Elevated Erythrocyte Sedimentation Rate Research Articles

Diagnosis and Management of Periprosthetic Joint Infections After Total Ankle Arthroplasty.

Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a dreaded complication that may lead to catastrophic outcomes. Risk factors include a history of surgery on the operated ankle, low preoperative function scores, diabetes, extended surgical time, and postoperative wound-healing problems. Clinical presentation varies and may include increasing ankle pain and swelling, high temperature, local erythema, wound drainage, and dehiscence. The initial diagnostic evaluation should include plain radiographs, erythrocyte sedimentation rate, C-reactive protein levels, and leukocyte count. In suspected cases with elevated erythrocyte sedimentation rate and C-reactive protein, aspiration of the ankle joint for synovial fluid analysis, Gram staining, and culture should be performed. Antibiotic therapy should be based on the pathogen identified, and the surgical strategy should be determined based on the time lines of PJI. Early PJI can be treated with irrigation and débridement with polyethylene exchange. The surgical treatment of choice for late PJI is two-stage revision arthroplasty, which includes removal of the implant, insertion of an antibiotic spacer, and reimplantation of a TAA. In certain chronic PJI cases, permanent articulating antibiotic spacers can be left in place or an ankle arthrodesis can be performed. Below-knee amputation is considered as the final option after limb-sparing procedures have failed.

Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery

Background: Wellens’ syndrome is characterised by a history of chest pain with an abnormal electrocardiogram (EKG), demonstrating biphasic or deeply inverted T waves in leads V2–3 (may extend to involve all precordial and lateral limb leads – the type B Wellens’ pattern). A Wellens’ EKG pattern is considered highly specific for critical stenosis involving the ostial/proximal left anterior descending artery (LAD). However, there are no reported cases of an association of a Wellens’ EKG pattern with myopericarditis. Here, we present such a rare case. Case description: A thirty-one-year-old female with known essential hypertension and psoriatic arthritis presented with a constant, central chest pain radiating to the shoulders and back. The patient’s physical examination was unremarkable at presentation other than elevated blood pressure at 170/68 mmHg. An EKG at presentation demonstrated deep symmetric T-wave inversions in anterolateral leads with elevated high-sensitivity troponin, and an elevated erythrocyte sedimentation rate. The patient was referred to the cardiac catheterisation laboratory for concerns of a Wellens’ EKG pattern; however, invasive angiography demonstrated only obtuse marginal branch disease – no LAD disease was noted. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of myopericarditis and absence of myocardial infarction. The patient was medically managed and discharged home in a stable condition. Conclusion: In literature and established clinical practice, the Wellens’ EKG pattern is considered highly concerning for critical ostial/proximal LAD stenosis. However, we now propose that myopericarditis may be considered in a differential diagnosis for this EKG pattern.

Chronic Nonbacterial Osteomyelitis, Hidradenitis Suppurativa, and SAPHO Syndrome

Introduction: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome may represent one side of a spectrum of disease that also includes chronic nonbacterial osteomyelitis. Case: A 23-year-old male with bone pain in the anterior chest, shoulder, clavicles, left elbow, and left ankle presented to rheumatology clinic after multiple evaluations for infectious osteomyelitis. Imaging and deep bone biopsies of affected areas were consistent with chronic osteomyelitis, with labs notable for elevated erythrocyte sedimentation rate, C-reactive protein, and positivity for HLA-B27. A full skin exam was consistent with hidradenitis suppurativa, and he was started on infliximab and methotrexate with improvement in both his osteoarticular and skin symptoms. Conclusions: Patients presenting with features of follicular occlusion or neutrophilic dermatoses in conjunction with bone pain should be evaluated for SAPHO/CNO. In patients with SAPHO/CNO with vertebral involvement, bisphosphonates in addition to anti-inflammatory medications (such as methotrexate and TNF-inhibitors) can be effective.

