Efficient pair, hydroxychloroquine monotherapy for tattoo-associated sarcoidosis.

Sarcoidosis is a systemic granulomatous disease which may affect the skin in about one-third of patients. It is characterised by the histopathological finding of non-caseating granulomas. There is a predilection for cutaneous sarcoidosis towards prior trauma sites.

Pseudogout in Primary Care Practice: An Approach to Diagnosis and Treatment.

Pseudogout refers to an autoinflammatory arthritis associated with the appearance of calcium pyrophosphate dihydrate crystals in the joint fluid. In acute pseudogout attacks patients typically endorse rapid onset of pain and swelling, at times following mechanical trauma to the joint. Physical exam reveals warmth, swelling with effusion, tenderness, and limited range of motion of the involved joint(s) which can mimic gout flares and an overlying soft tissue infection so maintaining a broad differential is important in the workup of pseudogout attacks.

Gout: A Rapid Review of Presentation, Diagnosis and Management.

Gout is inflammatory arthritis caused by monosodium urate crystal deposition in articular and non-articular structures. Acute gout flares are often monoarticular/polyarticular involving lower extremity joints characteristically involving 1st metatarsophalangeal joint. However, gout flares can also be polyarticular, involving upper extremity joints, especially in patients with multiple comorbidities and contraindications to urate-lowering therapies (ULT).

Crowned Dens Syndrome: A Challenging Diagnosis in Older Adults Presenting With Acute Neck Pain.

Crowned dens syndrome (CDS) is a rare syndrome of calcium pyrophosphate dihydrate (CPPD) deposition on the odontoid process of the second cervical vertebra leading to unique clinical presentation and radiographical findings. Symptoms usually overlap with more common etiologies, including meningitis, stroke, and giant cell arteritis. Thus, patients struggle with extensive evaluation before diagnosing this uncommon condition.

Delayed Diagnosis of West Nile Meningoencephalitis in a Patient Receiving Rituximab for Rheumatoid Arthritis.

West Nile virus (WNV) neuroinvasive disease is associated with substantial morbidity and mortality. Clinical suspicion is usually confirmed with cerebrospinal (CSF) immunoglobulin M (IgM) detection using enzyme-linked immunoassay (ELISA) techniques. CSF polymerase chain reaction (PCR) is rarely used to confirm the disease and is not widely available.

Methotrexate Hepatotoxicity Monitoring Guidelines in Psoriasis and Rheumatoid Arthritis: Is There a Consensus?

Methotrexate therapy has evolved over the years to become a fundamental component in the management of rheumatoid arthritis and psoriasis. Liver toxicity remains an ever-present concern when prescribing methotrexate. As such, methotrexate liver toxicity monitoring guidelines have been developed independently by rheumatologists and dermatologists.

Statin Associated Muscle Adverse Effects: From Presentation to Management.

Statins inhibit β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase, an enzyme involved in cholesterol synthesis, and are widely used for primary and secondary prevention of cardiovascular events. They are generally well tolerated but may cause muscle symptoms ranging from myalgias, myopathy, myositis to rhabdomyolysis. More recently, studies have reported autoimmune necrotizing myopathy associated with statin use, characterized by progressive symmetric weakness even after discontinuation of statins, often warranting immunosuppressive treatment.

Aspirin in Primary and Secondary Prevention of Cardiovascular Disease.

Aspirin is one of the most widely used drugs for the treatment of cardiovascular disease. While its use in patients with known cardiovascular disease has been supported with trials which have included mortality benefit, the utility of aspirin therapy in patients without established cardiovascular disease has been less clear. Early trials appeared to demonstrate benefit with the use of aspirin, but trials after 2000 did not consistently substantiate using aspirin for primary prevention of cardiovascular disease.

Meningeal rheumatoid nodules in a 55-year-old man presenting with chronic headaches and oculomotor nerve palsy: an uncommon extra-articular manifestation of rheumatoid arthritis.

Rheumatoid arthritis (RA) is a multisystem inflammatory disease which can involve many organ systems including the central nervous system (CNS). Though not very common, the results can be severely debilitating. The spectrum of the CNS involvement includes meningitis, encephalitis and occasionally rheumatoid nodules.

Promoting scholarship in a community-based internal medicine residency.

The University of South Dakota Sanford School of Medicine Internal Medicine residency implemented a program to enhance scholarship among residents. This residency is part of a small Mid-Western community-based school. : A Director of Research was hired and developed a structured approach consisting of: 1.

Point-Counterpoint: SLCO1B1 Genotyping for Statins.

There is a great deal of interest in understanding genes that predict drug response. In January, began publishing a series of monthly articles dedicated to reviewing the pros and cons of gene-based drug dosing. The first article in this series was a point-counterpoint argument by local content experts exploring the utility of CYP2C19 (cytochrome P450 gene, subfamily 2C19) genotyping for patients taking clopidogrel.

Polymyalgia Rheumatica and Giant Cell Arteritis: A Review Article.

Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) are two rheumatological conditions with significant overlap that typically affect the older white population. PMR is the most common inflammatory rheumatic disease of the elderly and shares many pathogenetic and epidemiological features with GCA. Diagnosis is made primarily on clinical grounds with supporting laboratory evidence.