Rheumatology
- Sorting out aortic aneurysms: A team enterprise
Aortic aneurysms present considerable diagnostic and treatment challenges owing to their diverse causes, incomplete understanding of pathogenesis, and variations in presentation and disease course.
- Preventing herpes zoster in immunocompromised patients: Current concepts
The authors review clinical aspects of herpes zoster vaccination, including identifying at-risk patients, weighing the risks and benefits of the recombinant zoster vaccine, and using best practices for administering the vaccine.
- Pursuing the diagnosis of low back pain
The recommended conservative approach eschewing initial imaging in patients with acute or subacute low back pain is unlikely to miss a significant clinical problem in those with no “red flags,” though the evaluation should be tempered in patients with chronic low back pain.
- Simultaneous hemorrhage and venous thrombosis in a patient with systemic lupus erythematosus
After undergoing hip arthroplasty, the patient had hematoma formation in the pelvis, active bleeding from the surgical site, and a prolonged activated partial thromboplastin time. Careful evaluation led to the diagnosis of an acquired bleeding disorder.
- Corticosteroids: Giving and taking away
Two articles this month highlight opposite ends of the treatment spectrum, one on introducing adjunctive corticosteroids when treating Pneumocystis pneumonia, and the other on syndromes associated with glucocorticoid withdrawal.
Glucocorticoid-induced adrenal insufficiency and glucocorticoid withdrawal syndrome: Two sides of the same coinThis review highlights the differences between primary adrenal insufficiency, secondary adrenal insufficiency, including glucocorticoid-induced adrenal insufficiency, and glucocorticoid withdrawal syndrome.
- A tale of scale: Corticosteroids and pustular psoriasis
Guidelines and textbooks have recommended caution when using and withdrawing corticosteroids in patients with psoriasis, yet strong evidence that defines this association is hard to come by.
- Steroid use triggers severe psoriatic reaction
After tapering prednisone, the patient developed a circular plaque bordered with pustules superimposed on erythematous skin.
- Why I, as a rheumatologist, am happy to make the diagnosis of obstructive sleep apnea
Why should a rheumatologist have special interest in this disorder? The answer lies in 2 major reasons patients are referred for a rheumatology consultation: fatigue and inflammation.
- Stiff hands in a man with type 1 diabetes
The patient had been on injectable insulin for the past 6 years, with frequent dose titrations because of poor control. A recent hemoglobin A1c was 7.2%.