Most patients with rheumatoid arthritis (RA) often start with pain and swelling in the joints of the extremities, especially the small joints of the hands. At present, the etiology of RA remains unclear, and its pathological process is difficult to control. In clinical treatment, Western medicine mostly uses non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), glucocorticoids, biologics, etc. While they can alleviate local joint symptoms and reduce inflammatory responses, long-term use may cause significant adverse effects and high costs. In recent years, there has been an increasing application of external Traditional Chinese Medicine (TCM) therapies for treating RA, with a growing number of related studies. In this study, we observed acupuncture combined with grain-sized moxibustion in the treatment of RA with finger joint pain, assessed the changes in tender joint counts (TJC), duration of morning stiffness, the visual analog scale (VAS), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level of the patients before and after treatment. The results indicated that acupuncture combined with grain-sized moxibustion was more effective in reducing finger joint pain compared to therapy with simple basic medication for treating RA. Guided by the theory of syndrome differentiation in TCM, this therapy exerts its effects primarily through the stimulation of acupoints and warmth. It offers advantages such as safety, simplicity, ease of operation, precise targeting, and low price, which makes it expected to become a potential complementary therapy to relieve finger joint pain associated with RA and further improve the quality of life for RA patients. The purpose of this study is to provide a standardized operational reference for treating RA with finger joint pain by acupuncture combined with grain-sized moxibustion based on the clinical trial.

Stiff Person syndrome (SPS) is a rare autoimmune disorder of the central nervous system characterized by stiffness and spasms in the lumbar and proximal lower limb muscles. Nonmotor symptoms include phobias, anxiety, and depression. SPS exists on a spectrum ranging from a focal disease known as the stiff limb syndrome to progressive encephalomyelitis with rigidity and myoclonus. Collectively, these conditions may be referred to as stiff person spectrum disorders, as they share similar core clinical features and autoantibodies against several neuronal proteins, which are involved in modulating central hyperexcitability. Antibodies against the glutamic acid decarboxylase enzyme are most frequently associated with SPS but their role in disease pathogenesis remains uncertain. Other antibodies associated with SPS now include those against the glycine receptor, amphiphysin, dipeptidyl-peptidase-like protein 6, gephyrin, γ-aminobutyric acid receptor A (GABAAR), and the GABAAR-associated protein. First-line treatments for SPS include diazepam and baclofen. Patients who do not respond adequately may benefit from immunotherapy. Intravenous immunoglobulin has the most supporting evidence, and while several other immunotherapies are used, further trials are required to determine their efficacy. Further studies to establish the precise role of autoantibodies in the pathogenesis of SPS are also needed to better understand and manage this disabling condition.

We present a rare case of low titre GAD65 antibody-associated autoimmune encephalitis and status epilepticus in a young woman. She initially presented with left arm dystonic movements, contractures and status epilepticus. Due to the concern of autoimmune encephalitis and seizures, the patient received intravenous immunoglobulin empirically. After the detection of low serum GAD65 antibodies, the patient underwent immunomodulation therapy with significant improvement. This case demonstrated that in autoimmune encephalitis, it is important to monitor serum GAD65 antibodies levels and consider immunotherapy, despite mildly elevated serum levels. The patient's history of left arm dystonic movements without impaired awareness may have been due to limb dystonia, a presenting symptom of stiff person syndrome (SPS), despite SPS more commonly affecting axial muscles. This case further demonstrates that GAD65 antibody-related syndromes can manifest with different neurological phenotypes including co-occurrence of epilepsy with possible focal SPS despite low GAD65 antibodies titres.

Stiff-person syndrome (SPS) is a rare immune-mediated disorder of the central nervous system that is characterized by progressive muscle rigidity and painful spasms in the axial and limb muscles, triggered by external stimuli. This disease has significant phenotypic polymorphism, which significantly complicates timely diagnosis and treatment, aggravating disability. Two clinical examples are presented: a patient with the classic phenotype of SPS and a patient with a focal phenotype - stiff leg syndrome. A feature of these cases was atypical symptoms, which made differential diagnosis difficult. Синдром ригидного человека (СРЧ) — редкое иммуноопосредованное заболевание центральной нервной системы, которое характеризуется прогрессирующей мышечной ригидностью и болезненными спазмами в аксиальных мышцах и мышцах конечностей, провоцируемыми внешними стимулами. Данное заболевание обладает значительным фенотипическим полиморфизмом, что значительно затрудняет своевременную диагностику и лечение, усугубляя инвалидизацию. Представлены два клинических примера: пациентки с классическим вариантом СРЧ и пациента с частичным вариантом СРЧ — синдромом ригидных конечностей. Особенностью данных клинических случаев явилась нетипичная симптоматика, затруднившая проведение дифференциального диагноза.

Complex regional pain syndrome type II (CRPS-II) is a rare condition associated with peripheral nervous system lesions. Its localized distribution in the fingers is unique, and its treatment is unclear. A 56-year-old male presented to the emergency department with a saw-cut index finger injury with associated tendon and nerve injuries. After surgery, he was admitted to physical therapy (PT) with persistent pain, joint stiffness, allodynia, and trophic changes compatible with CRPS-II localized in the index finger. The diagnosis was confirmed after applying the Budapest Criteria, and PT was progressive and individualized according to the patient's needs, including graded motor imagery, mobilizations, exercises, and education. After 12 weeks of PT, a clinically significant decrease in pain intensity and improvements in mobility and index finger and upper limb functionality was observed, reducing CRPS symptomatology. This report provides information about a unique case of a localized form of CRPS-II. After reviewing the literature on clinical cases of both CRPS-II and localized forms of CRPS, we highlight that the clinical features of this patient and his positive therapeutic response support the importance of translating the scientific evidence on CRPS into clinical practice.