Clinical and laboratory findings characterizing the need for systemic corticosteroids and nonsteroidal systemic therapies, and the predicted outcomes in cutaneous polyarteritis nodosa: A single-centre retrospective analysis

Abstract Background Cutaneous polyarteritis nodosa (cPN) is a necrotizing arteritis of medium-sized vessels limited to the skin. Because of its rarity and the diversity of its clinical manifestations, there is no consensus treatment. Moreover, there are no established indicators that predict disease severity or its outcome. Objectives To investigate clinico-laboratory features that predict patients requiring systemic therapy, including corticosteroids, to control the disease activity. Methods Thirty-six cPN patients who had not received systemic corticosteroids at the initial visit were retrospectively analysed by correlating the treatment and its response with clinico-laboratory findings. Results The major medications administered were antiplatelet agents (63.9%), vasodilators (38.9%), and prednisolone (PSL) (36.1%). In all, 23 cases achieved remission without PSL; 5 were managed with compression therapy alone or even observation; 18 received antiplatelet monotherapy or combined with vasodilator/dapsone; 13 required PSL; 10 achieved remission with PSL monotherapy or PSL and single/multiple medications and 3 with PSL and multiple drugs failed to achieve remission and underwent limb amputation. There were more skin ulcers and an elevated peripheral white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) before corticosteroid induction in patients requiring PSL. Three cases with treatment failure had a markedly elevated ESR (>50). Conclusions More than half of cPN can achieve remission without corticosteroids; an elevated WBC and the presence of skin ulcers predict the need for PSL; a high ESR before corticosteroid induction predicts treatment resistance, even with PSL.

Risk factors and early detection of joint damage in patients with psoriasis: a case-control study.

Our aim was to target the unsatisfied need for early detection of the at-risk population and determine the subgroup of patients whose psoriasis (PsO) could transform into psoriatic arthritis (PsA). A retrospective and longitudinal case-control study was conducted at Beijing Chao-yang Hospital. It included 75 patients who were clinically diagnosed with PsA in the case group and 345 who solely suffered from PsO without PsA in the control group. A variety of baseline covariates were gathered from every patient with PsO. Univariate and multivariate analyses and receiver operating characteristic (ROC) curves were used to identify underlying risk factors and determine whether it was necessary to examine the imaging of PsO patients. In multivariate logistic regression analysis, age ≥40 (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.02-1.06, P < 0.01), nail involvement (OR: 1.17, 95% CI: 1.09-1.32, P < 0.01), erythrocyte sedimentation rate (ESR) (OR: 1.03, 95% CI: 1.01-1.06, P < 0.05) and elevated high-sensitivity C-reactive protein (hs-CRP) (OR: 1.31, 95% CI: 1.13-1.53, P < 0.01) were perceived to be risk factors for the transformation from PsO into clinical PsA. By combining magnetic resonance imaging (MRI)-detected enthesitis with tenosynovitis, combined predictors demonstrated better diagnostic efficacy, with an improvement in specificity (94.3% vs. 69%) and similarities in sensitivity (89% vs. 84.6%). The areas under the ROC curve (AUCs) amounted to 0.925 (95% CI: 0.882-0.967, P < 0.01) and 0.858 (95% CI: 0.814-0.903, P < 0.01). It was identified that age ≥40, nail involvement, as well as an elevated ESR, and hs-CRP served as independent risk factors for PsO transforming into PsA. Additionally, MRI provides additional value for the early recognition of PsA.

Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis

ObjectivesThe diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies owing to small sample sizes, indicating the need for large cohort studies. MethodsA retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. In addition, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. A multivariate statistical analysis was performed to evaluate the factors associated with yield. ResultsA total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4% (359 of 525) of biopsies, and microbiological cultures were positive in 29.6% (169 of 570). Elevated erythrocyte sedimentation rate was positively associated with a histopathologic diagnosis of osteomyelitis (odds ratio [OR] =1.96, P = 0.007) and positive cultures from bone cores (OR = 1.02, P ≤0.001) and aspirate (OR = 1.02, P ≤0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis (OR = 1.81, P = 0.013) and positive cultures from bone cores (OR = 1.65, P = 0.049). Clinical management was affected by ICNB in 37.5% (214 of 570) of cases. ConclusionsIn this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of the patients.

