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The approval of the drug for more than a dozen different indications including the use in pediatric population provides a strong back-up of data (both from clinical trials and real-life practice from world wide registries) to secure a high standard of care when using the drug hair loss cures in the future buy dutasteride. The introduction of corticosteroids and sulfasalazine (in mid-1950s) anti hair loss cheap dutasteride master card, immunosuppressive agents such as methotrexate hair loss cure conspiracy purchase 0.5mg dutasteride with mastercard, azathioprine hair loss 4 month old baby purchase dutasteride on line amex, leflunomide, etc. These drugs have changed our clinical practice and outcomes in several chronic immunemediated inflammatory diseases. Mortality is also increased with shortening of life expectancy by about a decade with the onset of extra-articular disease. Premature atherosclerosis in poorly controlled disease adds-up as an additional risk factor. This was substantiated by various other studies which examined the 4-year and 3-year compliance, efficacy and safety. Continued long-term use of infliximab was shown to be effective, safe and well-tolerated over the years. Although spinal pain is reduced with these modalities, the inflammatory process relentlessly progresses resulting in new-bone formation and spinal fusion. These trials showed that infliximab was effective in treating PsA and its various manifestations, including joint disease and extra-articular manifestations like dactylitis, enthesitis, nail disease, as well as psoriatic skin involvement. Data from world wide registries have shown that the incidence of malignancies in patients treated with infliximab was similar to that seen in the general population. By and large, other than a small increase in risk of infections, infliximab has been shown to be relatively safe on long-term use. Inhibhition of radiographic progression has become an achievable goal with early use of infliximab. Infliximab in Psoriasis Three placebo-controlled trials showed the effectivess of infliximab in severe plaque psoriasis. Ten years of infliximab (remicade) in clinical practice: the story from bench to bedside. Safety of Infliximab With 12 years of clinical use and the availability of various biologics registries world wide, the safety profile of infliximab has been well characterized. Current estimation is that more than 200 million people worldwide are suffering from osteoporosis. According to the recent statistics from the International Osteoporosis Foundation worldwide,1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Bone remodeling involves the removal of older bone to replace with new bone in order to repair microfractures and prevent them from becoming macro fractures, thereby assisting in maintaining a healthy skeleton. Bone tissue homeostasis is maintained by remodeling cycle with resorption followed by formation; bone loss occurs if the resorption rate is more than the formation rate. Menopause and advancing age cause an imbalance between resorption and formation rates (resorption becomes higher than absorption), thereby increasing the risk of fracture. Osteoporosis is classified into two main groups by considering the factors affecting bone metabolism: primary osteoporosis and secondary osteoporosis. Primary osteoporosis can be divided into two subgroups: involutional osteoporosis Type I also known as postmenopausal osteoporosis, caused by the deficiency of estrogen, mainly affecting the trabecular bone. Secondary Osteoporosis is induced by diseases or drug therapy affecting bone tissue (Table 1). Glucocorticoid-induced osteoporosis is the most common cause for secondary osteoporosis. The degree of bone loss 10-40% occurs during the first year of corticosteroids therapy. Osteoporosis affects men and women of any age but is more common in postmenopausal women and women over 50 years of age. The reduction in the levels of estrogen leads to: (1) increased oxidative stress; (2) apoptosis of osteoblasts; and (3) rapid bone loss due to an increased rate of degradation of the bone tissue by osteoclasts. Woman 65 years old and all men 75 years old and/or younger ones with presence of the following risk factors (Table 2). Fragility fractures/low trauma fracture: Fragility fracture occurs because of fall from a standing height or less, or no identifiable trauma. Fractures due to bone fragility result from osteoporosis, affecting most often the spine, wrist, hip and forearm. The other sites are pelvis, proximal Role of Bone Turnover Markers Do not use them solely to diagnose osteoporosis. Use one marker of bone resorption and one marker of bone formation (Tables 4 to 9. Rare risk of hypocalcemia, osteonecrosis of jaw, atypical femoral fractures occur. Monitor S calcium and uric acid at 1, 6 and 12 months Screen for risk of osteosarcoma. Transiently inhibits osteoclast activity without decreasing osteoblast collagen synthesis. Major osteoporotic fracture includes fractures of the spine (clinical), hip, wrist, or humerus. Lifestyle modification: Balanced diet, adequate physical activity (weight bearing exercises), exposure to sunlight and avoidance of bone depleting agents such as tobacco and alcohol. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis - 2016-Executive Summary. Clinical practice guidelines on postmenopausal osteoporosis: An executive summary and recommendations. Geriatric syndromes are defined as "multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render an older person vulnerable to situational challenges".

