scholarly journals Granulomatous Mastitis in Rheumatoid Arthritis, Presenting as Breast Lumps - A Case Report

2021 ◽  
Vol 10 (22) ◽  
pp. 1739-1740
Author(s):  
Lata Kanyal Butola ◽  
Archana Dhok ◽  
Neelam Gusain ◽  
Anjali Vagga ◽  
Deepika Kanyal
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Disease ◽  
Breast Tissue ◽  
Granulomatous Mastitis ◽  
Annual Incidence Rate ◽  
Breast Lump ◽  
Breast Masses ◽  
History Of ◽  
Autoimmune Condition ◽  
Breast Lumps

Granulomatous mastitis (GM) of the breast is a rare inflammatory disease. We report a case of a 56 years old woman presenting with breast lump associated with history of rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic inflammatory autoimmune condition that induces inflammation, stiffness, rigidity, and lack of mobility in the joints and affects the peripheral joint synovial membrane, 1 which affects approximately 1 - 2 % of the world’s population with an annual incidence rate between 0.5 % and 1 %.2 Rheumatoid arthritis is an important cause of granulomatous mastitis. GM is an inflammatory disease in which granulomas form in breast tissue. It strikes mostly young to middle-aged women with painful and firm breast masses.3

scholarly journals FNAC OF BREAST LUMP WITH HISTOPATHOLOGICAL CORRELATION

2020 ◽  
pp. 1-2
Author(s):  
Vamshi Deepak Gudipati ◽  
Radhika Mucharla ◽  
Rammohan Peddi ◽  
K.Devender Reddy
Keyword(s):  
Excision Biopsy ◽  
Breast Lesions ◽  
Fibrocystic Disease ◽  
Breast Lump ◽  
Breast Masses ◽  
Medical College ◽  
Histopathological Correlation ◽  
Female Predominance ◽  
Palpable Breast ◽  
Breast Lumps

Introduction – FNAC has become increasingly popular in diagnosis of palpable breast masses. As it is sensitive, specific, economical and safe for screening of breast lesions Aims and objectives – to determine the histopathologic correlation of FNAC of breast lumps seen in department of pathology, Govt medical college, siddipet. Methods – 2 yrs. retrospective study if breast lumps , with all patients who had FNAC, with subsequent histopathological confirmation over the period July 2018 –July 2020. A total 232 cases included in which 187 cases are subjected to excision biopsy or mastectomy Results –2 yrs. under review (2018-2020) a total of 232 FNAC of breast lump were done. 197 (84.9%) benign cases, 13(11.6%) malignant cases, 8 (3.5%) inflammatory cases were diagnosed cytologically in which 98(42.24%) cases are fibro adenoma, 27(11.6%) are malignant cases and suspicious of malignancy, 26(11.2%) of gynecomastia, 23(9.91%) of fibrocystic disease with female predominance of 8:1 ratio (206:26). Age ranging from 9 yrs. – 85 yrs. with mean age of 47yrs ± 14.2 yrs. Conclusion – we therefore concluded that FNAC is a reliable diagnostic tool of breast lump in our hospital. FNAC guides the surgeons for further plan of management.

Evaluation of Breast Lumps by Ultrasound and Correlation with Histological Findings

2020 ◽  
Vol 23 (1) ◽  
pp. 10-12
Author(s):  
Nelema Jahan ◽  
Md. Mamunur Rahman ◽  
Mohammad Shahidul Alam ◽  
Md Saiful Islam
Keyword(s):  
Histopathological Examination ◽  
Breast Diseases ◽  
Histopathological Study ◽  
Common Symptom ◽  
Breast Lump ◽  
Histopathological Findings ◽  
Malignant Breast ◽  
Breast Lumps ◽  
One Year ◽  
A Prospective Study

Background: A breast lump is the most common symptom associated with both benign and malignant breast diseases. Therefore, a distinction of benign from malignant lump is of importance for proper management. Though a definitive diagnosis is possible with imaging for all the lesions, histopathological study is proven essential for confirming the diagnosis. Objective: The objective of this study was to evaluate the role of USG and histopathological findings of different breast lump in diagnosis and their comparison. Methods: A prospective study was conducted over a period of one year from January 2017 to December 2017. A total of 116 patients were included in this study. All breast lumps underwent surgery and the ultrasound findings of these lumps were compared with the histopathological findings. Data were collected from these patients by a preformed questionnaire and finally the data were analyzed. Results: Out of 116 patients only 21 cases were reported as malignant in ultrasound report but histopathology revealed 31 malignant patients. On histopathological examination 10 benign cases turned out to be malignant. Conclusion: The present study was undertaken to evaluate in diagnosing breast mass lesions individually by ultrasound and compared with histopathology for definitive management of a patient. Journal of Surgical Sciences (2019) Vol. 23 (1) : 10-12

scholarly journals THU0597 CORNEAL MELT - DON’T ALWAYS BLAME RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 540.3-540
Author(s):  
A. Munir ◽  
C. Sheehy
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Biopsy ◽  
Systemic Vasculitis ◽  
Lower Lobe ◽  
Visual Outcome ◽  
Eye Drops ◽  
Poor Visual Outcome ◽  
Methyl Prednisolone ◽  
History Of ◽  
And Function

