesters of pregnancy. They are discontinued at around 32 to 34 weeks to minimize the risk of complications in case ...



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