Corticosteroid therapy for rheumatoid arthritis. Benefits and limitations.

Oral corticosteroids, despite their potential side effects, have a select role in the treatment of rheumatoid arthritis. For articular disease, these drugs must be targeted to short-term goals, such as symptom relief. Close attention to the indications and potential hazards of steroid therapy may ensure optimal benefit and reduced risk. Intra-articular steroid injections can provide local symptomatic relief when only one or a few joints are swollen. Septic arthritis is most important to exclude before injection of a joint. Complications of intra-articular injection are few, and relief may be long-lasting.

Diabetic amyotrophy without pain. A puzzling clinical picture.

A patient with weight loss and weakness presents a diagnostic challenge. Drs Moeser and Kent describe an unusual case of diabetic amyotrophy that required extensive workup to arrive at the diagnosis and rule out more serious disease. Symptoms were dramatic, and recovery was spontaneous following conservative treatment.

Haemophilus influenzae polyarthritis in an adult: an analysis of serotype b strains.

A 61-year-old man who presented with clinical features suggestive of septic arthritis was found to have acute septic polyarthritis due to Haemophilus influenzae (type b). The clinical and laboratory diagnoses of the case are presented, and the isolates of H. influenzae are characterized. Four isolates recovered from different sites had identical minimal inhibitory drug concentrations, outer membrane protein patterns, and genomic DNA restriction digests. These observations indicate that the disseminated infection arose from a single source. The patient developed antibody to several outer membrane proteins, particularly the P6 protein.