Joint puncture yielded thick bloody fluid hair loss 101 discount dutasteride master card, which explains the increased density of the soft tissue mass seen on the radiograph hair loss cure regrowth cheap dutasteride 0.5 mg with visa. A: Lateral radiograph of the right knee shows fullness in the suprapatellar bursa that was interpreted as "joint effusion hair loss in men dutasteride 0.5 mg for sale. Note also the lobulated mass in the posterior aspect of the joint capsule hair loss cure 7 jours quality dutasteride 0.5 mg, extending toward the proximal tibia. The erosion at the posterior aspect of the distal femur (supracondylar) is clearly demonstrated by an area of low signal intensity (arrow). The most common differential diagnostic possibilities include hemophilic arthropathy, synovial chondromatosis, synovial hemangioma, and synovial sarcoma. However, it can be distinguished by the presence of multiple joint bodies, calcified or uncalcified. Occasionally, intra-articular radiation synovectomy is used when the abnormal synovial tissue is <5 mm thick. Recently, reports appeared of postsynovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of radioactive material such as yttrium-90 (90Y). A: Lateral radiograph of the left ankle of an 18-year-old man shows a lobulated dense mass adjacent to the posterior talus and calcaneus, encroaching the Kager fat pad (arrows). Observe small foci of low signal intensity within the mass, representing hemosiderin deposition. This lesion has also been found in the elbow, wrist, and ankle joints, as well as in tendon sheaths. Almost all patients with synovial hemangioma are symptomatic, frequently presenting with a swollen knee or with mild pain or limitation of movement in the joint. Synovial hemangioma is often associated with an adjacent cutaneous or deep soft tissue hemangioma. For this reason, some investigators classify knee joint lesions as intra-articular, juxta-articular, or intermediate, depending on the extent of involvement. According to one estimate, a correct preoperative diagnosis is made in only 22% of cases. Photograph of the surgical specimen removed from the knee of a patient with synovial hemangioma shows strawberry-like appearance of the synovial lining and marked hemosiderin staining of the tissue. Originating in the subsynovial layer mesenchyme of the synovial membrane, synovial hemangioma is a vascular lesion that contains variable amounts of adipose, fibrous, and muscle tissue, as well as thrombi in the vessels. When the lesion is completely intra-articular, it is usually well circumscribed and apparently encapsulated, attached to the synovial membrane by a pedicle of variable size, and adherent to the synovium on one or more surfaces by separable adhesions. Grossly, the tumor is a lobulated soft, brown, doughy mass with overlying villous synovium that is often stained mahogany brown by hemosiderin. On microscopic examination, the lesion exhibits arborizing vascular channels of different sizes and a hyperplastic overlying synovium, which may show abundant iron deposition in chronic cases with repeated hemarthrosis. Although radiographs appear normal in at least half of the patients, they may reveal soft tissue swelling, a mass around the joint, joint effusion, or erosions. Phleboliths, periosteal thickening, advanced maturation of the epiphysis, and arthritic changes are also occasionally noted on conventional radiographs. Arthrography usually shows nonspecific filling defects with a villous configuration. They can often reveal a vascular lesion and can demonstrate pathognomonic features of hemangioma. The soft tissue mass typically exhibits an intermediate signal intensity on T1-weighted sequences, appearing isointense with or slightly brighter than muscle but much less bright than fat. The mass is usually much brighter than subcutaneous fat on T2-weighted images and on fat suppression sequences. In general, the signal intensity characteristics of hemangiomas appear to be related to a number of factors, including slow flow, thrombosis, vessel occlusion, and stagnant blood that pools in larger vessels and dilated sinuses, as well as to the variable amounts of adipose tissue in the lesion. After intravenous injection of gadolinium, there is evidence of enhancement of the hemangioma. Anteroposterior (A) and lateral (B) radiographs of the right knee of a 7-year-old boy show articular erosions at femoropatellar and femorotibial joint compartments. An incidental finding is a nonossifying fibroma in the posterior tibia (arrowheads). Note the vascular structures exhibiting high signal intensity, separated by lowsignal linear structures, representing fibrofatty septa. Note the extension into the suprapatellar recess and into the posterior aspect of the joint (arrows). All proliferative chronic inflammatory processes, such as rheumatoid arthritis, tuberculous arthritis, and hemophilic arthropathy, should also be considered in the differential diagnosis, but these conditions, when involving the knee, can usually be distinguished clinically. Because it is extremely uncommon, lipoma arborescens is rarely included in the differential diagnosis. Most of the lesion will display a higher signal intensity than muscle on both T1- and T2-weighted sequences, with other portions exhibiting a low signal intensity on all sequences, reflecting the hemosiderin content of the tumor. Synovial chondromatosis can be distinguished from synovial hemangioma if radiography shows calcified bodies. Intra-articular osteochondral fragments of uniform size are almost pathognomonic for this condition. The term "arborescens" (from the Latin word arbor, meaning tree) describes the characteristic treelike morphology of the hypertrophied synovium, which exhibits a frondlike appearance.

