Symptoms Of Arthralgia Research Articles

Comparison of Chikungunya Virus-Induced Disease Progression and Pathogenesis in Type-I Interferon Receptor-Deficient Mice (A129) and Two Wild-Type (129Sv/Ev and C57BL/6) Mouse Strains.

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus causing a debilitating febrile illness with rheumatic disease symptoms of arthralgia and arthritis. Since its spread outside of Africa in 2005, it continues to cause outbreaks and disseminates into new territories. Intervention strategies are urgently required, including vaccination and antiviral approaches. To test efficacy, the use of small animal models is required. Two mouse strains, A129, with a deficiency in their type-I interferon (IFN) receptor, and C57BL/6 are widely used. A direct comparison of these strains alongside the wild-type parental strain of the A129 mice, 129Sv/Ev, was undertaken to assess clinical disease progression, viral loads in key tissues, histological changes and levels of sera biomarkers. Our results confirm the severe disease course in A129 mice which was not observed in the parental 129Sv/Ev strain. Of the two wild-type strains, viral loads were higher in 129Sv/Ev mice compared to C57BL/6 counterparts. Our results have established these models and parameters for the future testing of vaccines and antiviral approaches.

Pyrazinamide-induced Hyperuricemia in Pulmonary Tuberculosis Patients.

Pyrazinamide is one of the antitubercular drugs used for 2 months in the intensive phase. One of the adverse effects of pyrazinamide is hyperuricemia, with a symptom of arthralgia. This study aims to analyze the incidence of hyperuricemia and arthralgia and their causality in pulmonary tuberculosis (TB) patients undergoing treatment in the intensive phase. It was an analytic observational study with a prospective cohort design. Three ml of blood from each pulmonary TB patient was withdrawn to examine uric acid levels before and after 2 months of treatment with pyrazinamide. The Wilcoxon test was used to analyze changes in uric acid levels and the Chi-square test to analyze the association between uric acid levels and arthralgia. Naranjo algorithm is used to analyze the causality of hyperuricemia. Twenty pulmonary TB patients met the inclusion criteria in this study. Eight out of 12 (60%) TB patients showed uric acid levels ≥7 mg/dl and 8 of them (66.6%) showed symptoms of arthralgia. The median uric acid level increased significantly before (5.14 mg/dl) and after 2 months of treatment (7.74 mg/dl), P-value = 0.001. Uric acid levels ≥7 mg/dl were significantly associated with arthralgia (P-value = 0.017; odds ratio 14.00; 95% confidence interval 1.25-156.61). Based on the Naranjo algorithm, those with hyperuricemia, eight and four patients had a total score of 7 and 8, respectively, which are classified as probable. Uric acid levels significantly increased during the intensive phase. Pulmonary TB patients with hyperuricemia are a risk factor for arthralgia.

Respiratory Paralysis in Sjogren's Syndrome: A Case Report

Introduction: Primary Sjogren’s syndrome (pSS) a systemic autoimmune disease also known as sicca syndrome, primarily affects exocrine glands, particularly the salivary and lacrimal glands, and causes xerostomia and xerophthalmia. Renal involvement in cases of pSS is a rare occurrence. Patients with Sjogren’s syndrome presenting with severe hypokalemia or paralysis are uncommon. Methods: We present a case of a 45-year-old female presenting in our emergency department with hypokalemia-induced quadriparesis resulting from distal renal tubular acidosis due to Sjogren’s syndrome. It was revealed that symptoms of arthralgia and dry mouth had frequently been present for the past few years, with a persistent need for water intake. Results: The patient was given symptomatic treatment during hospitalization and recovered successfully. The report emphasizes that although Sjogren’s syndrome is most often associated with chronic sicca symptoms, it may present for the first time with extraglandular manifestations, which may be life-threatening. Conclusion: Extraglandular forms of Sjogren’s disease can result in severe hypokalemia and paralysis of the limbs and respiratory muscles, which, if ignored, can be deadly for the patient. The course of action for such situations should be early identification and timely treatment because they are treatable and can give patients an asymptomatic and decent quality of life.

