Reviews & Analysis

Although arthroscopic removal is the usual treatment for intra-articular tophi, surgery is not always an option. This Case Study demonstrates that continuous urate-lowering therapy is a suitable alternative: in a 67-year-old man, painful locking of the knee secondary to intra-articular tophi was alleviated following continuous allopurinol therapy. Resolution of the tophi was demonstrated by CT.

This Case Study describes a 13-year-old girl with systemic juvenile idiopathic arthritis who developed features consistent with macrophage activation syndrome. The patient's disease remained active following treatment with high-dose steroids, immunoglobulin and ciclosporin, but was successfully controlled following the introduction of anakinra.

This Case Study illustrates the differential diagnosis and management of nephrogenic systemic fibrosis, a progressively debilitating fibrosing disorder. The authors describe the case of a 60-year-old woman with chronic renal disease who presented with progressive stiffness in her arms and legs following exposure to gadolinium-containing contrast media.

In this Case Study, Drs Flossmann and Jayne describe the treatment of a patient with refractory Wegener's granulomatosis and discuss the challenges associated with managing this disorder.

Drs Asherson, Giampaolo and Strimling describe a middle-aged patient with total alopecia, muscular spasms, diarrhea and gastric ulceration. She is only the fifth reported case of adult-onset Satoyoshi syndrome (usual age of onset is 5–19 years), and the first person reported to have a combination of Satoyoshi syndrome, gastric ulceration, and eosinophilic enteritis.

Optic neuritis and myelitis can occur as manifestations of idiopathic demyelinating syndromes, as well as of systemic rheumatic syndromes. In this Case Study, Drs Birnbaum and Kerr present a patient with systemic lupus erythematosus and concomitant neuromyelitis optica (also known as Devic's syndrome), and discuss the distinguishing clinical and radiographic features critical for an accurate diagnosis.

Undifferentiated connective tissue disease is characterized by a mild clinical picture, with a low level of disease activity during the entire disease course, and by the absence of manifestations specific to any major connective tissue disease. In this Case Study, Drs Mosca, Tani and Bombardieri present a case of stable undifferentiated connective tissue disease and argue that this condition might constitute a distinct clinical entity.

Palmar fasciitis and polyarthritis syndrome can mimic other rheumatic conditions, and the underlying mechanism for its development has not yet been defined. This syndrome is an uncommon paraneoplastic presentation. In this Case Study, Dr Haroon and Dr Phelan discuss a patient diagnosed with palmar fasciitis and polyarthritis syndrome associated with pancreatic carcinoma.

This Case Study discusses the diagnostic and management challenges associated with the rare conversion of discoid lupus to antiphospholipid syndrome and systemic lupus erythematosus in a male patient in his 60s. This conversion resulted in dual pathology that primarily affected the patient's cerebral and renal vasculature.

This Case Study describes a rehabilitation program for an athletic man who sustained an injury that caused knee joint effusion. The torque and muscle size of the injured leg was comparable to that of the patient's contralateral, healthy, leg after 11 weeks of a regimen incorporating repetition of knee aspiration and resistance training.

Pulmonary arterial hypertension (PAH) contributes significantly to the morbidity and mortality of patients with systemic sclerosis. Clinical symptoms of PAH are unspecific and are late manifestations of disease. This Case Study highlights the challenges of diagnosing PAH in patients with systemic sclerosis and includes discussion of screening options.

Erdheim–Chester disease is a rare form of non-Langerhans cell histiocytosis characterized by foamy histiocyte infiltration of the skeleton and viscera. A case of Erdheim–Chester disease that was initially mistaken for Ormond's disease is presented with a discussion of the tests required to differentiate between the two diagnoses.