ABSTRACT
Calcium pyrophosphate dihydrate (CPPD) deposition disease is a relatively common condition primarily affecting the elderly. Various clinical presentations ranging from an acute arthritis resembling gout (pseudogout) to fever of unknown origin have been reported. We describe four elderly patients with fever and altered mental status. Each patient underwent an extensive unrevealing work-up. An acute arthritis missed by the health-care team in their initial evaluation was later identified, leading to rheumatologic consultation and subsequent diagnosis of CPPD disease after joint aspiration and synovial fluid analysis. Defervescence and resolution of mental status changes occurred after improvement of the arthritis. Awareness that CPPD disease may present with systemic symptoms, including fever and altered mental status, may assure careful examination of joints and can prevent unnecessary testing and diagnostic delay.
ABSTRACT
This article describes common soft tissue problems encountered in older adults, including fibromyalgia, selected bursitis/tendinitis syndromes, nerve entrapment syndromes, and miscellaneous topics such as Dupuytren's contractures, trigger fingers, palmar fasciitis, and reflex-sympathetic dystrophy. Clinical presentations, diagnosis, and treatment are emphasized. These are conditions that are frequently encountered but are generally diagnosed as arthritis or normal age-related problems. This article will hopefully enlighten the reader in distinguishing between these conditions.
Subject(s)
Fibromyalgia , Joint Diseases , Muscular Diseases , Nerve Compression Syndromes , Aged , Female , Humans , MaleABSTRACT
OBJECTIVE: To determine frequency and prevalence of finger pad tophaceous deposits in patients with chronic tophaceous gout. METHODS: We examined 36 consecutive patients with chronic tophaceous gout for intracutaneous tophaceous urate deposits in the fingers pads. Subjects were patients of outpatient clinics at 2 large university hospitals, Emory and the University of Pennsylvania Affiliated Hospital Systems. RESULTS: Finger pad tophaceous deposits were found in 30.5%, which was surprising, given how few cases are reported. CONCLUSION: Finger pad tophi may be more common than generally believed.
Subject(s)
Fingers , Gout/diagnosis , Hand Dermatoses/diagnosis , Adult , Aged , Aged, 80 and over , Chronic Disease , Creatinine/metabolism , Female , Gout/complications , Gout/metabolism , Hand Dermatoses/complications , Hand Dermatoses/metabolism , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Uric Acid/metabolismABSTRACT
Breast involvement with lupus panniculitis has been infrequently reported. We describe 2 cases with breast involvement proven by biopsy to be lupus panniculitis. Our review emphasizes the clinical presentation of lupus panniculitis with mastitis and its possible clinical similarity to malignancy. In addition, other connective tissue diseases and vasculitis with breast involvement are noted.