The preliminary development and clinical verification of the positive index score scale of "Heart Arthralgia Syndrome".

In recent years, the age of onset for coronary heart disease (CHD) has become one of the leading causes of death worldwide. The medical treatments occasionally cause side effects; therefore, there is still an urgent need to develop new therapeutic modalities for CHD in clinical practice. "Heart Arthralgia Syndrome (HAS)" is a general term for CHD with arthralgia symptoms proposed by our team based on clinical experience. At present, there is little in-depth research on the treatment of HAS by TCM. Pick Complex Therapy (PCT) is an innovative and developed theory of collateral acupuncture therapy for HAS. We collected data from 276 patients who met the criteria for (coronary heart disease with numbness of neck, shoulder, waist, and leg). We selected 24 diagnostic criteria for HAS by means of multiple methods, including Cronbach's α coefficient, retest reliability, subjective evaluation, discrete trend, Pearson's rank correlation coefficient and factor analysis method. We thereafter evaluated the reliability, validity and responsiveness of the scale. In the clinical validation phase, we verified whether the preliminary developed positive index (PI) scale can guide clinical practice. Forty (40) patients with HAS were selected in the study. SPSS23.0 statistical software was used for statistical processing and analysis. Assessment results of the initial PI scale for HAS: the average time to complete the scale was 7.47 ± 3.59 minutes. Cronbach's α coefficient for the initial table was 0.711, the retest reliability was 0.897, the Kaiser-Meyer-Olkin test result was 0.844, and the Bartlett test result was 2502.300. Following maximum variance rotation analysis, the cumulative variance contribution rate was determined to be 66.605%. In the clinical validation phase of the PI scale, we tested 40 patients before and after the PCT treatments. After 3 measurements, the correlation between the PI scale for HAS and the angina pectoris grading scoring method table decreased gradually. The last 2 measurement results of study indicated that there was a significant correlation between the PI scale and thrombin time, while physical and chemical examination showed no significant changes. The PI scale for HAS can be widely used in the clinic as a preliminary evaluation tool for guiding PCT.

Genetic, biological and epidemiological study on a cluster of H9N2 avian influenza virus infections among chickens, a pet cat, and humans at a backyard farm in Guangxi, China

ABSTRACT During an investigation in October 2018, two people with diarrhoea, mild abdominal pain, and mild arthralgia symptoms in Guangxi, China, were identified as infected by H9N2 avian influenza virus (AIV). Four H9N2 AIVs were isolated from one of two patients, a pet cat, and a dead chicken (two respective isolates from its lung and kidney tissues) bred by the patients at a backyard farm. Epidemiological investigation indicated that the newly bought chicken died first, and clinical syndromes appeared subsequently in the two owners and one cat. Furthermore, the two individuals possessed high H9N2-specific hemagglutination inhibition and microneutralization antibodies. Shared nucleotide sequence identity (99.9% – 100%) for all genes was detected in the four H9N2 isolates, and hemagglutinin (HA) T138A located on the receptor binding domain (RBD), resulted from nucleotide polymorphisms that were exclusively found in the isolate from the female patient. Moreover, HA K137N on the RBD was found in isolates from these three host species. Importantly, these four H9N2 isolates presented an exclusive binding preference for the human-type receptor (α2-6-SA), and could replicate and cause pathological changes in mice. Phylogenetic analyses showed that these four isolates clustered together and belonged to clade C1.2, lineage Y280. In addition, H9N2 viruses of human origin are genetically divergent and interspersed with the widespread poultry-origin H9N2 AIVs. All these results indicate a high risk of H9N2 AIVs in public health, and effective prevention and control measures against H9N2 AIVs should be considered and performed for both animal and human health.

