Rheumatic Disease : Article and Solution

FDA has asked that a boxed warning be added to the prescribing information for fluoroquinolone antibiotics. The warning will remind healthcare professionals that patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). (more…)

Howard A. Bird, Professor of Pharmacological Rheumatology University of Leeds, United Kingdom

ABSTRACT:
Since there is no diagnostic test for fibromyalgia, the diagnosis is essentially one of exclusion. The pitfall in primary care is to miss a more serious treatable diagnosis that has mimicked fibromyalgia. A careful history and examination, checking this against existing diagnostic criteria for fibromyalgia, is therefore important. However, the behaviour of pressure points can be fluctuant so in cases of doubt careful investigation may also be necessary. (more…)

Kiran Veerapen Faculty of Medicine, University of Victoria Canada

This discussion will deal with two aspects of Fibromyalgia: (1) The doctor patient relationship, (2) Recovery from Fibromyalgia
The doctor patient relationship
The doctor’s relationship to his patient is largely informed by his perception of the patient’s credibility, his understanding of the illness and his ability to effect improvement. The patient’s response to her doctor is based on her confidence in his competence and the empathy she perceives. In chronic inflammatory illness, diagnosis is based on objective findings and in the presence of such evidence of disease the patient’s suffering is validated and considered real, facilitating the doctor patient relationship.
In chronic pain disorders such as Fibromyalgia, which lack objective findings, the diagnosis may be problematic and the ability to treat or intervene limited and unpredictable. The doctor’s appreciation of the patients suffering is compromised by the subjectivity of the symptoms. All these factors undermine the development of a positive relationship and feed the doctor’s reluctance to being involved with the inevitable long term care of such patients. From the patients perspective a good relationship with her physician is implic

Septic arthritis is a rheumatologic emergency condition. Delayed in diagnosis and treatment can result in joint damage and deformity, the presence of osteomyelitis or even death. It is most often a consequence of systemic bacteremia. Penetrating trauma, intra-articular procedures (arthrocenthesis, intraarticular injection or arthroscopic procedures) can cause septic arthritis in minority of the cases.
The prevalence and incidence of septic arthritis depend on the criteria for the diagnosis and the type of population studied. However, the incidence of septic arthritis in tertiary care medical center is increasing. This is due to increasing age of the population (with co-morbid medical conditions), use of corticosteroid and immunosuppressive drugs, and the increase in incidence of human immunodeficiency virus (HIV) infection. Pre-existing joint condition, particularly rheumatoid arthritis, is the most common risk factor for septic arthritis. (more…)

The consequences of septic arthritis include joint destruction in some cases and death in others. As such, septic arthritis may be regarded as a medical and surgical emergency. In the era of joint replacement surgery, septic arthritis now takes on a new dimension to include acute infections of joint prostheses. Both the management and outcome of prosthetic infections are complex. Recognition of risk factors is important to maximize the potential for normal joints to resist infection. Systemic and local factors combine to impair the host’s ability to respond to infection. The rise of intravenous drug use and immunosuppression may account for a variety of less common infections. Investigations are becoming more sophisticated with better anatomic and functional imaging. Identifying microbiologic agents may also be enhanced through the use of molecular analyses. Typing of specific organisms has allowed the tracing of bacterial sources and the mechanisms of recurrent or regional spikes in infection.

Management of infections is through the combination of aggressive joint lavage or debridement in conjunction with appropriate antibiotic therapy. The commonest organisms are staphylococcal but resistant organisms are being seen more commonly.
Prosthetic joint infection is a devastating clinical problem and management of this in the acute setting remains controversial. The principle of management, however, remains similar to native joint infection which is to identify the organism, debride the infected tissue aggressively and provide appropriate and adequate quantities of antibiotic therapy. In some cases joint excision is also required. Our experience with salvage of infected prostheses will be presented.
(Professor Peter F.M. Choong Professor and Director of Orthopaedics St. Vincent’s Hospital Melbourne, Department of Surgery University of Melbourne, Victoria, Australia)