[11, 12] The Chinese study in this issue by Rong MU et al. has revealed poor awareness and deficiency in diagnostic skills amongst doctors including rheumatologists and is a must- read article for all. Some of the points discussed in the preceding paragraphs are realised in this paper. Many rheumatologists who considered themselves non-believers of this vague entity in the recent past, have now turned into believers in view of selleck chemicals emerging evidences cited above. No rheumatologist can afford to make a mistake today in diagnosing or excluding these modern day illnesses. “
“A 72-year-old woman with slight pulmonary interstitial reticular

markings was initially diagnosed with microscopic polyangiitis (MPA). Two years BIBF 1120 cost later, cavitated pulmonary masses appeared, and a biopsy specimen revealed granulomas. Granulomatosis with polyangiitis (GPA) was diagnosed. The masses resolved with treatment. Ten years later, the usual interstitial pneumonia (UIP) pattern appeared on chest computed

tomography (CT). The diagnosis of lung toxicity from methotrexate (MTX) or cyclophosphamide (CYC) was precluded by the clinical course. Despite treatment with prednisolone (PSL), the UIP progressed. The change of pulmonary pathology from masses to UIP is rare in patients with GPA. “
“Polyarteritis nodosa in children is a rare necrotizing vasculitis affecting mainly small and medium-size arteries. To describe the different clinical patterns and laboratory profiles of polyarteritis nodosa patients next in a tertiary care hospital. This was a retrospective cohort study carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 2007 to December 2012. A total of 13 patients fulfilling the European League Against Rheumatism/Paediatric Rheumatology International Trial Organization/Paediatric Rheumatology European Society (EULAR/PRINTO/PRES) classification criteria were enrolled in this study. Data was collected

via a predesigned questionnaire. Age range was 3–12 years, male : female ratio was 9 : 4. The duration of symptoms was 2–16 weeks. All the children had fever, anorexia and generalized weakness. Subcutaneous nodules were present in 77% of cases followed by arthritis and rash (69%), muscle pain (54%) and abdominal pain (38%). Impaired peripheral pulses were present in 54%, ulceration and gangrene was present in 31% and auto-amputation was present in 15% of cases. All the patients had high erythrocyte sedimentation rates followed by neutrophilic leukocytosis and thrombocytosis (85% and 62%). Skin biopsy was positive in 77% of cases and angiographic abnormalities were present in 23% of cases.