Delayed rupture of the spleen in rheumatoid arthritis

Article Abstract:

Rheumatoid arthritis, an inflammatory joint disease, may be associated with splenomegaly, the enlargement of the spleen; a rupture of the spleen may occur spontaneously, or after injury. A case is described of delayed rupture of the spleen occurring in a 56-year-old man with rheumatoid arthritis and splenomegaly. The patient, who was a factory health and safety officer, had tripped on a loose board and fallen forward. He instinctively went into a fetal tuck position to protect his rheumatoid hands before landing on his left side with the left elbow tucked against the side chest wall. The man was knocked unconscious, and was admitted to the hospital, but discharged 24 hours later. Within six days, the patient felt shaken and listless, and experienced stomach indigestion. Two weeks after the fall, the patient was admitted with severe pain above the stomach area spreading to the left shoulder. A diagnosis of delayed rupture of the spleen was confirmed during surgery, and his spleen was removed. After the operation, the patient received antibiotics and a pneumococcal vaccine. In this case, the patient's elbow caused the rupture of the spleen when he assumed a fetal tuck position to protect his painful hands. Patients with rheumatoid arthritis, particularly those who are prone to falling, should be aware of the risks of rupture to the spleen when they have developed reflexes to protect painful hands. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Spleen, Arthritics

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Symptomatic manubriosternal joint involvement in rheumatoid arthritis

Article Abstract:

Rheumatoid arthritis (RA), an inflammatory joint disease, is characterized by swelling, stiffness, hypertrophy (enlargement) of the cartilage, and pain. Pain in the area of the lung in patients with RA usually results from the pericardial or pleural cavities, which surround the heart and lungs, respectively. A case is described of a 61-year-old woman with RA, who complained of anterior chest pain. The pain had been present for six months and was worsened with deep breathing in and coughing. The tissue overlying the manubriosternal joint, located in the breastbone, was shown to be tender and swollen, and X-rays revealed synovitis, inflammation and deterioration of the joint. A corticosteroid drug, triamcinolone, was injected into the joint and symptoms resolved over the following week. Synovitis of the manubriosternal joint is common but seldom apparent, because the joint is normally immobile. This case shows that synovitis of the manubriosternal joint can produce symptoms, which can then be treated by injection of steroid drugs directly into the joint. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Joints, Abnormalities, Joints (Anatomy), Steroids (Drugs)

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