NEJM â Collection Updates for Rheumatic Disease

IMAGES IN CLINICAL MEDICINE: Anterior Sternal Dislocation

Samer Taslaq, M.R.C.S. (Engl.) and R. Christopher Nordstrom, M.B., B.S. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

An 83-year-old man was admitted to the acute medical ward after having fallen down in his home. On admission he was confused and agitated. Physical examination revealed a swelling with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

Daniela Kroshinsky, M.D., Jonathan Kay, M.D., and Rosalynn M. Nazarian, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

A 46-year-old woman was referred to a rheumatologist at this hospital because of swelling of the legs and skin changes.

The patient had been in her usual state of health until...

IMAGES IN CLINICAL MEDICINE: Gouty Tophi

Thomas Wiesner, M.D. and Isabella Fried, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

A 77-year-old man presented with a 5-day history of painful swelling of his right elbow, which was also red, warm, and tender. When pressure was applied, a toothpastelike, white, chalky...

ORIGINAL ARTICLE: Osteoporosis Associated with Neutralizing Autoantibodies against Osteoprotegerin

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Autoantibodies against osteoprotegerin, which block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-ÎºB (RANK), were identified in a man with celiac disease who...

IMAGES IN CLINICAL MEDICINE: Pericardial Calcification Noted Long after Sydenham's Chorea

R. Arthur Bouwman, M.D., Ph.D. and Rob J.M. Strack van Schijndel, M.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

A 76-year-old native Dutch woman was admitted to our intensive care unit for hemodynamic monitoring after undergoing vulvectomy and inguinal lymph-node dissection for vulvar carcinoma. Preoperative evaluation had revealed a...

CORRESPONDENCE: Ruptured Abdominal Aortic Aneurysm Related to IgG4 Periaortitis

Qi Qian, M.D., Kianoush B. Kashani, M.D., and Dylan V. Miller, M.D. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

To the Editor: Periaortitis that is associated with immunoglobulin G4 (IgG4) plasma-cell infiltration is a rare condition with undefined incidence and clinical features. In a single-center study in Japan, the...

IMAGES IN CLINICAL MEDICINE: Baker's Cyst in a Patient with Rheumatoid Arthritis

Catherine Bakewell, M.D. and Carin Dugowson, M.D., M.P.H. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

A 45-year-old man with moderately severe erosive rheumatoid arthritis presented with a several-month history of a painful left calf. He had a 1.5-year history of rheumatoid arthritis affecting both elbows,...

ORIGINAL ARTICLE: Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture

Thu, 03Â SepÂ 2009 00:00:00 -05:00

Background: Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

Jeremy S. Abramson, M.D., Subba Digumarthy, M.D., and Judith A. Ferry, M.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

Dr. David T. Ting (Medical Oncology): A 56-year-old woman was admitted to this hospital because of fever, rash, and lymphadenopathy.

She had been well until 11 weeks earlier when, while residing...

REVIEW ARTICLE: Interleukin-17 and Type 17 Helper T Cells

Pierre Miossec, M.D., Ph.D., Thomas Korn, M.D., and Vijay K. Kuchroo, Ph.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

In 1986, Mosmann and Coffman introduced the concept of distinct types of helper T cells, which was based on the types of cytokines that T cells produce when they are...

BOOK REVIEW:

Thu, 13Â AugÂ 2009 00:00:00 -05:00

The drama of chronic disease has many actors, but the single most important one â and far too often, the silent one â is the patient. Chronic illness changes the...

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 56-year-old woman presented to the emergency room with a 4-week history of malaise. During that time, her primary physician had ordered basic laboratory studies, which were normal except for...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

John H. Stone, M.D., M.P.H., Paul A. Caruso, M.D., and Vikram Deshpande, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Dr. John H. Stone: A 26-year-old woman was seen in the rheumatology clinic of this hospital because of painful swelling on both sides of the neck.

She had been well until...

IMAGES IN CLINICAL MEDICINE: Lupus-Associated Intestinal Vasculitis

De-Feng Huang, M.D. and Wei-Sheng Chen, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

A 28-year-old woman presented, and was admitted, to our hospital with a 2-day history of periumbilical postprandial abdominal pain with nausea and vomiting; she was receiving a maintenance regimen of...

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

Fouad Fadel, M.D., Khalil El Karoui, M.D., and Bertrand Knebelmann, M.D., Ph.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

To the Editor: A 64-year-old man with a history of metastatic melanoma was admitted to our hospital for the nephrotic syndrome in 2006. In 2005, subcutaneous metastases had been diagnosed,...

EDITORIAL: Gene Therapy â Still a Work in Clinical and Regulatory Progress

Elizabeth L. Hohmann, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

In this issue of the Journal, Frank and colleagues present the case history and autopsy results of a widely publicized death in the summer of 2007 of a young woman...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

Eric G. Neilson, M.D., and Alton B. Farris, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

Dr. Anna Greka (Renal Unit): A 61-year-old woman was admitted to this hospital because of abdominal pain, weight loss, and an elevated level of serum creatinine. She had been well...

ORIGINAL ARTICLE: Investigation of the Cause of Death in a Gene-Therapy Trial

Thu, 09Â JulÂ 2009 00:00:00 -05:00

We present a case of disseminated histoplasmosis, complicated by retroperitoneal bleeding and leading to death, in a patient who was receiving systemic immunosuppressive therapy for rheumatoid arthritis and who was...

EDITORIAL: Interleukin-1Î² and the Autoinflammatory Diseases

Charles A. Dinarello, M.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

Interleukin-1 is a highly active proinflammatory cytokine that causes not only fever, anorexia, and other constitutional symptoms but also tissue damage and remodeling. All these effects â including joint destruction,...

ORIGINAL ARTICLE: An Autoinflammatory Disease Due to Homozygous Deletion of the Locus

Thu, 04Â JunÂ 2009 00:00:00 -05:00

We describe a patient with an autoinflammatory disease in which the main clinical features are pustular rash, marked osteopenia, lytic bone lesions, respiratory insufficiency, and thrombosis. Genetic studies revealed a...

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

Thu, 04Â JunÂ 2009 00:00:00 -05:00

Background: Autoinflammatory diseases manifest inflammation without evidence of infection, high-titer autoantibodies, or autoreactive T cells. We report a disorder caused by mutations of IL1RN, which encodes the interleukin-1âreceptor antagonist, with...

ORIGINAL ARTICLE: Use of Canakinumab in the Cryopyrin-Associated Periodic Syndrome

Thu, 04Â JunÂ 2009 00:00:00 -05:00

Background: The cryopyrin-associated periodic syndrome (CAPS) is a rare inherited inflammatory disease associated with overproduction of interleukin-1. Canakinumab is a human antiâinterleukin-1Î² monoclonal antibody.

Methods: We performed a three-part, 48-week, double-blind,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Dr. Katharina Busl (Neurology): A 30-year-old man was admitted to this hospital because of progressive neurologic deficits.

Approximately 1 year before this admission, he began to have intermittent headaches and the...

REVIEW ARTICLE: Scleroderma

Armando Gabrielli, M.D., Enrico V. Avvedimento, M.D., and Thomas Krieg, M.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

Scleroderma (systemic sclerosis) is a complex disease in which extensive fibrosis, vascular alterations, and autoantibodies against various cellular antigens are among the principal features (Figure 1 and Figure 2).1 There...

IMAGES IN CLINICAL MEDICINE: Familial Hypercholesterolemia

Sheng Guang Li, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

An 18-year-old woman with familial hypercholesterolemia presented with a 4-year history of swelling and pain in the joints. She was born with multiple xanthomas, which grew in size as she...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2009 â A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung

Thu, 23Â AprÂ 2009 00:00:00 -05:00

A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung.

She had rheumatoid arthritis but had otherwise been well until approximately...

CLINICAL THERAPEUTICS: Minimally Invasive Total Knee Arthroplasty for Osteoarthritis

Seth S. Leopold, M.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

A 65-year-old woman with osteoarthritis of her right knee is referred by her primary care physician for orthopedic consultation. She is healthy except for some well-controlled hypertension. She is 5...

ORIGINAL ARTICLE: Association of HTRA1 Mutations and Familial Ischemic Cerebral Small-Vessel Disease

Thu, 23Â AprÂ 2009 00:00:00 -05:00

Background: The genetic cause of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), which is characterized by ischemic, nonhypertensive, cerebral small-vessel disease with associated alopecia and spondylosis, is...

IMAGES IN CLINICAL MEDICINE: Gingival and Periungual Vasculopathy of Juvenile Dermatomyositis

Lisa G. Rider, M.D. and Jane C. Atkinson, D.D.S. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

A 16-year-old girl with long-standing juvenile dermatomyositis had an illness marked by intermittent clinical flares, including increased muscle weakness, joint contractures, photosensitive rashes, and dysphagia, despite treatment with multiple immunosuppressive...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2009 â A 37-Year-Old Woman with Vertigo, Facial Weakness, and a Generalized Seizure

Didier Cros, M.D., R. Gilberto Gonzalez, M.D., Ph.D., and Eugene J. Mark, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

Dr. Sang-Woo (Steve) Han (Neurology): A 37-year-old woman was seen in the emergency department of this hospital because of a seizure. Four months earlier, episodes of vertigo began to occur...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Dr. John H. Stone: A 47-year-old woman was seen in the Rheumatology Clinic of this hospital because of numbness and pain in the legs and a rash.

The patient had been...

IMAGES IN CLINICAL MEDICINE: Chondrocalcinosis and Hypomagnesemia

Michael H. Ellman, M.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

A 50-year-old woman presented with a several-year history of acute and chronic joint pain. Her serum magnesium level was 0.9 mg per deciliter (0.4 mmol per liter) (normal range, 1.6...

IMAGES IN CLINICAL MEDICINE: Occult Hip Fracture

Emily N. Vinson, M.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

An 87-year-old man tripped and fell; subsequently, persistent pain developed in the left hip. A radiograph of the left hip 2 weeks after the fall revealed diffuse osteopenia with no...

ORIGINAL ARTICLE: Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Current standard therapy for Wegener's granulomatosis and microscopic polyangiitis combines corticosteroids and cyclophosphamide to induce remission, followed by a less toxic immunosuppressant such as azathioprine or methotrexate for maintenance...

REVIEW ARTICLE: Temporomandibular Disorders

Thu, 18Â DecÂ 2008 00:00:00 -05:00

The temporomandibular joint (TMJ) may be affected by inflammatory, traumatic, infectious, congenital, developmental, and neoplastic diseases, as seen in other joints. However, the most common affliction of the TMJ and...

IMAGES IN CLINICAL MEDICINE: Acute Calcific Tendinitis

Jonathan D. Wiper, M.B., Ch.B. and Anselmo Garrido, M.D. — Thu, 04Â DecÂ 2008 00:00:00 -05:00

A 56-year-old woman presented to the emergency department with a 3-day history of severe pain in and loss of movement of her right index finger. She reported that for the...

IMAGES IN CLINICAL MEDICINE: Infrapatellar Bursitis

Lars Kamper, M.D. and Patrick Haage, M.D. — Thu, 27Â NovÂ 2008 00:00:00 -05:00

A 69-year-old patient presented with chronic bilateral knee pain. No recent trauma or underlying medical condition was reported. A radiograph revealed multiple bilateral calcifications ventral to the tibial plateau, projecting...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2008 â A 59-Year-Old Man with Chronic Daily Headache

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Dr. Adam B. Cohen (Neurology): A 59-year-old man was admitted to the neurology service of this hospital because of chronic daily headache, fever, and myalgia.

Approximately 6 months earlier, the patient...

IMAGES IN CLINICAL MEDICINE: Cavernous Sinus Thrombosis

Ayaz Agayev, M.D. and Sabri Yilmaz, M.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

A 34-year-old woman with a 3-year history of systemic lupus erythematosus was admitted to the hospital with sore throat and headache that had lasted for 3 weeks. She had been...

CLINICAL PRACTICE: Anterior Cruciate Ligament Tear

Kurt P. Spindler, M.D., and Rick W. Wright, M.D. — Thu, 13Â NovÂ 2008 00:00:00 -05:00

The passage in 1972 of Title IX legislation, which guarantees equal access to athletic programs for both sexes at any high school or college receiving federal funds, has led to...

IMAGES IN CLINICAL MEDICINE: Ankylosing Spondylitis

Kyung-Su Park, M.D. and Young-Seok Cho, M.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

A 40-year-old man presented with a 3-day history of increasing abdominal pain. On physical examination, rebound tenderness was present, and both hip joints were fixed in flexion state with no...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

Charles M. Wiener, M.D., Victorine V. Muse, M.D., and Eugene J. Mark, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

Dr. Andrew Tinsley (Medicine): A 63-year-old woman was admitted to this hospital because of dyspnea on exertion.

The patient had been in her usual state of health until approximately 3 weeks...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2008 â A 39-Year-Old Man with Chest Pain, Arthralgias, and a Mediastinal Mass

Thu, 09Â OctÂ 2008 00:00:00 -05:00

A 39-year-old man was admitted to this hospital because of chest pain, arthralgias, and a mediastinal mass.

Two months before admission, pain in the middle and right chest developed, which radiated...

IMAGES IN CLINICAL MEDICINE: New-Onset Clubbing Associated with Lung Cancer

Bryan A. Faller, M.D. and John P. Atkinson, M.D. — Thu, 25Â SepÂ 2008 00:00:00 -05:00

A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the...