E075 Sacroiliitis potentially induced by isotretinoin: two case reports

Abstract Background/Aims Isotretinoin is a potent retinoid medication widely used to treat severe acne. Isotretinoin’s adverse effects range from well-documented dermatological side effects like dry skin to less common systemic manifestations. Sacroiliitis can arise from rheumatic and nonrheumatic causes. There has been limited attention in the literature to the rare occurrence of sacroiliitis as an adverse effect of isotretinoin. The precise mechanisms remain poorly understood, but the emergence of case reports suggests a potential link in immunomodulation through the alteration of cytokine balance and degradation of synovial membranes in joints. We present two patients with severe acne history who developed bilateral sacroiliitis within several weeks after starting isotretinoin Methods Case 1: A 19 year old male, started on 20 mg daily isotretinoin for acne vulgaris, experienced severe hip and lower back pain after one month, impacting his mobility. On examination, he displayed painful hip movements. Lumbar flexion was restricted and painful, with a 2 cm measurement on the Schober’s test. Medical investigation showed an elevation of erythrocyte sedimentation rate (ESR): 66mm/h, and C-reactive protein (CRP): 81 mg/l. HLA B27 was negative. X-ray radiography of the sacroiliac joint was normal, but the MRI examination showed the presence of bilateral sacroiliitis. Case 2: A 34 year old female received a six-months isotretinoin treatment for severe acne, with doses ranging from 20-40 mg daily. Then, in 2018, after a six-year gap, she received another isotretinoin course at 30 mg daily. Four months later, she began to experience gradual, intermittent lower back pain associated with 30 minutes of early morning stiffness. Her vital signs were stable, but she exhibited restricted and painful lumbar flexion. Her investigations revealed normal ESR and CRP. HLA B27 was negative. Her sacroiliac joint X-ray showed normal results, but her MRI indicated bilateral active sacroiliitis. Results Following the discontinuation of isotretinoin in both cases, NSAIDs were administered, which effectively relieved the pain. Our management of isotretinoin-induced sacroiliitis follows guidelines adapted from the ASAS-EULAR algorithm for axial spondyloarthritis. The algorithm entails an initial treatment with NSAIDs if no contraindications and to be titrated up to the maximum effective dose before considering biological/ targeted synthetic disease-modifying antirheumatic drugs. Conclusion The two cases highlight the rare but noteworthy association between isotretinoin therapy and sacroiliitis. In patients presenting with unexplained musculoskeletal symptoms during isotretinoin treatment at any point, clinicians should raise suspicions on the adverse effects of medication. Further research is needed to elucidate the immunomodulatory pathways involved in this association. Disclosure H. Almansoori: None. N. Alnuaimi: None. S. Alhosani: None. M. Alshehhi: None. S.A. Al Nokhatha: None.

Navigating the complexities: a case report on the varied presentation of lupus vulgaris

A 16-year-old female presented with an asymptomatic lesion in the right axilla, evolving over six months into a scaly, erythematous to brownish-colored plaque with associated axillary lymphadenopathy. Routine investigations revealed mild anemia, elevated erythrocyte sedimentation rate (ESR), and a positive Mantoux test. Histopathological examination confirmed lupus vulgaris, characterized by tuberculoid granulomas within the superficial dermis. Treatment with anti-tubercular therapy led to significant lesion improvement. Lupus vulgaris, a form of cutaneous tuberculosis, presents varied clinical features and poses diagnostic challenges. Early recognition and prompt treatment are essential to prevent morbidity and scarring. This case highlights the importance of considering lupus vulgaris in differential diagnosis of atypical cutaneous lesions, contributing to better disease management and reduced morbidity.

Approaching an undetermined diagnosis in the aftermath of rhombencephalitis: A case report

A 49-year-old male patient manifested acute onset increased imbalance, quadriparesis, and speech impairment 1 month after undergoing ventricular-peritoneal shunt for normal pressure hydrocephalus (although magnetic resonance imaging [MRI] of the brain with contrast was otherwise normal), which showed improvement afterward. He had hypercalcemia and elevated erythrocyte sedimentation rate. Repeat brain MRI revealed pachymeningitis coupled with rhombencephalitis, while cerebrospinal fluid study unveiled only increased protein level without evidence of active infection. Given these findings, neurosarcoidosis was preliminarily considered a plausible cause of the recent clinical manifestations, and the patient was prescribed methylprednisolone, which led to significant improvement. However, the steroid treatment was discontinued on the revelation that the patient grappled with severe sepsis. Despite an initial improvement following a post-management of sepsis, his condition deteriorated, and he became lost to follow-up after 4 months of initial presentation. An infective etiology was ruled out since his condition improved with steroid. Precluding vasculitis or demyelinating disorder left the physicians with primary central nervous system (CNS) lymphoma or sarcoidosis as a proper diagnosis based on the fact that the patient experienced deterioration when steroid was excluded from the treatment regimen. This case study portrays a need to conduct a more specific and elaborate investigation, driven by a strong perception to both primary CNS lymphoma and sarcoidosis, to optimize clinical diagnosis, which facilitates the formulation of an appropriate treatment regimen.

