This case study describes a 63-year-old female who presented with severe polyarthralgia two days after receiving a Sinopharm COVID-19 vaccine. She had symmetric joint pain and swelling in her hands, wrists, knees, ankles and shoulders. Initial testing and symptoms were suggestive of reactive arthritis, but she did not respond to steroids. Synovial fluid from her knees grew gram-negative bacilli identified as E. coli, indicating septic polyarthritis. This case highlights that septic arthritis can initially present as polyarthritis and be misdiagnosed as other conditions like reactive arthritis if infection is not considered.
Approach to Aquatic Skin & Soft Tissue Infections. Clinical Microbiology Residency Program
King Fahd Hospital of The University, Al Khobar
Saudi Arabia
Still's disease, sometimes referred to as Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash.
Rheumatology MCQs Practice questions with explanationDr. Almas A
Topic: Rheumatology
Exam type: MCQs Practice questions
Q. A 26-year-old female presented to ER with dry cough and shortness of breath and often complains of chest pain. Chest x-ray shows bilateral hilar lymphadenopathy. Which of the following will indicate that the patient suffers from sarcoidosis?
Q: A 50-year-old female presents to ER with dyspnea on exertion and orthopnea, red painful eyes. She complains of chronic dull pain in the gluteal region for the last 5 years and stiffness in the lower back that wakes her up in the morning. X-ray spine reveals squaring of vertebrae with bone spur formation. On MRI sacroiliitis is seen. Which of the following is the most likely diagnosis?
Q: A 60-year-old female presents in OPD with knee joint stiffness in the morning and increases with activity and decreases on rest. She also complains about a crackling noise on joint movement. X-ray shows narrowing of the joint space and osteophytes. Which of the following treatments is recommended in this patient?
Q: A 70-year-old female presented to ER with swelling of knee joint and severe pain. Arthrocentesis revealed rhomboid-shaped crystals that stained deeply blue with H&E stain, and show weak positive birefringence on light microscopy. X-ray reveals chondrocalcinosis. Which of the following statements is true?
Q: A 40-year-old female comes to OPD with dry eyes and dyspareunia for the last 6 months. She also complains of cough and fatigue with joint pains. On examination, her parotid gland was enlarged and laboratory tests revealed anti-Ro antibodies are positive. Which of the following tests is recommended to this patient?
Approach to Aquatic Skin & Soft Tissue Infections. Clinical Microbiology Residency Program
King Fahd Hospital of The University, Al Khobar
Saudi Arabia
Still's disease, sometimes referred to as Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash.
Rheumatology MCQs Practice questions with explanationDr. Almas A
Topic: Rheumatology
Exam type: MCQs Practice questions
Q. A 26-year-old female presented to ER with dry cough and shortness of breath and often complains of chest pain. Chest x-ray shows bilateral hilar lymphadenopathy. Which of the following will indicate that the patient suffers from sarcoidosis?
Q: A 50-year-old female presents to ER with dyspnea on exertion and orthopnea, red painful eyes. She complains of chronic dull pain in the gluteal region for the last 5 years and stiffness in the lower back that wakes her up in the morning. X-ray spine reveals squaring of vertebrae with bone spur formation. On MRI sacroiliitis is seen. Which of the following is the most likely diagnosis?
Q: A 60-year-old female presents in OPD with knee joint stiffness in the morning and increases with activity and decreases on rest. She also complains about a crackling noise on joint movement. X-ray shows narrowing of the joint space and osteophytes. Which of the following treatments is recommended in this patient?
Q: A 70-year-old female presented to ER with swelling of knee joint and severe pain. Arthrocentesis revealed rhomboid-shaped crystals that stained deeply blue with H&E stain, and show weak positive birefringence on light microscopy. X-ray reveals chondrocalcinosis. Which of the following statements is true?
Q: A 40-year-old female comes to OPD with dry eyes and dyspareunia for the last 6 months. She also complains of cough and fatigue with joint pains. On examination, her parotid gland was enlarged and laboratory tests revealed anti-Ro antibodies are positive. Which of the following tests is recommended to this patient?
Most common rheumatic disease in childhood but prevalence and incidence vary remarkably in different geographic regions
•Incidence : 0.8 to 22.6/100,000 children per year
•Prevalence : 7 to 401/ 100,000.