IMAGES IN CLINICAL MEDICINE: Colonic Saccular Diverticula

Elizabeth A. Steensma, M.D. and Fred M. Wu, M.D. — Thu, 18Â SepÂ 2008 00:00:00 -05:00

A 61-year-old woman with severe pulmonary hypertension and an 8-year history of the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) and with a positive anticentromere-antibody test was...

BOOK REVIEW:

Thu, 18Â SepÂ 2008 00:00:00 -05:00

Pediatric rheumatology has a quality that sets it apart from other pediatric subspecialties. In some respects, this quality is determined by the limited number of board-certified practitioners caring for an...

EDITORIAL: Arthroscopic Surgery for Osteoarthritis of the Knee?

Robert G. Marx, M.D. — Thu, 11Â SepÂ 2008 00:00:00 -05:00

Orthopedic surgeons perform arthroscopic surgery in many joints of the extremities, most commonly the knee. Two or three incisions are routinely made, each measuring approximately 7 mm. The knee is...

ORIGINAL ARTICLE: Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Background: Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that...

ORIGINAL ARTICLE: A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Background: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.

Methods: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe...

ORIGINAL ARTICLE: Adalimumab with or without Methotrexate in Juvenile Rheumatoid Arthritis

Thu, 21Â AugÂ 2008 00:00:00 -05:00

Background: Tumor necrosis factor (TNF) has a pathogenic role in juvenile rheumatoid arthritis. We evaluated the efficacy and safety of adalimumab, a fully human monoclonal anti-TNF antibody, in children with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2008 â A 43-Year-Old Man with Fatigue and Lesions in the Pituitary and Cerebellum

John A. Mills, M.D., R. Gilberto Gonzalez, M.D., Ph.D., and Ronald Jaffe, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

Dr. Flavia V. Castelino (Rheumatology, Allergy, and Immunology): A 43-year-old man was seen in the neuro-oncology clinic of this hospital because of fatigue and lesions in the pituitary and cerebellum...

IMAGES IN CLINICAL MEDICINE: Complex Regional Pain Syndrome Type 1

Oliver Guttmann, M.B., B.S. and Victoria Wykes, M.B., B.S., Ph.D. — Thu, 31Â JulÂ 2008 00:00:00 -05:00

An otherwise healthy and functional 35-year-old man had an undisplaced fracture of the right fifth metacarpal neck after a fall. He presented 21 months later with pain, extensive swelling (Panels...

IMAGES IN CLINICAL MEDICINE: Ankylosing Spondylitis

Jon K.C. Yoong, M.R.C.P. — Thu, 24Â JulÂ 2008 00:00:00 -05:00

A 66-year-old man had progressive reduction of global spine movement for more than two decades that eventually resulted in complete spinal immobility. Extensive calcification of the intervertebral ligaments, bilateral ossification...

IMAGES IN CLINICAL MEDICINE: Systemic Sclerosis and Acral Osteolysis

Leonardo Astudillo, M.D. and Elisabeth Arlet-Suau, M.D. — Thu, 26Â JunÂ 2008 00:00:00 -05:00

A 71-year-old woman received a diagnosis of systemic sclerosis more than 30 years ago when she presented with Raynaud's phenomenon and cutaneous sclerosis. At that time she did not require...

IMAGES IN CLINICAL MEDICINE: Rupture of a Calcified Achilles' Tendon

Marius C. Wick, M.D. and Michael Rieger, M.D. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

A 69-year-old man presented at the emergency room with stabbing pain and swelling of the right lower leg on standing up from a seated position. On clinical examination, rupture of...

CLINICAL PROBLEM-SOLVING: A Joint Venture

Thu, 05Â JunÂ 2008 00:00:00 -05:00

A 59-year-old woman presented with new-onset oligoarthritis and extreme fatigue. The patient had been in her usual state of health until 6 weeks earlier, when she noted a gradual onset...

CLINICAL PRACTICE: Rotator-Cuff Failure

Frederick A. Matsen III, M.D. — Thu, 15Â MayÂ 2008 00:00:00 -05:00

A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2008 â A 46-Year-Old Man with Rheumatoid Arthritis and Lymphadenopathy

Nikhil C. Munshi, M.D., Subba Digumarthy, M.D., and Aliyah Rahemtullah, M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

Viviany Taqueti (Harvard Medical School): A 46-year-old man was seen in the hematologyâoncology clinic of a cancer center affiliated with this hospital because of anorexia and generalized lymphadenopathy.

The patient had...

EDITORIAL: Collaboration, Genetic Associations, and Lupus Erythematosus

Mary K. Crow, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

Systemic lupus erythematosus (SLE), a disease that preferentially targets women during the reproductive years, is considered by many clinicians and investigators to be the prototypic autoimmune disease. Among clinicians, this...

REVIEW ARTICLE: Systemic Lupus Erythematosus

Anisur Rahman, Ph.D., and David A. Isenberg, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

To the clinician, systemic lupus erythematosus is important because it is a potentially fatal disease that is easily confused with many other disorders. To the immunologist, lupus is intriguing because...

ORIGINAL ARTICLE: Association of Systemic Lupus Erythematosus with and

Thu, 28Â FebÂ 2008 00:00:00 -05:00

Background: Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease in which the risk of disease is influenced by complex genetic and environmental contributions. Alleles of HLA-DRB1, IRF5, and STAT4...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Dr. Nancy Cibotti-Granof (Medicine): A 46-year-old woman with end-stage renal disease was seen by a rheumatology consultant because of stiffness of her joints and skin.

The patient had been well except...

CLINICAL PRACTICE: Lumbar Spinal Stenosis

Jeffrey N. Katz, M.D., M.Sc., and Mitchel B. Harris, M.D. — Thu, 21Â FebÂ 2008 00:00:00 -05:00

A 72-year-old woman with hypertension presents with a 4-month history of lower back discomfort that radiates to both buttocks and lateral thighs. Previously, she had walked 2 miles (3.2 km)...

ORIGINAL ARTICLE: Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Background: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

Methods: Surgical candidates with a history of at...

IMAGES IN CLINICAL MEDICINE: Sarcoid Arthropathy

Avnit Ahuja, M.D. and Mythili Seetharaman, M.D. — Thu, 14Â FebÂ 2008 00:00:00 -05:00

A 43-year-old woman presented with pain, swelling, and stiffness in the hands and feet; she reported having had the symptoms for the previous 5 years. Possible rheumatoid arthritis had been...

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. He reported mild pleuritic...

IMAGES IN CLINICAL MEDICINE: Paget's Disease of the Mandible

Mayank B. Patel, M.B., M.R.C.P. and Ashok Bhalla, M.D., F.R.C.P. — Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 55-year-old man presented with a 2-year history of painful jaw enlargement and progressively ill-fitting dentures. He had no headaches or visual-field defects and did not have hyperhidrosis, oily skin,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Dr. Esperance A. Schaefer (Medicine): A 38-year-old woman was admitted to the hospital, because of blurred vision and shortness of breath, 2 weeks after a cesarean section had been performed...

ORIGINAL ARTICLE: Mutations and Hereditary Angiopathy, Nephropathy, Aneurysms, and Muscle Cramps

Thu, 27Â DecÂ 2007 00:00:00 -05:00

Background: COL4A3, COL4A4, and COL4A5 are the only collagen genes that have been implicated in inherited nephropathies in humans. However, the causative genes for a number of hereditary multicystic kidney...

IMAGES IN CLINICAL MEDICINE: Calcinosis Associated with Renal Failure

Robert A. Cohen, M.D. and Samir M. Parikh, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

A 36-year-old woman presented with painless, subcutaneous nodules that had developed during the previous 5 months on her buttocks, shoulders, and left wrist (Panel A). Her medical history was notable...

REVIEW ARTICLE: Sarcoidosis

Thu, 22Â NovÂ 2007 00:00:00 -05:00

The modern history of sarcoidosis, an enigmatic multisystem disease, goes back to 1899, when the pioneering Norwegian dermatologist Caesar Boeck coined the term to describe skin nodules characterized by compact,...

IMAGES IN CLINICAL MEDICINE: Quinolone-Associated Rupture of the Achilles' Tendon

Harsha Vyas, M.D. and Guha Krishnaswamy, M.D. — Thu, 15Â NovÂ 2007 00:00:00 -05:00

An 81-year-old woman with rheumatoid arthritis, SjÃ¶gren's syndrome, and hypertension presented with swelling and pain in the area of the left heel, which had developed suddenly a week after a...

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

Don R. Martin, M.D., D. William Schlott, M.D., and John A. Flynn, M.D., M.B.A. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier. She...

CLINICAL PRACTICE: Osteoarthritis of the Hip

Nancy E. Lane, M.D. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

A 70-year-old man reports a gradual onset of hip pain that has limited his activities for about a year. The pain initially occurred only with walking and was limited to...

EDITORIAL: Lessons from a Genomewide Association Study of Rheumatoid Arthritis

Kazuhiko Yamamoto, M.D., Ph.D., and Ryo Yamada, M.D., Ph.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

Rheumatoid arthritis is a chronic inflammatory disorder in which the articular joints are gradually destroyed. Occasionally there is systemic involvement, which can include vasculitis in various organs and pulmonary fibrosis....

ORIGINAL ARTICLE: A Polymorphism in the Promoter Region Associated with Systemic Sclerosis

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: Systemic sclerosis (scleroderma) is a life-threatening autoimmune disease that is characterized by the presence of specific autoantibodies and fibrosis of the skin and major internal organs.

Methods: We genotyped a...

ORIGINAL ARTICLE: as a Risk Locus for Rheumatoid Arthritis â A Genomewide Study

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: Rheumatoid arthritis has a complex mode of inheritance. Although HLA-DRB1 and PTPN22 are well-established susceptibility loci, other genes that confer a modest level of risk have been identified recently....

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

Chuang-Wei Chen, M.D. and Shu-Wen Jao, Ph.D. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

A 20-year-old man presented for consideration of repair of a rectal prolapse that had been present since birth. Physical examination revealed hyperelasticity of the skin (Panel A) with easy bruisability,...

ORIGINAL ARTICLE: and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus

Thu, 06Â SepÂ 2007 00:00:00 -05:00

Background: Rheumatoid arthritis is a chronic inflammatory disease with a substantial genetic component. Susceptibility to disease has been linked with a region on chromosome 2q.

Methods: We tested single-nucleotide polymorphisms (SNPs)...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

Thu, 16Â AugÂ 2007 00:00:00 -05:00

Dr. Sheila F. Mitsuma (Department of Medicine): A 60-year-old man was admitted to this hospital because of fever, odynophagia, weight loss, and rash.

He had been well until 5 months earlier,...

EDITORIAL: Prophylactic Treatment for Prevention of Joint Disease in Hemophilia â Cost versus Benefit

Goris Roosendaal, M.D., Ph.D., and Floris Lafeber, Ph.D. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

Patients with severe hemophilia number only around 400,000 worldwide, but their lifespan has increased because of improved treatment, and with that the prevalence of the disease is increasing. Despite the...

ORIGINAL ARTICLE: Prophylaxis versus Episodic Treatment to Prevent Joint Disease in Boys with Severe Hemophilia

Thu, 09Â AugÂ 2007 00:00:00 -05:00

Background: Effective ways to prevent arthropathy in severe hemophilia are unknown.

Methods: We randomly assigned young boys with severe hemophilia A to regular infusions of recombinant factor VIII (prophylaxis) or to...

IMAGES IN CLINICAL MEDICINE: Saddle Nose Deformity

Sandeep Chauhan, M.D. and Sanjay D'Cruz, M.D., D.M. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

A 44-year-old man presented with intermittent epistaxis, fever, and polyarthralgias of 2 months' duration. For the previous week, he had had puffiness of the face and reduced urinary output. On...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2007 â A 19-Year-Old College Student with Fever and Joint Pain

Benjamin T. Davis, M.D., and Mark S. Pasternack, M.D. — Thu, 21Â JunÂ 2007 00:00:00 -05:00

Dr. Maxwell T. Vergo (Department of Medicine): A 19-year-old woman was transferred to this hospital because of joint pain, fever, and hypotension.

The patient, a freshman student at a local university,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Why Does Rheumatoid Arthritis Involve the Joints?

Peter E. Lipsky, M.D. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

A long-standing question in rheumatology is why inflammatory arthritides such as rheumatoid arthritis involve the joints. Many studies have addressed this question; a recent article by Lee et al.1 provides...

EDITORIAL: Advances in the Treatment of Amyloidosis

S. Vincent Rajkumar, M.D., and Morie A. Gertz, M.D. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

All forms of amyloidosis are characterized by the deposition of extracellular fibrils in various tissues. These fibrils are the result of the misfolding of a protein from its normal Î±-helical...

ORIGINAL ARTICLE: Natural History and Outcome in Systemic AA Amyloidosis

Thu, 07Â JunÂ 2007 00:00:00 -05:00

Background: Deposition of amyloid fibrils derived from circulating acute-phase reactant serum amyloid A protein (SAA) causes systemic AA amyloidosis, a serious complication of many chronic inflammatory disorders. Little is known...

ORIGINAL ARTICLE: Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Background: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled...

ORIGINAL ARTICLE: Surgery versus Prolonged Conservative Treatment for Sciatica

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Background: Lumbar-disk surgery often is performed in patients who have sciatica that does not resolve within 6 weeks, but the optimal timing of surgery is not known.

Methods: We randomly assigned...

