Academic literature on the topic 'Arthromyalgia'

Introduction. Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatism types in elderly population. The link between cancer and PMR is a matter of debate.Methods. We report two cases of PMR leading to the diagnosis of lymphoma and the growing interest of PET-TDM in this indication.Results. A 84-year-old man known for idiopathic neutropenia presented an inflammatory arthromyalgia of the limb girdle since one month. Blood exams highlighted the presence of a monoclonal B cell clone. Bone marrow concluded to a B cell lymphoma of the marginal zone. He was successfully treated with 0.3 mg/kg/d of prednisone, and response was sustained after 6 months. A 73-year-old man known for prostatic neoplasia in remission for 5 years presented arthromyalgia of the limb girdle since one month. PET-CT revealed bursitis of the hips and the shoulders, no prostatic cancer recurrence, and a metabolically active iliac lymphadenopathy whose pathologic exam concluded to a low grade follicular lymphoma. He was successfully treated with 0.3 mg/kg/d of prednisone.Conclusion. These observations may imply that lymphoma is sometimes already present when PMR is diagnosed and PET-CT is a useful tool in the initial assessment of PMR to avoid missing neoplasia.

A 42-year-old man, diabetic patient, after CML Ph+ diagnosis started a treatment with imatinib reaching both CHR and CCyR within 6 months. Because of two episodes of vitreous haemorrhage the treatment was discontinued for four months with the lost of the CCyR and the maintenance of the CHR. The patient begun second line therapy with nilotinib, another TK inhibitor, recovering CCyR after 3 months and MMolR after 12 months, and keeping them up after 18 months of treatment. Nilotinib related side effects were transient rash and first degree arthromyalgia that occurred during the first month of therapy. In this case nilotinib therapy has shown to be safe and effective also for diabetic patients with intolerance to imatinib.

Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

This thesis reports on a randomised controlled trial of medical and physical therapy in the management of chronic temporomandibular joint pain and dysfunction. The literature review first explores the meaning and measurement of chronic pain. The anatomy and dynamic function of the temporomandibular joint and associated musculature is then introduced before describing the pain and dysfunction which affects this specific region. The development of terminology, classification and epidemiology is addressed to provide a basis for understanding the condition. A discussion of the presumed multifactorial aetiology and current management follows, with focus on the two areas of specific interest in this study the physical and medical therapies The study methods, results and discussion are presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. A referral cohort of 1,038 subjects were screened and assessed. 250 subjects met inclusion criteria and agreed to participate with informed consent. Subjects were randomised into four groups: medical therapy, placebo, occlusal bite guard, medical therapy and occlusal bite guard. A three month treatment phase and a six month follow-up phase were then conducted. The first section of the results examines the referral cohort. Demographic, clinical diagnostic, and psychosocial profile are reported with treatment uptake for the trial. The second section examines the three month trial phase, treatment efficacy and outcome. The analysis of subgroups is explored, including the characteristics of responders and non-responders to therapy in addition to outcome measures in subjects with initially high pain scores and high levels of depression. The final section analyses reasons for patient withdrawal and non compliance before examining the follow up phase post therapy for maintenance of improvement. Both primary and secondary outcome measures revealed significant improvement in pain amongst all four groups which was maintained during the follow-up phase.