Synovial fluid evaluation in COVID-19 patients

Background: COVID-19 can provide symptoms outside the respiratory tract and musculoskeletal symptoms. Some viruses can indeed cause arthritis, and the genetic material of these viruses can be found in a joint fluid using PCR assays. With this study, we will conduct an examination using PCR on the joint fluid of COVID-19 patients who have musculoskeletal symptoms, especially arthralgia, during the infection.
 Methods: This cross-sectional study with a descriptive explanation of synovial fluid in COVID-19 patients was performed from April 1st to July 30th, 2021, with patient data collection conducted centrally at Wahidin Sudirohusodo Hospital Makassar Synovial fluid was taken from the knee using the sterile procedure in a patient that met the inclusion criteria, such as hospitalized patients who had positive PCR swab results in the nasopharynx for less than 2 weeks and had arthralgia symptoms on April – July 2021. Other musculoskeletal symptoms (e.g., myalgia and fatigue) were noted. About 2 ml sample of synovial fluid was tested using a PCR kit (M BioCov) in the laboratory. The sample shows a positive result when there is an amplification of RDNP with a CT value below 40.
 Results: 189 patients with 21 participated, 14 subjects were male, and 7 subjects were female. Age range 18 - 72 years with arthralgia, myalgia, and fatigue symptoms. Only 2 patients had arthralgia, 13 patients had myalgia and arthralgia, 1 patient had fatigue and arthralgia, and 5 patients had all of the symptoms (arthralgia, myalgia, and fatigue). Only 1 patient had direct contact with the COVID-19 patient. PCR test for synovial fluid in all patients showed negative for COVID-19.
 Conclusion: COVID-19 infection can be manifest in the musculoskeletal system. Detection of COVID-19 virus using a specimen from knee synovial fluid in a patient with musculoskeletal symptoms (arthralgia, myalgia, fatigue) was negative.

Feasibility Trial to Evaluate Tendon Stiffness Obtained from Shear Wave Elastography Imaging as a Biomarker of Aromatase Inhibitor-Induced Arthralgias

Aromatase inhibitor-induced arthralgia (AIA) comprises significant, activity-limiting musculoskeletal symptoms, including joint pain, myalgia, and joint stiffness. We conducted a prospective feasibility study in postmenopausal women diagnosed with early-stage (0–3) hormone receptor positive (HR+) breast cancer who were candidates for treatment with adjuvant AI therapy (n = 16). Tendons of the hands and wrists and the median nerve were imaged using gray-scale and power Doppler ultrasound (US) and US SWE. Arthralgia symptoms were evaluated using the Breast Cancer Prevention Trial (BCPT) Symptom Checklist musculoskeletal subscale (MS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness subscales. At baseline, there were significant differences in the SW velocities of tendons between dominant and nondominant hands. Increased velocity in 2 of 6 tendons and the median nerve was associated with greater pain at baseline, whereas slower velocity of the extensor digitorum tendon (suggesting decreased stiffness) was associated with a higher WOMAC stiffness score. Increased SW velocity (suggestive of increased stiffness) at baseline in the abductor pollicis longus tendon was associated with a worsening of all three pain and stiffness measures by 6 months. Future studies should evaluate SWE scores related to AIA outcomes in a larger sample size.

Blood Culture-negative Endocarditis Caused by Tropheryma whipplei: Whipple's endocarditis.

A 67-year-old man was admitted with progressive heart failure due to blood culture-negative endocarditis of the aortic valve. Urgent aortic valve replacement was needed. Polymerase chain reaction (PCR) testing of samples of the explanted aortic valve revealed Tropheryma whipplei. The patient received ceftriaxone, followed by long-term co-trimoxazole. Recent arthralgia may have been a diagnostic clue. Whipple's endocarditis should be considered in patients with arthralgia and blood culture-negative endocarditis (BCNIE). Whipple's endocarditis should be considered in patients with symptoms of arthralgia and blood culture-negative endocarditis (BCNIE).Serum polymerase chain reaction is the main diagnostic test.Both physician awareness and multidisciplinary management by regional endocarditis teams are recommended strategies to provide optimal patient care.

Genetic and clinical predictors of arthralgia during letrozole or anastrozole therapy in breast cancer patients.