PERSPECTIVE: Back Surgery â Who Needs It?

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Back surgery is not the final common pathway for everyone with persistent back pain. It offers specific therapy for specific anatomical derangements associated with specific complexes of symptoms. When surgery...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2007 â A 59-Year-Old Man with Fever and Pain and Swelling of Both Eyes and the Right Ear

Thu, 10Â MayÂ 2007 00:00:00 -05:00

Dr. David T. Ting (Medicine): A 59-year-old man was admitted to this hospital because of fever as well as pain and swelling of both eyes, which was worse in the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2007 â A 59-Year-Old Man with Neck Pain, Weakness in the Arms, and Cranial-Nerve Palsies

Thu, 12Â AprÂ 2007 00:00:00 -05:00

A 59-year-old man was admitted to this hospital in late summer because of back pain, weakness in the right arm, and cranial-nerve palsies.

The patient was in his usual state of...

EDITORIAL: Modern Genetics, Ancient Defenses, and Potential Therapies

Peter K. Gregersen, M.D. — Thu, 22Â MarÂ 2007 00:00:00 -05:00

Autoimmunity is the reflection of a basic problem confronting all living organisms â how to defend against foreign invasion while maintaining control of the defending forces. The B-cell and T-cell...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2007 â A 27-Year-Old Woman with Pain and Swelling of the Legs

Jean-Michel Vallat, M.D., Didier P. Cros, M.D., and E. Tessa Hedley-Whyte, M.D. — Thu, 22Â MarÂ 2007 00:00:00 -05:00

A 27-year-old woman was seen in the neurology clinic because of pain and swelling in her feet. She had been well until approximately 5 months earlier, when swelling of her...

ORIGINAL ARTICLE: in Vitiligo-Associated Multiple Autoimmune Disease

Thu, 22Â MarÂ 2007 00:00:00 -05:00

Background: Autoimmune and autoinflammatory diseases involve interactions between genetic risk factors and environmental triggers. We searched for a gene on chromosome 17p13 that contributes to a group of epidemiologically associated...

PERSPECTIVE: NSAID Trials and the Choice of Comparators â Questions of Public Health Importance

Thu, 25Â JanÂ 2007 00:00:00 -05:00

Under ideal conditions, large clinical trials would be designed so that they satisfied the marketing needs of the pharmaceutical manufacturers that generally sponsor them and, at the same time, answered...

CLINICAL PROBLEM-SOLVING: A Stain in Time

Thu, 04Â JanÂ 2007 00:00:00 -05:00

A 45-year-old woman from northern Ontario presented to her local hospital with a 2-year history of asymmetric migratory arthralgias involving the left knee, ankles, elbows, and fingers. She also had...

REVIEW ARTICLE: Whipple's Disease

Thu, 04Â JanÂ 2007 00:00:00 -05:00

The discovery of Whipple's disease and its causative bacterium, Tropheryma whipplei, is a prime example of how modern technologies have contributed to medical knowledge. Although Whipple's disease was first described...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2006 â A 24-Year-Old Woman with Systemic Lupus Erythematosus, Seizures, and Right Arm Weakness

Thu, 21Â DecÂ 2006 00:00:00 -05:00

Dr. Sherry Chou (Neurology): A 24-year-old woman was transferred to this hospital because of seizures and a lesion in the brain.

A diagnosis of systemic lupus erythematosus (SLE) had been made...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2006 â A 43-Year-Old Woman with Painful Nodules on the Fingertips, Shortness of Breath, and Fatigue

Thu, 21Â SepÂ 2006 00:00:00 -05:00

Dr. Tessa Cigler (Cancer Center): A 43-year-old woman was admitted to this hospital because of painful nodules on the fingertips, shortness of breath, and fatigue.

Systemic lupus erythematosus (SLE) had been...

CLINICAL THERAPEUTICS: Tumor Necrosis Factor Inhibitors for Rheumatoid Arthritis

D.L. Scott, M.D., and G.H. Kingsley, M.B., Ch.B., Ph.D. — Thu, 17Â AugÂ 2006 00:00:00 -05:00

Rheumatoid arthritis developed in a 25-year-old woman, who was found to have a positive rheumatoid factor (150 IU per milliliter); she had no periarticular radiologic erosions or extraarticular disease. Oral...

ORIGINAL ARTICLE: Alendronate or Alfacalcidol in Glucocorticoid-Induced Osteoporosis

Thu, 17Â AugÂ 2006 00:00:00 -05:00

Background: Treatment with glucocorticoids is associated with bone loss starting soon after therapy is initiated and an increased risk of fracture.

Methods: We performed a randomized, double-placebo, double-blind clinical trial of...

CLINICAL PRACTICE: Paget's Disease of Bone

Michael P. Whyte, M.D. — Thu, 10Â AugÂ 2006 00:00:00 -05:00

A 69-year-old man reports increasing pain in the right leg. Physical examination reveals warmth and anterolateral bowing of the right shin. The serum alkaline phosphatase level is 260 U per...

ORIGINAL ARTICLE: Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1Î² Inhibition

Thu, 10Â AugÂ 2006 00:00:00 -05:00

Background: Neonatal-onset multisystem inflammatory disease is characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation. Many patients have mutations in the cold-induced autoinflammatory syndrome 1...

OCCASIONAL NOTES: The Severe Gout of Holy Roman Emperor Charles V

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Holy Roman Emperor Charles V (who was also King Charles I of Spain) was one of the most powerful rulers of all time (Figure 1A). His 40-year reign (1516â1556) occurred...

EDITORIAL: Autoantibodies against PDGF Receptor in Scleroderma

Filemon K. Tan, M.D., Ph.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Scleroderma (systemic sclerosis) is characterized by the deposition and accumulation of excessive amounts of collagen and extracellular-matrix molecules, the dysfunction of microvascular endothelial cells, and altered immune tolerance. These interacting...

EDITORIAL: Cyclophosphamide for Scleroderma Lung Disease

Fernando J. Martinez, M.D., and W. Joseph McCune, M.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Clinically significant interstitial lung disease affects patients with systemic sclerosis (scleroderma) and is a cause of morbidity and mortality in approximately 40 percent of these patients.1 Management of this condition...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2006 â A 22-Month-Old Boy with the Rapid Growth of Subcutaneous Nodules

J. Patrick Whelan, M.D., Ph.D., and Artur Zembowicz, M.D., Ph.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Dr. Richard Chou (Rheumatology): A 22-month-old boy was seen in the pediatric rheumatology clinic because of enlarging subcutaneous nodules on the head, legs, and right hand. The patient had been...

ORIGINAL ARTICLE: Stimulatory Autoantibodies to the PDGF Receptor in Systemic Sclerosis

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: Systemic sclerosis (scleroderma) is characterized by immunologic abnormalities, injury of endothelial cells, and tissue fibrosis. Abnormal oxidative stress has been documented in scleroderma and linked to fibroblast activation. Since...

ORIGINAL ARTICLE: Cyclophosphamide versus Placebo in Scleroderma Lung Disease

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: We conducted a double-blind, randomized, placebo-controlled trial to determine the effects of oral cyclophosphamide on lung function and health-related symptoms in patients with evidence of active alveolitis and scleroderma-related...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Arthritis

Tim L. Jansen, M.D., Ph.D. and Anneke Spoorenberg, M.D., Ph.D. — Thu, 01Â JunÂ 2006 00:00:00 -05:00

A 51-year-old woman with a 15-year history of rheumatoid arthritis presented with swelling and loss of function of the right shoulder. Magnetic resonance imaging of the shoulder revealed severe destruction...

IMAGES IN CLINICAL MEDICINE: Rotator-Cuff Tear

Paranee Auethavekiat, M.D. and Clement J. Michet, Jr., M.D. — Thu, 11Â MayÂ 2006 00:00:00 -05:00

A 72-year-old man with advanced glenohumeral and acromioclavicular arthritis presented with a painless mass over his left shoulder that had become progressively larger over a period of about a year...

VIDEOS IN CLINICAL MEDICINE: Arthrocentesis of the Knee

Thu, 11Â MayÂ 2006 00:00:00 -05:00

...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Gangrene and Cutaneous Nodules

Stefan Schanz, M.D. and Anja Ulmer, M.D. — Thu, 06Â AprÂ 2006 00:00:00 -05:00

A 62-year-old man presented with a one-month history of digital gangrene affecting the right hand (Panel A). One digit had been partially amputated 20 years before, after an accident. The...

IMAGES IN CLINICAL MEDICINE: Giant Ganglion Cyst

Neil J. Mortimer, M.R.C.P. and Graham A. Johnston, M.R.C.P. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 90-year-old woman presented with a one-month history of a rapidly enlarging cystic lesion on the flexor aspect of her left fifth finger. The lesion was tender and caused impairment...

EDITORIAL: Nutritional Supplements for Knee Osteoarthritis â Still No Resolution

Marc C. Hochberg, M.D., M.P.H. — Thu, 23Â FebÂ 2006 00:00:00 -05:00

Osteoarthritis is the most common form of arthritis, and when it affects the knee, as opposed to other joints, it is more apt to cause symptoms, including pain and stiffness,...

CLINICAL PRACTICE: Osteoarthritis of the Knee

David T. Felson, M.D., M.P.H. — Thu, 23Â FebÂ 2006 00:00:00 -05:00

A 66-year-old woman who is overweight reports bilateral knee pain of gradual onset during the past several months that increasingly has limited her activities. Last week, when walking down the...

ORIGINAL ARTICLE: Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis

Thu, 23Â FebÂ 2006 00:00:00 -05:00

Background: Glucosamine and chondroitin sulfate are used to treat osteoarthritis. The multicenter, double-blind, placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) evaluated their efficacy and safety as a treatment for...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2006 â A 79-Year-Old Woman with Myalgias, Fatigue, and Shortness of Breath

Jonathan Kay, M.D., David S. Finn, M.D., and James R. Stone, M.D., Ph.D. — Thu, 09Â FebÂ 2006 00:00:00 -05:00

Dr. Celine R. Gounder (Department of Medicine): A 79-year-old woman was admitted to the hospital because of myalgias, fatigue, and shortness of breath.

Hyperlipidemia had been diagnosed six years earlier and...

IMAGES IN CLINICAL MEDICINE: Milwaukee Shoulder

Marcia S. Genta, M.D. and Cem Gabay, M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

An 85-year-old woman presented with right shoulder pain and swelling and a large hematoma extending into the chest wall. Active range of motion was severely limited, and passive mobility was...

IMAGES IN CLINICAL MEDICINE: PellegriniâStieda Syndrome

Eric L. Altschuler, M.D., Ph.D. and Thomas N. Bryce, M.D. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

A 38-year-old man with an incomplete spinal cord injury secondary to a diving accident some years before, which caused tetraplegia but preserved some sensation below the neck, reported new pain...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inhibiting Inflammation in Rheumatoid Arthritis

Gary S. Firestein, M.D. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

Targeting signal-transduction molecules, especially kinases, is a daunting task. First, these enzymes are often widely distributed in many tissues and contribute to a vast array of cellular processes essential for...

EDITORIAL: Expression of Concern: Bombardier et al., âComparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis,â N Engl J Med 2000;343:1520-8.

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

We have recently obtained information regarding inaccuracies in data in the report of the VIGOR (Vioxx Gastrointestinal Outcomes Research) study by Bombardier et al.1 that raise concern about certain conclusions...

EDITORIAL: Oral Contraceptives in Systemic Lupus Erythematosus â A Tough Pill to Swallow?

Bonnie L. Bermas, M.D. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

Oral contraceptives were introduced into clinical practice in the 1960s. The âpill,â as this method of contraception was quickly dubbed, was touted for its ease of administration and effectiveness. The...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 29-year-old pregnant woman with systemic lupus erythematosus was admitted to the hospital because of renal failure at 20 weeks 6 days of gestation.

The patient, a native of Panama, had...

ORIGINAL ARTICLE: Combined Oral Contraceptives in Women with Systemic Lupus Erythematosus

Thu, 15Â DecÂ 2005 00:00:00 -05:00

Background: Oral contraceptives are rarely prescribed for women with systemic lupus erythematosus, because of concern about potential negative side effects. In this double-blind, randomized, noninferiority trial, we prospectively evaluated the...

ORIGINAL ARTICLE: A Trial of Contraceptive Methods in Women with Systemic Lupus Erythematosus

Thu, 15Â DecÂ 2005 00:00:00 -05:00

Background: The effects of estrogen-containing contraceptives on disease activity in women with systemic lupus erythematosus have not been determined.

Methods: We conducted a single-blind clinical trial involving 162 women with systemic...

IMAGES IN CLINICAL MEDICINE: Deforming Gout

Gonzalo Pacheco, M.D. and Javier A. Cavallasca, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

An 80-year-old man with a 30-year history of gout was referred to the rheumatology clinic for further treatment. He had received colchicine and urate-lowering drugs intermittently over the previous several...

EDITORIAL: Febuxostat â Treatment for Hyperuricemia and Gout?

Larry W. Moreland, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

Gout is a relatively common cause of legendary, severe pain as well as tophi, joint deformities, and nephropathy. Unlike most noninfectious diseases, frequently a pharmacologic âcureâ for gout is attained....

ORIGINAL ARTICLE: Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and Gout

Thu, 08Â DecÂ 2005 00:00:00 -05:00

Background: Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol for patients with hyperuricemia and gout.

Methods: We randomly assigned 762 patients with gout and...

