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A pain in the neck
Answers to the following two quiz questions can be found on page 79 Theme: Neck Select one option from the following: Acute crush fracture Infective spondylodiscitis Langerhans Cell Histiocytosis Pharyngotonsillitis Retropharyngeal infection Retropharyngeal tumour Vertebral metastasis QUESTION 1 This 4-year-old boy presented to the emergency department with neck pain 1 week after falling over backwards. He was complaining of pain on neck extension but had a full range of neck movements. Cervical spine radiographs were obtained (lateral view from the series is shown in figure 1). He was reassured and sent home with pai...
Source: Archives of Disease in Childhood - Education and Practice - March 14, 2013 Category: Pediatrics Authors: Zacharkiw, A., Williams, H. Tags: Oncology, Immunology (including allergy), Bone and joint infections, Drugs: infectious diseases, TB and other respiratory infections, Pain (neurology), Pain (palliative care), Radiology, Interstitial lung disease, Rheumatology, Clinical diagnostic tests, Source Type: research

Do the 2010 ACR/EULAR or ACR 1987 classification criteria predict erosive disease in early arthritis?
Conclusions The ability of the 2010 ACR/EULAR and 1987 ACR classification criteria to identify erosive disease in early arthritis is low. The discriminative power of the 2010 ACR/EULAR criteria of erosiveness in 10 years is slightly better than that of the 1987 ACR criteria.
Source: Annals of the Rheumatic Diseases - April 4, 2013 Category: Rheumatology Authors: Makinen, H., Kaarela, K., Huhtala, H., Hannonen, P. J., Korpela, M., Sokka, T. Tags: Immunology (including allergy), Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Epidemiology Clinical and epidemiological research Source Type: research

What Causes Spontaneous Pneumothorax?
Discussion “A pneumothorax is a collection of air in the pleural space, and it can be categorized into spontaneous, traumatic or iatrogenic. Spontaneous pneumothorax can be further classified into primary with no clinical evidence of underlying lung disease or secondary due to pre-existing lung disease.” Spontaneous pneumothorax is a condition that is relatively rare in pediatrics. There is a bimodal age distribution – neonates and late adolescence. It is caused by tearing of the visceral pleural. Clinical signs include chest pain, dyspnea, tachycardia, tracheal deviation towards contralateral side, hypot...
Source: PediatricEducation.org - April 22, 2013 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news

Treatment of non-radiographic axial spondyloarthritis: it is only the beginning
The new nomenclature used in spondyloarthritis (SpA), axial versus peripheral, as proposed by the Assessment of SpondyloArthritis international Society (ASAS) and accepted in 2009, has changed the perspective of ankylosing spondylitis (AS) and other types of spondylarthropathies.1 2 The axial type of SpA is subdivided in the (early) non-radiographic type (nr-axial SpA) and the radiographic type, which is equivalent to the diagnosis of AS (according to the modified New York criteria3). Instead of debating whether patients with AS do fulfil the grade of radiographic signs of sacroiliitis necessary for the diagnosis AS, the f...
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: van der Horst-Bruinsma, I. E. Tags: Immunology (including allergy), Inflammation, Ankylosing spondylitis, Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Calcium and bone Editorials Source Type: research

EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis
Conclusions Ten key recommendations for the role of imaging in the management of RA were developed using research-based evidence and expert opinion.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Colebatch, A. N., Edwards, C. J., Ostergaard, M., van der Heijde, D., Balint, P. V., D'Agostino, M.-A., Forslind, K., Grassi, W., Haavardsholm, E. A., Haugeberg, G., Jurik, A.-G., Landewe, R. B., Naredo, E., O'Connor, P. J., Ostendorf, B., Potocki, K., Sc Tags: Immunology (including allergy), Inflammation, Radiology, Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Clinical diagnostic tests, Radiology (diagnostics) Recommendation Source Type: research

Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1)
Conclusions In patients with nr-axSpA, adalimumab treatment resulted in effective control of disease activity, decreased inflammation and improved quality of life compared with placebo. Results from ABILITY-1 suggest that adalimumab has a positive benefit–risk profile in active nr-axSpA patients with inadequate response to NSAIDs.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Sieper, J., van der Heijde, D., Dougados, M., Mease, P. J., Maksymowych, W. P., Brown, M. A., Arora, V., Pangan, A. L. Tags: Open access, Editor's choice, Immunology (including allergy), Pain (neurology), Inflammation, Ankylosing spondylitis, Biological agents, Connective tissue disease, Degenerative joint disease, Drugs: musculoskeletal and joint diseases, Musculoskeletal synd Source Type: research

