Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, and sleep abnormalities. Individuals with fibromyalgia often have comorbid anxiety, depression, and/or other pain syndromes. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Sensitive and appropriate methods of diagnosis and an integrated treatment plan including proper patient education, aerobic exercise, and cognitive-behavioral therapy have been shown to be effective in alleviating fibromyalgic symptoms.
An acute arthritis may accompany the onset of cancer. A case of metastatic adenocarcinoma of the synovium presenting as an acute arthritis is described. The diagnostic importance of a careful synovial fluid analysis and the use of closed synovial biopsy are emphasized.
Abstract The number of professional education programs in rheumatology is increasing at a rapid rate. All efforts to establish such programs should include a formal evaluation plan to assess their value. Clear definitions of program objectives and an understanding of the concepts of education program evaluation should be the basis of planning. We have developed an evaluation approach that focuses on education impact as the key measure of program benefits. Impact is measured in three critical areas: knowledge, clinical performance, and professional behavior. The tools used in this approach include two questionnaires and a trained patient. Educators may use these measures together to generate an overall estimate of education benefits, or they can use them separately to evaluate specific program objectives. This theory‐based strategy can serve as a general model for approaching the evaluation of professional education programs in rheumatology.
Persistent medical symptoms following COVID-19 infection may be related to chronic organ damage or dysfunction, primarily documented in the lungs, heart, and brain. This is more common in patients with severe COVID and who were treated in intensive care units. The atypical acute respiratory distress syndrome (ARDS) of COVID may lead to chronic pulmonary vascular disease and fibrosis. Myocarditis and cardiomyopathy may result in chronic cardiac disorders. Neurologic symptoms, including loss of taste and smell as well as mental and cognitive dysfunction, are common during acute COVID infection but may persist for months. In addition, 5%–10% of patients, including many with mild or moderate infection, report multiple unrelated symptoms lasting for months. These patients have been termed “long-haulers” or long-COVID syndrome and no significant laboratory or pathologic findings have been identified. The symptoms and clinical course are similar to chronic fatigue syndrome/benign myalgic encephalomyelitis and post-viral syndrome. In the general population, mental health issues have increased significantly, including depression and post-traumatic stress disorder (PTSD) and sleep disturbances.
Patients with elderly-onset rheumatoid arthritis (EORA) may represent a clinical subset of individuals who differ prognostically and therapeutically from patients with younger-onset disease (YORA). In order to test this hypothesis, we reviewed the records of 212 patients with rheumatoid arthritis and grouped them according to age at onset above or below 60 years old. Seventy-eight EORA patients and 134 YORA patients with disease duration of less than or equal to 10 years were used for a comparison of presenting features and disease outcome. Abrupt onset occurred somewhat more frequently in EORA, but was not associated with a significantly different clinical course than was an insidious presentation in this older group. There were no differences between the EORA and YORA groups in terms of mean initial joint score, although the scores for the YORA group had wider variation. An initial clinical presentation resembling polymyalgia rheumatica (PMR) was 4 times as frequent in EORA. Elderly patients were less likely to have subcutaneous nodules or rheumatoid factor at disease onset. At the final examination, the EORA patients had lower joint scores and higher health assessments despite similar courses of treatment. These outcome differences persisted when patients with PMR-like presentations were excluded. Multivariate analyses indicated that joint scores and disease duration made important contributions to a better outcome of EORA, whereas PMR presentation and abrupt onset did not. After an adjustment was made for these 4 features, age at onset was an important contribution to joint score outcome. These results confirm the existence of important differences in onset, clinical features, and prognosis between patients with EORA and those with YORA.
Fibromyalgia and chronic fatigue syndrome have similar clinical and demographic features. We found that most patients with chronic fatigue syndrome have a tender point examination similar to patients with fibromyalgia. Similar pathophysiologic mechanisms are also being explored in each syndrome, including a potential role for viral induced immune dysfunction.
A CLINICAL, roentgenographic, and serologic distinction between seropositive rheumatoid arthritis and the rheumatoid variants has recently gained wide acceptance.1-2Typical features that distinguish rheumatoid variants (eg, ankylosing spondylitis) from rheumatoid arthritis include, in the former, sacroiliitis, the presence of HL-A 27 (W 27), and the absence of rheumatoid factor and subcutaneous nodules. Our patient, in whom HL-A 27 was present in addition to rheumatoid factor and typical subcutaneous nodules, had classical ankylosing spondylitis associated with ulcerative colitis.
Report of a Case
A 48-year-old man had complained of back pain at 28 years of age. A diagnosis of ankylosing spondylitis was made on the basis of roentgenographic evidence. At 34 years of age, the patient contracted ulcerative colitis. During the past 12 years, the patient has had mild, symmetrical arthralgias and stiffness in his hands, knees, and feet. Ten years ago, at 38 years of age, subcutaneous nodules appeared over
