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Swollen joint

Viviane Marie Créteur, Pierre François Durieux, Nicolas Cuylits
History A 34-year-old man without underlying medical conditions came to the emergency department for evaluation of persistent pain over the volar portion of his right fifth finger after a fall during a football match 3 days before. At physical examination, the injured finger was swollen and purple. Passive and active flexion of the proximal and distal interphalangeal joints were compromised, without interphalangeal instability. Radiography was performed in the emergency department, and the patient was released with a diagnosis of a fifth digit sprain...
November 2017: Radiology
Philip Mease, Stephen Hall, Oliver FitzGerald, Désirée van der Heijde, Joseph F Merola, Francisco Avila-Zapata, Dorota Cieślak, Daniela Graham, Cunshan Wang, Sujatha Menon, Thijs Hendrikx, Keith S Kanik
BACKGROUND: Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who previously had an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (DMARDs). METHODS: In this 12-month, double-blind, active-controlled and placebo-controlled, phase 3 trial, we randomly assigned patients in a 2:2:2:1:1 ratio to receive one of the following regimens: tofacitinib at a 5-mg dose taken orally twice daily (107 patients), tofacitinib at a 10-mg dose taken orally twice daily (104), adalimumab at a 40-mg dose administered subcutaneously once every 2 weeks (106), placebo with a blinded switch to the 5-mg tofacitinib dose at 3 months (52), or placebo with a blinded switch to the 10-mg tofacitinib dose at 3 months (53)...
October 19, 2017: New England Journal of Medicine
Marisa Christin Beck, Anne-Marie Glimm, Sarah Ohrndorf, Kirsten Minden, Ralf Trauzeddel, Stephanie Gabriele Werner, Gerd Horneff, Marina Backhaus, Gerd Rüdiger Burmester, Tilmann Kallinich, Hermann Girschick, Jens Klotsche
BACKGROUND: Valid detection of arthritis is essential in differential diagnosis of joint pain. Indocyanin green (ICG)-enhanced fluorescence optical imaging (FOI) is a new imaging method that visualizes inflammation in wrist and finger joints. Objectives of this study were to compare FOI with ultrasonography (US, by gray-scale (GS) and power Doppler (PD)) and clinical examination (CE) and to estimate the predictive power of FOI for discrimination between inflammatory and non-inflammatory juvenile joint diseases...
October 17, 2017: Arthritis Research & Therapy
Prapit Teparrukkul, Jiraphorn Nilsakul, Susanna Dunachie, Direk Limmathurotsakul
Septic arthritis is a medical emergency, and if not treated appropriately, it can be associated with high morbidity and mortality. Melioidosis, a serious infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, is highly endemic in South and Southeast Asia and northern Australia. We reviewed the medical charts of adult patients admitted with bacterial septic arthritis at Sunpasitthiprasong Hospital, Ubon Ratchathani, northeast Thailand from January 2012 to December 2014. Bacterial septic arthritis was defined as one or more hot swollen joints with isolation of a pathogenic organism from an affected joint or from blood...
October 2, 2017: American Journal of Tropical Medicine and Hygiene
Dong Jin Go, Kichul Shin, Han Joo Baek, Seong Wook Kang, Young Mo Kang, Jae Bum Jun, Yun Jong Lee, Sung Hwan Park, Yeong Wook Song
The purpose of this study is to examine the patient-reported outcomes (PRO) after discontinuing nonsteroidal anti-inflammatory drugs (NSAIDs) and clinical factors associated with a favorable outcome in patients with rheumatoid arthritis (RA) in remission or with low-disease activity (LDA). A 16-week prospective open-label trial was conducted at eight rheumatology clinics in Korea. RA patients with 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) < 3.2 who were on NSAIDs for more than a month were enrolled, and NSAIDs were discontinued...
October 8, 2017: Clinical Rheumatology
Fowzia Ibrahim, Beatriz Lorente-Cánovas, Caroline J Doré, Ailsa Bosworth, Margaret H Ma, James B Galloway, Andrew P Cope, Ira Pande, David Walker, David L Scott
Objectives: RA patients receiving TNF inhibitors (TNFi) usually maintain their initial doses. The aim of the Optimizing Treatment with Tumour Necrosis Factor Inhibitors in Rheumatoid Arthritis trial was to evaluate whether tapering TNFi doses causes loss of clinical response. Methods: We enrolled RA patients receiving etanercept or adalimumab and a DMARD with DAS28 under 3.2 for over 3 months. Initially (months 0-6) patients were randomized to control (constant TNFi) or two experimental groups (tapering TNFi by 33 or 66%)...
