Vasculitis and Related Disorders

 
 

Vasculitis and Related Disorders

  • Recidivant Polychondritis Unresponsive to Treatment Arthur Kavanaugh, MD, comments on a patient with recidivant polychondritis whose eye involvement is unresponsive to treatment.
  • Treatment Options for Pulmonary Sarcoidosis and Steroid-Induced Diabetes What are the treatment options for a patient with pulmonary sarcoidosis who has had repeat failed treatment with methotrexate, infliximab, and etanercept?
  • Steroid Dosage for Henoch-Schonlein Vasculitis What is the right dosage of steroids for Henoch-Schonlein vasculitis? Are there other treatment alternatives?
  • Elevated ESR and Diabetes -- Temporal Arteritis A 65-year-old Hispanic male is referred for evaluation of erythrocyte sedimentation rate (ESR) > 100 mm/hour on several occasions...
  • Acceptable ESR in Giant-Cell Arteritis? Is it important to normalize the ESR completely without ongoing symptoms?
  • Patient With Painful Subcutaneous Nodules Patient is a 46-year-old white female with a several-month history of lower-extremity rashes.
  • Ask the Experts - Radial Artery Occlusion in Raynaud's Disease A 35-year-old woman recently presented with bilateral hand and finger pain with color changes. Initial diagnosis was Raynaud's disease. The condition worsened, and angiography revealed bilateral radial artery occlusion. At bypass surgery, a biopsy showed merely thrombosis (after 2 weeks of high-dose corticosteroid therapy). Five years earlier, a flare-up in this patient had included arthritis in t
  • Ask the Experts - Treatment of Depression in Fibromyalgia I have a patient with fibromyalgia (FM) who is being treated with 20 mg fluoxetine (Prozac) and 50 mg amitriptyline (Elavil) per day. She is not better after 2 months. What is the best antidepressant treatment for patients with FM?
  • Ask the Experts - Mycoplasma and Chronic Fatigue Syndrome In a very high percentage of my patients with chronic fatigue syndrome (CFS), I have noted a history of significant dental work (more than routine cleaning) during the 3 to 6 months before symptoms began. Because CFS may have a potentially infectious origin (or at least an infectious agent stimulating a neuroimmunologic disorder of the central nervous system), I was wondering if Mycoplasma fermen
  • Ask the Experts - Gangrene and Low-Molecular-Weight Heparin A middle-aged man who tested positive for rheumatoid factor (RF) suddenly developed gangrene on the medial aspect of his right ring finger.
  • Ask the Experts - Warfarin Sodium and Livedo Reticularis Does warfarin sodium (Coumadin) produce livedo reticularis in elderly patients?
  • Ask the Experts - Options for Recurrent Wegener's Granulomatosis She now presents with new pulmonary nodules and an increasing c-ANCA. Pulmonary evaluation does not suggest fungal disease, although the nodules are too small (5-7 mm, peripheral) for bronchoscopic biopsy. Serologic and purified protein derivative tests are negative. If this is recurrent Wegener's granulomatosis, what are my treatment options?
  • Ask the Experts - Raynaud's Disease and Arthritis What options do I have in treating a 30-year-old woman with a 6-year history of Raynaud's disease, onychodystrophy, arthritis of the hands and knees, myopathy, hair loss, and malar rash? All antibody tests have been negative and skin biopsy is inconclusive. She has been treated as having systemic lupus erythematosus (SLE).
  • Ask the Experts - Progesterone Levels and Fibromyalgia Is there a relationship between progesterone levels and fibromyositis? If so, are hormonal levels indicated for diagnosis, and is hormone replacement therapy a part of appropriate management?
  • Ask the Experts - APS and MS A 45-year-old white woman diagnosed with multiple sclerosis (MS) more than 20 years ago had a very strongly positive anticardiolipin IgM (tested at patient's request) in a neurology clinic. Anticardiolipin IgG was negative. She has several white-matter lesions considered consistent with MS by radiograph. Her activated partial thromboplastin time was slightly elevated. Dilute Russell viper venom te
  • Ask the Experts - Antiocardiolipin Antibodies A young woman with 1 early spontanous abortion with positive results for VDRL, a negative test for anticardiolipin IgG, and borderline results for IgM -- 4.29 IU\mL. Do you recommend treatment?
  • Ask the Experts - APS with High Titer anti-SSa-La A 44-year-old woman presented with a history of two thrombotic events (lungs and legs) in 1998. She was diagnosed antiphospholipid syndrome (APS), with high titer anticardiolipin antibodies; she was treated with prednisone, antimalarials, and nonsteroidal anti-inflammatory drugs. She is well now, taking an antimalarial and oral anticoagulant, with normal titer anticardiolipin antibodies.
  • Ask the Experts - Warfarin and a Positive IgG Anticardiolipin Antibody... I recently saw a patient with 2 transient ischemic attack-like episodes of regional limb weakness and parasthesias lasting for short periods without sequelae. Testing revealed a moderately elevated IgG anticardiolipin levels but negative test results for B2 glycoprotein I.
  • Ask the Experts - Etiology of Chronic Fatigue Syndrome I have a patient who believes that her chronic fatigue syndrome is caused by an occult infection by Mycoplasma fermentans. She has found information to support this idea on the Internet. What would you tell her?
  • Ask the Experts - Acute Peripheral Crisis with Raynaud's Phenomenon A 34-year-old woman with a history of scleroderma and Raynaud's phenomenon presents with vasospastic painful crisis in both hands. She is taking calcium channel blockers and has lost 3 fingers from prior crises. What would be appropriate therapy? How good is iloprost for this emergency?