What factors drive inflammation and progressive disease in ankylosing spondylitis (AS)? The answers have long eluded rheumatologists. Although 90% of patients with AS test positive for the HLA-B27 gene, pieces remain missing in our understanding of this chronic, inflammatory disease, which often leads to pain, spinal fusion and, in about half of patients, gut involvement,…
A number of autoinflammatory syndromes that result from genetic mutations have been described recently. The vast majority occur in children. However, three periodic fever syndromes are important for rheumatologists who treat adults to know about. The goal of this review is to provide a concise description of each condition, and to help the clinician understand…
Necrotizing autoimmune myopathy (NAM) is a relatively recently discovered subgroup of inflammatory myopathies. NAM is characterized by predominant muscle fiber necrosis and regeneration with little or no inflammation.1 One subgroup of NAM is 3-hydroxy-3-methylglutaryl-CoA reductase antibody (HMGCR Ab)-related immune-mediated necrotizing myopathy (IMNM), which occurs (rarely) after statin exposure, with a rough incidence of two per…
All rheumatologists have observed the impact of their patients’ mental health status on the long-term treatment of rheumatologic conditions. Depression, anxiety and even loneliness can lead to poor clinical outcomes and nonadherence to treatment, whether the patient is following medication regimens or participating in regular exercise. On the other hand, a patient’s resilience and positive…
Mysterious Ways The juxtaposition of the old and the new was readily evident that busy Wednesday morning. My first patient, a 94-year-old gentleman, Hal, arrived with a precise request. His rheumatologist for the past 40 years had just retired, and he was searching for a doctor with expertise in the use of gold sodium aurothioglucose,…
Anemia is common in patients with systemic rheumatic disease, yet it may not get the attention it deserves. Anemia can result from chronic inflammation, treatment side effects or other disease factors, or it may signal an unrelated condition. Although diagnosis and treatment of anemia are sometimes challenging, clinicians must do their utmost to rigorously investigate…
SAN DIEGO—The proposed classification criteria for systemic lupus erythematosus (SLE), supported but not yet approved by the ACR and EULAR, were debuted on Nov. 7 at the 2017 ACR/ARHP Annual Meeting. An international steering committee developed and validated the criteria, with patient input and the consensus of more than 150 global SLE experts. Rheumatology researchers…
This year, Selena Gomez underwent a kidney transplant as a result of damage from living with lupus. But how can this celebrity story aid rheumatologists? Many see it as an opportunity to raise awareness or create a dialogue with primary care physicians. But for lupus patients, it can be a reminder for them to take control of their own wellbeing, according to rheumatologist Susan Manzi, MD, MPH…
(Reuters Health)— Postmenopausal women should not use hormone therapy to prevent chronic medical conditions, because the risk of significant side effects outweighs the unclear evidence of a benefit, according to a government-backed panel of experts. Most chronic conditions – coronary heart disease, dementia, stroke, fractures, and breast cancer, for example – are more common with…
NEW YORK (Reuters Health)—Vitamin D-metabolite ratio (VMR) may be a better marker of bone health than 25(OH)D (25-hydroxyvitamin D), a new study suggests. “The parameter that’s currently used to assess vitamin D status, 25(OH)D, is a flawed measure because it doesn’t consistently associate with important bone outcomes like hip fractures,” Dr. Charles Ginsberg of Veterans…