Depression in ERA is common and initial high disease activity is associated with the probability of depression and its persistence. This risk seems particularly modified in women with active disease and represents an area for targeted focus and screening. Future studies in ERA are needed to determine if intervening during the "window of opportunity" to control disease activity has the potential to mitigate the development and maintenance of adverse mental health outcomes, including depression.
Diabetic muscle infarction is a rare complication of diabetes. Since first reported in 1965, approximately 130 patients have been reported, with only 2 cases described affecting the upper extremity. We report on 3 men (age, 40-63) with diabetic muscle infarction involving the arm. The patients had symptoms 4 to 18 days before presenting to the emergency department and all required admission for their pain. Only 1 of the patients was febrile. The patients had type 2 diabetes mellitus for 10 to 25+ years, and 2 were on chronic hemodialysis, with the third starting peritoneal dialysis shortly after admission. Hemoglobin A1c ranged from 0.049 to 0.095. Creatine kinase levels ranged from 69 to 483 U/L and the white blood cell count ranged from 9.6 to 12.0 x 10(3)/microL. None of the patients required surgery nor had biopsies, and the patients were managed with rest, transdermal fentanyl, and later physiotherapy. Diagnoses were supported by MRI images in 2 patients and serial ultrasounds in the third patient. Although rare, the condition may be under-recognized. Pathophysiology, which may have some unique features in patients on hemodialysis, is briefly discussed.
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