•Oligoarticular JIA (30-60%): The peak age at onset : Between 2 and 4 yr, F/M: 3:1 Polyarticular (30-35%): Bimodal distribution with peaks at 1-4 yr and 10-14 yr, F/M: RF negative (3 : 1), RF positive (5 : 1) JIA.
• Systemic onset (10-20%): peak 1-5 years(No sex predominance)
• Enthesitis related arthritis (10-20%):Onset usually after 6 years
and M/F: 7:1
• Juvenile psoriatic arthritis (2-5 %): Bimodal distribution 1-4 yr and 10-14 yr
8
Etiopathogenesis
• Both immunogenetic susceptibility and an external trigger
• Variants in major histocompatibility complex (MHC) class I and class II regions
• Non-HLA candidate loci: polymorphisms in the genes encoding protein tyrosine phosphatase nonreceptor 22 (PTPN22), tumor necrosis factor (TNF)-α, macrophage inhibitory factor, interleukin (IL)-6, and IL-1α.
• External trigger: bacterial and viral infections, enhanced immune responses to bacterial or mycobacterial heat shock proteins, abnormal reproductive hormone levels, and joint trauma.
9
10
• All these cause inflammatory synovitis, characterized by villous hypertrophy and hyperplasia with hyperemia and edema of synovial tissue.
• Vascular endothelial hyperplasia is prominent and is characterized by infiltration of mononuclear and plasma cells with a predominance of T lymphocytes
• Advanced and uncontrolled disease leads to pannus formation and progressive erosion of articular cartilage and contiguous bone
11
Genetics
• Monozygotic twins : 25% to 40% • Siblings : 15 to 30 fold higher
• Role of HLA class I and II alleles
HLA B27 Enthesis related arthritis
HLA-A2 is associated with early-onset JIA
HLA-DRB1*08, 11, and 13 and DPB1*02 :oligoarticular JIA. HLA-DRB1*08 : Rf negative polyarticular JIA.
12
JRA
13
• Age: <16 years & Duration : > 3 months
Subtypes (Based on characteristics at onset):
JCA
• Pauciarticular (1-4 joints)
• Polyarticular (≥5 joints)
• Presence of RF (2 positive tests at least 3 months apart) • Systemic onset with characteristic features
• Juvenile ankylosing spondylitis
• Juvenile psoriatic arthritis
14
• Age: <16 years & Duration : > 6 weeks
• Systemic onset JIA
• Oligoarticular JIA : Persistent and extended
• Polyarticular JIA : RF positive and RF negative • Psoriatic arthritis
• Enthesitis related arthritis
• Undifferentiated arthritis
JIA
15
16
Clinical features
Symptoms (Arthritis must be present to make a diagnosis of any JIA subtype):
Signs:
• Early:
• Swelling
• Warm on palpation
• Tenderness but not erythematous • Restricted ROM
• Antalgic gait
• Late:
• Deformities
• Growth disturbances
• Pain
• Swelling
• Stiffness following inactivity
• Easy fatigability and poor sleep quality
17
Systemic onset JIA
Arthritis in ≥1 joint with, or preceded by, fever of at least 2 weeks time.
When to Suspect Autoimmune or Rheumatic DiseaseSamar Tharwat
Rheumatic diseases are presented with many many manifestations .It is important to be oriented with these manifestations for early diagnosis and treatment
Rheumatological aspects in hemodialysis Samar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology )represents a lecture on rheumatological manifestations in patients with chronic renal failure and on hemodialysis.
