Sunburn Recall Reaction and Mucositis Secondary to Methotrexate Toxicity.

A 59-year-old Native American female presented with a 4-day history of malaise, abdominal pain, nausea, jaundice, and a "sunburn-like rash" on the upper chest and back despite lack of recent sun exposure (Figure 1). Medical history was significant for a twenty-year history of universal vitiligo and a five-year history of rheumatoid arthritis (RA) treated with methotrexate (MTX), adalimumab, prednisone, and naproxen sodium. Cutaneous examination revealed hemorrhagic crusting of upper and lower lips (Figure 2), scleral icterus, diffuse jaundice of the skin, and well-demarcated erythematous patches on mid-upper back and anterior neck. The patient had a few scattered erythematous papules with whitish center on bilateral extensor surfaces of the upper extremities and scattered petechiae on both the trunk and upper extremities.

Patients With Valgus Alignment and Patients With Varus Alignment Are Not Mere Opposites of Each Other Prior to Total Knee Arthroplasty.

Although it is common practice to assess alignment prior to total knee arthroplasty, preoperative knee alignment and its effect on patient-reported outcomes (PROs) postoperatively has not been well studied. The purpose of this retrospective study was to determine if there are differences in PROs between patients with valgus deformities and patients with varus deformities. Further, this study assessed the baseline differences between these 2 groups preoperatively. Patients were placed into either the valgus or the varus group. Data collected included age, sex, race, height, weight, body mass index, knee alignment, Kellgren-Lawrence grade, and 2 PRO measures. Patient-reported outcomes were assessed preoperatively and at 5 scheduled follow-up visits during the first year postoperatively. The authors found that a higher percentage of female patients had a valgus deformity (84.9%). The varus group tended to have a higher body mass index. Radiographs revealed differences in tibia and femur deformities. The overall deformity was less in patients with a valgus deformity than in patients with a varus deformity (mean, 6.6° [SD, 4.4°] vs 8.6° [SD, 4.8°], P=.010). Preoperative Knee injury and Osteoarthritis Outcome Score symptoms were significantly worse in the valgus group (P=.033). After adjusting for the significant baseline differences, all patients reported improved PROs during the postoperative period (P<.0001). Preoperatively, patients with valgus deformities and patients with varus deformities do not appear to be mere opposites of one another. The groups differed by sex, Knee injury and Osteoarthritis Outcome Score symptoms, and tibia, fibula, and overall deformity. Postoperatively, there were no significant differences in PROs during and up to 1 year. [Orthopedics. 2018; 41(6):e783-e788.].