Disease modifying anti-rheumatic agents are the cornerstone in management of Rheumatoid Arthritis and when used correctly they are life-saving. As the number of the agents increases, detailed guidelines become more an...Disease modifying anti-rheumatic agents are the cornerstone in management of Rheumatoid Arthritis and when used correctly they are life-saving. As the number of the agents increases, detailed guidelines become more and more important for clinicians to set safe and effective regimens. Herein, we combined the EULAR and ACR recommendations for clinicians and also pointed some important facts peculiar to our country.展开更多
BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multi-system fibroinflammatory disorder that can involve any organ,including the salivary glands,pancreas,and biliary tree.Treatment of immunoglobulin G4-relat...BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multi-system fibroinflammatory disorder that can involve any organ,including the salivary glands,pancreas,and biliary tree.Treatment of immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)is similar to that for IgG4-RD,but progression is irreversible in some cases.We present a case of IgG4-SC in which an immuno-suppressant induced marked clinical and radiologic improvement.CASE SUMMARY A 63-year-old male presented with a prominent itching sensation and wholebody jaundice.He showed obstructive-pattern jaundice,an elevated IgG4 level,and infiltration of a large number of IgG4-positive cells in the ampulla of Vater.The imaging findings of intrahepatic duct(IHD)and common bile duct dilation,an elevated serum IgG4 level,and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria.We planned to treat the patient with high-dose glucocorticoid(GC),followed by cyclophosphamide pulse therapy.After treatment with high-dose GC and an immunosuppressant,imaging studies showed that IHD dilatation had completely resolved.CONCLUSION Prompt diagnosis and appropriate treatment of IgG4-SC are important.Because there is a risk of relapse of IgG4-SC,the GC dose should be gradually reduced,and a maintenance immunosuppressant should be given.展开更多
The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (E...The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (EM) program at Downstate Medical Center/Kings County Hospital (postgraduate years 1 - 4) participated in a didactic lecture series during the first two months of the 2013 academic year. Two fifteen-minute lectures with a question and answer session were designed to focus on radiation risk, American College of Radiology (ACR) appropriateness criteria and the department of radiology’s policies. A short survey questionnaire that included questions on ACR appropriateness criteria, radiology experiences and opinions/attitudes regarding radiology was distributed and analyzed before and after the didactic series. The average score for the knowledge-based technical questions on ACR appropriateness criteria was 60.5% initially and 76.4% post-lecture with an overall improvement of 25%, which was statistically significant (p < 0.0001). Following a short didactic lecture series, EM residents showed significant improvement of their knowledge of appropriate image utilization on the post-lecture survey. This highlights the need for dedicated radiology-led lecture series for EM residents. This type of program could be implemented yearly and expanded to other departments to promote interdepartmental commuication, increases radiology awareness, improves ordering practices and encourages appropriate imaging utilization.展开更多
Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the diseas...Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.展开更多
Background: Rhupus is the rare association of two autoimmune diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) diagnosed according to validated ACR criteria. We present the first series of rhu...Background: Rhupus is the rare association of two autoimmune diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) diagnosed according to validated ACR criteria. We present the first series of rhupus in Niger. Observation 1: This is a patient suffering from chronic polyarthritis in whom the diagnosis of active seropositive, erosive and deforming RA had been made according to the 1987 ACR criteria and SLE on the presence of 4 criteria according to the 1997 ARA criteria and putting under conventional synthetic DMARDs. The outcome was favorable with a remission achieved after 8 weeks with a disease activity score (DAS) 28 at 2.2. Observation 2: 58-year-old patient with known diabetes type 2 in whom the diagnosis of rhupus was made according to the ACR/EULAR 2010 criteria for RA with a DAS28 of 3.6 and the 2019 LES criteria at 18 points with a SLEDAI score of 6. The evolution was marked by the occurrence of a myocardial infarction with a favorable outcome under medical management. Conclusion: Rhupus is a rare entity that can be complicated by cardiovascular events with the presence of an independent cardiovascular risk factor.展开更多
To determine which patients with Early Inflammatory Polyarthritis (EIP) with less than a year of evolution of the disease without a definitive diagnosis, progressed to rheumatoid arthritis according to ACR1987 criteri...To determine which patients with Early Inflammatory Polyarthritis (EIP) with less than a year of evolution of the disease without a definitive diagnosis, progressed to rheumatoid arthritis according to ACR1987 criteria, we developed a predictive model for classification of early rheumatoid arthritis, based on clinical characteristics by observation of theonset of the disease and to relate with certain laboratory variables. A total of 54 patients with arthritis of less than one year of evolution were evaluated. We conducted a physical examination and the following parameters were determined: DAS 28, HAQ, Rheumatoid Factor (RF), Citrullinated Peptide (anti-CCP) and C-Telopeptide (CTx-II);radiology of hands and feet was also carried out, and was assessed by the Sharp method modified by van der Heijde. The patient follow-up was performed every 3 months for 12 months, classifying them according to the development of self-limiting, persistent non-erosive, and persistent erosive arthritis, and according to definite diagnosis. We estimated the relative risk and 95% confidence intervals for the predictor variables considered. Overall, 80.4% of patients with EIP evolved to persistent arthritis. Most persistent arthritis was diagnosed as rheumatoid arthritis (67.4%). However 51.6% (16/31) were anti-CCP positive, 21/31 (67.7%) were RF, and 11/31 (35%) were CTx-II positive. The basal nodes and RF were able to predict the persistence of activity and symmetry;rheumatoid nodules predict the development of erosions. It is important to note that patients who had an high initial average by the Sharp method modified by van der Heijde tend to have a greater increase in erosion at 6 months compared to those who had an initial low average (Pearson correlation coefficient 0.40, p < 0.015). An initial erosive disease increases the risk of radiological progression.展开更多
文摘Disease modifying anti-rheumatic agents are the cornerstone in management of Rheumatoid Arthritis and when used correctly they are life-saving. As the number of the agents increases, detailed guidelines become more and more important for clinicians to set safe and effective regimens. Herein, we combined the EULAR and ACR recommendations for clinicians and also pointed some important facts peculiar to our country.