Female patients with breast cancer frequently develop arthralgia when treated with aromatase inhibitors (AI). Although the mechanism of AI-induced arthralgia is unknown, potential biomarkers have been identified. The purpose of this study was to investigate the clinical and genetic predictors of AI-induced arthralgia in a prospective cohort of patients with estrogen receptor-positive breast cancer. One hundred and ninety-six patients were enrolled at initiation of AI therapy with either letrozole or anastrozole. Patients completed two validated self-report questionnaires assessing pain, stiffness, and physical function at baseline, and repeated the questionnaires at two and at six months after the initiation of treatment with an AI. Germline DNA of all patients was genotyped for seven single-nucleotide polymorphisms (SNPs) previously identified by genetic screens and genome-wide association studies as associated with AI-induced arthralgia. More than 50% of the study group experienced arthralgia symptoms. Genetic analysis revealed that four SNPs, in CYP19A1 (rs4775936) and ESR1 (rs9322336, rs2234693, rs9340799), were associated with the development of arthralgia (adjusted P = 0.016, 0.018, 0.017, 0.047). High body mass index (BMI) was also associated with the development of arthralgia symptoms (adjusted P = 0.001). Patients prescribed letrozole were significantly more likely to develop arthralgia than patients on anastrozole (P = 0.018), and also more likely to discontinue AI therapy due to arthralgia. The CYP19A1 (rs4775936) SNP was significantly associated with discontinuation of therapy due to intolerable arthralgia. Our results suggested that BMI and AI drug (letrozole versus anastrozole) were clinical predictors of arthralgia, while genetic variants rs4775936, rs9322336, rs2234693, and rs9340799 were genetic predictors of AI-induced arthralgia. Significantly, rs4775936 was also a predictor of discontinuation of therapy.

Oxylipins Correlate with Quality of Life in Women Taking Aromatase Inhibitors for Breast Cancer

Abstract The purpose of this study was to determine if oxylipins – oxygenated bioactive lipid metabolites of ω-3 and ω-6 fatty acids with varying roles in inflammation and pain – correlate with aromatase inhibitor-associated arthralgia (AIA) and quality of life (QOL) in early stage breast cancer (ESBC) patients. Methods: ESBC patients on AI therapy were enrolled to an open-label study of sulindac, a non-steroidal anti-inflammatory drug (NSAID), for 12 months (n = 47). Pre-intervention arthralgia and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire, where higher scores indicate worse symptoms. The Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire was used to assess QOL, where higher scores indicate better QOL. A total of 53 plasma oxylipins in plasma were quantified by mass spectrometry. Pearson's correlation was used to measure the association between pre-intervention oxylipin concentrations, arthralgias and QOL. Results: Prior to initiating sulindac, baseline levels of 17 oxylipins were found to be significantly correlated with QOL scales. This included inverse associations between QOL and seven pro-inflammatory products of ω-6 fatty acid metabolism. Notably, prostaglandin E2, the primary target of NSAIDs, was negatively correlated with Social Well-Being (rho = −0.30; P = 0.04). Conversely, resolvin D1, a potent anti-inflammatory lipid, was positively associated with Total FACT-G (rho = 0.31; P = 0.03) and Emotional Well-Being (rho = 0.37; P = 0.01). Two ω-3 metabolites with unknown mechanisms were correlated with both QOL and WOMAC; 19,20-DiHDPE was positively correlated with Total (rho = 0.34; P = 0.02) and Social FACT-G (rho = 0.32; P = 0.03), and inversely with Total WOMAC (rho = -0.303; P = 0.04) and Stiffness (rho = −0.32; P = 0.03); and 5(6)-DiHETE was inversely correlated with Social FACT-G (rho = −0.33; P = 0.02) and positively with Total WOMAC (rho = 0.31; P = 0.04). Conclusions: This is the first evidence that plasma oxylipin metabolites of ω-3/ω-6 fatty acids correlate with QOL and arthralgia symptoms in patients on AIs and suggests oxylipins as a potential novel target for improving QOL and adherence to AI therapy in patients with ESBC.

Plasma microRNA Profiles as a Potential Biomarker in Differentiating Adult-Onset Still's Disease From Sepsis.

