Rheumatic Disease : Article and Solution

Julie T. Li-Yu, MD, FPCP, FPRA
University of Santo Tomas Hospital
Manila, Philippines

Musculoskeletal complaints among patients undergoing hemodialysis are commonly encountered. These appear to be major limiting factors in the quality of life in long term survivors. It might be considered a trade off for prolonged lifespan of patients kept on chronic hemodialysis that bone abnormalities are considered important in clinical management of these patients.
The variation as to the nature and type of bone disease is related to patient’s age, duration of renal disease, variation of the pathogenic processes involved, type of therapy, differences in diet, and type and duration of dialysis therapy.Abnormal metabolism or action of vitamin D is responsible for defective mineralization of bone in renal failure. (more…)

Richard Travers
Senior Rheumatologist and Head of Rheumatology Unit
Western Hospital, Footscray, Australia

This brief talk is aimed at the general physician whose opinion has been sought about a patient with joint pains. Rheumatology is a clinical specialty. There are a limited number of ways that a joint can react to noxious stimuli, and the answers to questions generated by the history and physical examination will nearly always point you in the right direction, and examples of the common entities will be given. The exceptions are those rare periodic syndromes (palindromic rheumatism and FMF, for example) where the joints and back movements may look normal at the first visit. The joints will also look normal in the common, but distressing, fibromyalgia, in some viral syndromes and in statin-related myalgia. (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…)

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)