Anteroposterior (A) and lateral (B) radiographs of the left ankle of a 10-year-old girl show soft tissue swelling and tibiotalar joint effusion hair loss cure found 2015 generic dutasteride 0.5mg on-line. Anteroposterior (A) and lateral (B) radiographs of the right knee of a 9-year-old girl show periarticular osteoporosis and joint effusion hair loss after pregnancy purchase dutasteride online pills. Sacroiliitis excessive hair loss cure buy dutasteride 0.5 mg on-line, which is the hallmark and usually the first manifestation of the disease hair loss causes in women generic dutasteride 0.5mg line, is typically bilateral and symmetric. Spinal involvement usually begins in the thoracolumbar or lumbosacral junction and extends symmetrically without skipping areas. The peripheral joints such as the hips, shoulders, and knees may also be involved. It is seen seven times more frequently in men than in women, and predominantly at a young age. Patients with ankylosing spondylitis commonly exhibit extra-articular features of disease including iritis, pulmonary fibrosis, cardiac conduction defects, aortic incompetence, spinal cord compression, and amyloidosis. Early mortality has been reported, associated mainly with an increased risk of cardiovascular morbidity. Rheumatoid factor is negative in patients with ankylosing spondylitis, which is the prototype of the seronegative spondyloarthropathies. Pathologically, ankylosing spondylitis is a diffuse proliferative synovitis of the diarthrodial joints exhibiting features similar to those seen in rheumatoid arthritis. In addition, there is inflammatory enthesopathy at the anterior and posterior aspects of the vertebral bodies, followed by a secondary process of progressive calcification and ossification, initially limited to the spinal ligaments and annulus fibrosus, and gradually spreading throughout the spine resulting in partial or total spine fusion. A: Photograph of the sagittal section of the lumbar spine shows anterior syndesmophytes (arrowheads) fusing the intervertebral disk spaces, which are not significantly narrowed. B: Photomicrograph shows marginal syndesmophytes (arrowheads) at the site of annulus fibrosus. As the condition progresses, syndesmophytes form, bridging the vertebral bodies. The delicate appearance of these excrescences and their vertical rather than horizontal orientation distinguish them from the osteophytes of degenerative spine disease. When the apophyseal joints and vertebral bodies fuse late in the course of the disease, a radiographic hallmark of this condition, the "bamboo" spine, can be observed. On the anteroposterior radiographs of the lumbar spine, a single radiodense central line (so called a dagger sign) may be identified, representing ossification of the supraspinous and interspinous ligaments. Sites of ankylosis are prone to "banana stick" fractures and subsequent pseudoarthrosis formation. The sacroiliac joints are also invariably affected in this process, exhibiting symmetric bilateral sacroiliitis. In the later stage of the disease, inflammation leads to complete fusion of sacroiliac joints. Among conditions affecting vertebral column that should not be mistaken for ankylosing spondylitis is progressive noninfectious anterior vertebral fusion, so-called Copenhagen syndrome. The disease usually presents in early childhood and adolescent age and is characterized by disk space obliteration and anterior osseous ankylosis with fusion of the vertebral bodies. Lateral radiograph of the lumbar spine in a 28-year-old man demonstrates squaring of the vertebral bodies secondary to small osseous erosions at the corners (osteitis) followed by repair/remodeling. Lateral radiograph of the cervical spine in a 31-year-old man demonstrates delicate syndesmophytes bridging the vertebral bodies, a common feature of ankylosing spondylitis. In the peripheral joints, inflammatory changes may be indistinguishable from those seen in rheumatoid arthritis. In the foot, erosions characteristically occur at certain tendinous insertions, particularly in the calcaneus. Involvement of the ischial tuberosities and iliac crests exhibits a lacelike formation of new bone called "whiskering. Surgery is usually limited to stabilization of spinal fractures, one of the complications of ankylosing spondylitis. Reactive Arthritis (Reiter Syndrome) Clinical Features Reactive arthritis, an autoimmune condition that develops in response to an infection in another part of the body, usually gastrointestinal or genitourinary infection, affects five times more males than females and is characterized by arthritis, conjunctivitis, and urethritis. It was first reported in 1916 by the German military physician Hans Conrad Julius Reiter (who later was prosecuted in Nuremberg as a war criminal for his involvement in forced human experimentation in the