REVIEW ARTICLE: Antiinflammatory Action of Glucocorticoids â New Mechanisms for Old Drugs

Turk Rhen, Ph.D., and John A. Cidlowski, Ph.D. — Thu, 20Â OctÂ 2005 00:00:00 -05:00

Inflammation is a reflexive response to infection, the binding of antibodies to antigens within the body, mechanical irritation, or injury.1 Microbes that breach epithelial barriers, for instance, directly activate complement...

IMAGES IN CLINICAL MEDICINE: Bone Changes in Rheumatoid Arthritis

Katsunori Ikari, M.D., Ph.D. and Shigeki Momohara, M.D., Ph.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 38-year-old woman with a five-year history of rheumatoid arthritis had complete remission after 17 months of weekly monotherapy with 4 mg of methotrexate. Radiographs of both hands and feet...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2005 â A 60-Year-Old Man with Skin Lesions and Renal Insufficiency

Jonathan Kay, M.D., and Robert T. McCluskey, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 60-year-old man was evaluated in the rheumatology clinic because of a rash and worsening renal function.

He had been well until three months earlier, when he began to have fatigue...

CLINICAL PROBLEM-SOLVING: Still Consider the Source

Thu, 06Â OctÂ 2005 00:00:00 -05:00

A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2005 â A 68-Year-Old Man with Periorbital Swelling, Rash, and Weakness

Thu, 22Â SepÂ 2005 00:00:00 -05:00

A 68-year-old man was admitted to the hospital because of a rash and muscle weakness.

He had been well until two weeks earlier, when, shortly after returning from a trip to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2005 â A 42-Year-Old Man with Weight Loss, Weakness, and a Rash

Myles Wolf, M.D., M.M.Sc., Henry Rose, M.D., and R. Neal Smith, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

A 42-year-old man was admitted to another hospital because of weight loss, hematuria, hemoptysis, weakness, and a rash.

He had been well until three years earlier, when his family had moved...

ORIGINAL ARTICLE: Abatacept for Rheumatoid Arthritis Refractory to Tumor Necrosis Factor Î± Inhibition

Thu, 15Â SepÂ 2005 00:00:00 -05:00

Background: A substantial number of patients with rheumatoid arthritis have an inadequate or unsustained response to tumor necrosis factor Î± (TNF-Î±) inhibitors. We conducted a randomized, double-blind, phase 3 trial...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: An Aggrecanase and Osteoarthritis

Gerard Karsenty, M.D., Ph.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

The study of degenerative diseases is often neglected by basic scientists, probably because these complicated pathophysiological conditions are considered to be mere consequences of aging. But there is an urgent...

IMAGES IN CLINICAL MEDICINE: Bilateral Pulmonary-Artery Aneurysms in BehÃ§et's Syndrome

Sudhir Lohani, M.D. and Robert Niven, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

A 28-year-old Asian woman presented with pyrexia of unknown origin, oral and genital ulcers, and hemoptysis. A chest radiograph showed bilateral central hilar opacities (Panel A, arrows). A computed tomographic...

CLINICAL PRACTICE: Cervical Radiculopathy

Simon Carette, M.D., M.Phil., and Michael G. Fehlings, M.D., Ph.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

A 37-year-old woman presents with a two-week history of severe neck pain radiating to her left shoulder girdle and extending to the arm, forearm, and dorsum of the hand. She...

PERSPECTIVE: Tailoring Arthritis Therapy in the Wake of the NSAID Crisis

Nancy J. Olsen, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

In recent months, physicians and patients have been presented with a confusing array of decisions by the Food and Drug Administration (FDA) and the pharmaceutical industry regarding the use of...

CLINICAL PRACTICE: Persistent Low Back Pain

Eugene J. Carragee, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 49-year-old maintenance worker with a history of depression and previous reports of minor back pain is seen after four months of continuing low back pain. He has remained out...

ORIGINAL ARTICLE: Leflunomide or Methotrexate for Juvenile Rheumatoid Arthritis

Thu, 21Â AprÂ 2005 00:00:00 -05:00

Background: We compared the safety and efficacy of leflunomide with that of methotrexate in the treatment of polyarticular juvenile rheumatoid arthritis in a multinational, randomized, controlled trial.

Methods: Patients 3 to...

PERSPECTIVE: Learning the Value of Drugs â Is Rofecoxib a Regulatory Success Story?

Rebecca S. Eisenberg, J.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Controversy over recent revelations concerning the adverse cardiovascular effects of selective cyclooxygenase-2 (COX-2) inhibitors has generally been framed as a story of regulatory failure, in which the Food and Drug...

PERSPECTIVE: Raising the Safety Bar â The FDA's Coxib Meeting

Susan Okie, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

After sitting through three days of testimony and debate last month, a panel of experts advising the Food and Drug Administration (FDA) rendered an ambivalent verdict on the future of...

EDITORIAL: COX-2 Inhibitors â A Lesson in Unexpected Problems

Jeffrey M. Drazen, M.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

This issue of the Journal contains three articles about the adverse cardiovascular effects of agents that selectively inhibit one form of prostaglandin endoperoxide synthase, commonly known as cyclooxygenase-2 (COX-2).123 This...

IMAGES IN CLINICAL MEDICINE: Destructive Eye Lesions in Wegener's Granulomatosis

Peer Malte Aries, M.D. and Marcus Both, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

A 33-year-old woman presented with malaise, bloody nasal discharge, nasal crusting, and arthralgia. On examination, disconjugate gaze and protrusion of the right eye with scleritis were found. Serologic evaluation revealed...

ORIGINAL ARTICLE: Etanercept plus Standard Therapy for Wegener's Granulomatosis

The Wegener's Granulomatosis Etanercept Trial (WGET) Research Group — Thu, 27Â JanÂ 2005 00:00:00 -05:00

Background: The majority of patients with Wegener's granulomatosis have disease flares after conventional medications are tapered. There is no consistently safe, effective treatment for the maintenance of remission.

Methods: We conducted...

PERSPECTIVE: The Spectrum of Wegener's Granulomatosis and Disease Relapse

Paul A. Bacon, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

Wegener's syndrome (Wegener's granulomatosis) is a rare systemic disorder, and because it involves multiple organs, affected patients may seek help from physicians in many specialties. It is classified as a...

IMAGES IN CLINICAL MEDICINE: âShoulder Padâ Sign

Carlos Geraldo Guerreiro de Moura, M.D. and SÃ©rgio Pinto de Souza, M.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

A 66-year-old man presented with a two-year history of fatigue, paresthesia of the legs and feet, weight loss, and shoulder enlargement, with limitation of movement. On physical examination, periorbital ecchymoses...

IMAGES IN CLINICAL MEDICINE: Scleromyxedema

Stefan Schanz, M.D. and Gerhard Fierlbeck, Ph.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

A 70-year-old patient presented with a one-year history of progressive tightening of the skin. Physical examination showed generalized sclerodermoid induration and discoloration of the skin (Panel A), as well as...

SPECIAL ARTICLE: Medicaid Prior-Authorization Programs and the Use of Cyclooxygenase-2 Inhibitors

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Background: Over the past five years, selective cyclooxygenase-2 inhibitors (coxibs) have accounted for a growing proportion of prescriptions for nonsteroidal antiinflammatory drugs (NSAIDs). To control these expenses, many state Medicaid...

PERSPECTIVE: Prior-Authorization Programs for Controlling Drug Spending

Mary Beth Hamel, M.D., M.P.H., and Arnold M. Epstein, M.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

Spending for prescription drugs represents more than 10 percent of the nation's health care costs and is currently the fastest-growing component of health care expenditures.1 The rapid increase in drug...

PERSPECTIVE: Merck's Recall of Rofecoxib â A Strategic Perspective

Felix Oberholzer-Gee, Ph.D., and S. Noorein Inamdar, M.S., M.B.A. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

When Merck announced the voluntary withdrawal of its acute-pain medication, rofecoxib (Vioxx), on September 30, 2004, its stock price collapsed, wiping out more than a quarter of the company's market...

PERSPECTIVE: Coxibs and Cardiovascular Disease

Garret A. FitzGerald, M.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

The coxibs are a subclass of nonsteroidal antiinflammatory drugs (NSAIDs) designed to inhibit selectively cyclooxygenase-2 (COX-2).1 Their development was based on the hypothesis that COX-2 was the source of prostaglandins...

PERSPECTIVE: Failing the Public Health â Rofecoxib, Merck, and the FDA

Eric J. Topol, M.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

On May 21, 1999, Merck was granted approval by the Food and Drug Administration (FDA) to market rofecoxib (Vioxx). On September 30, 2004, after more than 80 million patients had...

REVIEW ARTICLE: Prosthetic-Joint Infections

Werner Zimmerli, M.D., Andrej Trampuz, M.D., and Peter E. Ochsner, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

Prosthetic-joint replacement is used increasingly to alleviate pain and to improve mobility. Infections associated with prosthetic joints cause significant morbidity and account for a substantial proportion of health care expenditures.12...

ORIGINAL ARTICLE: Mannose-Binding Lectin Variant Alleles and the Risk of Arterial Thrombosis in Systemic Lupus Erythematosus

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: Cardiovascular disease is an important complication in patients with systemic lupus erythematosus (SLE). Variant alleles of the mannose-binding lectin gene are associated with SLE as well as with severe...

ORIGINAL ARTICLE: Fatal Myositis Due to the Microsporidian a Mosquito Pathogen

Thu, 01Â JulÂ 2004 00:00:00 -05:00

Microsporidia are obligate intracellular eukaryotes that have emerged as a cause of chronic diarrheal syndromes in patients with human immunodeficiency virus (HIV) infection.1 Most cases have been caused by Enterocytozoon...

REVIEW ARTICLE: Therapeutic Strategies for Rheumatoid Arthritis

James R. O'Dell, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

Rheumatoid arthritis, a chronic, systemic, inflammatory autoimmune disease, has as its primary target the synovial tissues. When the disease is unchecked, it leads to substantial disability and premature death.1 It...

ORIGINAL ARTICLE: Efficacy of B-CellâTargeted Therapy with Rituximab in Patients with Rheumatoid Arthritis

Thu, 17Â JunÂ 2004 00:00:00 -05:00

Background: An open-label study indicated that selective depletion of B cells with the use of rituximab led to sustained clinical improvements for patients with rheumatoid arthritis. To confirm these observations,...

ORIGINAL ARTICLE: Clostridium Infections Associated with Musculoskeletal-Tissue Allografts

Thu, 17Â JunÂ 2004 00:00:00 -05:00

Background: Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a...

PERSPECTIVE: B Cells, Be Gone â B-Cell Depletion in the Treatment of Rheumatoid Arthritis

George C. Tsokos, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

CD20 protein is expressed on the surface membrane of pre-B lymphocytes and mature B lymphocytes. The protein is located in the B-cell membrane, with 44 amino acids exposed in the...

REVIEW ARTICLE: New Drugs for Rheumatoid Arthritis

Nancy J. Olsen, M.D., and C. Michael Stein, M.B., Ch.B. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

Rheumatoid arthritis affects approximately 1 percent of the U.S. population and can cause irreversible joint deformities and functional impairment. The cause of this autoimmune disease remains obscure, but greater understanding...

CLINICAL PRACTICE: Plantar Fasciitis

Rachelle Buchbinder, M.B., B.S., F.R.A.C.P. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

A 55-year-old overweight woman presents with a three-month history of pain in her right inferior heel. The pain is worse on taking her first steps in the morning. The physical...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2004 â A Boy with Rash, Edema, and Hypertension

Michael J. Somers, M.D., Ghaleb H. Daouk, M.D., and Robert T. McCluskey, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 12-year-old boy was admitted to the hospital because of hypertension and edema, and because the results of urinalysis were abnormal.

Fourteen days before admission, cough and nasal congestion, followed by...

ORIGINAL ARTICLE: Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men

Thu, 11Â MarÂ 2004 00:00:00 -05:00

Background: Various purine-rich foods and high protein intake have long been thought to be risk factors for gout. Similarly, the possibility that the consumption of dairy products has a role...

PERSPECTIVE: Uric Acid and Diet â Insights into the Epidemic of Cardiovascular Disease

Richard J. Johnson, M.D., and Bruce A. Rideout, D.V.M., Ph.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

Gout, a disease that has been known since antiquity, is an acute, often recurrent arthritis mediated by the crystallization of uric acid within the joints and typically associated with hyperuricemia....

CLINICAL PROBLEM-SOLVING: Occam's Razor versus Saint's Triad

Thu, 05Â FebÂ 2004 00:00:00 -05:00

A 60-year-old woman with a history of radiologically confirmed seronegative rheumatoid arthritis presented to the emergency department with a 10-day history of worsening dyspnea on exertion, nonproductive cough, and subjective...

ORIGINAL ARTICLE: Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus

Thu, 18Â DecÂ 2003 00:00:00 -05:00

Background: Premature coronary artery disease is a major cause of illness and death in patients with systemic lupus erythematosus, but little is known about the prevalence, extent, and causes of...

ORIGINAL ARTICLE: Prevalence and Correlates of Accelerated Atherosclerosis in Systemic Lupus Erythematosus

Thu, 18Â DecÂ 2003 00:00:00 -05:00

Background: Although systemic lupus erythematosus is associated with premature myocardial infarction, the prevalence of underlying atherosclerosis and its relation to traditional risk factors for cardiovascular disease and lupus-related factors have...

