Pediatric spondyloarthropathies.

Seronegative spondyloarthropathies in childhood are often misdiagnosed as juvenile rheumatoid arthritis, but recognition of their distinct clinical manifestations and unique underlying pathophysiologies can aid in making a proper diagnosis. Ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, and the arthritis associated with inflammatory bowel disease are arthritides most often found in young adults, but they may also be present in children. Extraarticular manifestations include inflammation of the eyes, skin, gastrointestinal tract, and genitourinary tract associated with inflammation of the entheses. The proper diagnosis will allow for treatment regimens that differ from those usually used for juvenile rheumatoid arthritis. Early diagnosis and treatment often lead to an early recovery and a return to normal daily activities.

A review of musculoskeletal problems in instrumental musicians.

Musculoskeletal problems are common in instrumental musicians. Most of these problems can be classified as musculotendinous overuse, nerve entrapment/thoracic outlet syndrome, or motor dysfunction. Also seen in musicians are problems related to hypermobility and degenerative arthritis. Although these problems are seen in all instrumentalists, their prevalence is highest in professional musicians, with string players most commonly affected by musculotendinous overuse. Keyboard players are the performers most commonly affected by motor dysfunction. History and physical examination performed with an understanding of the problems of musicians are usually adequate to make the correct diagnosis. Electrophysiological studies are often helpful in confirming or excluding a diagnosis of nerve entrapment. With the exception of motor dysfunction, once these problems are recognized, they can be adequately treated. Treatment should begin conservatively with rest, evaluation of technique and practice habits, and possibly nonsteroidal antiinflammatory drugs. Depending on the type and severity of the problem, physical therapy, adaptive devices, steroid injection, or surgery may be indicated. A strong partnership with music educators is important in the management and prevention of these musculoskeletal problems.

Tuberculous arthritis presenting as tophaceous gout.

A 73-year-old black man with chronic gout presented with a 1 1/2 year history of a swollen painful left wrist. Two draining ulcers over the ventral aspect of his wrist and radiographic changes of the affected area suggested chronic gouty arthritis, but culture of the fluid from the wrist grew Mycobacterium tuberculosis. This case extends the list of infectious agents producing septic arthritis in patients with gout to include Mycobacterium tuberculosis. The need for culture evaluation of joint fluid in patients with chronic as well as acute gout is emphasized.

Profound muscle weakness and hypokalemia due to clay ingestion.

We have presented the case of a 43-year-old woman with severe myositis due to clay ingestion and hypokalemia. EMG studies revealed a pattern consistent with myositis, and muscle biopsy showed a nonspecific diffuse myositis. The clay was shown to act as a potassium binder. With potassium replacement and discontinuance of clay ingestion, the symptoms and signs abated and laboratory values returned to normal.

Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma.

Rat-bite fever results from an infection with the organism Streptobacillus moniliformis. Symptomatic patients often present with fever, malaise, cough, maculopapular rash, and occasional arthritis, and usually have a history of rodent exposure. This report describes a patient with rat-bite fever resulting in suppurative arthritis. The patient's diagnosis was made by culture of S moniliformis from his left wrist. The diagnosis was delayed, however, owing to the lack of an exposure history, atypical clinical presentation, and the unusual microbiologic characteristics shown by this organism.

Arthritis in children with multiple epiphyseal dysplasia.

Multiple epiphyseal dysplasia is an autosomal dominantly inherited disorder characterized by dwarfism, stubby digits, and abnormalities in maturing epiphyses. This syndrome has been associated with the onset of osteoarthritis during early adolescence; frank arthritis before puberty has not been reported. We describe 4 children with multiple epiphyseal dysplasia who developed chronic arthritis during the first decade of life.

Eosinophilic fasciitis in a child.

A 13-year-old boy with a three-year history of an illness characterized by stiff hands, arthralgias in the metacarpophalangeal joints, flexion contractures in all fingers, and thickened skin over his hands, arms, and thighs had an initial diagnosis of juvenile rheumatoid arthritis with dry synovitis. Eosinophilia and a deep-fascial biopsy led to a diagnosis of eosinophilic fasciitis. Prednisone therapy resulted in sustained subjective and objective improvement.

Baker's cyst and venous thrombosis.

A patient with deep venous thrombophlebitis had superficial thrombophlebitis while receiving adequate anticoagulation therapy and was then found to have a large Baker's cyst. The patient responded well to intra-articular steroids. Although an uncommon situation, thrombophlebitis may coexist with "pseudothrombophlebitis." Diagnosis requires a high index of suspicion and daily assessment of response to therapy.