Buchenwald concentration camp during the Second World War), and in the same year, it was described by the French physicians Fiessinger and LeRoy. Reactive arthritis is also well known for the presence of mucocutaneous rash, keratoderma blennorrhagica. Like in ankylosing spondylitis, eye involvement is common and can include conjunctivitis, iritis, uveitis, and episcleritis. Unlike ankylosing spondylitis, reactive arthritis may exhibit unilateral sacroiliac diseases. Prominent feature of reactive arthritis is enthesitis -inflammation of sites of tendon and ligament attachments to bone. First, the sporadic or endemic type, which is common in the United States, is associated with nongonococcal urethritis, prostatitis, or hemorrhagic cystitis, although recently genital infections with Chlamydia trachomatis and Neisseria gonorrhoeae have been reported. It occurs almost exclusively in males, with male-to-female ratio ranging from 5:1 to 10:1, and the peak onset in the third decade. In Europe, a second type has been identified, which is an epidemic form associated with bacillary (Shigella) dysentery. There has been considerable research on the putative role of Yersinia enterocolitica in inducing disease, particularly in Scandinavia, where such infections are more prevalent than in North America. A: Lateral radiograph of the cervical spine of a 32-year-old man shows delicate vertically oriented anterior and posterior syndesmophytes (arrowheads). B: Lateral cone-down radiograph of the lumbosacral segment of a 29-year-old man shows delicate vertically oriented anterior syndesmophytes (arrowheads). A: Lateral radiograph of the cervical spine in a 53-year-old man with advanced ankylosing spondylitis shows anterior syndesmophytes bridging the vertebral bodies and posterior fusion of the apophyseal joints, together with paravertebral ossifications, producing a "bamboo-spine" appearance. The same phenomenon is seen on the anteroposterior (B) and lateral (C) radiographs of the lumbosacral spine.

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These disorders have similarities in certain clinical features and genetic predispositions hair loss 7 year old daughter cheap dutasteride 0.5 mg amex. The characteristic skin lesion keratoderma blennorrhagica is seen most commonly on the palm and sole hair loss cure university pennsylvania order cheap dutasteride. The onset of disease begins in second and third decade and is more common in male (M:F = 2:1 to 3:1) hair loss kids cheap 0.5mg dutasteride overnight delivery. Patient presents with dull aching pain in lower lumbar region associated with morning stiffness hair loss 5 years after chemo cheap generic dutasteride canada. Psoriasis involves arthritis of the distal interphalangeal joint, asymmetric oligoarthritis, and symmetric polyarthritis similar to rheumatoid arthritis, axial arthritis, and arthritis mutilans. The result adds information and is one piece of evidence used along with the evaluation of signs, symptoms, and other laboratory tests to support or rule out the diagnosis of certain autoimmune disorders. However, the signs and symptoms related to the diseases can often be milder in women. How the presence of these specific subtypes affects the likelihood of developing an autoimmune disease is not yet known. Do not look or search for diagnosis based on lab test, rather first reach clinical diagnosis and order for lab tests to confirm or to exclude the underlying disease. If we miss, absolutely patients may miss right medications or else miserably lead to unncessary stress to patients and of course even to physicians. Note: Low titer, auto antibodies can be seen after biological treatments, end-stage renal disease, massive proteinuric anti-Ro and La antigens are transient and it can be fixed only by acetone, other fixative like alcohol, washes away these antigens. If the results are positive, do not jump to conclude that you are right in diagnosis, and do not abruptly start treatment, because quite a number of nonautoimmune diseases per se can give positive results. Once rheumatoid patients develop vasculitis and ulcers, paradoxically, their joints symptoms are greatly reduced. It can be useful to identify and subcategorize the patient and accordingly, proceed for an appropriate treatment. Some laboratories are asking to do these tests, not only as profiles and more so, advertising that they are capable of identifying for more than 64100 autoantibodies and asking clinicians to do it and ultimately patients become aloof and wandering here and there with the test kits. Thrombocytopenia Irrespective of age group and sexes, quite large numbers of patients are coming to hospital with thrombocytopenia. Across all field of medicine and gynecology, real trouble for everyone during an out break of epidemics of viral fever, which are rampantly present in