Stress fractures of the legs and swelling of the ankles in a patient with lupus: a diagnostic dilemma

Article Abstract:

Stress fractures, which are fine hairline fractures, of the long bones are somewhat uncommon in patients with rheumatoid arthritis. Factors that contribute to such fractures include osteoporosis (bone wasting), joint deformities that produce mechanical stresses on bone, and increased activity by patients after surgery to reconstruct joints. Stress fractures have not been reported in patients with systemic lupus erythematosus, another rheumatic disease. A case is reported of a 51-year-old woman with a 24-year history of lupus, who developed stress fractures in both legs within a six-month period. She initially developed pain and swelling in the right ankle, which was worsened by walking; X-rays showed no abnormality. This was initially thought to be joint inflammation, but there was no other evidence of active lupus disease. However, an old stress fracture was seen on X-ray three months later, and swelling resolved with fracture healing, suggesting the inflammation was a consequence of the fracture. Five months after the first incident, the patient developed sudden pain and swelling in the left ankle and was unable to bear weight. Treatment with steroids, standard therapy for active rheumatic disease, was not effective. Bone scans showed pronounced bone cell activity, and X-ray showed a lesion in an area where stress fractures are uncommon. A biopsy was taken to rule out disease such as cancer or osteomyelitis (bone infection or inflammation), and the results revealed a stress fracture instead, with ongoing healing. Unlike the right leg, the left leg continued to be inflamed after the fracture healed, and this was probably true lupus-associated joint inflammation. This case illustrates some diagnostic difficulties that can occur when stress fractures and inflammation develop in patients with rheumatic diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Inflammation, Stress fractures

---

Behcet's disease in a patient with immunodeficiency virus infection

Article Abstract:

Behcet's disease can affect the joints, intestines, lungs, blood vessels, nerves, and eyes, and can cause ulcers on the genital organs. Although the cause of this disease is unknown, recent studies have suggested that an autoimmune process (the production of antibodies that attack and destroy the body's own tissues) may be involved. This article describes the case report of a 27-year-old black woman who was infected with the human immunodeficiency virus (HIV, the virus that causes AIDS) and later developed Behcet's disease. Her initial symptoms included fever, fatigue, night sweats, anorexia (loss of appetite), and painful ulcers in her mouth and on her genital organs. She had several episodes of swollen and painful hands, feet, knees and ankles, and she had recurrent conjunctivitis (inflammation of the eye membranes). She tested positive for the presence of HIV antibodies in her blood, indicating that she had HIV infection. Laboratory tests showed no signs of liver or kidney disorders. The patient was diagnosed as having Behcet's disease with HIV infection. During the following three weeks, the genital ulcers became worse and new ulcers developed in the mouth. Treatment with acyclovir, prednisone and thalidomide did not improve her condition. Treatment with colchicine helped the ulcers heal during the following four months, and zidovudine was given for the HIV infection. Eight months later the patient remained without symptoms. It is concluded that Behcet's disease was related to the HIV infection in this patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV infection, HIV infections, Autoimmune diseases, Behcet's disease, Behcet's syndrome

---

Factors associated with fatigue in patients with systematic lupus erythematosus

Article Abstract:

Among patients with systemic lupus erythematosus (SLE), the severity of fatigue seems to be related to health status, poor health relkating to more severe fatigue. It also seems related to a higher tender point count, such as are seen in fibromyalgia. In fact, among patients with SLE, the factors usually associated with quality of life and fibromyalgia seem to have more relation to the degree of fatigue than the current level of SLE disease activity. This was the result of studying 81 patients of an average age of 43 years and a disiease history of 12.7 years on average.

Physiological aspects, Development and progression, Fatigue

Similar abstracts:

• Abstracts: A prospective study of the development of diabetes in relatives of patients with insulin-dependent diabetes. Successful in utero treatment of fetal goiter and hypothyroidism
• Abstracts: Beneficial effects of treatment of nicotine dependence during an inpatient substance abuse treatment program. Medications to treat alcohol dependence: adding to the continuum of care
• Abstracts: New approaches may aid patients with inflammatory bowel disease. Largest-ever antismoking effort aims to form grass-roots coalitions
• Abstracts: Incidence of neuropathy in 395 patients with ovarian cancer treated with or without cisplatin. Cisplatin-induced peripheral neuropathy: frequent off-therapy deterioration, demyelinating syndromes, and muscle cramps
• Abstracts: The expression of progesterone receptors coincides with an arrest of DNA synthesis in human breast cancer. Steroid-hormone receptors in nonpalpable and more advanced stages of breast cancer: a contribution to the biology and natural history of carcinoma of the female breast

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.