Recurrent Vision Loss in a Patient with Giant Cell Arteritis while on High Dose Corticosteroids

Giant cell arteritis (GCA) is a chronic vasculitis that can lead to permanent vision loss. In this case we describe a patient with permanent monocular vision loss from GCA, managed with long-term glucocorticoids, who presented with elevated erythrocyte sedimentation rate and acute visual loss. This patient was promptly given intravenous steroids, with initial improvement, however, she again experienced acute vision loss on the fourth day of treatment. Given the rare nature of this recurrent GCA-related vision loss during treatment, a broader workup was pursued without an alternative cause identified. Temporal biopsy was not performed due to concern of a false-negative in the setting of chronic steroid use. In this report we discuss the long-term monitoring and management of GCA, recurrence in the acute treatment setting, and present evidence related to diagnosis of GCA in the context of long-term steroid use.

General dermatology & dermatology in primary health care.

A woman in her late 50s presented with rapidly progressing, painful nodulo-ulcerative lesions on bilateral forearms that ulcerated and bled within two weeks of onset. She reported low-grade fever, productive cough, epistaxis, myalgias, and bilateral mixed hearing loss. Investigations revealed microcytic hypochromic anemia, elevated erythrocyte sedimentation rate, hematuria, and lobulated opacities in the chest. A skin biopsy showed dermal neutrophilic infiltration, vessel destruction, and granulomas, with negative stains for tuberculosis and absence of fungal elements.

Postmenopausal Hormone, Hematology and Immune Modulation in Rheumatoid Arthritis Patients

Background: There is a significant hormonal shift in Postmenopausal women with low levels of estrogen and progesterone. These changes may cause the pathogenesis of autoimmune diseases, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), which exhibit a higher prevalence in women. It is crucial to determine the pathophysiology and treatment strategies and to understand the hematological, hormonal, and immunological differences in postmenopausal women with RA and SLE. This study determined the hematological, hormonal, and immunological parameters in postmenopausal RA and SLE patients. Methods: 75 postmenopausal women (aged 52-65 years) were recruited in this study, comprising 25 with RA, 25 with SLE, and 25 with healthy controls. Blood samples were collected for complete blood count (CBC), erythrocyte sedimentation rate (ESR), and serum hormone and immunoglobulin assays. Statistical analyses were conducted using Fisher's test, t-test, and ANOVA, with significance at p &lt; 0.05. Results: In postmenopausal RA and SLE patients, significant blood parameter differences were observed versus controls. RA showed elevated WBC count (18.189±0.782) and PLT (373.778±14.644), lower RBC (4.009±0.149) and Hb (11.705±0.328). SLE had lower WBC (3.016±0.595), RBC (4.293±0.112), and Hb (12.270±0.312), and higher RDW (18.830±1.719) and lower MPV (8.327±0.314). Hormonal differences included higher FSH and lower LH, estrogen, and testosterone in both groups, while RA exhibited decreased cortisol and increased progesterone, and both diseases showed elevated rheumatoid factor (RF), ESR, and immunoglobulin E (IgE). Conclusion: Postmenopausal women with RA and SLE showed distinct hematological, hormonal, and immunological profiles compared to healthy controls. This study demonstrated the complex interplay between hormonal changes and autoimmune diseases, warranting further investigation into their underlying mechanisms and potential implications for treatment strategies.