August 17, 2017: Rheumatology
Shafay Raheel, Eric L Matteson, Cynthia S Crowson, Elena Myasoedova
Objective: To assess trends in the occurrence of flares and remission in RA over recent decades. Methods: A retrospective medical records review of each clinical visit was performed in a population-based cohort of patients with RA (age ⩾30 years; 1987 ACR criteria met in 1988-2007) to estimate flare and remission status. RA flare was defined as any worsening of RA activity leading to an initiation, change or increase of therapy (OMERACT 9). The primary definition for remission required the absence of RA disease activity (i...
September 14, 2017: Rheumatology
Zhuochao Zhou, Chengde Yang, Junna Ye
A 56-year-old man presented with bilateral swollen knees and associated arthralgia. The right knee had been swollen for six years whilst the left knee had only been swollen for four months. His background was that he worked as a sailor and reported a history of multiple unprotected sexual encounters and had been treated intermittently in the hospitals. This article is protected by copyright. All rights reserved.
September 27, 2017: Arthritis & Rheumatology
S Chandrashekara, Masoodi Mukhtar Ahmad, Panchagnula Renuka, K R Anupama, K Renuka
OBJECTIVES: The neutrophil to lymphocyte ratio (NLR) is one of the well-recognized sensitive measures of inflammation. This cross-sectional observational study was aimed at characterizing the relationship of NLR with the inflammatory markers erythrocyte sedimentation rate (ESR), C-reative protein (CRP), Disease Activity Score of 28 joints (DAS28)-CRP(3), joint counts and quality measures of rheumatoid arthritis (RA). MATERIALS AND METHODS: Patients with RA were recruited in two phases...
September 26, 2017: International Journal of Rheumatic Diseases
Jens Olesen, Finn Elkjær Johannsen
Acute non-traumatic swelling of the knee is a common clinical challenge. The reason for the swelling has to be explored in order to give the correct treatment. This article gives an overview of possible diagnoses and suggests an algorithm for an approach to non-traumatic knee arthritis. Fundamental in the examination is a thorough patient anamnesis, which will help to differentiate between inflammatory and non-inflammatory arthritis. If there is not an obvious degenerative reason for the knee effusion, a joint aspiration followed by synovial fluid white cell count (WCC), microscopy and/or culture will add valuable information...
September 18, 2017: Ugeskrift for Laeger
Jean-Paul Muzemb Kanyik, Annibale Coi, Asgar Ali Kalla
The aim of this study was to describe the clinical features of patients with psoriatic arthritis (PsA) in a South African cohort. This is a retrospective analysis of patients contributing to development of the international classification criteria for PsA, ClASsification criteria for Psoriatic ARthritis (CASPAR). Patients were all seen at the arthritis clinics at Groote Schuur Hospital, Cape Town. Demographic, clinical, laboratory and radiographic information was collected. This study describes the relevant findings relating to the clinical profile of the patients seen at our centre as well as the effect of family history and/or dactylitis in determining the severity of psoriatic arthritis...
November 2017: Clinical Rheumatology
Cheryl Barnabe, Stacy Lockerbie, Elizabeth Erasmus, Lynden Crowshoe
OBJECTIVE: To evaluate a model of care to improve arthritis detection and treatment in an urban Aboriginal population. DESIGN: Cohort study. SETTING: The Elbow River Healing Lodge in Calgary, Alta. PARTICIPANTS: A total of 26 participants with noninflammatory arthritis and 12 with inflammatory arthritis. INTERVENTION: A monthly rheumatology clinic was embedded in the primary health care service and received referrals from primary care providers and allied health care professionals, or self-referrals...
September 2017: Canadian Family Physician Médecin de Famille Canadien
Ferdinand C Breedveld, Heather E Jones, Kim Peifer, Joan Korth-Bradley
A randomized, parallel-dose study assessed the pharmacokinetics (PK) and pharmacodynamics (PD) of etanercept in 61 patients with rheumatoid arthritis (RA) who received doses from 10 mg once-weekly to 50 mg twice-weekly for 4 weeks. Empiric application of a maximal-effect (Emax ) model to pooled steady-state concentrations (Css ) and PD markers provided half-maximal-effect concentration estimates of 567, 573, 465, 87, and 159 ng/mL for change from baseline in number of swollen joints, number of painful joints, erythrocyte sedimentation rate, interleukin-6, and matrix metalloproteinase-3, respectively...