Background:Corneal melt is a rare inflammatory disease of the peripheral cornea; it may lead to perforation of the globe and visual failure. Corneal melt can be a manifestation of systemic vasculitis in patients with RA and other conditions, such as cancer. Without early and aggressive treatment it may be associated with a poor visual outcome and a high mortality. It has been reported in patients with stable RA.Objectives:A case report in a patient with long standing but well controlled Rheumatoid Arthritis (RA) and metastatic disease.Methods:A 75 year old male with a background of sero positive Rheumatoid Arthritis for more than 10 years presented to the Eye Casualty with a two week history of a painful left red eye. His other medical history was significant for Stage IIB poorly differentiated cancer of the left lower lobe. Left lower lobectomy with a patch of diaphragm resected. Intratumoural lymphovascular invasion noted. He completed Adjuvant Carboplatin/Vinorelbine chemotherapy September, 2017. He had DVT proximal left leg 22ndof September, 2017. Follow up CT in 2018 demonstrated a right renal upper pole lesion for which he was awaiting biopsy with?metastatic lung disease vs primary renal carcinoma. His RA was well controlled on Methotrexate 10mg weekly. He had been treated by the ophthalmology team for left marginal Keratitis for the prior 2 months with steroid eye drops without significant improvement. On presentation to ED, he described sharp eye pain, waking him from the sleep, associated with watery discharge and photophobia. Examination showed corneal melt in left eye involving 25% of inferior portion of the cornea and spastic entropion with injecting eye lashes. He had no active joints and there were no other signs of vasculitis. CRP was 4.1. He had a negative ANA and ANCA; viral swabs were negative. He was admitted under the medical team. Intravenous Methyl Prednisolone was started. The patient felt better after 5 days of Methyl Prednisolone. Left temporary tarsorrhaphy was done by Ophthalmology. Cyclophosphamide was initiated after discussion with Oncologist pending the result of the renal biopsy. Patient was discharged after 5 days of admission in the hospitalResults:The renal biopsy was positive for metastatic Squamous cell carcinoma of lung. Cyclophosphamide was withdrawn and he was started on Carboplatin/Gemcitabine. The corneal melt improved with complete resolution of his visual symptoms.Conclusion:In this case, although the history of RA was felt by the ophthalmology team to be the most likely association with the corneal melt, we would argue the oncological diagnoses were likely the driving force behind the presentation.References:[1]Sule A, Balakrishnan C, Gaitonde S, Mittal G, Pathan E, Gokhale NS, et al. Rheumatoid corneal melt. Rheumatology (Oxford)2002;41:705–6.[2]S. Yano, K. Kondo, M. Yamaguchi et al., “Distribution and function of EGFR in human tissue and the effect of EGFR tyrosine kinase inhibition,” Anticancer Research, vol. 23, no. 5, pp. 3639–3650, 2003.Disclosure of Interests:None declared

scholarly journals P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Family History ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Mineral Density ◽  
History Of

Abstract Background/Aims  Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods  This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results  1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003<0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075<0.01-0.101-0.129,-0.072<0.01BMI (mg/m2)0.0080.008,0.0101<0.010.01130.019,0.013<0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion  This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure  M.A. Swar: None. M. Bukhari: None.

scholarly journals The association between subclinical hypothyroidism and TPOAb positivity with infertility in a population-based study: Tehran thyroid study (TTS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Batul Birjandi ◽  
Fahimeh Ramezani Tehrani ◽  
Atieh Amouzegar ◽  
Maryam Tohidi ◽  
Razieh Bidhendi Yarandi ◽  
...  
Keyword(s):  
Thyroid Autoimmunity ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Population Based Study ◽  
History Of ◽  
Autoimmune Condition ◽  
Biochemical Measurements ◽  
Adverse Pregnancy ◽  
Adjusted Logistic Regression

