Systemic autoinflammatory diseases (SAIDs) are rare syndromes characterized by alterations in innate immunity that result in a variety of clinical manifestations that are usually associated with recurrent fevers.1 Thanks to advances in genetic sequencing over the past few years, monogenic causes for some of these autoinflammatory diseases, such as Yao syndrome, have been discovered.2 Previously…
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Case Report: Lipoma Arborescens of the Knee
Lipoma arborescens is a rare, benign intra-articular lesion characterized by diffuse replacement of synovial tissue by mature adipocytes, causing a villous lipomatous proliferation of the synovial membrane.1 Typically, this is a monoarticular condition, with the knee being the most commonly affected although it has been rarely reported to occur in an oligo-/polyarticular fashion and in…
Asymmetrical Laughter by a Provider Erodes Trust
It was Christmas Eve, 1996. The pain had become excruciating—it had to be for Kerby to opt to go to the hospital on Christmas Eve because Kerby’s pain tolerance was high. At that point, he had been living with what had ultimately been diagnosed as psoriatic arthritis for about 30 years. That Christmas Eve, the…
Therapeutic Drug Monitoring May Offer Little Benefit to Patient Remission Rates During Infliximab Induction Therapy
Although rheumatologists prescribe tumor necrosis factor inhibitors (TNFi’s) to treat several rheumatic diseases, they recognize immunogenicity influences the efficacy and safety of TNFi’s. Example: The formation of anti-drug antibodies can affect infusion reactions and cause low-serum drug levels and therapeutic failure. The induction phase is a period of high incidence of immunogenicity, and observational data…
Case Study: Cerebral Toxoplasmosis in a Newly Diagnosed Lupus Patient
The occurrence of opportunistic infections is an established complication in patients diagnosed with systemic lupus erythematosus (SLE). The foremost challenge in such circumstances is differentiating between an exacerbation or progression of SLE, and the effects of the infection itself.1 Toxoplasma gondii is a ubiquitous parasite that often causes an asymptomatic infection in healthy, immunocompetent adults….
Tips for Understanding the Pathways of Pain & Choosing Treatments
SNOWMASS VILLAGE, COLO.—The science underlying the neurobiology of chronic pain isn’t something rheumatologists often think about. However, pain is an important reason why patients see a rheumatologist. At the 2020 ACR Winter Symposium in January, Leslie Crofford, MD, gave two presentations addressing pain experienced by rheumatology patients, including a session on the fundamental mechanisms of…
New Study Sheds Light on Deficiency of Adenosine Deaminase 2 (DADA2)
Since it was first described, the spectrum of disease caused by deficiency of adenosine deaminase 2 (DADA2) has been broadening. Features described include systemic vascular and inflammatory features and recurrent stroke, which overlap with childhood-onset polyarteritis nodosa (PAN). Previous data show that DADA2 has extensive genotypic and phenotypic variation.1 Results from a recently published study…
Pediatric Cases Require Special Considerations & Aggressive Treatment Plans
ATLANTA—Managing pediatric patients with rheumatic disease involves special considerations, such as developmental concerns and physiological traits that may affect dosing of medications, according to two experts. During a session at the 2019 ACR/ARP Annual Meeting, Courtney Kremer, ARNP, a pediatric nurse practitioner at the University of Iowa Stead Family Children’s Hospital, Iowa City, and Jessica…
Case Report: A 50-Year-Old Man Suffers Dye-Induced Arthritis
Hair dye products are commonly used by both men and women to enhance youth and beauty and to follow fashion trends. As reported in the medical literature, hair dyes and their ingredients are associated with allergic contact dermatitis. A possible association with joint inflammation has also been recognized. There is literature to support that para-phenylenediamine…
Ultrasound Aids Diagnosis of Man with Knee Pain & Swelling
A 56-year-old automobile mechanic was referred to our rheumatology service by his orthopedist to evaluate left posterior knee pain and swelling that had been present for three months. The patient had undergone bilateral total knee arthroplasties (TKAs) for sports-related osteoarthritis three years before. In addition to the knee pain, the patient described several years of…
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