Rheumatology Advisor

LATEST NEWS

Policies Encouraging Use of Biosimilars Could Save Taxpayers Billions

Osteopenia Rates in Early Middle Age Suggest Need for More Osteoporosis Screening

Smoking Linked to Poor Oral Health in Rheumatoid Arthritis

EULAR Recommendations for Management of Henoch-Schönlein Purpura

Validating REVEAL: Can Scores Accurately Predict Survival in SSc-PAH?

Guselkumab vs Secukinumab Treatment Outcomes in Self-Reported PsA

Immune Checkpoint Inhibitor-Induced Arthritis: Incidence and Treatment Efficacy

Subcutaneous Formulation of Infliximab Biosimilar CT-P13 Investigated in RA

Glucocorticoid Dose Tapering Schedule Shown to Be Safe in Rheumatoid Arthritis

Modified New York and ASAS Criteria Interchangeable in AxSpA With Radiographic Sacroiliitis

Priority Review Granted to Rituximab for Pediatric Microscopic Polyangiitis

Long-Term Denosumab Treatment Reduces Nonvertebral Fractures in Osteoporosis

LATEST FEATURES

blood test

Therapeutic Drug Monitoring in RA Is of Uncertain Utility

Physicians interviewed by Rheumatology Advisor recommend using the Clinical Disease Activity Index and to treat-to-target by measuring clinical response and adapting therapy rapidly for patients with rheumatoid arthritis.

Examining the Cardioprotective Benefits of Urate-Lowering Therapy in Gout

The authors reviewed the effects of urate-lowering therapy on cardiovascular disease in patients with gout.

coronary atherosclerosis micrograph

Cardiovascular Risks in RA: Current Challenges and Future Directions

Researchers found data that showed screening, and subsequent statin intervention, is cost-effective and cost-saving, which might be increased by identifying patients with rheumatoid arthritis who are high-risk for cardiovascular disease and in need of preventive therapy.

Cause or Effect? The Link Between Psychological Stress and Osteoporosis

An osteoporosis diagnosis may affect a patient’s mental health because of diminished quality of life, fear of falling, embarrassment about posture changes, or general depression about the diagnosis.

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OPINIONS

Pete Salzmann, MD, VP, Immunology at Lilly

Rheumatoid Arthritis

Seizing the Opportunity to Create Change in the Rheumatology Field

Effective and affordable treatment options are essential to controlling costs within the rheumatoid arthritis treatment space and delivering value to patients.

Clinician filling out a prescription

Pain Management

The Opioid Epidemic: Why Your Prescribing Habits Matter

If physicians have a genuine interest in acting with beneficence and nonmaleficence, they should recognize that their prescribing habits have significant consequences for their patients.

Doctor and patient concierge medicine.

Practice Management

Reexamining the Role of Concierge Medicine in Primary Care

During the last decade, the number of medical students choosing internal or family medicine has dropped by approximately 80%.

woman wearing a fitbit

Opinion

Wearable Fitness Trackers: Are We Placing Too Much Faith in Them?

The utility and effectiveness of wearable fitness devices are discussed in a clinician’s opinion piece.

Practice Management

Practice Managers Can Help Physician Group Grow, Thrive

Practice managers can either be beneficial to a practice, or add unneeded stress.

CASE STUDIES

Photomicrograph of the kidney

Case Study: Systemic Lupus Erythematosus With Lupus Nephritis and Thrombotic Microangiopathy

By

Yongen Chang, MD, PhD, and Eric Seronick, DO

A 19-year-old woman presents with complaints of progressive shortness of breath, chest pain, and lower extremity edema over the past month.

tent for camping

Case Study: A Syncopal Episode During a Camping Trip

By

George Marzouka, MD

A 52-year-old man presents to the emergency department with dizziness and fatigue after a syncopal episode on a camping trip.

rheumatoid arthritis hands x-ray ulnar deviation

Case Study: Rheumatoid Arthritis Cardiac Manifestations

By

George Marzouka, MD

A 69 year old man presents joint pain (wrists, elbows, hands, and knees) and swelling with no evidence of erosions.

Case Study and Clinical Highlight: Respiratory Failure in a Patient With SLE

By

Corinna Sison, MD

A female patient with systemic lupus erythematosus presents to the emergency department with an 8 week history of dyspnea, dysphonia, and non-productive cough.

Case Study and Clinical Highlight: A Patient With Nephrotic Syndrome and Ankylosing Spondylitis

By

Corinna Sison, MD

AA amyloidosis is a rare but significant complication of ankylosing spondylitis (AS) and may lead to proteinuria and renal dysfunction.

SLIDESHOWS

Uncommon Mimickers of Systemic Lupus Erythematosus

Patients with RA experience localized and generalized bone loss.2 Data have also shown that patients with well-controlled RA have significantly more bone loss than healthy individuals.4 The pathology of bone loss in RA is multifactorial and complex. The pannus, a proliferation of inflamed synovial tissue, releases several proinflammatory cytokines. Some, such as TNF-α, IL-1, IL-6, and IL-17, are osteoclastogenic and promote bone resorption, partly through upregulation of nuclear factor-kB ligand.1,3,5 They also inhibit anti-osteoclastogenic cytokines.1 Further, TNF-α upregulates proteins that inhibit the Wnt pathway, thus suppressing osteoblast activity.1,3,5 The resulting imbalance in bone remodeling, favoring bone resorption, causes bone loss and inferior bone quality. Immobility and glucocorticoid use, both common in patients with RA, also promote bone loss.1,2 Standard risk factors for bone loss may exacerbate RA-induced bone loss.5

Skeletal Complications in Rheumatoid Arthritis: A Comprehensive Review

Artificial intelligence (AI) may be the key to combating burnout among clinicians. According to a report published in Medical Economics, AI can reduce clinicians’ burdens by recognizing patterns in large amounts of data.4 The Cleveland Clinic notes that “with AI’s continued integration into healthcare, caring for patients has become a matter of working smarter, not harder.”3 Considering burnout and depression often develop in tandem, this is especially welcome news for the medical community.

Predictions in Medicine 2019: What’s Ahead

Derm Dx: Erythematous Rash on the Upper Back

Ischemic stroke is the most common severe neurologic complication of APS. Among 1000 people with APS participating in the Euro-Phospholipid Project, 20% presented with stroke and 11% presented with transient ischemic stroke.2,5 About 13% of patients with stroke are aPL-positive,2 and they are more likely to be younger or female compared with aPL-negative patients.3 More than 20% of strokes in patients <45 years may be related to APS.3 In APS, stroke occurs when a clot forms in an arterial vessel of the brain or when clot or plaque debris travels from another site (usually the heart) to a blood vessel in the brain.2,3 Less common cerebrovascular diseases seen in patients with APS that may increase stroke risk are cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome, acute ischemic encephalopathy (a rare feature of SLE), and Sneddon syndrome.3 To reduce stroke risk, clinicians may want to discuss modifiable risk factors for vascular disease, such as smoking and obesity, with those who are positive for aPL.3 Image Credit: Zephyr/Science Source

Examining the Spectrum of Neurologic Manifestations in Antiphospholipid Syndrome

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