Munchausen's syndrome simulating reflex sympathetic dystrophy

Article Abstract:

Munchausen's syndrome is a psychiatric disorder characterized by patients' seeking medical care for physical symptoms which appear to be under their voluntary control. Typically, patients go from one clinic or emergency room to another after the true nature of their physical complaints is detected, but they rarely receive needed psychiatric care. Munchausen's syndrome differs from conversion reaction, which is involuntary, and malingering, which is voluntary but usually consciously practiced to avoid work or other situations. This article describes a case of Munchausen's syndrome in a 15-year-old girl who complained of symptoms associated with reflex sympathetic dystrophy, a poorly defined disorder in which damage to bone or soft tissue and adjacent nerves (nervous dysregulation) leads to burning pain. The patient had a four-month history of pain, swelling, loss of left hand motion, and fever. She had previously been examined elsewhere and had several tests, including a biopsy of the wrist. Numerous laboratory tests were negative. X-rays showed loss of bone mass of the left hand, and a bone scan revealed increased bone cell activity. Additional biopsies were done and produced negative results, and the symptoms did not respond to steroid therapy. When the patient was closely observed, she was found to alter the thermometer reading by rubbing it, while hand symptoms were produced with a tourniquet. The patient was referred for psychiatric care. Two months later, hand swelling and osteoporosis had resolved, but the patient simulated a contraction of wrist movement. The effects of the tourniquet suggest a mechanism that may occur in true reflex sympathetic dystrophy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Case studies, Causes of, Reflex sympathetic dystrophy, Factitious disorder, Factitious disorders

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Loss of bone mineral density in premenopausal women with systemic lupus erythematosus

Article Abstract:

Premenopausal women with systemic lupus erythematosus (SLE) taking prednisone to suppress inflammatory reactions may be more likely to develop osteoporosis. Seventy-four premenopausal SLE patients had X-ray absorptiometry of the lumbar spine and the thigh bone to determine bone mineral density. Results were compared with bone mineral density in a group of 50 healthy premenopausal women volunteering for a screening program for age-related bone loss. Bone mineral density was reduced in both locations in SLE patients. Twelve percent of SLE patients versus no control women had bone mineral densities low enough to be considered osteoporotic. The adverse effect on bone mineral density may be due to the effects of prednisone, lack of menstrual cycles in SLE patients, overactivity of the parathyroid resulting from kidney failure, conscious avoidance of sunshine, or lack of physical activity as a result of painful joints.

Bones, Bone density

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Bone mineral density in systemic lupus erythematosus: comparison with rheumatoid arthritis and healthy controls

Article Abstract:

Many patients with systemic lupus erythematosus experience bone loss, according to a study of 75 SLE patients, 75 rheumatoid arthritis patients, and 75 healthy volunteers. Pre-menopausal women with SLE who take corticosteroids are especially vulnerable.

Risk factors, Osteoporosis

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