PERSPECTIVE: Systemic Lupus Erythematosus and Accelerated Atherosclerosis

Bevra Hannahs Hahn, M.D. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

An association between accelerated atherosclerosis and systemic lupus erythematosus (SLE), typified by the occurrence of a myocardial infarction in a 30-year-old woman who had had the disease for more than...

IMAGES IN CLINICAL MEDICINE: Arthritis Mutilans

Robert Monger, M.D. and Virginia Hrywnak, D.O. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

A 94-year-old woman had rheumatoid arthritis that was diagnosed when she was 8 years old. She had not sought treatment for arthritis until she was in her 60s, and by...

ORIGINAL ARTICLE: Treatment of Rheumatoid Arthritis by Selective Inhibition of T-Cell Activation with Fusion Protein CTLA4Ig

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Effective new therapies are needed for rheumatoid arthritis. Current therapies target the products of activated macrophages; however, T cells also have an important role in rheumatoid arthritis. A fusion...

CLINICAL PRACTICE: Gout

Robert A. Terkeltaub, M.D. — Thu, 23Â OctÂ 2003 00:00:00 -05:00

A 59-year-old man with bilateral olecranon-bursa tophi has frequent bouts of acute gouty arthritis, including three in the past year. His serum uric acid level is consistently above 9 mg...

ORIGINAL ARTICLE: Development of Autoantibodies before the Clinical Onset of Systemic Lupus Erythematosus

Thu, 16Â OctÂ 2003 00:00:00 -05:00

Background: Although much is known about the natural history of systemic lupus erythematosus (SLE), the development of SLE autoantibodies before the diagnosis of the disease has not been extensively explored....

PERSPECTIVE: Autoantibodies in Systemic Lupus Erythematosus â There before You Know It

Robert H. Shmerling, M.D. — Thu, 16Â OctÂ 2003 00:00:00 -05:00

Autoantibodies are an integral part of the process of classifying, detecting, and, at least in some cases, mediating autoimmune diseases. Since the discovery of the antinuclear antibody more than 40...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Nicholas Magee, M.R.C.P. and Rory Convery, M.R.C.P. — Thu, 25Â SepÂ 2003 00:00:00 -05:00

A 48-year-old woman had a 30-year history of dermatomyositis treated with prednisolone. She was admitted for depression and nausea. Examination revealed multiple craggy skin nodules, shown on the right flank...

EDITORIAL: Treatment of the Antiphospholipid Syndrome

Michael D. Lockshin, M.D., and Doruk Erkan, M.D. — Thu, 18Â SepÂ 2003 00:00:00 -05:00

Two decades after the presence of anticardiolipin antibodies and a syndrome of spontaneous thrombosis and fetal death were linked,1 and after the publication of approximately 3500 reports in which the...

ORIGINAL ARTICLE: A Comparison of Two Intensities of Warfarin for the Prevention of Recurrent Thrombosis in Patients with the Antiphospholipid Antibody Syndrome

Thu, 18Â SepÂ 2003 00:00:00 -05:00

Background: Many patients with the antiphospholipid antibody syndrome and recurrent thrombosis receive doses of warfarin adjusted to achieve an international normalized ratio (INR) of more than 3.0. However, there are...

IMAGES IN CLINICAL MEDICINE: Systemic Mastocytosis

Arjun Deb, M.D. and Ayalew Tefferi, M.D. — Thu, 14Â AugÂ 2003 00:00:00 -05:00

A 44-year-old woman presented with a one-year history of neck and lower back pain. The neck and back pain had worsened over the previous two months and was associated with...

ORIGINAL ARTICLE: Inherited Deficiency of Mannan-Binding LectinâAssociated Serine Protease 2

Thu, 07Â AugÂ 2003 00:00:00 -05:00

The complement system is part of the innate immune system and contributes to the establishment of adaptive immune responses.1 The mannan-binding lectin pathway of the complement system is activated when...

IMAGES IN CLINICAL MEDICINE: Relapsing Polychondritis

David Vroman, M.D. and Kerry D. Solomon, M.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

A 64-year-old man was referred to an eye clinic because of recurrent bilateral red eyes and lid swelling, which had started 14 months earlier. One or both eyes would become...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2003 â A 72-Year-Old Man with Repetitive Strokes in the Posterior Circulation

Thu, 10Â JulÂ 2003 00:00:00 -05:00

A 72-year-old, right-handed man was admitted to the hospital because of recurrent neurologic symptoms.

The patient had been well until 10 days earlier, when he briefly had numbness of the right...

REVIEW ARTICLE: Medium- and Large-Vessel Vasculitis

Cornelia M. Weyand, M.D., Ph.D., and JÃ¶rg J. Goronzy, M.D., Ph.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

Inflammation of large arteries such as the aorta and its major branches occurs in a number of disorders, including Kawasaki's syndrome, BehÃ§et's syndrome, rheumatoid arthritis, syphilis, and tuberculosis. However, aortitis...

ORIGINAL ARTICLE: A Randomized Trial of Maintenance Therapy for Vasculitis Associated with Antineutrophil Cytoplasmic Autoantibodies

Thu, 03Â JulÂ 2003 00:00:00 -05:00

Background: The primary systemic vasculitides usually associated with autoantibodies to neutrophil cytoplasmic antigens include Wegener's granulomatosis and microscopic polyangiitis. We investigated whether exposure to cyclophosphamide in patients with generalized vasculitis...

PERSPECTIVE: Treatment of ANCA-Associated Vasculitis

Carol A. Langford, M.D., M.H.S. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

Vasculitis is defined by inflammation of the blood-vessel wall and forms the pathological foundation of a diverse group of individual disease entities. Among the primary systemic vasculitic diseases, Wegener's granulomatosis...

IMAGES IN CLINICAL MEDICINE: Acute Vertebral Osteomyelitis

Michelle V. Lee, M.D. and Anthony Minotti, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

A 77-year-old man with diabetes presented with a four-day history of fever and worsening left-sided neck and shoulder pain accompanied by numbness and paresthesias in the fingers of the hand...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Mast Cell in Inflammatory Arthritis

David E. Woolley, Ph.D., D.Sc. — Thu, 24Â AprÂ 2003 00:00:00 -05:00

Rheumatoid arthritis is a chronic destructive disease of joints, characterized by inflammation, synovial hyperplasia, and abnormal cellular and humoral immune responses. Although several types of cells have been proposed to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2003 â A 16-Year-Old Girl with a Rash and Chest Pain

Ivor Caro, M.D., and Artur Zembowicz, M.D. — Thu, 13Â FebÂ 2003 00:00:00 -05:00

A 16-year-old girl was admitted to the hospital because of pleuritic chest pain.

Bilateral imbrication of the hip capsules had been performed 15 months earlier at this hospital because of recurrent...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2003 â A 60-Year-Old Man with Mild Congestive Heart Failure of Uncertain Cause

Thu, 16Â JanÂ 2003 00:00:00 -05:00

A 60-year-old man was admitted to the hospital because of dyspnea and pulmonary vascular congestion.

The patient had reportedly been well until seven days earlier, when he began to have dyspnea...

EDITORIAL: NSAIDs, and Pandora's Box

Thu, 26Â DecÂ 2002 00:00:00 -05:00

Widespread use of nonsteroidal antiinflammatory drugs (NSAIDs) among the elderly has resulted in a large population of persons at risk for ulcer complications. Selective cyclooxygenase-2 (COX-2) inhibitors were introduced with...

ORIGINAL ARTICLE: Natural History of Alkaptonuria

Thu, 26Â DecÂ 2002 00:00:00 -05:00

Background: Alkaptonuria, caused by mutations in the HGO gene and a deficiency of homogentisate 1,2-dioxygenase, results in an accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue. There...

ORIGINAL ARTICLE: Celecoxib versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis

Thu, 26Â DecÂ 2002 00:00:00 -05:00

Background: Current guidelines recommend that patients at risk for ulcer disease who require treatment for arthritis receive nonsteroidal antiinflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 or the combination of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2002 â A 35-Year-Old Man with Headache, Deviation of the Tongue, and Unusual Radiographic Abnormalities

William F.C. Rigby, Chieh-Min Fan, and Eugene J. Mark — Thu, 19Â DecÂ 2002 00:00:00 -05:00

A 35-year-old right-handed man was admitted to the hospital because of a persistent headache and deviation of the tongue.

The patient had been in excellent health until about one month earlier,...

IMAGES IN CLINICAL MEDICINE: Acute Episode of Raynaud's Disease

Marsha J. Bluto, R.N., B.Bus. and Daniel A. Norman, M.D. — Thu, 26Â SepÂ 2002 00:00:00 -05:00

Figure 1. A 54-year-old man had an acute primary episode of Raynaud's disease after surfing for 80 minutes in water that was 21Â°C. The distinctive asymmetric pallor of the terminal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2002 â An Eight-Year-Old Girl with Fever, Hemoptysis, and Pulmonary Consolidations

Brian P. O'Sullivan, Lori A. Erickson, and John L. Niles — Thu, 26Â SepÂ 2002 00:00:00 -05:00

An eight-year-old girl was admitted to the hospital because of fever, cough, hemoptysis, and pulmonary consolidations.

She had been well until six days before admission, when she was visiting El Salvador....

CLINICAL PRACTICE: Raynaud's Phenomenon

Fredrick M. Wigley, M.D. — Thu, 26Â SepÂ 2002 00:00:00 -05:00

A 37-year-old woman reports that her fingers turn blue when they are exposed to cold temperatures. She also has fatigue, arthralgias, and recurrent small, painful digital ulcers. How should she...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2002 â A 17-Year-Old Boy with Acute Mitral Regurgitation and Pulmonary Edema

Bradley J. Bloom and R. Neal Smith — Thu, 19Â SepÂ 2002 00:00:00 -05:00

A 17-year-old boy was admitted to the hospital because of acute mitral regurgitation and pulmonary edema.

The patient had received a diagnosis of juvenile spondyloarthropathy two years earlier. He had intermittent...

IMAGES IN CLINICAL MEDICINE: Osteoporosis Circumscripta

Kirsten M. Leu, M.D. and Gregory P. Kalemkerian, M.D. — Thu, 01Â AugÂ 2002 00:00:00 -05:00

Figure 1. An 87-year-old asymptomatic woman was incidentally found to have an elevated alkaline phosphatase level (216 IU per liter; upper limit of the normal range, 136). The remainder of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2002 â A 73-Year-Old Man with Leg Pains, Occipital Headaches, and Night Sweats

William P. Docken and Eugene J. Mark — Thu, 25Â JulÂ 2002 00:00:00 -05:00

A 73-year-old man was admitted to the hospital because of leg pains, occipital headaches, and night sweats.

He had been in good health until two months earlier, when he began to...

REVIEW ARTICLE: Polymyalgia Rheumatica and Giant-Cell Arteritis

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Polymyalgia rheumatica and giant-cell arteritis are closely related conditions that affect persons of middle age and older and frequently occur together. Many authorities consider them to be different phases of...

ORIGINAL ARTICLE: Osteoprotegerin Deficiency and Juvenile Paget's Disease

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Background: Juvenile Paget's disease, an autosomal recessive osteopathy, is characterized by rapidly remodeling woven bone, osteopenia, fractures, and progressive skeletal deformity. The molecular basis is not known. Osteoprotegerin deficiency could...

ORIGINAL ARTICLE: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

Thu, 11Â JulÂ 2002 00:00:00 -05:00

Background: Many patients report symptomatic relief after undergoing arthroscopy of the knee for osteoarthritis, but it is unclear how the procedure achieves this result. We conducted a randomized, placebo-controlled trial...

EDITORIAL: DÃ©bridement and Lavage for Osteoarthritis of the Knee

Thu, 11Â JulÂ 2002 00:00:00 -05:00

Approximately 6 percent of the population of the United States 30 years of age or older and 12 percent of those 65 years of age or older have frequent knee...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2002 â A 21-Year-Old Man with Arthritis during Treatment for Hyperthyroidism

Simon M. Helfgott and R. Neal Smith — Thu, 11Â JulÂ 2002 00:00:00 -05:00

A 21-year-old man was admitted to the hospital because of inflammatory lesions of the foot.

The patient had been well until 15 months before admission. At that time, while he was...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2002 â A 48-Year-Old Man with a Cough and Bloody Sputum

Richard L. Kradin, M.D., and Eugene J. Mark, M.D. — Thu, 13Â JunÂ 2002 00:00:00 -05:00

A 48-year-old man was admitted to the hospital because of bilateral pulmonary infiltrates, bloody sputum, and microhematuria.

The patient was a physician who had been well until about eight years earlier,...

CLINICAL PROBLEM-SOLVING: Diagnosis Still in Question

Ashish K. Jha, M.D., Harold R. Collard, M.D., and Lawrence M. Tierney, M.D. — Thu, 06Â JunÂ 2002 00:00:00 -05:00

A 59-year-old banker was referred for the evaluation of fevers that had started three weeks earlier, shortly after his arrival in western Texas on business. The fevers were associated with...

CLINICAL PRACTICE: Carpal Tunnel Syndrome

Jeffrey N. Katz, M.D., and Barry P. Simmons, M.D. — Thu, 06Â JunÂ 2002 00:00:00 -05:00

A 64-year-old, right-handed, retired woman presents with intermittent numbness, tingling, and burning pain in the three radial digits of both hands. She has had these symptoms for three months, and...

