Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults.

OBJECTIVE: To identify proximate causes ('triggers') of flares in adults with, or at risk of, knee osteoarthritis (OA), estimate their course and consequences, and determine higher risk individuals. METHODS: In this 13-week web-based case-crossover study adults aged ≥40 years, with or without a recorded diagnosis of knee OA, and no inflammatory arthropathy who self-reported a knee flare completed a questionnaire capturing information on exposure to 21 putative activity-related, psychosocial and environmental triggers (hazard period, ≤72 h prior). Comparisons were made with identical exposure measurements at four 4-weekly scheduled time points (non-flare control period) using conditional logistic regression. Flare was defined as a sudden onset of worsening signs and symptoms, sustained for ≥24 h. Flare characteristics, course and consequence were analysed descriptively. Associations between flare frequency and baseline characteristics were estimated using Poisson regression. RESULTS: Of 744 recruited participants (mean age [SD] 62.1 [10.2] years; 61% female), 376 reported 568 flares (hazards) and provided 867 valid control period measurements. Thirteen exposures (eight activity-related, five psychosocial/environmental) were positively associated with flare onset within 24 h (strongest odds ratio estimate, knee buckling: 9.06: 95% confidence interval [CI] 5.86, 13.99; weakest, cold/damp weather: 1.45: 95%CI 1.12, 1.87). Median flare duration was 5 days (IQR 3, 8), less common if older (incident rate ratio [IRR] 0.98: 95%CI 0.97, 0.99), more common if female (IRR 1.85: 95%CI 1.43, 2.39). CONCLUSIONS: Multiple activity-related, psychosocial and environmental exposures are implicated in triggering flares. This evidence can help inform prevention and acute symptom management for patients and clinicians.

Microcystic adnexal carcinoma. First reported case in a black patient.

BACKGROUND: Microcystic adnexal carcinoma is an uncommon malignancy of the skin with a propensity for local aggressive growth and high rates of recurrence. To date, this neoplasm has been described mainly in the Caucasian population. We describe here the first reported case in a black patient. OBJECTIVE: To discuss the successful identification and management of this aggressive neoplasm in the non-Caucasian population. METHODS: Mohs micrographic surgery was performed on this tumor. RESULTS: The tumor was successfully excised without evidence of recurrence at 6 months. CONCLUSIONS: We present the first reported case of microcystic adnexal carcinoma in a black patient. This tumor was identified in its early stages and removed by Mohs micrographic surgery without sequelae.

Innovative dressing method for Mohs' surgery.

Mohs' surgery often requires multiple dressing changes in a single day. The innovative dressing method described here provides a reproducible, visually acceptable dressing with minimal damage to the patient's uninvolved skin. It also allows speedy removal and a smooth flow of events for the health care team.

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma).

Microcystic adnexal carcinoma (MAC) is a recently described malignant neoplasm of the adnexal structures of skin that shows a marked propensity for early infiltrative and locally aggressive growth. Its banal clinical appearance may lead to a delay in diagnosing the tumor by biopsy, and its multifaceted histologic features may lead to an incorrect tissue diagnosis. Confusion with benign tumors and less aggressive malignancies can lead to inadequate initial treatment and extensive recurrences. We describe three cases of microcystic adnexal carcinoma and review the clinical and histologic features, treatment, and prognosis of this neoplasm.

Cutaneous protothecosis presenting as recurrent chromomycosis.

Chromomycosis and protothecosis are both rare cutaneous infections. We report a case in which protothecosis mimicked a relapse of chromomycosis both clinically and on special stains. The chromomycosis responded to local excision and ketoconazole therapy. The protothecosis failed to respond to ketoconazole but resolved with combined amphotericin B and tetracycline hydrochloride therapy.