every state of India. In my experience over 25 years, about 60-70% are idiopathic and benign and of course, the majorities are responding to steroids. Suspected Overlap Syndrome Whenever you see a case with constellation of symptoms suggestive of two or more diseases, always think about overlap syndrome. Antinuclear antibodies and their detection methods in diagnosis of connective tissue disease: a journey revisited. Effective use of autoantibody tests in the diagnosis of systemic autoimmune disease. Serum autoantibodies in chronic hepatitis C: Comparison with autoimmune hepatitis and impact on the disease profile. Practical evaluation of methods for detection and specificity of autoantibodies to extractable nuclear antigens. Concentration of antibodies to extractable nuclear antigens and disease activity in systemic lupus erythematosus. Clinical and serological aspects of patients with anti-Jo-1 antibodies- an evolving spectrum of disease manifestations. The first relationship of these antibodies with vasculitis was first reported in patients with glomerulonephritis by Davies et al in 1982. There may be various types of skin rashes ranging from patechiae, purpura, nodules, cutaneous infarcts to skin ulcerations and large pyoderma gangrenosum-like lesions. Levamisole contamination of cocaine is attributed to be the culprit of cocaine associated vasculitis. In this method, the buffy coat cells which are washed and free of platelets are smeared on to the glass slides and are fixed with ethanol. Then, the serum and conjugate is incubated followed by evaluation with an incident light illuminated fluorescence microscope. The main problem with this technique is the lack of experienced manpower to read these slides. Clinical features and long-term outcomes of 105 granulomatosis with polyangiitis patients: A single center experience from north India. Validation of the consensus methodology algorithm for the classification of systemic necrotizing vasculitis in Indian patients. Pauci-immune glomerulonephritis: does negativity of anti-neutrophilic cytoplasmic antibodies matters Factors Determining the Clinical Utility of Serial Measurements of Antineutrophil Cytoplasmic Antibodies Targeting Proteinase 3. Subramanian Shankar, Arun Valsan India has one of the lowest public healthcare expenditures in the world at about 1. It is a relatively new area of research in medical science wherein principles of economics are used to prioritize the utilization of meagre resources judiciously in delivery of healthcare. The analysis of multiple variables to make a treatment decision may baffle even the most experienced clinician and they often rely on informal heuristics to make many decisions on a daily basis. It is here that a formal understanding of various tools of health care economics empowers the clinician to make value-based health care decisions.

Anteroposterior (A) and lateral (B) radiographs of the right knee of a 58-year-old woman hair loss in cats buy 0.5mg dutasteride otc, whose knee joint aspiration revealed calcium pyrophosphate crystals hair loss hormones order 0.5 mg dutasteride, show chondrocalcinosis and marked narrowing of the femoropatellar joint hair loss years after chemo cheap 0.5 mg dutasteride free shipping. Anteroposterior (A) and lateral (B) radiographs of the right knee of a 67-year-old woman show extensive chondrocalcinosis of the fibrocartilaginous menisci (arrows) and advanced arthrosis of the femoropatellar joint compartment hair loss in men treatment cheap dutasteride 0.5 mg with mastercard. Anteroposterior (C) and lateral (D) radiographs of the left knee of a 75-year-old woman demonstrate very similar findings: there is severe narrowing and subchondral sclerosis of the femoropatellar joint compartment, but the medial and lateral compartments are essentially within normal range. The arrows are pointing to chondrocalcinosis, and the curved arrow to calcification within gastrocnemius tendon. Acute symptoms include pain, tenderness on palpation, and local swelling and edema. Imaging Features Radiographic features depend on the site of involvement, but usually cloudlike or dense homogeneous calcific deposits are seen around the joint and tendons. The most common location is around the shoulder joint at the site of the supraspinatus tendon. At this location, it is commonly referred to as calcific peritendinitis or tendinitis (tendinosis or tendinopathy), calcific periarthritis, or periarthritis calcarea. Calcific deposits can migrate into the adjacent bone, into the adjacent bursa, or into the tendon extending along the myotendinous plane. Treatment Treatment of this condition includes application of shockwave therapy (using sound waves), acetic acid iontophoresis, and drugs such as corticosteroids and cimetidine. Occasionally, arthroscopic or open shoulder surgery is required to