Coexistent lyme disease and parvovirus infection in a child.

Infectious diseases commonly cause illnesses that mimic rheumatic diseases. Both Lyme disease and Parvovirus B19 infections produce arthritis, rashes, and a systemic illness that may be thought to represent a chronic rheumatic disease. In the case presented, a child with both infections simultaneously exhibited arthralgias, aseptic meningitis, and a facial rash. The features of Lyme disease and Parvovirus B19 infection that may mimic systemic lupus erythematosus include a facial rash, often in a malar distribution, hematologic abnormalities, arthritis, neurologic disorders, and autoantibody positivity. Given the proper season and geographical location, one must consider the possibility of co-infection with these two organisms, especially in those with atypical rheumatic complaints.

Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy.

Chronic pain disorders, including fibromyalgia and myofascial pain syndrome often do not respond adequately to standard therapy. The cases reviewed herein suggest the strain and counterstrain (SCS) technique, described in 1981 by Jones, may be helpful in reducing pain and improving function in patients with localized myofascial pain syndromes. This was a case study and retrospective review of 20 patients who had had chronic pain for an average of 2.7 years and were treated with SCS for pain relief. For all these patients, prior medical treatment had failed to provide pain relief or return of function. The procedure is a fairly common osteopathic and chiropractic technique, which to our knowledge has not received any systematic evaluation. Areduction in pain and an increase in function of 50%-100% occurred in 19 of 20 patients immediately after SCS therapy. Partial improvement was maintained for 6 months in 11 of 20 patients, and 4 were still pain free. We believe that SCS techniques should be considered and evaluated further as adjunctive therapy for patients previously unresponsive to standard treatment for myofascial pain syndrome.

Autoimmune manifestations of the Wiskott-Aldrich syndrome.

OBJECTIVE: To describe and review the autoimmune features and typical manifestations of Wiskott-Aldrich syndrome (WAS). DESIGN: Case series and review of the literature. SETTING: Tertiary care medical center and pediatric referral center. PATIENTS: The presentation, diagnosis, and management of two cases are reported. In addition to the typical features of WAS, the first patient had hemolytic anemia, arthritis, leukocytoclastic vasculitis, and colitis. The second patient had colitis and arthralgias. Detailed review of features and therapeutic options in WAS as exemplified by these two patients are presented. Both patients had bone marrow transplantation, the only definitive treatment for WAS. CONCLUSIONS: WAS has variable clinical and autoimmune manifestations. Diagnosis must be suspected in a boy with small, decreased number of platelets and autoimmune problems or infections. Bone marrow transplantation is the only successful mode of treatment for all aspects of WAS.

Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis.

OBJECTIVE: To determine the prevalence and outcome of chronic uveitis in patients with juvenile rheumatoid arthritis (JRA). METHODS: A retrospective analysis of 760 patients with JRA followed in 4 pediatric rheumatology centers. Patients with chronic uveitis were identified and their medical and ophthalmologic records were reviewed. RESULTS: Seventy-four patients with uveitis were identified. The prevalence of uveitis was 9.3%. The mean interval from the onset of JRA to the onset of uveitis was 21 months, and 90% of the patients who developed uveitis did so within the first 4 years of their disease. Visual complications (synechiae, band keratopathy, cataract, or glaucoma) developed in 31% of the patients with uveitis. Complications were more common in patients who presented with uveitis early in the course of their JRA. Complications were also more common in antinuclear antibody (ANA) negative than in ANA positive patients. Visual loss to 20/50 or worse occurred in only 11% of patients with uveitis, and no patient became blind. CONCLUSION: In a very large cohort of patients with JRA, uveitis was uncommon and poor visual outcome was rare. Visual complications did not necessarily result in a poor outcome.

Isolated digital swelling as the initial presentation of juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA) is an inflammatory condition that affects children under 16 years of age. The cases of 7 patients with isolated finger swelling as the initial manifestation of JRA are reviewed. In these children, the diagnosis was significantly delayed (t-test, p < .0076) for up to 14 months (mean, 8 months) when compared to a mean of 3.4 months in the JRA patients with a typical onset. Of the patients with the initial presentation of isolated digital swelling, +/7 (57%) had disease that became polyarticular, whereas only 15% of the patients with the initial presentation of large-joint disease experienced progression to polyarticular disease (Fisher's exact test, p < .0307). This presentation of JRA should be recognized so that appropriate management can be instituted promptly.