Odontoid erosions in rheumatoid arthritis: utility of the open mouth view.

To determine if odontoid erosions are a marker for more severe cervical spine disease in rheumatoid arthritis (RA), 25 patients with RA were enrolled and had radiographs of the cervical spine including lateral and open mouth odontoid (OMO) views. The presence of odontoid erosions and of anterior atlantoaxial subluxation (AAS) was noted. Lateral cervical spine views were available for 19 patients, 11 of whom demonstrated odontoid erosions.

Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of acute gouty arthritis.

Objective: To determine the best alternative therapy for acute gouty arthritis when nonsteroidal antiinflammatory drugs or colchicine are contraindicated.

Methods: Thirty-one patients with crystal proven gout presenting with an acute attack of < 5 days' duration were treated prospectively with either a single intramuscular injection of adrenocorticotropic hormone (ACTH) 40 IU or triamcinolone acetonide 60 mg. The patients were followed for 30 days.

Coronary artery stenosis in Reiter's syndrome: a complication of aortitis.

Seronegative spondyloarthritis may be complicated by a variety of cardiac lesions including aortitis. We describe a patient with Reiter's syndrome who presented with angina and new onset heart murmurs. Cardiac catheterization revealed myocardial ischemia and aortic insufficiency.

Rheumatic manifestations of hepatitis C infection.

With the advent of serological testing for the hepatitis C virus (HCV) clinicians can better recognize disorders associated with a subset of non-A, non-B hepatitis. As with hepatitis A and B virus infections, HCV disease may be associated with arthritis. Three patients with atypical arthritis who were subsequently discovered to have HCV infection are described.

Diabetic muscular infarction.

In the evaluation of patients with a painful atraumatic mass in an extremity, the clinician should consider a number of clinical entities: primary tumor of muscle, focal or localized nodular myositis, local muscular abscess or soft-tissue infection, osteomyelitis, and thrombophlebitis. A rare complication of diabetes, viz, diabetic muscular infarction, heretofore not reported in the rheumatic disease literature is reviewed. This entity is compared with the conditions of focal and localized nodular myositis, which are nearly as rare.

Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis.

Twenty-seven patients presenting within 5 days of the onset of crystalline proven acute gout were prospectively treated with either indomethacin 50 mg tid or triamcinolone acetonide 60 mg intramuscularly. Patients with contraindications to therapy with indomethacin received triamcinolone acetonide. They were followed for 30 days.

Images in Rheumatology: a multimedia program for medical education.

In recent years, undergraduate medical education has benefited from the use of computer-based instructional programs. However, in the case of clinical and postgraduate medical education there is a scarcity of such programs, particularly those with access to high-resolution images. Having a fundamental knowledge base of disease-associated images is crucial for the physicians during the diagnostic process.

Tryptophan-associated eosinophilic connective-tissue disease. A new clinical entity?

Seven patients who developed a syndrome of eosinophilia, connective-tissue disease, and cutaneous abnormalities while ingesting tryptophan were examined. Other clinical manifestations commonly seen were pulmonary symptoms, fever, lymphadenopathy, and the development of myopathy. Laboratory features included mild elevations of aldolase and lactate dehydrogenase levels, with essentially normal creatine kinase levels, erythrocyte sedimentation rates, and C-reactive protein levels.

Jaccoud's-type arthropathy: an association with malignancy.

We describe a patient who developed Jaccoud's type arthropathy as an initial manifestation of small cell anaplastic carcinoma of the lung. This is the first time this arthropathy has been reported as a musculoskeletal manifestation of malignancy.

Azathioprine induced hepatic veno-occlusive disease in rheumatoid arthritis.

A patient with rheumatoid arthritis developed hepatic veno-occlusive disease following the use of azathioprine. Although azathioprine induced veno-occlusive disease is suspected to occur more frequently in patients with autoimmune dysfunction, it has not previously been reported as a complication of treatment in rheumatoid arthritis. The mechanism responsible for this condition remains unknown.

Coexistence of Paget's disease and dermatomyositis.

The occurrence of Paget's disease and dermatomyositis in a single patient has not been previously reported. We present 2 patients with this combination of disorders and consider why these diseases might coexist.

Iliofemoral thrombophlebitis presenting as an acute abdomen: report and literature review.

Iliofemoral thrombophlebitis characteristically presents as acute inflammation and swelling of the affected extremity. We report a patient in whom the presenting complaints of high fever, nausea and left lower quadrant pain mimicked an acute abdomen. The diagnosis was confirmed by venogram after gallium scan and computer tomographic scan revealed abnormalities consistent with iliofemoral thrombophlebitis.

Is atherosclerosis a complication of long-term corticosteroid treatment?

In clinical practice, arteriosclerotic heart disease has not been recognized as a complication of long-term corticosteroid treatment. Yet, an increasing body of evidence suggests that prolonged corticosteroid therapy accelerates the development of atherosclerosis. An important element in this process may be the fact that corticosteroids induce or exacerbate several known coronary risk factors, including hypertension, hypercholesterolemia, hypertriglyceridemia, and impairment of glucose tolerance.

C-reactive protein: a marker for disease activity in ankylosing spondylitis and Reiter's syndrome.

Forty-four patients, 22 with ankylosing spondylitis (AS) and 22 with Reiter's syndrome (RS) were studied to determine the reliability of C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) as indicators of disease activity. CRP levels were significantly elevated in patients with active disease for both AS and RS while ESR values for active and inactive disease were not statistically different. Misdiagnosis was more likely when ESR rather than CRP was used as the variable for activity.

Fistulous rheumatism.

Fistulous rheumatism is an unusual complication of rheumatoid arthritis. We have reported the first case of fistulous rheumatism to involve a major joint and have reviewed the literature on this subject.