Clinical features and prognostic analysis of checkpoint inhibitor pneumonitis in patients with non-small cell lung cancer

Objective: To describe the clinical characteristics of patients with non-small cell lung cancer (NSCLC) who developed checkpoint inhibitor pneumonitis (CIP) and to explore potential prognostic factors. Methods: NSCLC patients who were complicated with CIP after immune checkpoint inhibitors (ICIs) therapy in our institute were enrolled in this study from 1 July 2018 to 30 November 2022. Clinical data of NSCLC-CIP patients were collected, including clinical and radiological features and their outcomes. Results: Among the 70 enrolled NSCLC-CIP patients, there were 57 males (81%) and 13 females (19%). The mean age at the diagnosis of CIP was (65.2±6.3) years. There were 46 smokers (66%), 26 patients (37%) with emphysema, 19 patients (27%) with previous interstitial lung disease, and 26 patients (37%) with a history of thoracic radiation. The mean interval from the first application of checkpoint inhibitor to the onset of CIP was (122.7±106.9) days (range: 2-458 days). The main chest CT manifestations were coincided with non-specific interstitial pneumonia (NSIP) pattern and organizing pneumonia (OP) pattern. Most patients had grade 2 (21 cases) or grade 3 (34 cases) CIP. Seventeen patients had been concurrent with other immune-related adverse events such as rash, hepatitis, colitis, and thyroiditis. Half of the enrolled patients (36 patients/51%) had fever, and most patients had elevated C-reactive protein (52 patients/72%) and all patients had elevated erythrocyte sedimentation rate (70 patients/100%). Serum lactate dehydrogenase was elevated in 34 CIP patients. Prednisone≥1 mg·kg-1·d-1 (or equivalent) was the most commonly used initial treatment in CIP patients (50 patients/71.4%). Complications with pulmonary infections (OR=4.44, P=0.03), use of anti-fungal drugs (OR=5.10, P=0.03) or therapeutic dose of sulfamethoxazole (OR=4.86, P=0.04), longer duration of prednisone≥1 mg·kg-1·d-1 (or equivalent) (Z=-2.33, P=0.02) were probable potential risk factors for poor prognosis. Conclusions: Older males with smoking history might be predisposed to develop NSCLC-CIPs after ICIs therapy. NSIP pattern and OP pattern were common chest CT manifestations. Complications with pulmonary infections (especially fungal infection or Pneumocystis jirovecii pneumonia), longer duration, longer duration of high-dose corticosteroids were likely potential risk factors for poor prognosis.

Rates and Risk Factors of Progression in Patients With Nontuberculous Mycobacterial Pulmonary Disease: Secondary Analysis of a Prospective Cohort Study

BackgroundThe clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) is varied, and a watchful waiting management strategy is appropriate for a subset of patients. Understanding disease progression and risk factors for progression is essential for deciding on an appropriate follow-up strategy. Research QuestionWhat is the rate of NTM-PD progression, and what are the predictors of progression? Study Design and MethodsPatients with NTM-PD who were enrolled in a prospective observational cohort study between July 1, 2011, and December 31, 2022 were included in this analysis. Clinical, bacterial, laboratory, and radiographic data were collected at enrollment and then regularly during follow-up. NTM-PD progression was defined as either the initiation of treatment or the clinician’s intention to treat. The rate of progression was calculated and the predictors for progression were analyzed. ResultsOf the 477 patients enrolled, NTM-PD progressed in 192 patients over a median follow-up of 5.4 years. The incidence of NTM-PD progression was 11.0 cases per 100 person-years (95% confidence interval [CI] 9.5–12.7). The proportion of patients experiencing disease progression was 21.4% at 1 year, 33.8% at 3 years, and 43.3% at 5 years. The final multivariable analysis model identified female sex (adjusted hazard ratio [aHR] 1.69, 95% CI 1.19–2.39), elevated erythrocyte sedimentation rate (aHR 1.79, 95% CI 1.31–2.43), percent predicted forced expiratory volume in 1 second (aHR 0.89, 95% CI 0.82–0.96), and the presence of a cavity (aHR 2.78, 95% CI 2.03–3.80) as predictors of progression. InterpretationAbout half of patients with NTM-PD experienced progression during an observation period of more than 5 years. Patients with risk factors for progression should be observed closely. Trial registrationClinicalTrials.gov; No.: NCT01616745; URL: www.clinicaltrials.gov