IMAGES IN CLINICAL MEDICINE: Finger-Pad Tophi

Komal F. Chopra, M.D. and Marc E. Grossman, M.D. — Thu, 30Â MayÂ 2002 00:00:00 -05:00

Figure 1. A 57-year-old man presented with a three-month history of cream-yellow papules of 2 to 3 mm on the pulps of his fingers on both hands (Panel A) and...

EDITORIAL: AntiâTNF-Î± Therapy for Ankylosing Spondylitis â A Specific or Nonspecific Treatment?

Thu, 02Â MayÂ 2002 00:00:00 -05:00

The spondyloarthropathies comprise ankylosing spondylitis, reactive arthritis, arthritis that accompanies inflammatory bowel disease, some forms of psoriatic arthritis, and undifferentiated forms of spondyloarthropathy. The report in this issue of the...

ORIGINAL ARTICLE: Treatment of Ankylosing Spondylitis by Inhibition of Tumor Necrosis Factor Î±

Thu, 02Â MayÂ 2002 00:00:00 -05:00

Background: There are few effective treatments for ankylosing spondylitis, which causes substantial morbidity. Because of the central role of tumor necrosis factor Î± in the spondyloarthritides, we performed a randomized,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2002 â A 56-Year-Old Woman with a Persistent Left-Sided Pleural Effusion

Deborah A. Quinn, M.D.,and Eugene J. Mark, M.D. — Thu, 14Â MarÂ 2002 00:00:00 -05:00

A 56-year-old woman was admitted to the hospital because of a persistent left-sided pleural effusion.

The patient had a history of rheumatoid arthritis, which had become disabling about two years before...

ORIGINAL ARTICLE: Paternally Inherited Inactivating Mutations of the Gene in Progressive Osseous Heteroplasia

Thu, 10Â JanÂ 2002 00:00:00 -05:00

Background: Progressive osseous heteroplasia (POH), an autosomal dominant disorder, is characterized by extensive dermal ossification during childhood, followed by disabling and widespread heterotopic ossification of skeletal muscle and deep connective...

EDITORIAL: Rational Use of Analgesic and Antiinflammatory Drugs

Thu, 20Â DecÂ 2001 00:00:00 -05:00

âTake two aspirin and call me in the morningâ? Clinical decision making is no longer so straightforward. Millions of patients take analgesic and antiinflammatory medications regularly. The reasons are simple:...

ORIGINAL ARTICLE: Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin

Thu, 20Â DecÂ 2001 00:00:00 -05:00

Background: Patients with arthritis and vascular disease may receive both low-dose aspirin and other nonsteroidal antiinflammatory drugs. We therefore investigated potential interactions between aspirin and commonly prescribed arthritis therapies.

Methods: We...

REVIEW ARTICLE: Hereditary Periodic Fever

Joost P.H. Drenth, M.D., Ph.D., and Jos W.M. van der Meer, M.D., Ph.D. — Thu, 13Â DecÂ 2001 00:00:00 -05:00

Periodic fever is defined as recurrences of fever that last from a few days to a few weeks, separated by symptom-free intervals of variable duration. This pattern of fever can...

EDITORIAL: An Exception to the Rule

Thu, 18Â OctÂ 2001 00:00:00 -05:00

In 1972, the first biochemical abnormality to be identified in a form of the EhlersâDanlos syndrome, a deficiency of lysyl hydroxylase, a collagen-modifying enzyme, was described in the Journal.1 Many...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2001 â A 77-Year-Old Man with Rheumatoid Arthritis and Acute Dyspnea and Renal Failure

Helen M. Hollingsworth, M.D. and Eugene J. Mark, M.D. — Thu, 18Â OctÂ 2001 00:00:00 -05:00

A 77-year-old man was transferred to this hospital because of worsening bilateral air-space disease and acute renal failure.

He had stopped smoking 30 years before admission. He had mild chronic obstructive...

ORIGINAL ARTICLE: A Recessive Form of the EhlersâDanlos Syndrome Caused by Tenascin-X Deficiency

Thu, 18Â OctÂ 2001 00:00:00 -05:00

Background: The EhlersâDanlos syndrome is a heritable connective-tissue disorder caused by defects in fibrillar-collagen metabolism. Mutations in the type V collagen genes account for up to 50 percent of cases...

ORIGINAL ARTICLE: Tuberculosis Associated with Infliximab, a Tumor Necrosis Factor Î±âNeutralizing Agent

Thu, 11Â OctÂ 2001 00:00:00 -05:00

Background: Infliximab is a humanized antibody against tumor necrosis factor Î± (TNF-Î±) that is used in the treatment of Crohn's disease and rheumatoid arthritis. Approximately 147,000 patients throughout the world...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2001 â A 22-Year-Old Man with Hyperthyroidism, Fever, Abdominal Pain, and Arthralgia

Mahboob U. Rahman, M.D., Ph.D, Chieh-Min Fan, M.D., and Hyon K. Choi, M.D. — Thu, 27Â SepÂ 2001 00:00:00 -05:00

A 22-year-old man was admitted to the hospital because of fever, abdominal pain, diarrhea, and polyarthralgia.

The patient had been well until two years before admission, when a tremor developed and...

ORIGINAL ARTICLE: Wild-Mushroom Intoxication as a Cause of Rhabdomyolysis

Thu, 13Â SepÂ 2001 00:00:00 -05:00

The growing popularity of eating wild mushrooms has led to an increase in the incidence of mushroom poisoning. Most fatalities are due to amatoxin-containing species, which cause fulminant hepatocytolysis, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2001 â Hypertensive Encephalopathy with Impaired Renal Function in a 67-Year-Old Woman with Polymyositis

Joseph H. Korn, M.D., and Shamila Mauiyyedi, M.D. — Thu, 23Â AugÂ 2001 00:00:00 -05:00

A 67-year-old woman was initially admitted to this hospital because of hypertensive encephalopathy.

The patient had been well until one month before admission, when she became weak and began to have...

REVIEW ARTICLE: The Coxibs, Selective Inhibitors of Cyclooxygenase-2

Garret A. FitzGerald, M.D., and Carlo Patrono, M.D. — Thu, 09Â AugÂ 2001 00:00:00 -05:00

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used to treat arthritis, menstrual pain, and headache. Although they are effective, their long-term use is limited by gastrointestinal effects such as dyspepsia and...

REVIEW ARTICLE: Autoimmune Diseases

Anne Davidson, M.B., B.S., and Betty Diamond, M.D. — Thu, 02Â AugÂ 2001 00:00:00 -05:00

Autoimmune diseases, with the exception of rheumatoid arthritis and autoimmune thyroiditis, are individually rare, but together they affect approximately 5 percent of the population in Western countries.12 They are a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2001 â A 50-Year-Old Man with Fever and Joint Pain

Simon M. Helfgott, Alexander Kratz — Thu, 21Â JunÂ 2001 00:00:00 -05:00

A 50-year-old man was admitted to the hospital because of fever and arthralgias.

The patient had been in excellent health until six weeks earlier, when a sore throat, rhinorrhea, headaches, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2001 â A 42-Year-Old Man with Multiple Pulmonary Cysts and Recurrent Respiratory Infections

R. Scott Harris, Eugene J. Mark — Thu, 31Â MayÂ 2001 00:00:00 -05:00

A 42-year-old man was admitted to the hospital because of pulmonary cysts.

The patient had a long history of nasal allergy, with occasional wheezing on exposure to cats; hives after ingestion...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2001 â Rapidly Progressive Renal Failure in a 35-Year-Old Woman with Systemic Lupus Erythematosus

Cecil H.Coggins, Robert T. McCluskey — Thu, 12Â AprÂ 2001 00:00:00 -05:00

A 35-year-old woman was admitted to the hospital because of rapidly worsening renal failure.

Twelve years before admission, she had received a diagnosis of systemic lupus erythematosus, manifested by Raynaud's syndrome,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2001 â A 53-Year-Old Woman with Arthritis and Pulmonary Nodules

Dorothy A. White, Eugene J. Mark — Thu, 29Â MarÂ 2001 00:00:00 -05:00

A 53-year-old woman was admitted to the hospital because of radiographically evident pulmonary nodules.

The patient had a long history of seropositive rheumatoid arthritis, which was usually well controlled with naproxen....

REVIEW ARTICLE: Cytokine Pathways and Joint Inflammation in Rheumatoid Arthritis

Ernest H.S. Choy, M.D., and Gabriel S. Panayi, M.D., Sc.D. — Thu, 22Â MarÂ 2001 00:00:00 -05:00

Rheumatoid arthritis is a common chronic inflammatory and destructive arthropathy that cannot be cured and that has substantial personal, social, and economic costs. The long-term prognosis is poor: 80 percent...

REVIEW ARTICLE: Low Back Pain

Richard A. Deyo, M.D., M.P.H., and James N. Weinstein, D.O. — Thu, 01Â FebÂ 2001 00:00:00 -05:00

About two thirds of adults suffer from low back pain at some time. Low back pain is second to upper respiratory problems as a symptom-related reason for visits to a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2001 â A 26-Year-Old Man with a Mass in the Knee

Thomas A. Einhorn, G. Petur Nielsen — Thu, 11Â JanÂ 2001 00:00:00 -05:00

A 26-year-old man was admitted to the hospital because of a mass in the knee.

The patient had been in good health except for a nine-year history of intermittent pain in...

IMAGES IN CLINICAL MEDICINE: Mediastinal Abnormalities in Systemic Sclerosis

William Choe, M.D. and David Mehlman, M.D. — Thu, 14Â DecÂ 2000 00:00:00 -05:00

Figure 1. A 37-year-old woman who had had systemic sclerosis for several years, with known esophageal and skin involvement, presented with dyspnea on exertion and a large pericardial effusion. Transthoracic...

EDITORIAL: Biologic Therapy for Rheumatoid Arthritis

Thu, 30Â NovÂ 2000 00:00:00 -05:00

This year marks the 50th anniversary of the awarding of the Nobel Prize in Physiology and Medicine to Kendall, Hench, and Reichstein for the isolation and characterization of adrenocorticotrophic hormones.1...

ORIGINAL ARTICLE: Infliximab and Methotrexate in the Treatment of Rheumatoid Arthritis

Thu, 30Â NovÂ 2000 00:00:00 -05:00

Background: Neutralization of tumor necrosis factor Î± (TNF-Î±) for three to six months reduces the symptoms and signs of rheumatoid arthritis. However, the capacity of this approach to effect a...

ORIGINAL ARTICLE: A Comparison of Etanercept and Methotrexate in Patients with Early Rheumatoid Arthritis

Thu, 30Â NovÂ 2000 00:00:00 -05:00

Background: Etanercept, which blocks the action of tumor necrosis factor, reduces disease activity in patients with long-standing rheumatoid arthritis. Its efficacy in reducing disease activity and preventing joint damage in...

ORIGINAL ARTICLE: Disease-Related Conditions in Relatives of Patients with Hemochromatosis

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Hemochromatosis occurs in approximately 5 white people per 1000 and is usually due to homozygosity for mutations in the HLA-linked HFE gene. Although screening has been proposed, the proportion...

ORIGINAL ARTICLE: Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Each year, clinical upper gastrointestinal events occur in 2 to 4 percent of patients who are taking nonselective nonsteroidal antiinflammatory drugs (NSAIDs). We assessed whether rofecoxib, a selective inhibitor...

IMAGES IN CLINICAL MEDICINE: Idiopathic Clubbing

Klaus Reynen, M.D. and Werner G. Daniel, M.D. — Thu, 26Â OctÂ 2000 00:00:00 -05:00

Figure 1. A 44-year-old man had had marked swelling of the terminal digits since early childhood. No other family members had this finding. The patient did not have cyanosis, was...

EDITORIAL: Treatment of Lupus Nephritis â A Work in Progress

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Until the pathogenesis of nephritis due to systemic lupus erythematosus has been unraveled, optimal treatment for patients with this disease will remain an elusive goal. When the causes of lupus...

ORIGINAL ARTICLE: Efficacy of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Background: The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether mycophenolate mofetil can be substituted for cyclophosphamide is...

ORIGINAL ARTICLE: Spinal Cord Stimulation in Patients with Chronic Reflex Sympathetic Dystrophy

Thu, 31Â AugÂ 2000 00:00:00 -05:00

Background: Chronic reflex sympathetic dystrophy (also called the complex regional pain syndrome) is a painful, disabling disorder for which there is no proven treatment. In observational studies, spinal cord stimulation...

IMAGES IN CLINICAL MEDICINE: Lung Cancer Presenting as an Ankle Metastasis

Ronald C. McGarry, M.D., Ph.D. — Thu, 27Â JulÂ 2000 00:00:00 -05:00

Figure 1. A 45-year-old man with a 70-pack-year history of smoking began to have pain and then swelling in his right foot and ankle. He had no history of trauma....

EDITORIAL: Pain and Public Policy

Thu, 20Â AprÂ 2000 00:00:00 -05:00

Some physicians, patients, and policy makers conceive of illness in purely biologic terms. According to this view, social, economic, and legal forces are irrelevant to symptoms and behavior; only tissue...

SPECIAL ARTICLE: Effect of Eliminating Compensation for Pain and Suffering on the Outcome of Insurance Claims for Whiplash Injury

Thu, 20Â AprÂ 2000 00:00:00 -05:00

Background: and Methods: The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation for pain and suffering. On January 1, 1995, the...

EDITORIAL: Disparities in the Use of Total Joint Arthroplasty

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Osteoarthritis is a common, chronic, and degenerative disease of the joints. It afflicts more than 16 million people in the United States and is one of the leading causes of...