En aquesta Tesi Doctoral he analitzat diferents manifestacions múscul-esquelètiques que sovint manifesten els pacients amb Lupus Eritematós Sistèmic, en una àrea metropolitana Mediterrània. Per una banda hem estudiat als pacients amb símptomes de dolor osteoarticular generalitzat, i per una altra banda hem estudiat als pacients amb dolor articular a mans de ritme inflamatori. Tant en un grup de pacients com en l’altre, l’exploració física no mostrava signes inflamatoris suggestius d’activitat de la malaltia lúpica. En primer lloc, l’estudi d’artromiàlgies generalitzades (compatible amb fibromiàlgia) en pacients amb Lupus Eritematós Sistèmic planteja els següents objectius: a) establir la prevalença de clínica compatible amb fibromiàlgia, i de clínica suggestiva d’ansietat i de depressió; b) establir-ne la relació entre ells; c) demostrar l’absència de relació amb l’activitat de la malaltia lúpica, i avaluar-ne la percepció de qualitat de vida i discapacitat associades. En segon lloc, l’estudi de les artràlgies inflamatòries a mans en pacients amb Lupus Eritematós Sistèmic em plantejà els objectius següents: a) establir la relació entre la presència d’artràlgies inflamatòries i la presència d’alteracions inflamatòries a nivell ecogràfic; b) descriure’n les troballes; c) demostrar-ne l’associació amb l’activitat de la malaltia lúpica, i avaluar-ne la percepció de qualitat de vida i discapacitat associades. La metodologia emprada va ser similar en ambdós treballs. A partir d’una població de pacients amb Lupus Eritematós Sistèmic, vam definir els criteris d’inclusió en funció de la simptomatologia a estudi. En tots els participants, inclosos consecutivament, se’ls va realitzar l’anamnesi i l’exploració física acurades, se’ls van realitzar qüestionaris d’activitat, qualitat de vida, discapacitat, ansietat i depressió, se’ls practicaren anàlisis rutinaris amb les principals mesures d’activitat, i se’ls van avaluar ecogràficament les articulacions de les mans (en el segon treball). Totes les dades es van registrar i analitzar posteriorment a la recollida transversal que es va fer de totes elles en un mateix temps de forma individual, al llarg dels anys 2005 a 2009. El primer treball va comparar la presència de fibromiàlgia entre pacients amb Lupus Eritematós Sistèmic, i posteriorment va analitzar les diferents associacions a estudi, i es van comparar amb els pacients que no presentaven fibromiàlgia. En el segon treball es van comparar pacients amb Lupus Eritematós Sistèmic amb artràlgies a mans amb aquells que no les presentaven. Amb tot, es van recollir dades de 84 pacients per al primer treball, i de 58 per al segon, que han estat publicades en dos articles científics de revistes de l’àrea de la Reumatologia. Les conclusions a les que he arribat són les següents: En pacients amb Lupus Eritematós Sistèmic, la prevalença de Fibromiàlgia és del 35.7%, la d’Ansietat del 35.7% i la de Depressió del 19%. S’estableix una relació entre la presència de Fibromiàlgia i la d’Ansietat i/o Depressió, sense observar relació amb una major activitat de la malaltia lúpica, produint una pitjor percepció de la qualitat de vida tant en el seu domini físic com en el mental. En pacients amb Lupus Eritematós Sistèmic hem observat una relació entre la presència d’artràlgies inflamatòries i rigidesa matutina a articulacions de les mans i la presència d’alteracions ecogràfiques, fins al 71.4% d’aquests pacients, essent-ne les més freqüents: tenosinovitis de d’extensors, vessament a l’articulació ràdio-carpiana, senyal Doppler positiva, sinovitis a l’articulació ràdio-carpiana, vessament a articulacions metacarp-falàngiques, vessament a articulacions interfalàngiques proximals, tenosinovitis de flexors. Aquestes alteracions s’associen a la presència de major activitat lúpica, produint una pitjor percepció de la qualitat de vida en el seu domini físic, però no en el mental, i produint una tendència a presentar major discapacitat.
This Doctoral Thesis I have completed, I assessed several musculoskeletal manifestations that patients with Systemic Lupus Erythematosus patients from a metropolitan and Mediterranean region often complain. I studied two kind of patients, those with widespread musculoskeletal pain and those with hand and wrist inflammatory arthralgia. Both types of patients did not show inflammatory signs at physical exam. In the study of patients with widespread pain (fibromyalgia-like symptoms) I aimed the following objectives: to establish fibromyalgia, anxiety and depression prevalence; to assess the relationship between them; to demonstrate the absence of lupus activity in these patients and to assess the associated quality of life and disability. In the study of the inflammatory hand and wrist arthralgia I aimed the following objectives: to establish its relationship with the presence of ultrasound abnormalities; to describe these abnormalities; to demonstrate its association to lupus activity, and to assess the associated quality of life and disability. The methodology used was similar in both projects. I studied a well defined and controlled Systemic Lupus Erythematosus patient’s cohort, and I defined inclusion criteria based on the symptoms aimed to evaluate. All participants were included consecutively after careful clinical interrogatory and physical exam. Patients and I fulfilled several activity, quality of life, disability, and psychiatric disorders questionnaires. They also received routine blood tests assessing main activity markers, and, in the second project, they were assessed by joint ultrasound at both hands. All data were registered and analysed after the cross-sectional intervention, through 2005-2009. The first work also compared data with lupus patients without fibromyalgia, and the second work compared data with lupus patients without hand and wrist arthralgia. A total of 84 patients were assessed in the study of widespread pain, and 58 were included in the study of hand and wrist arthralgia. Results were published in two different original articles in two scientific Rheumatology journals each. Conclusions: Patients with Systemic Lupus Erythematosus from a metropolitan and Mediterranean area showed a prevalence of 35.7% of both fibromyalgia and anxiety and 19% of depression. An association between the presence of fibromyalgia and psychiatric disorders was observed. No relationship to lupus disease activity was observed. Patients with fibromyalgia showed both mental and physical poorer quality of life. In patients with Systemic Lupus Erythematosus from a metropolitan and Mediterranean area a relationship between the presence of inflammatory hand and wrist arthralgia and the presence of ultrasound abnormalities was observed in up to 71.4%. The main ultrasound abnormalities observed were digital extensorum tenosynovitis, radio-carpal joint effusion, positive Doppler signal, radio-carpal joint synovitis, proximal interphalangeal joints effusion and digital flexorum tenosynovitis. These ultrasound abnormalities were associated to the presence of higher lupus activity, poorer physical quality of life (not mental) and a trend to higher disability.

Contents. Bacterial infections of the mouth. Viral infections of the mouth. Oral candidosis (candidiasis). Recurrent aphthous stomatitis (ulcers). Vesiculo-bullous lesions—intraepithelial. Vesiculo-bullous lesions—subepithelial. White patches. Pigmented lesions of the mouth. Premalignant lesions. Oral cancer. Abnormalities of the lips and tongue. Salivary gland disease—1. Salivary gland disease—2. Drug-induced lesions of the mouth. Facial pain. Oral manifestations of skin disease. Oral manifestations of gastrointestinal disease. Oral manifestations of haematological disease. Oral manifestations of endocrine disease. Oral manifestations of neurological disease. Oral manifestations of HIV infection and AIDS. Cervico-facial lymphadenopathy. An approach to oral ulcers. Temporomandibular pain—dysfunction/facial arthromyalgia.