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by cytokine storm. However, a diagnostic test for AOSD in clinical use is yet to be validated. The aim of our study was to identify non-invasive biomarkers with high specificity and sensitivity to diagnosis of AOSD. MicroRNA (miRNA) profiles in PBMC from new-onset AOSD patients without any treatment and healthy controls (HCs) were analyzed by miRNA deep sequencing. Plasma samples from 100 AOSD patients and 60 HCs were used to validated the expression levels of miRNA by qRT-PCR. The correlations between expression levels of miRNAs and clinical manifestations were analyzed using advanced statistical models. We found that plasma samples from AOSD patients showed a distinct miRNA expression profile. Five miRNAs (miR-142-5p, miR-101-3p, miR-29a-3p, miR-29c-3p, and miR-141-3p) were significantly upregulated in plasma of AOSD patients compared with HCs both in training and validation sets. We discovered a panel including 3 miRNAs (miR-142-5p, miR-101-3p, and miR-29a-3p) that can predict the probability of AOSD with an area under the receiver operating characteristic (ROC) curve of 0.8250 in training and validation sets. Moreover, the expression levels of 5 miRNAs were significantly higher in active AOSD patients compared with those in inactive patients. In addition, elevated level of miR-101-3p was found in AOSD patients with fever, sore throat and arthralgia symptoms; the miR-101-3p was also positively correlated with the levels of IL-6 and TNF-α in serum. Furthermore, five miRNAs (miR-142-5p, miR-101-3p, miR-29c-3p, miR-29a-3p, and miR-141-3p) expressed in plasma were significantly higher in AOSD patients than in sepsis patients (P < 0.05). The AUC value of 4-miRNA panel (miR-142-5p, miR-101-3p, miR-29c-3p, and miR-141-3p) for AOSD diagnosis from sepsis was 0.8448, revealing the potentially diagnostic value to distinguish AOSD patients from sepsis patients. Our results have identified a specific plasma miRNA signature that may serve as a potential non-invasive biomarker for diagnosis of AOSD and monitoring disease activity.

Joint pain and falls among women with breast cancer on aromatase inhibitors.

Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls. We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up. Among 667 participants (median age 63years, interquartile range 57-69years), 232 (35%, 95% CI 31 to 39%) reported falls 12-24months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12months by their primary care physician (44%) or oncologist (36%). Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.

Letrozole concentration is associated with CYP2A6 variation but not with arthralgia in patients with breast cancer.

The aromatase inhibitor (AI) letrozole is a first-line drug in the adjuvant treatment of breast cancer in postmenopausal women. Adherence to AI therapy, including letrozole, remains problematic due to the development of debilitating AI-induced arthralgia. Letrozole is metabolized in the liver by CYP2A6. It remains unknown if plasma letrozole levels or CYP2A6 genetic variation is associated with the development of arthralgia. We enrolled 126 female breast cancer patients initiated on letrozole therapy and prospectively collected blood samples at baseline and two follow-up time points to determine letrozole plasma concentrations and CYP2A6 genotype. At each visit, participants completed two validated questionnaires to assess the severity of arthralgia symptoms. More than half (55%) of patients experienced a significant increase in their arthralgia symptoms after initiation of treatment. The clinical variables of body mass index (P = 0.0003) and age (P = 0.0430) were negatively and positively associated with plasma letrozole concentrations, respectively. CYP2A6 genotype was significantly associated with letrozole levels (P < 0.0001), and increased plasma letrozole levels were observed in patients with CYP2A6 reduced-function genotypes. Plasma levels of letrozole and CYP2A6 genotype were not significantly associated with a change in pain score from baseline. CYP2A6 genotype was a significant predictor of letrozole plasma levels, but was not associated with the development of arthralgia.

Effectiveness of non-steroidal anti-inflammatory drugs among patients with primary hypertrophic osteoarthropathy: A systematic review