SPECIAL ARTICLE: Differences between Men and Women in the Rate of Use of Hip and Knee Arthroplasty

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Background: Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure...

SOUNDING BOARD: Experience of a Scientific Panel Formed to Advise the Federal Judiciary on Silicone Breast Implants

Thu, 16Â MarÂ 2000 00:00:00 -05:00

Scientific methods for determining truth differ from judicial methods. Scientists confer, develop theories, and then test their theories by performing data-based research. If important findings appear to be inconsistent with...

EDITORIAL: Tumor Necrosis Factor Blockers in Rheumatoid Arthritis

Thu, 16Â MarÂ 2000 00:00:00 -05:00

For patients with rheumatoid arthritis, a new era in treatment has begun. This optimistic view, shared widely by rheumatologists, reflects the introduction in the past two years of novel agents...

ORIGINAL ARTICLE: Meta-Analyses of the Relation between Silicone Breast Implants and the Risk of Connective-Tissue Diseases

Thu, 16Â MarÂ 2000 00:00:00 -05:00

Background: The postulated relation between silicone breast implants and the risk of connective-tissue and autoimmune diseases has generated intense medical and legal interest during the past decade. The salience of...

ORIGINAL ARTICLE: Etanercept in Children with Polyarticular Juvenile Rheumatoid Arthritis

Thu, 16Â MarÂ 2000 00:00:00 -05:00

Background: We evaluated the safety and efficacy of etanercept, a soluble tumor necrosis factor receptor (p75):Fc fusion protein, in children with polyarticular juvenile rheumatoid arthritis who did not tolerate or...

EDITORIAL: EhlersâDanlos Syndrome

Thu, 09Â MarÂ 2000 00:00:00 -05:00

The first comprehensive description of a syndrome comprising laxity and fragility of the skin associated with hypermobility of the large joints was published in 1892 by Tschernogobow1 in Moscow. With...

REVIEW ARTICLE: Molecular Mimicry and Autoimmunity

Lori J. Albert, M.D., and Robert D. Inman, M.D. — Thu, 30Â DecÂ 1999 00:00:00 -05:00

Autoimmune disease is the consequence of an immune response against self-antigens that results in the damage and eventual dysfunction of target organs. Although the triggering event in most autoimmune diseases...

IMAGES IN CLINICAL MEDICINE: Gangrene and Type I Cryoglobulinemia in Multiple Myeloma

Lorenzo Cirasino, M.D. and Pier Remigio Barbano, M.D. — Thu, 18Â NovÂ 1999 00:00:00 -05:00

Figure 1. A 57-year-old woman was admitted because of ischemia of the feet (Panel A). A monoclonal IgG- Î» gammopathy and type I cryoglobulinemia (cryocrit, 13.8 percent) were found in...

EDITORIAL: The Paradox of Osteopathy

Thu, 04Â NovÂ 1999 00:00:00 -05:00

In the spring of 1864, Andrew Taylor Still, a rural Kansas practitioner, watched helplessly as the best medications then available failed to save his three children from spinal meningitis. Bitterly...

ORIGINAL ARTICLE: A Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain

Thu, 04Â NovÂ 1999 00:00:00 -05:00

Background: The effect of osteopathic manual therapy (i.e., spinal manipulation) in patients with chronic and subchronic back pain is largely unknown, and its use in such patients is controversial. Nevertheless,...

IMAGES IN CLINICAL MEDICINE: Nutritional Rickets

Tom D. Thacher, M.D. — Thu, 19Â AugÂ 1999 00:00:00 -05:00

Figure 1. A 30-month-old girl had had progressive bowing of the legs since she began walking at the age of 11 months. She reported bilateral thigh pain. Physical examination revealed...

REVIEW ARTICLE: Common Musculoskeletal Tumors of Childhood and Adolescence

Carola A.S. Arndt, M.D., and William M. Crist, M.D. — Thu, 29Â JulÂ 1999 00:00:00 -05:00

Common malignant tumors of the musculoskeletal system in children, adolescents, and young adults (<30 years old) include rhabdomyosarcoma, osteosarcoma, and Ewing's sarcoma. Together they constitute about 10 percent of newly...

IMAGES IN CLINICAL MEDICINE: Synovial Hemangioma

Denis Macdonald, M.D. and Jeffrey Gollish, M.D. — Thu, 29Â JulÂ 1999 00:00:00 -05:00

Figure 1. A 19-year-old man presented with a five-year history of a gradually increasing mass on the lateral aspect of his right knee. He first noted this mass after receiving...

EDITORIAL: Calcific Tendinitis of the Shoulder

Thu, 20Â MayÂ 1999 00:00:00 -05:00

Calcific tendinitis of the shoulder is a self-limiting calcification of the rotator cuff (Figure 1). Radiologically evident calcification has been reported in 7.5 to 20 percent of adults with no...

ORIGINAL ARTICLE: Ultrasound Therapy for Calcific Tendinitis of the Shoulder

Thu, 20Â MayÂ 1999 00:00:00 -05:00

Background: and Methods: Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography...

ORIGINAL ARTICLE: Lack of Effectiveness of Bed Rest for Sciatica

Thu, 11Â FebÂ 1999 00:00:00 -05:00

Background: and Methods: Bed rest is widely advocated for sciatica, but its effectiveness has not been established. To study the effectiveness of bed rest in patients with a lumbosacral radicular...

EDITORIAL: Anticytokine Therapy â A New Era in the Treatment of Rheumatoid Arthritis?

Thu, 28Â JanÂ 1999 00:00:00 -05:00

With the clinical availability of two different approaches to decrease the activity of tumor necrosis factor (TNF), a new era in the treatment of rheumatoid arthritis has begun. In this...

ORIGINAL ARTICLE: A Trial of Etanercept, a Recombinant Tumor Necrosis Factor Receptor:Fc Fusion Protein, in Patients with Rheumatoid Arthritis Receiving Methotrexate

Thu, 28Â JanÂ 1999 00:00:00 -05:00

Background: Patients treated with methotrexate for rheumatoid arthritis often improve but continue to have active disease. This study was undertaken to determine whether the addition of etanercept, a soluble tumor...

EDITORIAL: KashinâBeck Disease â Expanding the Spectrum of Iodine-Deficiency Disorders

Thu, 15Â OctÂ 1998 00:00:00 -05:00

Selenium, as selenocysteine, is an integral component of two important enzymes â glutathione peroxidase and iodothyronine deiodinase â that are present in many tissues, including the thyroid gland. Glutathione peroxidase...

ORIGINAL ARTICLE: KashinâBeck Osteoarthropathy in Rural Tibet in Relation to Selenium and Iodine Status

Thu, 15Â OctÂ 1998 00:00:00 -05:00

Background: and Methods: KashinâBeck disease is a degenerative osteoarticular disorder that is endemic to certain areas of Tibet, where selenium deficiency is also endemic. Because selenium is involved in thyroid...

EDITORIAL: What Role for Chiropractic in Health Care?

Thu, 08Â OctÂ 1998 00:00:00 -05:00

On September 18, 1895, Daniel David Palmer manipulated the spine of Harvey Lilliard, allegedly restoring Mr. Lilliard's sense of hearing and founding the practice of chiropractic.1 From this beginning, despite...

ORIGINAL ARTICLE: A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain

Thu, 08Â OctÂ 1998 00:00:00 -05:00

Background: and Methods: There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted...

IMAGES IN CLINICAL MEDICINE: Blue Sclerae in Osteogenesis Imperfecta

Gudrun Leidig-Bruckner, M.D. and Andreas Grauer, M.D. — Thu, 01Â OctÂ 1998 00:00:00 -05:00

Figure 1. A 26-year-old woman (Panel A) and her 6-year-old daughter (Panel B) were evaluated for recurrent bone fractures. Both had blue sclerae. The mother had had a femoral-neck fracture...

IMAGES IN CLINICAL MEDICINE: Vertebral Tuberculosis

Peter J. Jenks, M.D. and Bruce Stewart, M.D. — Thu, 04Â JunÂ 1998 00:00:00 -05:00

Figure 1. A 62-year-old man presented to the hospital with an inability to walk unaided. He had noticed progressive weakness of his legs over the previous two weeks and had...

REVIEW ARTICLE: Antibodies to DNA

Bevra Hannahs Hahn, M.D. — Thu, 07Â MayÂ 1998 00:00:00 -05:00

Antibodies to DNA are of interest to a broad spectrum of physicians and other scientists. The presence of large amounts of serum antibodies to double-stranded DNA is specific for systemic...

EDITORIAL: Microchimerism and Autoimmune Disease

Thu, 23Â AprÂ 1998 00:00:00 -05:00

The mythological Chimera is described as having the head of a lion, the body of a goat, and the tail of a serpent. In medicine, the term âchimeraâ is used...

SPECIAL ARTICLE: Aging, Health Risks, and Cumulative Disability

Thu, 09Â AprÂ 1998 00:00:00 -05:00

Background: Persons with lower health risks tend to live longer than those with higher health risks, but there has been concern that greater longevity may bring with it greater disability....

ORIGINAL ARTICLE: Gene Fusion as a Determinant of Morphology and Prognosis in Synovial Sarcoma

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Background: Synovial sarcomas account for up to 10 percent of soft-tissue sarcomas and include two major histologic subtypes, biphasic and monophasic, defined respectively by the presence and absence of glandular...

IMAGES IN CLINICAL MEDICINE: Ivory Vertebra

Isaac E. Silverman, M.D. and John A. Flynn, M.D. — Thu, 08Â JanÂ 1998 00:00:00 -05:00

Figure 1. A 67-year-old man with difficulty walking and recent constipation, nocturia, and anorexia was found to have wasting of his legs and a firm, enlarged prostate. A chest radiograph,...

REVIEW ARTICLE: Small-Vessel Vasculitis

J. Charles Jennette, M.D., and Ronald J. Falk, M.D. — Thu, 20Â NovÂ 1997 00:00:00 -05:00

Vasculitis is inflammation of vessel walls. It has many causes, although they result in only a few histologic patterns of vascular inflammation. Vessels of any type in any organ can...

EDITORIAL: Sonography in Giant-Cell Arteritis

Thu, 06Â NovÂ 1997 00:00:00 -05:00

Giant-cell (temporal) arteritis is a disease of middle-aged and older persons and in some populations is the most frequent form of vasculitis. The prevalence may be as high as 1...

ORIGINAL ARTICLE: Color Duplex Ultrasonography in the Diagnosis of Temporal Arteritis

Thu, 06Â NovÂ 1997 00:00:00 -05:00

Background: The diagnosis of temporal arteritis usually requires a biopsy of the temporal artery. We examined the usefulness of color duplex ultrasonography in patients suspected of having temporal arteritis.

Methods: In...

IMAGES IN CLINICAL MEDICINE: Angioid Streaks in Pseudoxanthoma Elasticum

Edward W. Cheeseman, Jr., M.D. and Ann E. Bidwell, M.D. — Thu, 18Â SepÂ 1997 00:00:00 -05:00

Figure 1. A 22-year-old man with pseudoxanthoma elasticum and normal visual acuity was found to have bilateral angioid streaks. These vessel-like streaks (arrowheads) are breaks in Bruch's membrane beneath the...

SPECIAL REPORT: Cost Effectiveness of Oral as Compared with Intravenous Antibiotic Therapy for Patients with Early Lyme Disease or Lyme Arthritis

Thu, 31Â JulÂ 1997 00:00:00 -05:00

Lyme disease, which is caused by the tick-transmitted spirochete Borrelia burgdorferi,1 usually begins with an expanding skin lesion, erythema migrans, accompanied by malaise and fatigue, fever, headache, stiff neck, and...

EDITORIAL: Workers with Disabling Back Pain

Thu, 31Â JulÂ 1997 00:00:00 -05:00

For much of this century the countries of the industrialized world have grappled with the problem of covering disabling back pain under workers' compensation insurance plans.1 These insurance programs entitle...

SPECIAL ARTICLE: A Controlled Trial of an Educational Program to Prevent Low Back Injuries

Thu, 31Â JulÂ 1997 00:00:00 -05:00

Background: Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under...

EDITORIAL: Anticytokine Therapy in Rheumatoid Arthritis

Thu, 17Â JulÂ 1997 00:00:00 -05:00

Only a few years ago, little was known about the role of cytokines in rheumatoid arthritis. The original view of the cytokine milieu in the inflamed joint as a melange...

ORIGINAL ARTICLE: Treatment of Rheumatoid Arthritis with a Recombinant Human Tumor Necrosis Factor Receptor (p75)âFc Fusion Protein

Thu, 17Â JulÂ 1997 00:00:00 -05:00

Background: Tumor necrosis factor (TNF) is a proinflammatory cytokine involved in the pathogenesis of rheumatoid arthritis, and antagonism of TNF may reduce the activity of the disease. This study evaluated...

REVIEW ARTICLE: Osteomyelitis

Daniel P. Lew, M.D., and Francis A. Waldvogel, M.D. — Thu, 03Â AprÂ 1997 00:00:00 -05:00

Known since antiquity,1 osteomyelitis is a difficult-to-treat infection characterized by the progressive inflammatory destruction and new apposition of bone.234 This review focuses on current knowledge of the disease and the...

