Immunoglobin G4-related disease (IgG4-RD) is a rare fibro-inflammatory disease of unknown etiology that has been recently recognized. It can cause fibro-inflammatory masses in almost every organ of the body and is associated with dense lymphoplasmacytic infiltration of IgG4-postitive plasma cells, storiform fibrosis and elevated levels of serum IgG4.1 IgG4-RD is a systemic disease that may…
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Kussmaul, Meier & Polyarteritis Nodosa
In 1866, Adolf Kussmaul, an internist, and Rudolf Maier, a pathologist, published the classic characterization of what eventually became known as polyarteritis nodosa.1 It was the first scientific clinical characterization of a noninfectious vasculitis. As such, it became a paradigmatic point of contrast to other types of vasculitides that were later described. Their description also…
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
Have We Reached the Limits of Clinical Classification?
There is an old adage that there are two types of people—lumpers and splitters. For some, people are easily categorized into liberal vs. conservative, Democrat vs. Republican, Donald Trump supporter vs. Hillary Clinton supporter. For others, everyone is a snowflake, and what makes us different is much more important than what makes us the same….
Can Certain DMARDs Treat Dementia?
In the complex web of interactions between systemic inflammatory response, rheumatic disease and disease-modifying anti-rheumatic drugs (DMARDs), what is the potential for using rheumatologic therapies to treat other medical conditions linked to inflammation? Some medical researchers have looked at cardiac conditions, and others have examined the overlap with Alzheimer’s disease and other dementias. Positive effects…
Ethics Forum: What to Do When an Autoimmune Patient Needs a Transplant?
Despite our best efforts and modern interventions, we still have patients in the intensive care unit with organ failure. Although renal failure can be mitigated by dialysis, patients with cardiac or respiratory failure secondary to active autoimmune disease raise difficult clinical and ethical issues. Two recent cases, both with organ failure, led us to examine…
The FDA Approved Several New Rheumatology Drugs in 2017
SAN DIEGO—In a session at the 2017 ACR/ARHP Annual Meeting, Kam Nola, PharmD, MS, professor in the College of Pharmacy and vice chair in the Department of Pharmacy Practice at Lipscomb University in Nashville, Tenn., updated participants on new medications and new indications for rheumatology treatments and safety labeling changes approved by the U.S. Food…
Updates on Managing Lupus Complications
SAN DIEGO—To manage patients with systemic lupus erythematous (SLE), rheumatologists must be aware of potentially serious complications affecting many organ systems. On Nov. 7 at the 2017 ACR/ARHP Annual Meeting, two experts offered insights on cardiovascular and hematological complications of lupus. Myocardial Disease in Lupus Lupus patients are at increased risk for heart-related complications, especially…
Transcriptional Programming Research, & a Twist on CAR-T Cell Therapy
SAN DIEGO—At the 2017 ACR/ARHP Annual Meeting this past November, an expert said researchers are making progress in identifying drugs that can correct problems with transcriptional programming, which, if perfected, could go a long way toward harnessing more fully the power of genetics knowledge and directing it toward patient care. The session also delved into…
ANCA-Associated Vasculitis Pathogenesis & Treatment Updates
SAN DIEGO—At the 2017 ACR/ARHP Annual Meeting this past November, three researchers discussed the latest ANCA-associated vasculitis (AAV) research, including studies on AAV pathogenesis, therapies and remission maintenance. In the Philip Hench, MD, Memorial Lecture, J. Charles Jennette, MD, chair in pathology and laboratory medicine at the University of Carolina at Chapel Hill in Chapel…
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