BackgroundPrimary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis is a rare genetic disease which predominantly affects skin, bone and soft connective tissue. It is characterized by the triad of pachydermia, digital clubbing and periostosis of long bones. Arthralgia or arthritis is also present in most of the cases. Genetic studies have identified the impaired PGE2 metabolism as a culprit for hypertrophic osteoarthropathy in PHO cases. We conducted a systematic review to examine the effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), a PGE2 synthesis blocker to reduce the symptoms among PHO patients. MethodsWe searched the evidence in five databases; Cochrane Library, CINAHL, EMBASE, MEDLINE, and PubMed. We reported the evidence using narrative synthesis. ResultsOut of 238 identified studies, we selected 26 for the synthesis. All were case reports which included a total of 54 patients. Among them, 39 patients were treated with at least one type of NSAIDs. Around 70% of the patients treated with NSAIDs had clinical improvement for their symptoms, mostly arthritis or arthralgia symptoms. ConclusionNSAIDs were effective in improving arthralgia or arthritis symptoms in majority of the PHO patients. Therefore, we recommend the use of NSAIDs in PHO patients to treat arthralgia or arthritis.

Safety Concerns with Two Classes of Diabetes Drugs

* Canagliflozin, a sodium–glucose cotransporter-2 inhibitor used to treat type 2 diabetes and marketed under the trade name of Invokana (and Invokamet, which also contains metformin) elevates patients’ risk of bone fractures. There is also an elevated risk of diminished bone mass. * All drugs in the class called dipeptidyl peptidase-4 can cause severe and disabling arthralgia (joint pain). The time to onset of arthralgia symptoms has ranged from one day to years after the start of therapy.

Mayaro Virus Disease

Mayaro virus produces a nonspecific, sublethal disease in man with symptoms that are often confused with dengue. The symptoms of arthralgia, often associated with these viral infections, can cause an incapacitating disability. To date, outbreaks have been localized and sporadic within the Pan-Amazonia forest since its first isolation in 1954 (Trinidad and Tobago). The available literature is diverse, scarce and dispersed. Mayaro virus is an alphavirus, which is phylogenetically related to the Semliki forest antigenic complex. In the New World, Mayaro and the related UNA viruses are the only members of this complex that have been isolated. The genome of Mayaro consists of single-stranded RNA with a positive charge and a length of 12 kb that can be subdivided into genomic and subgenomic regions that encode nonstructural and structural proteins, respectively. Mayaro has shown great plasticity in hosts for vertebrate infections, but high specificity in invertebrates towards the family Culicidae (mosquitoes). Risk factors for infection are forested areas in northern South America and the rainy season. Two genotypes of MAYV have been identified, L (restricted to Belterra, Brazil) and D (widely distributed in the Pan-Amazonia). The enzootic cycle is similar to the jungle cycle of yellow fever, which involves Haemagogus mosquitoes and monkeys as reservoirs. Of concern is the potential spread of the virus by the involvement of other secondary vectors and hosts such as Aedes aegypti, Aedes albopictus and Aedes scapularis that have been shown experimentally to efficiently transmit the virus. Together with the observed high viremia levels of infected individuals, a significant risk exists for an emerging disease in urban, rural and peridomestic locations close to enzootic foci of Mayaro virus.

Sarcoidosis lymphoma syndrome - the value of PET-CT in the diagnosis

We report a 52-year-old patient who developed B-cell non-Hodgkin’s lymphoma subsequent to sarcoidosis. Sarcoidosis was diagnosed 16 years ago and remained asymptomatic for 14 years after steroid treatment. She presented with new symptoms of arthralgia, photosensitivity, butterfly erythema, autoimmune antibodies (ANA, chromatin positivity) associated with progression of the known left upper lobe lesion on the chest X-ray suggesting primary autoimmune disease (systemic lupus erythematosus). As steroid treatment was not effective, we started bolus cyclophosphamide therapy after which progression was seen on the chest X-ray. Computed tomography (CT)-guided needle biopsy confirmed malignancy of indefinable origin. Despite of the well-known fluorodeoxyglucose (FDG) avidity in active sarcoidosis, a FDG-positron emission tomography (PET) scan was performed to stage the primary tumour. Intensive FDG uptake was detected in the affected lung segment, with moderate uptake in mediastinal lymph nodes. The patient underwent left upper lobectomy. The histology showed pulmonary mucosa-associated lymphoma (bronchus-associated lymphoid tissue (BALT) lymphoma) in the lung tissue, while only sarcoidosis was present in the mediastinal lymph nodes. Bone marrow biopsy was negative.The association between sarcoidosis and lymphoma is known as sarcoidosis lymphoma syndrome, which is a rare disease. PET-CT was helpful in the differentiation of sarcoidosis and malignancy in this patient. It is important to be aware of the risk of lymphoma in sarcoidosis and FDG-PET, used for adequate purpose, can help the diagnosis.

