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Articles by Keyword - Pathogenesis
Listing articles 31 to 40 of 45
Features: Myositis Mysteries
A 26-year-old female was referred to the rheumatology service two years after the insidious onset of “walking funny” that progressed to significant proximal muscle weakness over a 10-month period. Early in the course of her illness, her creatine kinase (CK) was 4,000. Subsequent muscle biopsy revealed muscle fiber degeneration and regeneration in addition to numerous phagocytic cells. She was diagnosed with polymyositis but, despite treatment with high-dose corticosteroids, methotrexate (MTX),...
Features: Watch Those Eyes
Although ophthalmologists and rheumatologists come from the same medical-school background, our training can diverge so much that even the language we speak is incompletely shared. We know many rheumatologists who stare uncertainly at the notations that are the standard nomenclature for an eye examination. And we know ophthalmologists who are unfamiliar with the new drugs—including the biologics—that are now the mainstay of immunosuppressive therapy. Given the complexity of systemic...
Columns: Know Your Unknown Unknowns
During a press conference in 2002, then Secretary of Defense Donald Rumsfeld provided a categorization of information. To Rumsfeld, information could be divided into three types: known knowns, which are things that we know we know; known unknowns, which are things that we know we don’t know; and unknown unknowns, which are things that we don’t know we don’t know.
Features: A Better Family Plan
As women with systemic lupus erythematosus (SLE) live longer and healthier lives, more and more are asking whether they can or should become pregnant. Forty years ago, a rheumatologist would have been correct to discourage a woman with SLE who wanted to have a child; the rate of pregnancy loss for a woman with SLE was more than 40% at that time. In recent years, however, the success rate of SLE pregnancies has increased significantly. Currently, the risk of pregnancy loss for someone with SLE is roughly...
Features: What Causes Nephrogenic Systemic Fibrosis?
In August 2001, Diane Endicott* noted the spontaneous onset of tightening of the skin over her feet and lower legs. Endicott was a 40-year-old woman with type 1 insulin-dependent diabetes mellitus which started at age 10 and stage 5 chronic kidney disease (kidney failure with glomerular filtration rate less than 15 mL/min/1.73 m2 or receiving dialysis), who had been on hemodialysis for the previous two years. This skin tightening progressed rapidly to involve the skin on her thighs, hands, and forearms....
Features: Meet the Lumbar Spinal Stenosis Challenge
Although lumbar spinal stenosis will have a major effect on public health, the number of studies on appropriate diagnostic and therapeutic choices is surprisingly small. Despite this lack of evidence-based options, clinicians need to make the best choices with available evidence and clinical acumen. In this article, I will provide my approach to this challenging clinical disorder based upon the available medical literature and my experience of 29 years in practice.
Features: Difficult Gout
Gout is arguably the best understood rheumatic disease. The diagnosis of gout is typically straightforward, and effective serum urate–lowering drugs and anti-inflammatory compounds are available to manage the majority of patients with gout.There has been a sense of complacency about gout—until recently. The last two decades have seen a remarkable resurgence of gout in the United States. This comeback has clinicians facing increasingly complex cases in which age, comorbidities, and concomitant...
Features: Build up Bone
Osteoporosis is a disease defined by low bone strength such that the bone fractures when exposed to unusually low stress. While many aspects of osteoporosis are not yet understood, research during the past 10 years has provided important information to identify individuals at high risk for the disease, institute screening, and offer treatment for patients who are at risk of fracture. We now have several effective bone-active agents that improve bone strength and reduce incident fractures in individuals at...
Features: Have We Reached an Estrogen Comfort Zone?
Physicians caring for women with systemic lupus erythematosus (SLE) often face difficult decisions regarding the use of exogenous estrogens as part of the overall management plan. In certain circumstances the discussion is moot because a patient may have an unambiguous contraindication to estrogen therapy such as a thrombotic diathesis. In other cases, physician and patient must have a lengthy discussion, attempting to balance evidence for and against use. Three recently published randomized controlled...
From the College: Hepatitis-C Virus–Associated Arthritis
Hepatitis-C virus (HCV)-associated arthritis is highlighted this month in our ongoing series on patient education materials.
