J Rheumatol
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Rheumatology training is essential for family practice residents, but major inadequacies have been described in current programs. In an effort to guide the design of our own rheumatology curriculum, all patient visits to a family health center over a 15-week period were surveyed. ⋯ Osteoarthritis and regional joint pain were the 2 most frequent problems noted, whereas systemic and inflammatory rheumatic diseases were unusual. Rheumatology curricula for family physicians should stress evaluation, management and prevention of problems in those defined areas.
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Case Reports
Mixed connective tissue disease with pulmonary hypertension: a clinical and pathological study.
Clinical and autopsy findings of 2 cases with mixed connective tissue disease (MCTD) associated with severe pulmonary hypertension are reported. Both cases showed marked intimal and medial thickening in small and medium sized pulmonary arteries. In one of the cases plexiform lesions, endarteritis obliterans, and fibrous intimal thickening of the pulmonary veins were recognized. In some cases with MCTD, pulmonary hypertension develops due to pulmonary vascular lesions which are similar to those of primary pulmonary hypertension.
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Sleep physiology, pain and mood symptoms of 8 patients with idiopathic osteoarthritis of the hands who complained of morning symptoms were compared to 7 age and sex matched subjects with similar joint pathology, but who did not complain of morning symptoms. The "AM Symptoms" group had sleep related (nocturnal) myoclonus, associated with increased morning peripheral joint tenderness and decreased grip strength, whereas the "No Complaint" group had improved mood in the morning.
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We studied 14 cases of polymyositis-dermatomyositis (PM-DM) and found roentgenographic evidence of interstitial lung disease in 9 patients with DM (64.3%). Serum anti-Jo-1 antibody was demonstrated in only one case. ⋯ Response to corticosteroid therapy was poor, and 6 cases (67%) succumbed to respiratory failure and died. We conclude that interstitial lung disease in DM occurs more frequently than previously reported and may be an important prognostic factor.