Chikungunya Virus-associated Long-term Arthralgia: A 36-month Prospective Longitudinal Study

BackgroundArthritogenic alphaviruses, including Chikungunya virus (CHIKV), are responsible for acute fever and arthralgia, but can also lead to chronic symptoms. In 2006, a Chikungunya outbreak occurred in La Réunion Island, during which we constituted a prospective cohort of viremic patients (n = 180) and defined the clinical and biological features of acute infection. Individuals were followed as part of a longitudinal study to investigate in details the long-term outcome of Chikungunya.Methodology/Principal FindingsPatients were submitted to clinical investigations 4, 6, 14 and 36 months after presentation with acute CHIKV infection. At 36 months, 22 patients with arthralgia and 20 patients without arthralgia were randomly selected from the cohort and consented for blood sampling. During the 3 years following acute infection, 60% of patients had experienced symptoms of arthralgia, with most reporting episodic relapse and recovery periods. Long-term arthralgias were typically polyarthralgia (70%), that were usually symmetrical (90%) and highly incapacitating (77%). They were often associated with local swelling (63%), asthenia (77%) or depression (56%). The age over 35 years and the presence of arthralgia 4 months after the disease onset are risk factors of long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases. These data helped define the features of CHIKV-associated chronic arthralgia and permitted an estimation of the economic burden associated with arthralgia.Conclusions/SignificanceThis study demonstrates that chronic arthralgia is a frequent complication of acute Chikungunya disease and suggests that it results from a local rather than systemic inflammation.

Arthralgia During Aromatase Inhibitor Treatment in Early Breast Cancer Patients

Many breast cancer patients experience arthralgia symptoms during aromatase inhibitor (AI) treatment, which leads to poor compliance and a lower quality of life. The research questions of this study were as follows: (1) What is the incidence of arthralgia during AI treatment in early breast cancer patients, (2) what is the impact of AI-associated arthralgia on hand function, daily activities, and AI adherence, and (3) does the healthcare provider recognize AI-associated arthralgia as relevant in clinical practice? A total of 57 breast cancer patients of a University Breast Cancer Clinic participated in this study. Each patient completed a questionnaire, performed 2 function tests (goniometry of the wrist and a handgrip strength measurement), and consented to a review of the medical chart. Forty-two breast cancer patients (74%) reported symptoms of arthralgia. All patients with arthralgia symptoms experienced an impact on their daily activities, and 65% had a decrease in hand and finger function. Sixty-nine percent of all patients were fully adherent in their medicine treatment. In 26% of cases with arthralgia, the symptoms were not reported in the medical chart. Given the large number of patients with AI-associated arthralgia and its impact on daily life and functioning, it is of great importance to improve the recognition and care of arthralgia symptoms during AI treatment. Oncology nurses could play an important role in assessment of modifiable risk factors, providing lifestyle advice and support in coping.

Role of traditional Japanese medicines in the relief effort in areas affected by the Great East Japan Earthquake

Abstract The medical system of the Tohoku region was disrupted by the Great East Japan Earthquake on March 11, 2011. Akita University Hospital provided medical support to earthquake-affected areas in Rikuzentakata City, Iwate Prefecture. The 11th team, out of 27 Akita University Hospital Medical support teams, provided medical support service including Kampo, traditional Japanese medicine, from April 17 to 20, 2011. However, out of the 210 Kampo preparations, only 11 were available. Kampo medicines were prescribed for 13 patients for 3 days. The patients presented with symptoms of arthralgia and myalgia caused by coldness of the body, skin manifestations caused by a lack of bathing, respiratory disorders due to pollen dispersal and dust, and depression due to the loss of family. Kampo medicines were effective for treating both physical and mental distress even in unusual circumstances. Hence, Kampo medicine is potentially useful in relief efforts in disaster-stricken areas.