HISTORY OF PRESENT ILLNESS: This patient is a 57-year-old Cuban woman with a long history of rheumatoid arthritis. She has received methotrexate on a weekly basis as an outpatient for many years. Approximately 2 weeks ago she developed a respiratory infection for which she received antibiotics and completed that course of antibiotics. She developed some ulcerations of her mouth and was instructed to discontinue the methotrexate approximately 10 days ago. She showed some initial improvement but over the last 3 to 5 days has had malaise, a low-grade fever, and severe oral ulcerations with difficulty in swallowing although she can drink liquids with less difficulty. Patient denies any other problems at this point except for a flare of arthritis since discontinuing the methotrexate. She has rather diffuse pain involving both large and small joints. This has caused her some anxiety.…
Per PT note dated 12/23/15, the IW reported no change in symptoms. She still complains of left knee pain. On examination of the left knee, tenderness is noted. Swelling is also seen. Gait is antalgic. Plan is to continue management.…
HOSPITAL COURSE: This 57-year-old Cuban female was admitted from my office for treatment of severe stomatitis and mild volume depletion secondary to poor fluid and food intake. Initially, the possibility of erythema multiforme-like picture was raised because she did have some skin lesions. However, dermatology consultation with Dr. Kato suggested this was most likely methotrexate related. She was given intravenous leucovorin and high dose prednisone treatment. This along with her intravenous fluids stabilized her condition. At the time of discharge her oral ulcers had markedly decreased; she could sallow without difficulty and her p.o. intake was adequate.…
HISTORY OF PRESENT ILLNESS: This patient is a 57-year-old Cuban woman with a long history of rheumatoid arthritis. She has received methotrexate on a weekly basis as an outpatient for many years. Approximately 2 weeks ago she developed a respiratory infection, for which she received antibiotics, and completed that course of antibiotics. She developed some ulcerations of her mouth and was instructed to discontinue the methotrexate approximately 10 days ago. She showed some initial improvement, but over the last 3-5 days has had malaise, a low-grade fever, and severe oral ulcerations with difficulty in swallowing; although she can drink liquids with less difficulty. Patient denies any other problems at this point, except for a flare of arthritis since discontinuing the methotrexate. She has rather diffuse pain involving both large and small joints. This has caused her some anxiety.…
11/16/15 Progress note indicated that the patient has constant pain. He has burning, stabbing pain in the right lateral elbow. He has difficulty in making a full fist. It takes a long time to release with the use of hot water, if he does make a fist. The pain radiates from his shoulder down to his right thumb, index and middle fingers. Pushing, pulling, reaching and turning doorknob aggravate the pain. Pain medications…
A 4 year old boy presents to the Pediatrician’s office with pain and swelling of multiple large joints. He first developed pain over his right elbow, then right knee and both shoulders. The pain progressed, became associated with low grade fever and his mother also noticed swelling of the affected joints. By the end of day 2, the boy refused to bear weight and had to be carried to the clinic.…
* How: repetitive stress(that causes interstitial tearing, and inflammation), overuse of flexors or overload activities…
HISTORY OF PRESENT ILLINESS: The patient is a very pleasant 57 year old white female, a native of Cuba, being seen for an evaluation and treatment of sores in her mouth that she has had for the last 10-12 days. The patient has a long history of severe and debilitating rheumatoid arthritis for which she has had numerous treatments, but over the past ten years she has been treated with methotrexate quit successfully. Her dosage has varied somewhere between 20 and 25 mg per week. About the beginning of this year, her dosage was decreased from 25 mg to 20 mg, but because of a flare of the rheumatoid arthritis, it was increased to 22.5 mg per week. She has had no problems with the methotrexate as far as she knows. She also took an NSAID about a month ago that was recently discontinued because of the ulcerations in her mouth. About two weeks ago, just about the time the stomatitis began she was placed on an antibiotic for suspected upper respiratory infection. She does not remember the name of the antibiotic. Although she claims she remembers taking this type of medication in the past without any problems. She was on that medication, three pills a day for three to four days. She notes no other problems with her skin. She remembers no allergic reactions to medications. She has no previous history of fever blisters.…