Biological therapy in rheumatic diseasesSamar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology)represents a lecture on biological Therapy and its role in various rheumatic diseases.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. Enemy in Shadows
(Case Study)
Samar Tharwat Radwan
Assistant Professor of Rheumatology and Immunology
(Internal Medicine Department )
Musculoskeletal Ultrasound –EULAR
Mansoura University
2. July ,2021
A 63-year-old female was referred to our clinic because of a 2-day-
history of severe polyarthralgia
3. Her
articular
complaint
• Began less than two days after receiving a
single dose of BBIBP-CorV vaccine
(Sinopharm COVID-19 vaccine)
• The condition was acute on onset
• Additive pattern of arthritis
• With symmetric distribution
4. The condition was associated with
Constitutional
manifestations:
fatigue, malaise and
low-grade fever
No weight loss No enthesitis
No specific joint
deformities
5. Past history
Hx of bronchial
asthma 10 years ago
Well-controlled on
bronchodilators
6. Past history
• There were no previous arthritic complaints
• She had no history of recent infections
• No relevant medical history such as inflammatory low back pain, inflammatory bowel disease, psoriasis
or uveitis
• No history of neurological symptoms, trauma or falling
• No family history of seronegative spondyloarthritis
11. On examination
Tenderness at both shoulders
The range of motion of all these joints was decreased
due to pain and swelling
Global assessment of the patient for pain based on the
visual analog scale (VAS) was 90 mm
12. Skin and mucosa
• Multiple oral ulcers with fungal infection
• No malar rash, vasculitis rash, psoriasis ,or any specific skin rash
• No genital ulceration
• No Raynaud’s phenomenon
38. After 5 days
Clinical
The same or even worse
✓ Function
✓ Pain score
Laboratory
To some extent improved
✓ ESR : 50 mm/hr
✓ CRP: 80 mg/L
✓ WBCs :10.000/mm
39. What is next
Not reactive
Arthritis
Reactive
Arthritis
(not
responding )
40. Reactive Arthritis
after COVID-19
vaccine not
responding to high
dose of steroids
✓Pulse Solu Medrol
✓sDMARDs: Methotrexate ,Sulfasalazine ,Azathioprine
✓Biological DMARDs: Etanercept , Infliximab
41.
42. Synovial fluid
aspiration
It is critical in diagnosing
monoarthritis
Has a limited role in the
differential diagnosis of
polyarthritis.
52. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
53. Can septic arthritis be
presented with
polyarthritis ?
The typical clinical presentation is a rapid
onset of severe joint pain, warmth, and
tenderness in a single joint
Polyarticular involvement is seen in 10–15%
of patients
Gonococcal infections should be suspected
in sexually active patients
The classical triad of disseminated
gonococcal infection (DGI) comprises acute
tenosynovitis, dermatitis, and arthritis
54. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
56. Who is at a risk septic polyarthritis?
• Preexisting joint disease : RA
• Immunosuppressed patients are on treatment for active malignancy,
inflammatory bowel disease, or polymyalgia rheumatica.
• Systemic infections
• Hypogammaglobulinemia ,Complement deficiency
59. A case of SLE presented with polyarthritis
Resistant to treatment with high dose steroids
Nucleic acid amplification test (NAAT) of the urine for Neisseria gonorrhea was positive
Final Diagnosis :Disseminated gonococcal infection.
60.
61. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
62. Can septic arthritis be
presented without any signs
of fulminant inflammation
(erythema) ?
Elderly patients may not manifest fever or other signs of inflammation
63. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
64. Septic arthritis with negative blood culture?
Blood cultures may be positive in one-third to one-half of patients
with septic arthritis
Negative synovial fluid cultures are the result of recent antibiotics
or infection with a fastidious organism
Can septic arthritis be presented without any signs of fulminant
inflammation (erythema) ?
65. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
67. • Here, we report a case of an 80-year- old man with no history of rheumatic
disease who presented with acute onset of bilateral hand pain, pitting oedema
and synovitis after the second dose of the BNT162b2 mRNA C0VID-19 vaccine
• Significant improvement was noted with prednisolone
68. The patient started oral prednisone (25 mg once daily) and increased
MTX dosage (10 mg weekly), with a rapid clinical improvement
It is known that vaccination itself triggers an IFN-gamma and TNF-α release from Th1 cells, which could
represent a possible mechanism for vaccination-induced inflammation
69. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered
70. Septic arthritis after vaccination ?
Septic arthritis of the shoulder following vaccination
Routine skin cleansing practice
before vaccinations
Should there then, as evident in the case report, be any need
for a revision of routine skin cleansing practice before
vaccination in some groups?
72. A 68-year-old woman presented for left shoulder pain, decreased range
of motion (ROM) and fever 7 days following COVID-19 vaccination
Septic Arthritis
73. 1. Can septic arthritis be presented with polyarthritis ?
2. Who is at a risk septic polyarthritis?
3. Can septic arthritis be presented without any signs of fulminant inflammation (erythema) ?
4. Septic arthritis with negative blood culture?
5. Puffy hands?
6. Septic arthritis after vaccination ?
7. Septic polyarthritis after Vaccination ?
8. Septic polyarthritis after COVID-19 vaccination?
Several questions need to be answered