Recurrent miscarriage and low-titer antiphospholipid antibodies

ObjectiveTo evaluate the clinical features and pregnancy outcomes in patients experiencing recurrent miscarriage (RM) with either low-titer or medium-high titer positivity of antiphospholipid antibodies (aPL).MethodsA retrospective review of medical records was conducted for patients with aPL positivity and recurrent miscarriage between 2018 and 2022. The clinical features, treatment strategies, outcomes were compared between the patients with low (n = 92) and medium (n = 32) titer of aPL.ResultsA total of 118 patients, resulting in 124 obstetric episodes (pregnancies), with a mean age of 33. 15 ± 4.56 and 31.47 ± 4.41 years between the two groups. The low-titer group exhibited a higher frequency of anti-cardiolipin antibodies IgM (P < 0.001), whereas the medium-high titer group demonstrated a higher frequency of anti-β2-glycoprotein 1 antibodies IgG (P < 0.001) and IgM (P = 0.032). Moreover, the medium-high titer group displayed a significantly elevated erythrocyte sedimentation rate compared to the low-titer group (P < 0.05). In the low-titer group, 71 patients (77.2%) received appropriate treatment, resulting in 48 live births (67.6%) and 23 repeat abortions (32.4%). In the medium-high titer group, 29 patients (90.6%) received relevant treatment, leading to 23 live births (79.3%) and 6 repeat abortions (20.7%). No significant differences were observed in live births or maternal-fetal complications between the two groups (all P > 0.05).ConclusionNoteworthy distinctions in laboratory parameters were identified between the low-titer and medium-high titer groups. However, when appropriately treated, the fetal-maternal outcomes were comparable in both groups. Timely intervention by clinicians is imperative to enhance pregnancy outcomes in patients experiencing recurrent miscarriage with low levels of aPL.Key Points• This study challenges the conventional belief that only the higher antiphospholipid antibodies (aPL) titers directly correlated with worse pregnancy outcomes, which emphasized the importance of patients with low titer positive aPL-positive RM.• The results underscore the need for timely intervention in women with low titer aPL-positive RM, as it leads to favorable maternal–fetal outcomes.

Complex Case: Acute-on-Chronic Gouty Arthritis, Septic Arthritis, and Severe Joint Deformities in a Young Adult Patient

Background: Gout is the most prevalent type of inflammatory arthritis, which can lead to inflammation in the joints. However, septic arthritis is unusual in gout.&#x0D; Case presentation: A 34-year-old male presented with lumps on the right ankle with cloudy white fluid discharge for 5 days prior to admission. The patient also has lumps observed on the left pedis, and manus bilateral. The patient regularly takes Allopurinol daily and Piroxicam prior to admission. The physical examination had a limited range of movement. Laboratory examinations found elevated uric acid, impaired renal function, elevated white blood cells, and elevated erythrocyte sedimentation rate. The patient was then referred for surgical debridement.&#x0D; Conclusion: Chronic gout marked by persistent polyarticular engagement and the formation of tophi. In individuals left untreated, septic arthritis and gout may manifest, followed by deformities of joints, which need further diagnosis and management.

Correlation between Quality of Life and Erythrocyte Sedimentation Rate with Disease Activity in Rheumatoid Arthritis.

Inflammatory markers are crucial in diagnosing and monitoring rheumatoid arthritis. Patients with rheumatoid arthritis (RA) live with constant pain that limits their daily activities. Our study highlights the effects of disease activity on the quality of life in patients with rheumatoid arthritis. Swollen joint count (SJC), tender joint count (TJC), and visual activity scale (VAS) were utilized to acquire patients' subjective feelings of wellness and their performance of routine daily activities to determine the disease activity. The patient's erythrocyte sedimentation rate (ESR) was measured at the clinical hematology laboratory using the Westergren method. The Quality of Life was rated on a scale of 1 to 10. Our study found that disease activity is inversely proportional to the quality of life. Out of 111 patients, 3 (2.7%) were in remission, 1 (0.9%) had mild disease, 51 (45.9%) had moderate disease, and 56 (50.5%) had high disease activity. The ESR was normal (<20) in 11 patients (9.9%), moderately elevated (20-50) in 56 (50.5%) patients, and very high (>50) in 44 (39.6%) patients. The study revealed that 66% of patients in remission had normal, while 33% had moderately elevated ESR. About 12.5% of patients with moderate disease activity had normal ESR, and none with high disease activity had normal ESR. Of 44 patients with high ESR, 7 had moderate disease activity, and 37 had high disease activity. In our study, 60% of patients had a less than 50% quality of life compared to patients with pre-arthritis. High disease activity affects the productivity and quality of life in patients with rheumatoid arthritis. Assessing the impact of different interventions on the QOL should be an essential task that can help define a holistic and integrative treatment and rehabilitation model for RA patients.