Abstract Background Thyroid autoimmunity(TAI) is the most prevalent autoimmune condition in women of fertile age. There are increasing data regarding the association of thyroid dysfunction and thyroid autoimmunity with adverse pregnancy outcomes but there is no consensus regarding infertility and TPOAb positivity; thus we aimed to evaluate the association between thyroid TPOAb positivity and infertility in females and males in a population-based study (TTS). Methods Cross-sectional study of 3197 female and male participants in Tehran Thyroid Study (TTS) at the framework of the Tehran Lipid and Glucose Study (TLGS). Data included biochemical measurements and a self-administered questionnaire. Results A total of 12,823 cases in phase 4, 3719 cases (2108 female and 1611 male) were analyzed. The mean TSH of the infertile female and male was 2.52 ± 2.68 μIU/ml and 3.24 ± 10.26 μIU/ml respectively. The TPO median(IQR) of women with and without a history of infertility were 6.05 (3.30–13.96)and 6.04 (3.17–11.15);(P = 0.613), they were 5.08 (3.20–125.68) and 5.31 (3.93–125.68);(P = 0.490) in male participants, respectively. Results of crude and adjusted logistic regression analysis of the development of infertility by thyroid function and TPOAb, except for fT4 in male subjects, depicted no association between infertility and other variables in both crude and adjusted models. Conclusion Based on the result, thyroid autoimmunity was not associated with infertility in both females and males.

scholarly journals SAT0589 RISK FOR PSYCHIATRIC HOSPITALIZATION FOLLOWING A RHEUMA-RELATED HOSPITALIZATION: RESULTS FROM A CZECH NATIONWIDE, COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1253.2-1254
Author(s):  
T. Formánek ◽  
K. Mladá ◽  
M. Husakova
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Ankylosing Spondylitis ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Psychiatric Hospitalization ◽  
Population Based ◽  
Index Hospitalization ◽  
Increased Risk ◽  
History Of

Background:Cohort studies using nationwide health registers have shown an increased risk for affective and anxiety disorders in people with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) (1-3). Moreover, a nationwide cohort study demonstrated an increased risk for mental disorders in people with rheumatic diseases (4).Objectives:We aimed to investigate the risk for psychiatric hospitalization following a hospitalization for rheumatic disease.Methods:Using data from the Czech nationwide register of all-cause hospitalizations, we obtained 4 971 individuals hospitalized (index hospitalization) between 2004 and 2012 for rheumatic diseases - RA, spondyloarthritis (including AS, psoriatic arthritis and undifferentiated spondyloarthritis), systemic lupus erythematosus and systemic sclerodermia, with no history of psychiatric and rheuma-related hospitalization in the previous 10 years from the index hospitalization. On these individuals, we randomly matched (on age, gender and year of index hospitalization) controls that were hospitalized in the same time period for a non-rheumatic disease and have no history of psychiatric and rheumatic hospitalization in the last 10 years from their index hospitalization, in the ratio of 1:5. We employed conditional logistic regression for assessing the risk for psychiatric hospitalization in the subsequent 3 years from the index hospitalization. To strengthen our results, we repeated the matching step 100 times and run the analysis on each resulting dataset separately, and pooled the results. The findings are expressed as odds ratios (OR) with 95% confidence intervals (95% CI).Results:We identified an elevated risk for psychiatric (OR = 1.34, 95% CI = 1; 1.78) and for affective disorders (OR = 2.19, 95% CI = 1.17; 4.1) in people hospitalized for rheumatic diseases. We did not find a statistically significant association with organic, psychotic and anxiety disorders.Conclusion:There is an increased risk for experiencing a psychiatric disorder in the period of 3 years after a rheuma-related hospitalization.References:[1]Shen C-C, Hu L-Y, Yang AC, Kuo BI-T, Chiang Y-Y, Tsai S-J. Risk of Psychiatric Disorders following Ankylosing Spondylitis: A Nationwide Population-based Retrospective Cohort Study. The Journal of Rheumatology. 2016;43(3).[2]Park J-S, Jang H-D, Hong J-Y, Park Y-S, Han K, Suh S-W, et al. Impact of ankylosing spondylitis on depression: a nationwide cohort study. Scientific Reports. 2019;9(1):6736.[3]Hsu C-C, Chen S-C, Liu C-J, Lu T, Shen C-C, Hu Y-W, et al. Rheumatoid Arthritis and the Risk of Bipolar Disorder: A Nationwide Population-Based Study. PLOS ONE. 2014;9(9).[4]Sundquist K, Li X, Hemminki K, Sundquist J. Subsequent Risk of Hospitalization for Neuropsychiatric Disorders in Patients With Rheumatic Diseases: A Nationwide Study From Sweden. Archives of General Psychiatry. 2008;65(5):501-7.Acknowledgments:Supported by the project (Ministry of Health Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology).Disclosure of Interests:Tomáš Formánek: None declared, Karolina Mladá: None declared, Marketa Husakova Speakers bureau: Novartis

scholarly journals Predictors for clinical effectiveness of baricitinib in rheumatoid arthritis patients in routine clinical practice: data from a Japanese multicenter registry

