Many patients with rheumatoid arthritis (RA) report pain despite excellent control of inflammation with immunotherapies. Variable degrees of coexisting fibromyalgia (FM) may explain this disparity. RA patients who have the highest 2011 ACR FM survey criteria scores appear to share neurobiologic features consistently observed in FM patients. This study is the first to provide neuroimaging evidence that RA is a mixed pain state, with many patients’ symptoms being related to the central nervous system rather than to classic inflammatory mechanisms…
BMD Not a Reliable Predictor of Vertebral Fragility Fracture in Older Women
NEW YORK (Reuters Health)—Bone mineral density (BMD), particularly lumbar BMD, may not reliably indicate the presence of asymptomatic vertebral fragility fractures in post-menopausal women, new findings suggest. In a study online May 9 in Bone, Italian researchers found such fractures were common among women seen at an osteoporosis clinic, yet the vast majority had not…
Disease-Modifying Antirheumatic Drugs Cut RA Risk
NEW YORK (Reuters Health)—Disease-modifying antirheumatic drugs (DMARDs) reduce the risk of developing rheumatoid arthritis (RA) in patients with early undifferentiated arthritis, researchers from France report. Several studies have suggested that conventional or biological DMARDs might interfere with the pathogenic process and prevent more established forms of RA, but it remains unclear whether these drugs are…
Study Results for 9 New Psoriatic Arthritis Drugs
CHICAGO—As Eric Ruderman, MD, professor of medicine in rheumatology at Northwestern University Feinberg School of Medicine in Chicago, began his talk on psoriatic arthritis treatment at the ACR State-of-the-Art Clinical Symposium in April, he marveled a bit at how much there was to cover. Drugs gaining prominence in the treatment of rheumatoid arthritis and dermatological…
When Is It Appropriate to Discontinue Bisphosphonates?
CHICAGO—A 75-year-old woman with low bone density, who has had a fracture and has other risk factors for fracture, is treated with the bisphosphonate alendronate. After five years on the drug she comes back, wondering: Should I stop taking the drug? She’s had no additional fractures. Her bone density has improved, but her lumbar spine…
Eosinophilia & Hypereosinophilia Diagnosis & Treatment Tips
CHICAGO—High eosinophil counts that can’t be explained should concern rheumatologists and spark attempts to identify what’s happening, an expert said at the ACR State-of-the-Art Clinical Symposium in April. “Eosinophil counts over 1,500 (per microliter) should provoke worry,” said Bruce Bochner, MD, professor of medicine in allergy and immunology at Northwestern University Feinberg School of Medicine…
Understanding & Treating Neonatal Lupus
CHICAGO—Neonatal lupus is a rare disorder, but its onset can be dramatic, and it can be fatal. Clinicians must be armed with information to manage it and help guide parents through difficult decisions, an expert said in April at the State-of-the-Art Clinical Symposium. Despite the name, neonatal lupus does not mean that either the mother…
Precision Medicine for Lupus Continues to Progress
CHICAGO—The promise of precision medicine—the tailoring of treatment to a given patient based on genetics and other factors—has probably been best illustrated in oncology, with therapies targeted specifically to markers expressed on tumors. But rheumatology is in the thick of precision medicine as well, said Judith James, MD, PhD, chair of the arthritis and clinical…
Case Report Illustrates Hypercoagulability in Behçet’s Disease
Behçet’s disease is a chronic, relapsing and remitting vasculitis with multisystem involvement. Commonly referred to as the Silk Road disease due to its prevalence in the Asian and Mediterranean region of the traditional Silk Road, Behçet’s was first described by Hippocrates as a triad of symptoms—genital and oral ulcers with uveitis—and attributed to links with…
Can Rheumatologists Get More Systematic about Psychosocial Care?
A recent position statement by the Society of Behavioral Medicine (SBM) concludes that patients with persistent pain need better access to psychosocial care in all healthcare settings.1 The SBM offers 10 health policy recommendations for improving such access, including removing system-related barriers, providing referral tools, reimbursing for evidence-based psychosocial approaches, prioritizing generalist-level and specialist pain…
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