ACR Appropriateness Criteria® Chronic Wrist Pain.

Radiographs are indicated as the first imaging test in all patients with chronic wrist pain, regardless of the suspected diagnosis. When radiographs are normal or equivocal, advanced imaging with MRI (without or without intravenous contrast or following arthrography), CT (usually without contrast), and ultrasound each has a role in establishing a diagnosis. Furthermore, these examinations may contribute to staging disease, treatment planning, and prognostication, even when radiographs are diagnostic of a specific condition. Which examination or examinations are best depends on the specific location of pain and the clinically suspected conditions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR Appropriateness Criteria® Chronic Hip Pain.

Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Acute myocardial infarction after treatment of thrombocytopenia in a young woman with systemic lupus erythematosus.

We describe a case of an acute myocardial infarction (MI) coincident with correction of severe thrombocytopenia in a 23-year old African American woman with systemic lupus erythematosus (SLE) in the absence of coronary artery disease on angiography. Despite a history of anticardiolipin and beta(2)-glycoprotein I antibodies, she had no prior thromboembolic events. The occurrence of an acute MI after rapid normalization in the platelet count suggests the need for close monitoring of possible cardiovascular events during and after treatment of severe thrombocytopenia in the presence of antiphospholipid antibodies.

Current management of rheumatoid arthritis.

Rheumatoid arthritis (RA), the most common form of inflammatory arthritis, is a chronic, inflammatory, progressive disease. Most patients have moderate disease, with a variable disease course and symptomatic flares interspersed with periods of relatively lower disease activity. Over the last 2 decades, the treatment of RA has evolved dramatically, from use of disease-modifying antirheumatic drugs to newer biologics. None of these therapies represents a cure for RA; however, the availability and the efficacy of multiple treatments has made remission of the disease a realistic target.

Psoriatic arthritis: prevalence, diagnosis, and review of therapy for the dermatologist.

Psoriatic arthritis is an inflammatory arthritis that is commonly associated with psoriasis. While traditionally viewed as being a benign disease, recent evidence indicates the potential for a significant amount of morbidity and disability, making early recognition and intervention important. Treatment includes both traditional immunomodulatory agents as well as the recently available biologic response modifiers.