Similar response rates in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis after 1 year of treatment with etanercept: results from the ESTHER trial
Conclusions The response rate to TNF-blockers does not differ between AS and nr-axSpA if the baseline data regarding symptom duration and disease activity are similar for the two groups.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Song, I.-H., Weiss, A., Hermann, K.-G. A., Haibel, H., Althoff, C. E., Poddubnyy, D., Listing, J., Lange, E., Freundlich, B., Rudwaleit, M., Sieper, J. Tags: Editor's choice, Immunology (including allergy), Ankylosing spondylitis, Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Calcium and bone Clinical and epidemiological research Source Type: research

Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study
Conclusions A greater reduction in radiographic progression after initial combination therapy with ADA and MTX was seen at week 48, even after discontinuation of ADA treatment at week 24. This sustained effect was not found at the primary endpoint (DAS28 reduction).
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Detert, J., Bastian, H., Listing, J., Weiss, A., Wassenberg, S., Liebhaber, A., Rockwitz, K., Alten, R., Kruger, K., Rau, R., Simon, C., Gremmelsbacher, E., Braun, T., Marsmann, B., Hohne-Zimmer, V., Egerer, K., Buttgereit, F., Burmester, G.-R. Tags: Immunology (including allergy), Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis Clinical and epidemiological research Source Type: research

Rheumatoid factor determines structural progression of rheumatoid arthritis dependent and independent of disease activity
Conclusions The data reveal that damage progression in seropositive RA patients is related to higher levels of disease activity and to independent effects of RF, particularly on bone damage. This calls for consideration of RF status irrespective of disease activity.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Aletaha, D., Alasti, F., Smolen, J. S. Tags: Immunology (including allergy), Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Epidemiology Clinical and epidemiological research Source Type: research

In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis
Conclusions Inflammatory signs are more frequent in EOA than in non-EOA, not only in erosive joints but also in non-erosive joints, suggesting an underlying systemic cause for erosive evolution.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Kortekaas, M. C., Kwok, W.-Y., Reijnierse, M., Huizinga, T. W. J., Kloppenburg, M. Tags: Immunology (including allergy), Inflammation, Radiology, Degenerative joint disease, Musculoskeletal syndromes, Osteoarthritis, Clinical diagnostic tests, Radiology (diagnostics) Clinical and epidemiological research Source Type: research

Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI
Conclusions Wb-MRI detects active inflammation and SC more frequently in the SIJs than in the spine. Half of the patients showed inflammation in non-axial sites. Active inflammatory and structural lesions were present both in patients with AS and those with nr-axSpA, being only slightly more common in patients with AS.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Althoff, C. E., Sieper, J., Song, I.-H., Haibel, H., Weiss, A., Diekhoff, T., Rudwaleit, M., Freundlich, B., Hamm, B., Hermann, K.-G. A. Tags: Immunology (including allergy), Inflammation, Ankylosing spondylitis, Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis, Calcium and bone Clinical and epidemiological research Source Type: research

Does the site of magnetic resonance imaging abnormalities match the site of recent-onset inflammatory back pain? The DESIR cohort
Conclusions The site of pain (thoracic spine, lumbar spine or buttock(s)) is associated with MRI inflammation at the same site in patients with recent IBP.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Blachier, M., Coutanceau, B., Dougados, M., Saraux, A., Bastuji-Garin, S., Ferkal, S., Le Corvoisier, P., Farrenq, V., Poulain, C., Ghaleh, B., Canoui-Poitrine, F., Claudepierre, P. Tags: Immunology (including allergy), Pain (neurology), Inflammation, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Epidemiology Clinical and epidemiological research Source Type: research

Progression to rheumatoid arthritis in early inflammatory arthritis is associated with low IL-7 serum levels
Conclusion These data demonstrate that low IL-7 levels in patients with recent onset of symptoms may have value as a diagnostic biomarker predicting the progression to RA, particularly in ACPA-negative disease, as well as being related to RA progression.
Source: Annals of the Rheumatic Diseases - May 10, 2013 Category: Rheumatology Authors: Goeb, V., Aegerter, P., Parmar, R., Fardellone, P., Vittecoq, O., Conaghan, P. G., Emery, P., Le Loet, X., Ponchel, F. Tags: Immunology (including allergy), Connective tissue disease, Degenerative joint disease, Musculoskeletal syndromes, Rheumatoid arthritis Basic and translational research Source Type: research

What Causes Spontaneous Pneumothorax?
Discussion “A pneumothorax is a collection of air in the pleural space, and it can be categorized into spontaneous, traumatic or iatrogenic. Spontaneous pneumothorax can be further classified into primary with no clinical evidence of underlying lung disease or secondary due to pre-existing lung disease.” Spontaneous pneumothorax is a condition that is relatively rare in pediatrics. There is a bimodal age distribution – neonates and late adolescence. It is caused by tearing of the visceral pleural. Clinical signs include chest pain, dyspnea, tachycardia, tracheal deviation towards contralateral side, hypot...
Source: PediatricEducation.org - May 20, 2013 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news