A 51-year-old man with a history of limited systemic sclerosis with Raynaud’s phenomenon and pulmonary hypertension being treated with tadalafil and macitentan presented to a clinic with ulceration of his right pinkie. The patient had injured the finger two months earlier. He reported poor healing and the presence of a persistent ulcer since the injury….
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Case Report: Hydralazine-Induced ANCA-Associated Vasculitis
Hydralazine has been in use as a treatment for hypertension, most notably in heart failure patients, since 1951.1 The drug is a known cause of autoimmune disease, most specifically hydralazine-induced lupus. Hydralazine-induced lupus occurs in 7–13% of those taking the medication.2-4 It often presents with constitutional symptoms, arthritis/arthralgias, cutaneous lesions, serositis, myalgias and/or hepatomegaly. Features…
Coronary Microvascular Dysfunction May Predict Heart Disease in Rheumatoid Arthritis
Cardiovascular disease (CVD) is a leading cause of death in patients with rheumatoid arthritis (RA). Patients with RA have a 1.5 times increased risk for heart attack compared with the general population. Although the treatment of RA has advanced significantly, the ability to prevent cardiovascular events hasn’t followed. A study in Arthritis Care & Research…
Polymyalgia Rheumatica Rapid Symptom Improvement After Glucose Is Controlled
(Reuters Health)—In a case series report, researchers describe rapid symptom improvement in three patients with polymyalgia rheumatica (PMR) when high glucose levels were brought down. After glucose was controlled, patients experienced improvement in both symptoms and laboratory measures of PMR without glucocorticoid administration or an increase in glucocorticoid dosage, according to the report in the…
Bloody Important: Atherosclerosis & Thrombotic Disease in Rheumatic Conditions
During the 2020 ACR State-of-the-Art Clinical Symposium, Zoltán Szekanecz, MD, PhD, addressed the risks of vascular disease and how to manage them in patients with rheumatic diseases.
A Peaceful Medical Mission in Guatemala, Days before COVID-19
My first-ever medical mission trip, after 37 years of medical practice, was to Teleman, Alta Verapaz, Guatemala. Prior to the trip, my excitement as an adult-trained rheumatologist was balanced against my apprehension about witnessing new diseases, caring for children and practicing in an austere environment with limited medical resources. As directed by the travel clinic,…
The History of Treating Lupus with Hydroxychloroquine
Given how unexpectedly front and center hydroxychloroquine has been in discussions about the treatment of COVID-19 this year, it makes sense to look at how it became so central to the treatment of a rheumatologic condition. In 1991, an article appeared in The New England Journal of Medicine that would alter the way rheumatologists approached…
5 Challenges in the Treatment & Diagnosis of Lupus
A recent study published in Lupus Science & Medicine lays out five of the top barriers impeding progress in lupus diagnosis and treatment.1 The Addressing Lupus Pillars for Health Advancement project (ALPHA), led by the Lupus Foundation of America (LFA), researchers at the Tufts School of Medicine Center for the Study of Drug Development (Tufts…
Case Report: Tumor Treatment Unleashes Autoimmunity
Immune checkpoint inhibitors (ICIs) targeting the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) or programmed cell death protein 1 (PD-1) axes have revolutionized therapy and improved survival in advanced cancers. However, these immune system modulators also lead to immune-related adverse events (IRAEs).1,2 In clinical trials, IRAEs mainly involved the gastrointestinal tract, skin, endocrine glands, liver and lung,…
Case Report: Cardiac Tamponade in a Rheumatoid Arthritis Patient
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease. Although RA develops its central pathology within the synovium of diarthrodial joints, many non-articular organs can be involved, particularly in patients with severe joint disease.1 Although most patients are asymptomatic, cardiac involvement is relatively common and includes rheumatic heart nodules, pericarditis (30–50%), pericardial effusion and…
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