Recurrent Multifocal Mycoplasma orale Infection in an Immunocompromised Patient: A Case Report and Review.

A young woman with mixed connective tissue disease complicated by erosive arthritis, secondary hypogammaglobulinemia due to rituximab, and a history of many infectious complications developed multiple nonhealing wounds, polyarticular joint pain, and leukocytosis. Radiographic studies demonstrated multiple scattered areas of osteomyelitis and complex abscesses. Purulent fluid drained from multiple sites did not yield a microbiologic diagnosis by standard culture technique, but Mycoplasma orale was ultimately identified using 16 S ribosomal RNA gene amplification and sequencing. We describe this unique case and review the literature.

Minimal clinically important differences of 3 patient-rated outcomes instruments.

PURPOSE: Patient-rated instruments are increasingly used to measure orthopedic outcomes. However, the clinical relevance of modest score changes on such instruments is often unclear. This study was designed to define the minimal clinically important differences (MCIDs) of the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH (subset of DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires for atraumatic conditions of the hand, wrist, and forearm. METHODS: We prospectively analyzed 102 patients undergoing nonoperative treatment for isolated tendinitis, arthritis, or nerve compression syndromes from the forearm to the hand. By phone, patients completed the DASH, QuickDASH, and PRWE at enrollment and at 2 weeks (n = 78 used in the analysis) and 4 weeks (n = 24 used in the analysis) after initiating treatment. Patients reporting clinical improvement each contributed a single data point categorized as no change (n = 41), minimal improvement (n = 30), or marked improvement (n = 31) via a validated anchor-based approach. We calculated the MCID as the mean change score for each outcome measure in the minimal improvement group. RESULTS: The MCID (95% confidence interval) for the DASH was 10 (5-15). The MCID for the QuickDASH was 14 (9-20). The MCID was 14 (8-20) for the PRWE. The MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement. The MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores. CONCLUSIONS: Longitudinal changes on the DASH of 10 points, on the QuickDASH of 14 points, and on the PRWE of 14 points represent minimal clinically important changes. We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients. These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.