Bilateral complex regional pain syndrome in a woman with major depressive disorder.

Complex regional pain syndrome type 1 (CRPS1) refers to a disorder usually caused by trauma; it is characterized by pain, swelling, limited range of motion, vasomotor instability, skin changes, joint stiffness, and patchy bone demineralization. Most often it occurs after trauma. Other etiologies include myocardial ischemia, cerebrovascular accidents, infection and emotional stress. We report a case of bilateral CRPS1 of the upper extremities in a 52-year-old woman suffering from major depressive disorder. She was complaining about her hands' stiffness and pain. She also reported swelling of both upper extremities and anhydrosis, thickening of the skin and muscle wasting, finger movement limitation, contracture of the digits and trophic skin changes. The diagnosis of CRPS1 was suspected, according to history, physical examination, radiographic changes and bone scintigraphy.

Secondary Sjogren's syndrome presenting with hypokalemic periodic paralysis.

Renal tubular acidosis (RTA) may develop in a large population of patients with Sjogren's syndrome (SS), but most of the subjects are asymptomatic. Here, we report a patient with known rheumatoid arthritis and symptoms of xerostomia, xerophthalmia and periodic paralysis. SS should be considered as a cause of RTA. The treatment of the underlying disorder may ameliorate the symptoms.

Depicting and comparing the time to normalize "erythrocyte sedimentation rate" following two combination therapies in rheumatoid arthritis patients: a randomized clinical trial.

BACKGROUND: Erythrocyte sedimentation rate (ESR) is one of the predictors of improvement in handling rheumatoid arthritis. This study was designed to define and compare the time of achieving normal ESR and also the percentage for the normalization of this marker at several points of time in two different combination therapies. METHODS: Fifty-two rheumatoid arthritis patients randomly received methotrexate, chloroquine, prednisolone (MCP) or azathioprine, chloroquine, prednisolone (ACP) and all were followed up for 34 weeks. Chloroquine and azathioprine were given, 150 mg/d and 2 mg/kg/d, respectively. Methotrexate was given, 0.2 mg/kg/week and simultaneously increased 2.5 mg monthly if no clinical response was seen. Prednisolone was started, 0.3 mg/kg/d and tapered after one week. ESR at baseline and during follow-up were checked. The data were collected and analyzed. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: 2012110611383N1. RESULTS: The percentages of obtaining normal ESR after 2nd, 4th, 6th, 8th, 18th, 34th weeks of follow up were 42.4%, 53.9%, 57.7%, 65.4%, 88.5%, 96.2% in the MCP group and 47.9%, 65.3%, 74%, 78.3%, 82.7%, 87% in the ACP group. The mean time of obtaining normal ESR was 9.15 (95%CI, 5.58 to 12.73) weeks in MCP group and 9.04 (4.04 to 14.05) weeks in the ACP group (p>0.05). CONCLUSION: The results show that the time to achieve normal ESR and percentage of its normalization were almost the same in both treated groups.