REVIEW ARTICLE: The Management of Paget's Disease of Bone

Pierre D. Delmas, M.D., Ph.D. and Pierre J. Meunier, M.D. — Thu, 20Â FebÂ 1997 00:00:00 -05:00

Paget's disease of bone is a localized, monostotic or polyostotic disease characterized by increased bone remodeling, bone hypertrophy, and abnormal bone structure that leads in symptomatic patients to pain and...

EDITORIAL: Bisphosphonates in the Treatment of Bone Diseases

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Bisphosphonates are drugs that inhibit bone turnover by decreasing the resorption of bone. They do this both directly, by inhibiting the recruitment and function of osteoclasts (the bone-resorbing cells), and...

ORIGINAL ARTICLE: An Echocardiographic Study of Valvular Heart Disease Associated with Systemic Lupus Erythematosus

Carlos A. Roldan, M.D., Bruce K. Shively, M.D., and Michael H. Crawford, M.D. — Thu, 07Â NovÂ 1996 00:00:00 -05:00

Background: Valvular heart disease is the most important cardiac manifestation of systemic lupus erythematosus. We performed a study to determine the relation of valvular disease to other clinical features of...

ORIGINAL ARTICLE: Clinical and Biochemical Manifestations of Hyaluronidase Deficiency

Thu, 03Â OctÂ 1996 00:00:00 -05:00

The mucopolysaccharidoses are lysosomal storage disorders caused by a genetic deficiency of enzymes that catalyze the degradation of glycosaminoglycans (mucopolysaccharides). These disorders are clinically variable and commonly associated with mental...

EDITORIAL: Actions of Parathyroid HormoneâRelated Peptide and Its Receptors

Thu, 05Â SepÂ 1996 00:00:00 -05:00

Building on the insight gained from their initial identification of a mutation in the receptor for parathyroid hormone (PTH) and parathyroid hormoneârelated peptide (PTHrP) in a patient with Jansen's metaphyseal...

ORIGINAL ARTICLE: Constitutively Activated Receptors for Parathyroid Hormone and Parathyroid HormoneâRelated Peptide in Jansen's Metaphyseal Chondrodysplasia

Thu, 05Â SepÂ 1996 00:00:00 -05:00

Background: An activating mutation of the receptor for parathyroid hormone (PTH) and parathyroid hormoneârelated peptide (PTHrP) was recently found in a patient with Jansen's metaphyseal chondrodysplasia, a rare form of...

EDITORIAL: Fibrodysplasia Ossificans Progressiva â Lessons from Rare Maladies

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Just as the study of rare inborn errors of metabolism has yielded important insights into normal metabolic pathways, the study of rare genetic defects can help define the roles of...

ORIGINAL ARTICLE: Overexpression of an Osteogenic Morphogen in Fibrodysplasia Ossificans Progressiva

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Background: Fibrodysplasia ossificans progressiva is a heritable disorder of connective tissue characterized by congenital malformation of the great toes and postnatal formation of ectopic bone. Although the disorder was first...

EDITORIAL: Empiricism and Wegener's Granulomatosis

Thu, 04Â JulÂ 1996 00:00:00 -05:00

Many medical treatments are based on sheer empiricism. In 1975 I noted that trimethoprimâsulfamethoxazole had a salutary effect in a woman with Wegener's granulomatosis involving all major sites, including the...

REVIEW ARTICLE: The Tumor Necrosis Factor Ligand and Receptor Families

Flavia Bazzoni, Ph.D., and Bruce Beutler, M.D. — Thu, 27Â JunÂ 1996 00:00:00 -05:00

Tumor necrosis factor (TNF) and lymphotoxin-Î± were isolated more than 10 years ago, on the basis of their ability to kill tumor cells in vitro and to cause hemorrhagic necrosis...

ORIGINAL ARTICLE: Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three Medications

Thu, 16Â MayÂ 1996 00:00:00 -05:00

Background: Rheumatoid arthritis is a common disease that causes substantial morbidity and mortality. The responses of patients with rheumatoid arthritis to treatment with a single so-called disease-modifying drug, such as...

EDITORIAL: Management of Myeloma with Bisphosphonates

Thu, 22Â FebÂ 1996 00:00:00 -05:00

Osteolytic lesions are a hallmark of multiple myeloma. At the time of diagnosis, most patients have bone lesions whose extent is directly related to the mass of the tumor. About...

ORIGINAL ARTICLE: Efficacy of Pamidronate in Reducing Skeletal Events in Patients with Advanced Multiple Myeloma

Thu, 22Â FebÂ 1996 00:00:00 -05:00

Background: Skeletal complications are a major clinical manifestation of multiple myeloma. These complications are caused by soluble factors that stimulate osteoclasts to resorb bone. Bisphosphonates such as pamidronate inhibit osteoclastic...

REVIEW ARTICLE: The Management of Gout

Bryan T. Emmerson, M.D., Ph.D. — Thu, 15Â FebÂ 1996 00:00:00 -05:00

Gout is a clinical syndrome resulting from the deposition of urate (monosodium urate monohydrate) crystals. The crystals may be deposited in a joint, leading to an acute inflammatory response, or...

NEJM â Collection Updates for Rheumatic Disease

IMAGES IN CLINICAL MEDICINE: Anterior Sternal Dislocation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

IMAGES IN CLINICAL MEDICINE: Gouty Tophi

ORIGINAL ARTICLE: Osteoporosis Associated with Neutralizing Autoantibodies against Osteoprotegerin

IMAGES IN CLINICAL MEDICINE: Pericardial Calcification Noted Long after Sydenham's Chorea

CORRESPONDENCE: Ruptured Abdominal Aortic Aneurysm Related to IgG4 Periaortitis

IMAGES IN CLINICAL MEDICINE: Baker's Cyst in a Patient with Rheumatoid Arthritis

ORIGINAL ARTICLE: Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

REVIEW ARTICLE: Interleukin-17 and Type 17 Helper T Cells

BOOK REVIEW:

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

IMAGES IN CLINICAL MEDICINE: Lupus-Associated Intestinal Vasculitis

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

EDITORIAL: Gene Therapy â Still a Work in Clinical and Regulatory Progress

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

ORIGINAL ARTICLE: Investigation of the Cause of Death in a Gene-Therapy Trial

EDITORIAL: Interleukin-1Î² and the Autoinflammatory Diseases

ORIGINAL ARTICLE: An Autoinflammatory Disease Due to Homozygous Deletion of the Locus

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

ORIGINAL ARTICLE: Use of Canakinumab in the Cryopyrin-Associated Periodic Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

REVIEW ARTICLE: Scleroderma

IMAGES IN CLINICAL MEDICINE: Familial Hypercholesterolemia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2009 â A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung

CLINICAL THERAPEUTICS: Minimally Invasive Total Knee Arthroplasty for Osteoarthritis

ORIGINAL ARTICLE: Association of HTRA1 Mutations and Familial Ischemic Cerebral Small-Vessel Disease

IMAGES IN CLINICAL MEDICINE: Gingival and Periungual Vasculopathy of Juvenile Dermatomyositis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2009 â A 37-Year-Old Woman with Vertigo, Facial Weakness, and a Generalized Seizure

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

IMAGES IN CLINICAL MEDICINE: Chondrocalcinosis and Hypomagnesemia

IMAGES IN CLINICAL MEDICINE: Occult Hip Fracture

ORIGINAL ARTICLE: Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

REVIEW ARTICLE: Temporomandibular Disorders

IMAGES IN CLINICAL MEDICINE: Acute Calcific Tendinitis

IMAGES IN CLINICAL MEDICINE: Infrapatellar Bursitis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2008 â A 59-Year-Old Man with Chronic Daily Headache

IMAGES IN CLINICAL MEDICINE: Cavernous Sinus Thrombosis

CLINICAL PRACTICE: Anterior Cruciate Ligament Tear

IMAGES IN CLINICAL MEDICINE: Ankylosing Spondylitis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2008 â A 39-Year-Old Man with Chest Pain, Arthralgias, and a Mediastinal Mass

IMAGES IN CLINICAL MEDICINE: New-Onset Clubbing Associated with Lung Cancer

IMAGES IN CLINICAL MEDICINE: Colonic Saccular Diverticula

BOOK REVIEW:

EDITORIAL: Arthroscopic Surgery for Osteoarthritis of the Knee?

ORIGINAL ARTICLE: Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons

ORIGINAL ARTICLE: A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

ORIGINAL ARTICLE: Adalimumab with or without Methotrexate in Juvenile Rheumatoid Arthritis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2008 â A 43-Year-Old Man with Fatigue and Lesions in the Pituitary and Cerebellum

IMAGES IN CLINICAL MEDICINE: Complex Regional Pain Syndrome Type 1

IMAGES IN CLINICAL MEDICINE: Ankylosing Spondylitis

IMAGES IN CLINICAL MEDICINE: Systemic Sclerosis and Acral Osteolysis

IMAGES IN CLINICAL MEDICINE: Rupture of a Calcified Achilles' Tendon

CLINICAL PROBLEM-SOLVING: A Joint Venture

CLINICAL PRACTICE: Rotator-Cuff Failure

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2008 â A 46-Year-Old Man with Rheumatoid Arthritis and Lymphadenopathy

EDITORIAL: Collaboration, Genetic Associations, and Lupus Erythematosus

REVIEW ARTICLE: Systemic Lupus Erythematosus

ORIGINAL ARTICLE: Association of Systemic Lupus Erythematosus with and

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

CLINICAL PRACTICE: Lumbar Spinal Stenosis

ORIGINAL ARTICLE: Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis

IMAGES IN CLINICAL MEDICINE: Sarcoid Arthropathy

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

IMAGES IN CLINICAL MEDICINE: Paget's Disease of the Mandible

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

ORIGINAL ARTICLE: Mutations and Hereditary Angiopathy, Nephropathy, Aneurysms, and Muscle Cramps

IMAGES IN CLINICAL MEDICINE: Calcinosis Associated with Renal Failure

REVIEW ARTICLE: Sarcoidosis

IMAGES IN CLINICAL MEDICINE: Quinolone-Associated Rupture of the Achilles' Tendon

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

CLINICAL PRACTICE: Osteoarthritis of the Hip

EDITORIAL: Lessons from a Genomewide Association Study of Rheumatoid Arthritis

ORIGINAL ARTICLE: A Polymorphism in the Promoter Region Associated with Systemic Sclerosis

ORIGINAL ARTICLE: as a Risk Locus for Rheumatoid Arthritis â A Genomewide Study

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

ORIGINAL ARTICLE: and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus

NEJM â Collection Updates for Rheumatic Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

EDITORIAL: Gene Therapy â Still a Work in Clinical and Regulatory Progress

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2009 â A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2009 â A 37-Year-Old Woman with Vertigo, Facial Weakness, and a Generalized Seizure

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2008 â A 59-Year-Old Man with Chronic Daily Headache

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2008 â A 39-Year-Old Man with Chest Pain, Arthralgias, and a Mediastinal Mass

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2008 â A 43-Year-Old Man with Fatigue and Lesions in the Pituitary and Cerebellum

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2008 â A 46-Year-Old Man with Rheumatoid Arthritis and Lymphadenopathy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

ORIGINAL ARTICLE: as a Risk Locus for Rheumatoid Arthritis â A Genomewide Study

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

EDITORIAL: Prophylactic Treatment for Prevention of Joint Disease in Hemophilia â Cost versus Benefit

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2007 â A 19-Year-Old College Student with Fever and Joint Pain

PERSPECTIVE: Back Surgery â Who Needs It?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2007 â A 59-Year-Old Man with Fever and Pain and Swelling of Both Eyes and the Right Ear

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2007 â A 59-Year-Old Man with Neck Pain, Weakness in the Arms, and Cranial-Nerve Palsies

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2007 â A 27-Year-Old Woman with Pain and Swelling of the Legs

PERSPECTIVE: NSAID Trials and the Choice of Comparators â Questions of Public Health Importance

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2006 â A 24-Year-Old Woman with Systemic Lupus Erythematosus, Seizures, and Right Arm Weakness

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2006 â A 43-Year-Old Woman with Painful Nodules on the Fingertips, Shortness of Breath, and Fatigue

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2006 â A 22-Month-Old Boy with the Rapid Growth of Subcutaneous Nodules

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Arthritis

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Gangrene and Cutaneous Nodules

EDITORIAL: Nutritional Supplements for Knee Osteoarthritis â Still No Resolution

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2006 â A 79-Year-Old Woman with Myalgias, Fatigue, and Shortness of Breath

IMAGES IN CLINICAL MEDICINE: PellegriniâStieda Syndrome

EDITORIAL: Expression of Concern: Bombardier et al., âComparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis,â N Engl J Med 2000;343:1520-8.

EDITORIAL: Oral Contraceptives in Systemic Lupus Erythematosus â A Tough Pill to Swallow?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

EDITORIAL: Febuxostat â Treatment for Hyperuricemia and Gout?

REVIEW ARTICLE: Antiinflammatory Action of Glucocorticoids â New Mechanisms for Old Drugs

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2005 â A 60-Year-Old Man with Skin Lesions and Renal Insufficiency

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2005 â A 68-Year-Old Man with Periorbital Swelling, Rash, and Weakness

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2005 â A 42-Year-Old Man with Weight Loss, Weakness, and a Rash

PERSPECTIVE: Learning the Value of Drugs â Is Rofecoxib a Regulatory Success Story?

PERSPECTIVE: Raising the Safety Bar â The FDA's Coxib Meeting

EDITORIAL: COX-2 Inhibitors â A Lesson in Unexpected Problems