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nobunori Takahashi ◽  
Shuji Asai ◽  
Tomonori Kobayakawa ◽  
Atsushi Kaneko ◽  
Tatsuo Watanabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Disease Activity ◽  
Retention Rate ◽  
Oral Prednisone ◽  
Multivariate Logistic Regression Analysis ◽  
Jak Inhibitors ◽  
Short Term ◽  
History Of ◽  
Multicenter Registry

AbstractThis study aimed to evaluate the short-term effectiveness and safety profiles of baricitinib and explore factors associated with improved short-term effectiveness in patients with rheumatoid arthritis (RA) in clinical settings. A total of 113 consecutive RA patients who had been treated with baricitinib were registered in a Japanese multicenter registry and followed for at least 24 weeks. Mean age was 66.1 years, mean RA disease duration was 14.0 years, 71.1% had a history of use of biologics or JAK inhibitors (targeted DMARDs), and 48.3% and 40.0% were receiving concomitant methotrexate and oral prednisone, respectively. Mean DAS28-CRP significantly decreased from 3.55 at baseline to 2.32 at 24 weeks. At 24 weeks, 68.2% and 64.1% of patients achieved low disease activity (LDA) and moderate or good response, respectively. Multivariate logistic regression analysis revealed that no previous targeted DMARD use and lower DAS28-CRP score at baseline were independently associated with achievement of LDA at 24 weeks. While the effectiveness of baricitinib was similar regardless of whether patients had a history of only one or multiple targeted DMARDs use, patients with previous use of non-TNF inhibitors or JAK inhibitors showed lower rates of improvement in DAS28-CRP. The overall retention rate for baricitinib was 86.5% at 24 weeks, as estimated by Kaplan–Meier analysis. The discontinuation rate due to adverse events was 6.5% at 24 weeks. Baricitinib significantly improved RA disease activity in clinical practice. Baricitinib was significantly more effective when used as a first-line targeted DMARDs.

scholarly journals Global Hypertrophic Calcification of Shoulder Joint Capsule

2021 ◽  
Vol 14 ◽  
pp. 117954762110253
Author(s):  
Abdulkarim Yousef Aldehaim ◽  
Abdurhman Saud Alarfaj
Keyword(s):  
Rheumatoid Arthritis ◽  
Shoulder Joint ◽  
Joint Capsule ◽  
Surgical Approaches ◽  
Contributing Factors ◽  
Severe Arthritis ◽  
History Of ◽  
Excellent Control ◽  
Specific Symptoms ◽  
Calcific Deposits

Background: Calcification around the shoulder joint usually occur inside or around the tendons of the rotator cuff. We herein report on a case of global hypertrophic calcification of shoulder joint capsule in a patient with Rheumatoid arthritis. Case Report: An 86 years-old male with a long-standing history of seropositive Rheumatoid arthritis. The treatment for his Rheumatoid arthritis included Methotrexate and Hydroxychloroquine initially, but due lack of control, adalimumab was added with excellent control of his arthritis. He has progressively experienced an increasing pain and stiffness in his shoulders, in addition to an increasing limitation of shoulder movement. Magnetic Resonance Imaging revealed severe arthritis with remoulding deformity with extensive capsular calcification, intra-articular loose-bodies. Discussion: This phenomenon of calcification of shoulder capsule has not been reported before. The pathophysiology of calcific tendinopathy of the shoulder remains controversial. The calcific deposits consist of poorly-crystallized hydroxyapatite. Conclusion: Global hypertrophic calcification of shoulder joint capsule is unique and unreported in the literature. We can postulate that the long-standing inflammation of the synovial lining of the capsules had a major part. Moreover, Diabetes Mellitus, smoking, and repetitive manoeuvres are recognized contributing factors as well for similar conditions. Genetic predisposition seems to play a role as well. We think all those have played part in the development of this unprecedented presentation. Management should be tailored to target specific symptoms for pain, rigidity, and decreasing calcification size. Several options are available, including Kinesiotherapy, electrotherapy modalities, iontophoresis, electroshock wave therapy, and finally surgical approaches for progressive and refractory cases.

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