A tale of two effusions diagnosing and managing pleural and pericardial empyema

A male in his early 50s with no comorbidities presented with a weeklong history of left-sided chest pain, breathlessness, and cough with yellow–green expectoration. Over 4 months, he reported a 5 kg weight loss and decreased appetite. Investigations revealed mild anemia, electrolyte imbalances, elevated erythrocyte sedimentation rate, and alkaline phosphatase. An electrocardiogram showed low-voltage complexes, and an echocardiogram detected pericardial effusion. A chest X-ray showed bilateral pleural effusion. Ultrasound-guided thoracentesis indicated pleural and pericardial empyema. Sputum tests identified Proteus mirabilis and pericardial fluid grew Escherichia coli. After the therapeutic intervention, the patient initially improved but later worsened, requiring mechanical ventilation, and inotrope support. On the 5th day of admission, he suffered a cardiac arrest and expired despite resuscitative efforts.

Hyper-IgE syndrome: a case report

Introduction and importance: Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency disorder characterized by elevated serum IgE levels, recurrent infections, and various clinical features. Early diagnosis, prompt management of infections, and supportive care are essential in improving outcomes for individuals with HIES. Genetic testing, including STAT3 gene sequencing, plays a crucial role in confirming the diagnosis. Further research is needed to enhance our understanding of HIES and develop targeted therapies to improve the quality of life for affected individuals. Case presentation: This case report presents the clinical features and management of a 37-year-old male with HIES, diagnosed at the age of 2 due to recurrent cold abscesses caused by Staphylococcal infections. Clinical discussion: The patient exhibited typical symptoms of HIES, including recurrent eczema, frequent bacterial infections, mucocutaneous candidiasis, and various physical abnormalities. Diagnostic markers such as elevated IgE levels and eosinophilia supported the HIES diagnosis, which was further confirmed by the identification of a STAT3 gene mutation. Treatment primarily involved supportive measures and antibiotics for infections. The patient’s blood test results and imaging findings revealed abnormalities such as low red blood cell count, elevated erythrocyte sedimentation rate, and pulmonary nodules. Conclusion: This case report highlights the importance of early diagnosis, prompt management of infections, and the need for ongoing research to improve our understanding and treatment of HIES.

Long noncoding nuclear enriched abundant transcript 1_2 is a promising biomarker for childhood‐onset systemic lupus erythematosus

ABSTRACTImportanceSystemic lupus erythematosus (SLE) is a diffuse connective tissue disease with complex clinical manifestations and prolonged course. The early diagnosis and condition monitoring of SLE are crucial to disease prognosis.ObjectiveTo assess the diagnostic value of long noncoding RNA (lncRNA) nuclear enriched abundant transcript 1 (NEAT1) in childhood‐onset SLE (cSLE).MethodsFifty‐seven children diagnosed with SLE, 40 children diagnosed with juvenile idiopathic arthritis (JIA), and 40 healthy children were included. Peripheral blood samples from each patient were collected. A quantitative polymerase chain reaction was used to confirm the expression of lncNEAT1_1 and lncNEAT1_2 in peripheral blood. Associations among parameters were analyzed using the Mann‐Whitney U test or independent sample t‐test.ResultsThe expression of both lncNEAT1_1 and lncNEAT1_2 in patients with cSLE were significantly higher than that of healthy control and patients with JIA. Receiver operating characteristic curves revealed an area under the curve (AUC) of 0.633 (95% confidence interval [CI], 0.524–0.742; P = 0.024) for lncNEAT1_1. The AUC of lncNEAT1_2 was 0.812 (95% CI, 0.727–0.897; P &lt; 0.0001) to discriminate individuals with cSLE from health control and children with JIA with a sensitivity of 0.622 and a specificity of 0.925. Moreover, lncNEAT1_2 expression was higher in patients with cSLE presenting with fever, lupus nephritis, elevated erythrocyte sedimentation rate, active disease activity, and decreased C3 level, compared with those without these conditions. However, no similar correlation was observed for lncNEAT1_1.InterpretationThe expression of lncNEAT1_2 was significantly elevated in children with SLE, especially those with fever, renal involvement, and low C3 levels. These findings suggest that lncNEAT1_2 may represent a potential biomarker for cSLE.