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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Since those early years of investigation, thermography has been found to be less reliable for detecting DVT than ultrasound imaging combined with a blood test to detect fibrinolysis.187 More recent studies show that venous thrombosis may occur as a complication of arterial vasculitis because the damage to the endothelial lining of the vessels with subsequent clot formation occurs in veins as well as arteries. In large-vessel arteritis, there is a 2.5-fold increased risk of both deep vein thrombosis and pulmonary embolism compared to the normal population.188 Similar complications may occur in polymyalgia rheumatica, systemic lupus, rheumatoid arthritis, systemic sclerosis, and other vasculitides.189 Migratory SVT, an inflammation that may come and go in otherwise normal veins of the limbs and trunk, is associated with pancreatic cancer and other adenocarcinomas.190 To non-invasively detect thrombophlebitis, a combination of thermography and Doppler ultrasound imaging has proven very effective. While ultrasound imaging is excellent for detecting deep thromboses, thermography can readily visualize superficial phlebitis due to the NO produced by venous inflammation. In the absence of visible varicose veins, a vein that appears significantly warmer than the surrounding tissue should arouse suspicion for active phlebitis.191 The “vascular cape” seen thermographically at times across the upper chest wall may be a migrant phlebitis similar to Mondor's disease.192
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Rheumatoid factor (RF) is positive in around 66% of people with later onset RA, compared to 80–90% of those with younger onset disease.27 It may also be weakly positive in a number of healthy older people. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are an alternative diagnostic test. They are also present in around two thirds of those with RA, but less common outside this condition.27 ESR is characteristically elevated. The differential diagnosis includes polymyalgia rheumatica (see page 431). Synovitis may be seen in the hands, usually affecting the wrists, proximal interphalangeal and metacarpal phalangeal joints. X-rays may show erosive changes (typically juxta-articular) and joint space narrowing. Ultrasound assessments can detect subclinical synovitis to aid assessment.
Paper 1
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Differential diagnoses of polymyalgia rheumatica make up a long list and include many systemic/vasculitic/infective/bone diseases. Malignancy is always in the mix as well. However, hypothyroidism rather than hyperthyroidism is more implicated here.
Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit
Published in Current Medical Research and Opinion, 2023
Bahar Bektan Kanat, Veysel Suzan, Gulru Ulugerger Avci, Halit Eyyup Mungan, Damla Unal, Tugce Emiroglu Gedik, Deniz Suna Erdincler, Alper Doventas, Hakan Yavuzer
There are many benign conditions in the differential diagnosis of malignancy. In our study, we diagnosed very different and surprising diseases in patients who were admitted to the inpatient clinic with suspicion of malignancy. Anticoagulant antiaggregant use is quite common in geriatric patients due to comorbid diseases and these drugs may cause bleeding. Iron deficiency anemia due to chronic bleeding causes symptoms such as weakness, fatigue, shortness of breath in older patients and impairs blood tests and requires examination for malignancy. Polymyalgia rheumatica is also at the forefront in the differential diagnosis of malignancy, especially in older patients, due to the constitutional symptoms it causes and the high acute phase reactants. In our study, we also revealed that depression, which is frequently encountered in geriatric individuals, is one of the conditions that fall into the differential diagnosis of malignancy by causing complaints such as fatigue, loss of appetite, and weight loss.
Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2019
C Turesson, O Börjesson, K Larsson, AJ Mohammad, A Knight
GCA is very rare before the age of 50 years and occurs mainly after the age of 60, with an incidence that increases with age (1). Women are afflicted with the disease two to three times more often than men. The highest incidence has been observed in Scandinavia (2). Common symptoms are headache, jaw claudication, and soreness of the temporal arteries (3). Symptoms of polymyalgia rheumatica (PMR), fever, and malaise are also common. PMR can also be a disease on its own, but the treatment guidelines for PMR are not included in this document. Blindness is the most feared complication of GCA (4). Approximately 15% of patients have complications from major vessels, that is, inflammation of the aorta and its branches (5), and neurological symptoms with stroke affect about 10% (6).
Disorders of vision in multiple sclerosis
Published in Clinical and Experimental Optometry, 2022
Roshan Dhanapalaratnam, Maria Markoulli, Arun V Krishnan
Arteritic ischaemic optic neuropathy is predominantly caused by giant cell arteritis and affects older patients, generally over the age of 60 to 70.72 The condition can present in the setting of polymyalgia rheumatica and clues to the diagnosis include the presence of jaw claudication, headache and scalp tenderness, with elevated serum erythrocyte sedimentation rate and C- reactive protein levels.73 On examination of the fundus, a pale and swollen disc can be seen with peripapillary haemorrhage and branch or central retinal artery occlusions. Temporal artery biopsy remains the gold standard in diagnosis however PET scans have increasingly been used to aid diagnostic specificity.74