September 11, 2017: Clinical and Translational Science
Mine Karagülle, Sinan Kardeş, Rian Dişçi, Müfit Zeki Karagülle
This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36-37 °C for 20 min except Sundays...
September 7, 2017: International Journal of Biometeorology
Shruti Dev, Sonali Perti, Mirna Garhnayak, Kalinga K Sahoo, Angurbala Dhal, Lokanath Garhnayak
BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disorder that usually affects joints and making them warm, painful, and swollen. The chief purpose of this study was to evaluate movements of mandible in geriatric patients suffering from RA with or without temporomandibular joint dysfunction. MATERIALS AND METHODS: A total of 45 people were included in this study with age of 60 years and above. Partially or completely edentulous patients were divided into experimental and control group...
September 1, 2017: Journal of Contemporary Dental Practice
Roberto Alfaro-Lara, Hector Fabricio Espinosa-Ortega, César Alejandro Arce-Salinas
OBJECTIVE: To assess the efficacy and side effects of methotrexate and leflunomide in patients with rheumatoid arthritis (RA) as the first disease-modifying antirheumatic drug (DMARD). METHODS: We performed a systematic review and meta-analysis of clinical studies that included patients who took methotrexate, leflunomide, placebo or another DMARD for RA treatment. A systematic review yielded 1971 articles from databases; once completely reviewed, 73 trials that completed inclusion criteria were selected...
August 31, 2017: Reumatología Clinica
Ricardo J O Ferreira, Maxime Dougados, John R Kirwan, Cátia Duarte, Maarten de Wit, Martin Soubrier, Bruno Fautrel, Tore K Kvien, José A P da Silva, Laure Gossec
Objectives: ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. Methods: We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ⩽1), near-remission (tender and swollen joint counts, and CRP are all ≤1 but PGA >1) and non-remission...
September 1, 2017: Rheumatology
Proton Rahman, Michel Zummer, Louis Bessette, Philip Baer, Boulos Haraoui, Andrew Chow, John Kelsall, Suneil Kapur, Emmanouil Rampakakis, Eliofotisti Psaradellis, Allen J Lehman, Francois Nantel, Brendan Osborne, Cathy Tkaczyk
OBJECTIVE: To describe the minimal disease activity (MDA) rate over time in patients with psoriatic arthritis (PsA) receiving antitumour necrosis factor agents, evaluate prognostic factors of MDA achievement and identify the most common unmet criteria among MDA achievers. DESIGN: Biologic Treatment Registry Across Canada (BioTRAC): ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis or PsA with infliximab (IFX), golimumab (GLM) or ustekinumab...
August 30, 2017: BMJ Open
Dimitrios A Pappas, Joel M Kremer, Jenny Griffith, George Reed, Bob Salim, Chitra Karki, Vishvas Garg
INTRODUCTION: Current recommendations for the management of rheumatoid arthritis (RA) focus on a treat-to-target approach with the objective of maximizing long-term health-related quality-of-life in patients with RA. Published studies from randomized clinical trials have reported limited data regarding the long-term efficacy and safety of adalimumab in patients with RA. This study aims to evaluate the long-term (10+ years) persistency and effectiveness of adalimumab in patients with RA in a real-world setting...
August 24, 2017: Rheumatology and Therapy
Jana Hurnakova, Hana Hulejova, Jakub Zavada, Petra Hanova, Martin Komarc, Herman Mann, Martin Klein, Olga Sleglova, Marta Olejarova, Sarka Forejtova, Olga Ruzickova, Jiri Vencovsky, Karel Pavelka, Ladislav Senolt
BACKGROUND: Calprotectin may be a sensitive biomarker of rheumatoid arthritis (RA) disease activity. OBJECTIVES: In the current study, we investigated whether calprotectin is a better biomarker than CRP for predicting clinical activity and ultrasound parameters in patients with RA. METHODS: A total of 160 patients with RA underwent clinical (swollen joint count-SJC, tender joint count-TJC, Disease Activity Score-DAS28, Clinical Disease Activity Index-CDAI, and simplified Disease Activity Index-SDAI) and ultrasound (German US7) examination...
2017: PloS One
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