Previous problems: muscle and joint pains (gout) to knees in the past relieved by Tylenol and Prednisone no stiffness, backache, redness, swelling or trauma to joints or muscles, cramping occasionally on dialysis increase fluid removal.…
PHYSICAL EXAMINATION: The patient is a well-developed, well-nourished male who appears to be in moderate distress with pain and swelling in the upper left arm. VITAL SIGNS: Blood pressure 140/90, temperature 98.3 degrees Fahrenheit, pulse 97, respiration 18.HEENT: Head normal, no lesions. Eyes, arcus senilis, both eyes. Ears, impacted cerumen, left ear. Nose, clear. Mouth, dentures fit well, no lesions. NECK: Normal range of motion in all directs. INTEGUMENTARY: Psoriatic lesion, right thigh, approximately 1 mL in diameter. CHEST: Clear breath sounds bilaterally. No rales or rhonchi noted. HEART: Normal sinus rhythm. There is a holosystolic murmur. No friction rubs noted. ABDOMEN: Normal bowl sounds. Liver, kidneys, and spleen are normal to palpitation. GENITALIA: Tests normally descended bilaterally. RECTAL: Prostate 2+ and benign. EXTREMITIES: Pain and swelling noted above…
There are over 100 different types of arthritis conditions affecting over 20 million people in the United States, of those Osteoarthritis is the most common. It affects as many pople as all other types of arthritis combined. Arthritis is the leading cause of disability among older adults. Joint diseases account for half of all chronic conditions in persons aged 65 years and over. The prevalence of Osteoarthirtis is high and will get even higher as the number of older Americans increases. Because of its prevalence it is recognized as a significant public health problem.…
Arthritis is a disease that in some way effects everyone. Whether you have arthritis or not, chances are, you know someone who does and can see the effect it has on them. There are some common misconceptions about arthritis, types of arthritis, and the causes. There are in fact some different types of the disease that most people don’t know about. Arthritis is a general term for approximately 100 diseases that produce either inflammation of connective tissues, particularly in joints, or non-inflammatory degeneration of these tissues. The word means "joint inflammation," but because other structures are also affected, the diseases are often called connective tissue diseases.…
Background: A meta-analysis indicates that the use of foot orthoses seems to improve foot disability and reduced pain related to chronic plantar fasciitis. Preliminary evidence suggests that plantar fascia thickness greater than 4mm appears related to foot disability in individuals with chronic plantar fasciitis. However, it seems contradictory that inserting more plantar thickness, via foot orthosis or taping, to the already thickened plantar fascia, may be linked to reduced pain and disability. An alternate rationale could be that wearing foot orthosis may augment the sensory perception of these individuals resulting in enhanced outcomes. Sensory perception (i.e. tactile acuity) is robustly linked with cortical processing of tactile stimuli in the primary somatosensory cortex. However, there is a paucity of research that has concurrently described the persistent pain, plantar fascia thickness, range of motion (ROM) and tactile acuity of the involved versus the uninvolved foot.…
Osteoarthritis (OA), is the most common musculoskeletal condition, is a long-term chronic disease involving depletion of cartilage over time. It is also the cause of bone rubbing on bone which causes pain, stiffness, immobility, which affects the overall quality of life. Osteoarthritis is known as “Degenerative joint disorder”. There are many factors that can cause OA: age, obesity, lack of physical activity, genetic contribution, bone density, trauma and gender. The most common group of people affected by Osteoarthritis is the elderly populations around the globe, especially in developed countries. The prevalence of OA is increasing with people…
A systematic literature search was conducted using the Cochrane library, PUBMED and EMBASE for all Randomized Control Trials (of the use of tocilizumab for Rhumatoid Arthritis treatment). Fixed effect meta-analyses were conducted to give the incidence of Adverse effects after treatment with and 8 mg/kg tocilizumab monotherapy, with controls. Pooled summary odds ratios (ORs) were calculated using the Mantel–Haenszel method.…