remove the calcific deposits. However, it has to be stressed that often the results of the treatment are disappointing. A: Anteroposterior radiograph of the right shoulder of a 41-year-old man shows calcific deposit within the attachment of the supraspinatus tendon to the greater tuberosity of the humerus (arrow). B: Anteroposterior radiograph of the left shoulder (Grashey view) of a 50-year-old woman who had been experiencing pain in this region for several months demonstrates an amorphous, homogenous calcific deposit in the soft tissues at the site of supraspinatus tendon (arrow). A: In a 38-year-old woman who presented with left shoulder pain, a calcific deposit is seen at the site of insertion of the supraspinatus tendon to the greater tuberosity of the humerus. It may be primary (endogenous or idiopathic), caused by an error in metabolizing iron, or secondary, caused by iron overload. In the classical form of the disease, cysteine is substituted by tyrosine at amino acid 282 in both alleles. The so-called compound heterozygote is less common (representing about 10% of cases) but is also compatible with hereditary hemochromatosis. In this form, histidine is substituted by aspartic acid at amino acid 63 in one allele and cysteine by tyrosine at amino acid 282 in the other (C282Y/H63D). More recently, additional mutations in other molecules involved in iron metabolism, including hepcidin, hemojuvelin, and ferroportin, have been identified. The secondary form of hemochromatosis is related to increased intake and accumulation of iron (iron overload) such as occurs in patients with alcoholic liver cirrhosis, multiple blood transfusions, refractory anemia, and in those with chronic excessive oral iron ingestion. It is generally diagnosed between the ages of 40 and 60 on the basis of markedly elevated serum iron levels. Pathologic findings include hemosiderin granules accumulation either in the synovioblasts or in the perivascular histiocytes. Calcification may be seen within the fibrocartilage and hyaline cartilage (chondrocalcinosis). The explanation of the mechanism of this abnormality is based on the fact that ferric salts promote the formation and deposition of intraarticular calcium pyrophosphate crystals by inhibiting the activity of synovial pyrophosphates and decreasing the clearance of intraarticular immune complexes by inhibiting the activity of synovial reticuloendothelial cells. Imaging Features Fifty to eighty percent of patients with hemochromatosis will develop a slowly progressing arthropathy, starting in the small joints of the hands, but eventually, the large joints such as hips, knees, and shoulders may become affected. The development of arthropathy appears to be intimately related to the deposition of small amounts of iron or hemosiderin within the affected joints. The intervertebral disks in the cervical and lumbar region may become affected as well. Some investigators believe that the arthropathy seen in this condition differs from typical degenerative joint disease and warrants classification in the group of metabolic arthritides. In the hand, the second and third metacarpophalangeal joints are characteristically affected. Loss of the articular space, eburnation, subchondral cyst formation, and osteophytosis are the most prominent radiographic features. The morphologic abnormalities may occasionally mimic those seen in rheumatoid arthritis. However, accumulation of iron in the synovium or in articular cartilage is less pronounced, unless gradient echo sequences, which are more susceptible to the paramagnetic properties of iron, are used. Treatment the treatment of hemochromatosis consists of phlebotomy on a regular basis. Unfortunately, one survey of 2,851 patients with hemochromatosis showed that patients had consulted a physician after an average 2 years of symptoms, and on average, it took additional 10 years before the diagnosis was made. It is characterized by degenerative changes in the brain (basal ganglia), cirrhosis of the liver, and pathognomonic KayserFleischer rings of greenish-brown pigment deposited in the Descemet membrane in the limbus of the cornea. The clinical symptoms result from accumulation of copper in the body, particularly in the liver and brain. Increased amount of copper within the liver overwhelms the proteins that normally bind it, causing oxidative damage through the process known as Fenton chemistry (or Fenton reaction). Lenticular degeneration leads to neurologic symptoms, including tremor, rigidity, dysarthria, and dyscoordination. The affected joints include those of the hand, wrist, elbow, shoulder, hip, and knee. Light and electron microscopy failed to detect crystal-containing calcium neither in synovial fluid nor in synovial biopsies. Synovial biopsies showed hyperplasia of synovial lining cells with mild inflammatory response.