Management of rheumatoid neck

Article Abstract:

Rheumatoid arthritis involvement of the neck is common but rarely leads to neurological complication, which is caused by spinal cord and nerve compression from bony and soft tissue damage. The only treatment is surgery, but diagnosis is often delayed, so that patients are in poor condition for surgery. The use of newer imaging techniques, particularly magnetic resonance imaging (MRI), may increase the likelihood of early diagnosis if a careful examination is performed as well. To illustrate, a case is described of a 55-year-old man who had weakness of the right arm and difficulty in walking. He had developed rheumatoid arthritis 18 years before, which was persistent and slowly progressive. He had undergone extensive joint replacement surgery. In the previous year, paresthesias (sensory abnormalities such as tingling and numbness) had developed insidiously, first in one and then both arms. Bending of the neck exacerbated these problems, and the muscle weakness and walking difficulty developed soon after. Physical examination confirmed these symptoms, and there were abnormal reflexes in the legs. X-ray showed dislocation of cervical (neck) vertebrae with narrowing of the disc area between vertebrae and fusion of some vertebral areas. MRI confirmed these findings, showed better the extent of the arthritic disease process in soft tissues, and indicated other vertebral dislocations as well. The report indicates that careful examination is indispensable, as the degree of dislocation does not correlate well with the extent of neurological complications. These patients are more likely to have severe disease of extremity joints, rheumatoid nodules, and to have been using steroids for a long time, and the condition is more common in men. Demonstration of the exact location of the nerve lesion is essential. Nerve-derived pain and spinal cord involvement are the indications for surgery, which involves decompressing the affected area, then bone fusion. This is complex, but prognosis is poor if the condition is left untreated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Spinal cord compression

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Concurrent onset of adult onset Still's disease and insulin dependent diabetes mellitus

Article Abstract:

Adult onset of Still's disease (also called juvenile rheumatoid arthritis) is a rare occurrence. The disease affects a number of organ systems and is characterized by various symptoms including fever, rash, and arthritis (inflammation of the joints). The cause of this disease is not known, but may be related to viral infection. Some cases of insulin-dependent diabetes mellitus may also be caused by viral infection. The simultaneous occurrence of these two conditions has not been previously reported. A case is described of a 32-year-old man who developed Still's disease and insulin-dependent diabetes mellitus within two weeks after an infection of the upper respiratory tract. Both disorders persisted for 24 months, and laboratory findings showed a persistent increase in the levels of antibodies to rubella virus, suggestive of a rubella virus infection. Antibodies are immune proteins which specifically bind and inactivate foreign cells, such as viruses. The simultaneous occurrence of insulin-dependent diabetes mellitus and Still's disease may indicate a common cause, possibly a viral infection. Some cases of Still's disease have been preceded by rubella infection, and various viruses including rubella, mumps, and Coxsackie B have been involved in some cases of insulin-dependent diabetes mellitus. In this case, the patient, his wife, and two-year-old child had recent symptoms of upper respiratory tract infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Type 1 diabetes, Rheumatoid arthritis in children, Juvenile rheumatoid arthritis

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