ABSTRACT
IgG4-RSD should be suspected in any patient presenting with lacrimal or salivary gland enlargement, particularly if male and manifesting mild glandular dysfunction. A serum IgG4 level, if increased, may be helpful, although a gland biopsy staining for IgG4-positive plasma cells is the definitive test. Primary low-grade B cell lymphomas of the glandular tissue, specifically MALT lymphoma and other glandular malignancy, should be considered, particularly in patients with asymmetric glandular enlargement. Patients with idiopathic uveitis should have a thorough evaluation to exclude malignancy, in particular PIOL and melanoma in adults, and diffuse retinoblastoma and ALL in children. RF remains a diagnostic challenge and atypical features such as outward displacement of the retroperitoneal structures should raise the suspicion for a malignant infiltrative process. CRPS rarely may be the first presentation of an occult malignancy and requires a thorough review of age-appropriate cancer screening. Carpal tunnel syndrome, if bilateral or associated with other systemic features, should prompt a search for amyloidosis.
Subject(s)
Complex Regional Pain Syndromes/diagnosis , Neoplasms, Unknown Primary/diagnosis , Paraneoplastic Polyneuropathy/diagnosis , Retroperitoneal Fibrosis/diagnosis , Sialadenitis/diagnosis , Uveitis/diagnosis , Complex Regional Pain Syndromes/immunology , Diagnosis, Differential , Humans , Immunoglobulin G/blood , Neoplasms, Unknown Primary/immunology , Paraneoplastic Polyneuropathy/immunology , Paraproteinemias/diagnosis , Paraproteinemias/immunology , Retroperitoneal Fibrosis/immunology , Sialadenitis/immunology , Uveitis/immunologyABSTRACT
Despite the increasing success of transplantation, graft recipients experience a high burden of musculoskeletal symptoms that may hinder quality of life. Post-transplant musculoskeletal problems may result from sequelae of the organ dysfunction that indicated the transplant or from the subsequent anti-rejection therapy. Rheumatology consultants need to be familiar with the spectrum of musculoskeletal syndromes presenting in these unique patients and their appropriate treatment in the context of complex drug regimens and immunosuppression.
Subject(s)
Musculoskeletal Diseases/etiology , Organ Transplantation/adverse effects , Postoperative Complications , Arthritis/etiology , Arthritis/pathology , Arthritis/physiopathology , Female , Gout/etiology , Gout/pathology , Gout/physiopathology , Graft vs Host Disease/immunology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Male , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/physiopathology , Osteonecrosis/etiology , Osteonecrosis/pathology , Osteonecrosis/physiopathology , Osteoporosis/etiology , Osteoporosis/pathology , Osteoporosis/physiopathology , Quality of Life , Vasculitis/etiology , Vasculitis/pathology , Vasculitis/physiopathologyABSTRACT
What is the role of pregabalin (Lyrica) in the treatment of fibromyalgia? In this article the authors explore the putative pathophysiology of fibromyalgia, pregabalin's mechanism of action and evidence of efficacy, and its emerging role in treating this challenging disease.
