hmhm - thrombolyser

[ArchivalUser]

the thing is to diagnose felty- there must be triad.....
DLE can not be so severe

[ArchivalUser]

y not rh flare

[ArchivalUser]

y not rh flare

can be NHL due to etarnecpt side effect????????

[ArchivalUser]

whts d ans

[ArchivalUser]

sorry for being late
This patient most likely has systemic lupus erythematosus induced by the anti“tumor necrosis factor agent etanercept. Discontinuation of the inciting drug is indicated for this uncommon clinical problem. Corticosteroid therapy also may be warranted to acutely treat this patient's arthritis, pericarditis, and rash. Antinuclear antibody positivity in a previously antinuclear antibody“negative patient would strongly support this diagnosis. Up to 20% of patients with rheumatoid arthritis treated with anti“tumor necrosis factor agents develop new-onset antinuclear antibody positivity and may develop an associated lupus-like syndrome. However, a significant number of patients with rheumatoid arthritis may have positive findings on antinuclear antibody assays before initiation of anti“tumor necrosis factor therapy.

Patients with rheumatoid arthritis have an increased incidence of large B-cell, non-Hodgkin's lymphoma compared with age- and sex-matched control populations. There also is an association between methotrexate therapy for rheumatoid arthritis and development of B-cell lymphoma; tumors have even been shown to resolve in some patients on discontinuation of methotrexate. In nearly 50% of these patients, tumors contain Epstein“Barr virus, which is a cofactor in tumor development. It is uncertain whether anti“tumor necrosis factor therapy causes an increased incidence of this type of tumor. However, patients with rheumatoid arthritis with B-cell lymphoma usually do not present with joint pains, pericarditis, and the rash described in this patient.

Rheumatoid arthritis flare is possible in this setting but is unlikely because her condition was well controlled and she does not have a history of extra-articular manifestations of rheumatoid arthritis. Serum sickness is an immune complex disease triggered by drugs such as antibiotics that develops 1 to 2 weeks after initiation of the inciting agent. This condition frequently causes severe swelling of the joints, urticaria, and eosinophilia. Bacterial infection is more common in patients treated with anti“tumor necrosis factor agents, especially in the setting of concomitant use of methotrexate. Characteristic bacterial infections include upper respiratory infections; urinary tract infections; and skin infections, which are particularly common in patients with leg ulcers. Felty's syndrome causes granulocytopenia but would not cause the malar rash and pericarditis seen in this patient.

Endocarditis may cause a single joint inflammation or localized skin lesions but not the diffuse symptoms that this patient has. Pericarditis is an uncommon manifestation of endocarditis, particularly in the setting of joint flare and rash.

[ArchivalUser]

thanks thrombolyser.
u were right nimishkum, my bad

[ArchivalUser]

i had b and d only in mind............but drug induce is mild if u read the topic........sometimes this question make me feel frustrated..........but at the same time make my thinking very braod..........good to discuss always

[ArchivalUser]

thanx u guys for good discussion on this 1
I missed this 1 too

[ArchivalUser]

to
typo

[ArchivalUser]

thrombolyser, emedicine says feltys is acute in onset and can cause pleuropericarditis.