General Arthritis Q & A

My rheumatologist said he believes that I had palindromic rheumatism that has turned into RA. What is Palindromic Rheumatism and how does it turn into RA? My RA factor is positive and the titer is 80. I am a 39 yr old female.

I am a practicing internist in Orlando area florida. My wife, previously healthy 31 year old Asian female, G4P1A2, 18 week old female started having persistant fever about 7 days ago. Her pregnancy was complicated with moderate GERD and anorexia. No symptoms of sore throat, headache, cough, urinary sysmptoms or diarhhea. Fever of 101-103 F would come with shaking chills and barely subside with tylenol. Workup was done on 5th day by her ObGYN, including a CBC with a WBC of 5,000 and 95% neutrophils and Platelet ct of 156,000. AST was 169, with an ALT of 190 with albumin of 2.7. She was admitted to the local hospital. Her ATL jumped up to 240 and AST to 190 She developed diffuse progressive arthritis on the 6th dayalong with a maculopapular rash on her trunk and extrimities on the 7th day of the illness. Today she had mild improvement in her Alt(190) and AST(90) but an Albumin of 2.3. 24 hour urine shows protein of 500mg/dl. PT is normal. Rash is getting progressively coalescent. Arthritis is involving small and big joints and is intrestingly sparing DIPs. Rhem Wup shows a -ve ANA, Esr of 55, -ve, Anti smooth muscle antibody is -ve. RA factor is pending. The titers for CMV, coxsackie, Herpes, HIV test is pending. Question is wheather she has Still’s disease, and what tests we should order, how should we treat it and what would be the prognosis?

How is moderate bone marrow edema treated in the first metatarsel Phalangeal joint (i.e. the great toe)in a 55 year old male?

My son, who is one year old, has had repeated episodes of septic arthritis of the left hip joint since he was 7 months of age. First time around, he received antibiotics (vancomycin and moncef) for a total of 8 weeks (3 Iv and 5 oral). However, within 3 months we noticed limitation of the movement and he was crying in pain. His joint was surgically drained and PCR for TB was done, which was positive. Synovial fluid culture showed staph albus. We were told that though bone TB is rare in such young children it can’t be ruled out completely. (my son was 2 months premature and his birth weight was 840 grams. Before the first episode of septic arthritis, he had spend around 3months in the hospital). We were also told that staph albus is usually non-pathogenic and a contaminant. However, within 15 days of starting ATT, he again had the same complain. His joint was again surgically drained. Tissue cultures and biopsy were done. These were negative for TB, fungal infection and again showed staph albus. Post surgery, spica was put on his leg. He was given IV antibiotics (teicoplannin) for 3 weeks and is currently on oral antibiotics (clindamycin). He has received 5 weeks of antibiotics so far. His plaster was removed a couple of days back but he is still not moving his leg. Questions are: 1) Can staph albus play such havoc? What should we do to ensure that there is no repeat of these incidents? 2) Post plaster, how much time does it take for infants to start moving their leg? Do infants experience stiffness post spica as adults? 3) what can i do to help my child recover and move his leg? 4) why is my son having these repeated episodes? I believe recurrence of septic arthritis is rare, then why is son having it so frequently?

I have RA in both hands and wrists and recently also been told by my doctor that I also have CTS in both wrists. He suggeted using braces for my hands. I find the braces help the CTS but caused my RA in my fingers to act up. Is there any different treatment for CTS that is different from my RA treatments? I am only using the braces at night should they be used during the day while I am at work on the computer?

What are the implications of having a high SED rate? Or is it necessary to treat a high SED rate and if so, can you tell me what kind of damage it does and to what please? Thanks very much!