Zeitschrift für Rheumatologie
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If acute arthritis occurs in the elderly in addition to typical degenerative, load-related joint complaints, this is often induced by crystal deposition. The crystals lead to activation of the immune system resulting in acute inflammation. In addition to gout, calcium pyrophosphate deposition (CPPD) disease in particular must also be taken into consideration. ⋯ In contrast to gout, which can be well controlled by the pharmaceutical lowering of uric acid levels, there is no causal therapy for CPPD disease so far. As CPPD may occur as a secondary effect in metabolic disorders, such as hyperparathyroidism or hemochromatosis, it seems to be important to search for the underlying disease. The following article presents the current knowledge on clinically relevant aspects of the pathogenesis, diagnosis and therapy of CPPD disease.
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A female patient developed systemic rash, lung edema, electrocardiogram (ECG) abnormalities and fulminant hepatitis with partial liver failure 4 weeks after the start of sulfasalazine treatment. Peripheral T-cell activation, a positive PCR test for human herpesvirus (HHV) 6 as well as eosinophilia in bronchial lavage and a differential blood count were also present. After initiation of systemic corticosteroid therapy and cessation of accompanying medication the clinical symptoms and abnormal laboratory test levels were gradually resolved. A DRESS syndrome (drug rash with eosinophilia and systemic symptoms) was confirmed in accordance with the diagnostic criteria.
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Psoriatic arthritis occurs almost exclusively together with psoriasis (of the skin). Thus, psoriasis-associated diseases or comorbidities are also seen in psoriatic arthritis patients. Among the clinically most relevant comorbidities are cardiovascular diseases and their risk factors, namely smoking, obesity and the metabolic syndrome. ⋯ The link between psoriasis, psoriatic arthritis and its comorbidities has been established based on epidemiological studies; however, at least for the cardiovascular comorbidities, the association can be explained based on novel insights into the pathogenesis of atherosclerosis. For the practising physician it is important to take into account the aspect of comorbidity to come to an optimal treatment decision in each individual case. Clinical decision-making is complicated further by the fact that comorbidity necessitates comedication which again influence the choice of treatment.