A 59-year-old woman was admitted to the hospital with a fever and rigors for 2 days. She was on chemotherapy (docetaxel, carboplatin, and trastuzumab) for her stage II invasive ductal carcinoma of the breast. Her physical exam was unremarkable except for the fever. The white blood cells were 21,200/mm(3) with 92% of neutrophils. ESR was 106 mm/h. An extensive infectious workup was negative. On day 6, while still febrile, the patient complained of a left-sided neck pain. She exhibited tenderness over the left carotid artery. A CT scan of the neck without intravenous contrast showed perivascular inflammation of the left common carotid artery, without evidence of a collection, arterial thrombosis, aneurysm, or dissection. The etiology of this finding was possibly chemotherapy related. It dramatically responded to oral prednisone. A repeat CT scan of the neck with IV contrast 2 weeks later showed a remarkable improvement. Drug reactions can simulate systemic inflammatory diseases and should always be considered in the diagnosing process.

We conducted a longitudinal evaluation of a patient with systemic lupus erythematosus who constitutively exhibited elevated levels of circulating ainterferon ( a -I F N ) . This study demonstrated that the serum levels of an activity that renders the endogenous a-IFN acid labile are positively correlated with disease activity. This IFN acid lability-inducing activity can also be found in the sera of systemic lupus erythematosus patients who have active disease but who do not have circulating a-IFN.Previous reports have documented that up to 50% of patients with systemic lupus erythematosus (SLE) have abnormally elevated serum levels of the antiviral cytokine, a-interferon (a-IFN), and that there is a positive correlation between the clinical activity of SLE and serum titers of a-IFN (1,2). Because a-IFN possesses many potent and diverse immunoregulatory From the

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Purpose: Patello-femoral (PF) cartilage damage can cause severe knee pain and result in increasing disability. The purpose of this study was to identify factors associated with grade 4 defects of the patello-femoral joint. Methods: A cohort of 2601 patients (average age¼45, range, 18 to 83) who underwent knee arthroscopy for knee pathology were studied prospectively. All patients had complete demographic data, surgical data, WOMAC scores, and health status (SF12) collected at initial exam and stored in a data registry. Patients with chondral defects of the knee were included. Patients less than 18 years of age were excluded. Results: Grade 4 PF chondral defects were seen in 23% (586) of knees, with 6% (150) patellar (PAT) defects, 10% (267) trochlear groove (TG) defects and 6% (169) combined PAT and TG defects. 29% of patients with grade 4 PF chondral defects had medial compartment chondral defects, while 14% of patients with no PF chondral defect had medial compartment chondral defects (p<0.001). 20% of patients with PF chondral defects had lateral compartment chondral defects, while 12% of knees with no PF chondral defect had lateral compartment chondral defects. PF chondral defects were 3.0 [95%CI: 2.1 to 4.3] times more likely to be chronic injuries. Knees without PF defects were 20 [95%CI: 15.7 to 26.2] times more likely to have ligament injuries than knees with PF defects. Patients with grade 4 TG defects were older (51 vs 45) and had increased stiffness (how was stiffness determined?) compared to other patients (p<0.001). Patients with grade 4 PAT defects were older (52 vs 45; p<0.001) and had increased pain compared to other patients. Patients with diffuse grade 4 PAT defects had increased age, increased WOMAC (increased disability) and decreased Lysholm scores. Conclusions: This study confirms that grade 4 defects of the PF compartment are common. They often occur with chondral defects in other compartments; however, they are not associated with ligament or meniscus injuries. Patients with PF defects are older than patients with other cartilage damage, and patients with grade 4 diffuse defects of the patella suffer the most disability and loss of function. These data confirm the importance of new treatment strategies for chondral defects of the patellofemoral compartment, especially since patellar resurfacing remains controversial.

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