Psoriatic arthritis (PsA), a chronic inflammatory arthritis characterized by structural damage to the joints, has been associated with reduced health-related quality of life, disability and reduced life expectancy. The joint changes in PsA are characterized radiographically by a combination of erosive and proliferative bone changes, including erosive joint destruction, fluffy periostitis and pencil-in-cup deformities. Radiographic…
Articles by Arthritis & Rheumatology
Arthritis Prevalence on the Rise, Creating Challenges for Healthcare System
Updated projections suggest that arthritis and arthritis-attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs. By 2040, the number of U.S. adults with doctor-diagnosed arthritis is projected to increase 49% to 78.4 million. Can the healthcare system accommodate these projected increases? Not without changes. By 2025, the expected demand for rheumatologists is expected to exceed supply by 2,576 adult and 33 pediatric rheumatologists…
Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes
A variety of immune and nonimmune pathophysiologic mechanisms causing the disruption of alveolar capillaries with bleeding into the alveolar spaces can lead to diffuse alveolar hemorrhage (DAH). Immune-mediated mechanisms can cause DAH with or without the presence of capillaritis. The antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) syndromes—granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)—are the…
2015 Treatment Recommendations for Psoriatic Arthritis
Psoriatic arthritis (PsA) is remarkably diverse in presentation and course. To assist clinicians in its management, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published treatment recommendations in 2009 based on a systematic evidence review. To be clinically relevant, such recommendations must be dynamic, and significant developments in PsA pathophysiology and disease assessment, particularly regarding the important contribution of comorbidities coupled with major therapeutic advances, necessitated an update of the GRAPPA recommendations…
Wise Transitions: Improving Pediatric–Adult Care
Transitions in medical care can be high-risk periods due to the loss of continuity in care and worsening of medical conditions. Approximately one-quarter of the estimated 18 million adolescents aged 18–21 years in the U.S. have chronic conditions, including rheumatic diseases. Interventions in rheumatology practice can improve transition processes. Transition-readiness assessment tools and transition-satisfaction scales are available for use in rheumatology transition processes…
Cholesterol Levels in Patients with RA Starting Methotrexate
Although research regarding the increased cardiovascular (CV) morbidity and mortality in rheumatoid arthritis (RA) has burgeoned in recent years, the need remains for a better understanding of the effects of widely used DMARDs on CV risk and risk factors in RA patients. These authors set out to evaluate the long-term changes in cholesterol levels in patients with early RA. Decreases in RA disease activity over long-term follow-up were associated with increases in cholesterol levels in patients with early RA treated with either biologic or nonbiologic therapies…
Enthesitis: New Insights into the Pathogenesis, Diagnostic Modalities & Treatment
Enthesitis is a central feature of spondyloarthritis (SpA). This review article summarizes the substantial progress that has been made in addressing the pathophysiology, molecular mechanisms, genetic associations, clinical features, diagnostic modalities and treatment of enthesitis. Further examination into the role of the inflammatory mediators, including IL-17, IL-22, and IL-23 as well as potentially others, in driving enthesitis and bone formation will be important to direct our attention toward future therapeutic targeted pathways in patients with SpA…
2015 ACR Guideline for the Treatment of Rheumatoid Arthritis
“Treat to target regardless of disease activity level” tops the list of recommendations for both early and established RA in the 2015 Guideline for the Treatment of Rheumatoid Arthritis. The guideline addresses six major topics, including DMARDs, glucocorticoids and biologics, and includes 74 recommendations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients together…
Low-Grade Inflammation in Symptomatic Knee OA
Although osteoarthritis (OA) was formerly considered a non-inflammatory joint disease, it’s now well-appreciated that inflammatory mediators, such as PGE2 and IL-1β, are produced by osteoarthritic joint tissues and can be used to identify patients with symptomatic knee OA. A peripheral blood leukocyte inflammatory transcriptome identifies a subset of symptomatic knee OA patients at higher risk for radiographic progression and may reflect persistent low-grade joint inflammation…
Do Diet & the Environment Induce RA via ACPA Generation?
A new study has examined how ACPA may originate at the molecular level. The researchers propose that numerous environmental factors may trigger the generation of ACPAs that then cross-react with various citrullinated human autoantigens through molecular mimicry to induce RA…