文摘BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multi-system fibroinflammatory disorder that can involve any organ,including the salivary glands,pancreas,and biliary tree.Treatment of immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)is similar to that for IgG4-RD,but progression is irreversible in some cases.We present a case of IgG4-SC in which an immuno-suppressant induced marked clinical and radiologic improvement.CASE SUMMARY A 63-year-old male presented with a prominent itching sensation and wholebody jaundice.He showed obstructive-pattern jaundice,an elevated IgG4 level,and infiltration of a large number of IgG4-positive cells in the ampulla of Vater.The imaging findings of intrahepatic duct(IHD)and common bile duct dilation,an elevated serum IgG4 level,and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria.We planned to treat the patient with high-dose glucocorticoid(GC),followed by cyclophosphamide pulse therapy.After treatment with high-dose GC and an immunosuppressant,imaging studies showed that IHD dilatation had completely resolved.CONCLUSION Prompt diagnosis and appropriate treatment of IgG4-SC are important.Because there is a risk of relapse of IgG4-SC,the GC dose should be gradually reduced,and a maintenance immunosuppressant should be given.
文摘The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (EM) program at Downstate Medical Center/Kings County Hospital (postgraduate years 1 - 4) participated in a didactic lecture series during the first two months of the 2013 academic year. Two fifteen-minute lectures with a question and answer session were designed to focus on radiation risk, American College of Radiology (ACR) appropriateness criteria and the department of radiology’s policies. A short survey questionnaire that included questions on ACR appropriateness criteria, radiology experiences and opinions/attitudes regarding radiology was distributed and analyzed before and after the didactic series. The average score for the knowledge-based technical questions on ACR appropriateness criteria was 60.5% initially and 76.4% post-lecture with an overall improvement of 25%, which was statistically significant (p < 0.0001). Following a short didactic lecture series, EM residents showed significant improvement of their knowledge of appropriate image utilization on the post-lecture survey. This highlights the need for dedicated radiology-led lecture series for EM residents. This type of program could be implemented yearly and expanded to other departments to promote interdepartmental commuication, increases radiology awareness, improves ordering practices and encourages appropriate imaging utilization.
文摘Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.
文摘Background: Rhupus is the rare association of two autoimmune diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) diagnosed according to validated ACR criteria. We present the first series of rhupus in Niger. Observation 1: This is a patient suffering from chronic polyarthritis in whom the diagnosis of active seropositive, erosive and deforming RA had been made according to the 1987 ACR criteria and SLE on the presence of 4 criteria according to the 1997 ARA criteria and putting under conventional synthetic DMARDs. The outcome was favorable with a remission achieved after 8 weeks with a disease activity score (DAS) 28 at 2.2. Observation 2: 58-year-old patient with known diabetes type 2 in whom the diagnosis of rhupus was made according to the ACR/EULAR 2010 criteria for RA with a DAS28 of 3.6 and the 2019 LES criteria at 18 points with a SLEDAI score of 6. The evolution was marked by the occurrence of a myocardial infarction with a favorable outcome under medical management. Conclusion: Rhupus is a rare entity that can be complicated by cardiovascular events with the presence of an independent cardiovascular risk factor.
文摘To determine which patients with Early Inflammatory Polyarthritis (EIP) with less than a year of evolution of the disease without a definitive diagnosis, progressed to rheumatoid arthritis according to ACR1987 criteria, we developed a predictive model for classification of early rheumatoid arthritis, based on clinical characteristics by observation of theonset of the disease and to relate with certain laboratory variables. A total of 54 patients with arthritis of less than one year of evolution were evaluated. We conducted a physical examination and the following parameters were determined: DAS 28, HAQ, Rheumatoid Factor (RF), Citrullinated Peptide (anti-CCP) and C-Telopeptide (CTx-II);radiology of hands and feet was also carried out, and was assessed by the Sharp method modified by van der Heijde. The patient follow-up was performed every 3 months for 12 months, classifying them according to the development of self-limiting, persistent non-erosive, and persistent erosive arthritis, and according to definite diagnosis. We estimated the relative risk and 95% confidence intervals for the predictor variables considered. Overall, 80.4% of patients with EIP evolved to persistent arthritis. Most persistent arthritis was diagnosed as rheumatoid arthritis (67.4%). However 51.6% (16/31) were anti-CCP positive, 21/31 (67.7%) were RF, and 11/31 (35%) were CTx-II positive. The basal nodes and RF were able to predict the persistence of activity and symmetry;rheumatoid nodules predict the development of erosions. It is important to note that patients who had an high initial average by the Sharp method modified by van der Heijde tend to have a greater increase in erosion at 6 months compared to those who had an initial low average (Pearson correlation coefficient 0.40, p < 0.015). An initial erosive disease increases the risk of radiological progression.
