Although systemic lupus erythematosus still does not have a definite cause or cure, rheumatologists and researchers over the past 50 years have witnessed and contributed to a great deal of progress that helps patients, says Peter H. Schur, MD, director emeritus of the Lupus Center, Brigham and Women’s Hospital, and professor, Harvard Medical School, Boston. Dr. Schur’s…
A 53-year-old female presented to the clinic for severe polyarticular joint pain and was found to have a seronegative inflammatory arthritis. Six months before, she had completed 10 months of treatment for stage IV metastatic melanoma with the immune checkpoint inhibitors, nivolumab and ipilimumab, achieving complete remission of her cancer. She said that throughout her…
Ipilimumab (Yervoy) is a monoclonal antibody directed against cytotoxic T-lymphocyte antigen 4 (CTLA-4). It was the first drug to demonstrate a survival benefit in advanced melanoma and was approved by the FDA in 2011.1 By blocking the CTLA-4 receptor, ipilimumab enhances the immune response against tumors via cytotoxic T lymphocyte activation and proliferation.2 However, immunopotentiating…
A 56-year-old African American man presents to the emergency department with polyarthralgias and a fever of 103ºF. One month prior to admission, he presented with right knee pain and swelling. Blood cultures grew S. epidermidis. He was treated for presumed septic arthritis complicated by MSSE bacteremia. He was treated with meropenem and a prolonged course…
As clinicians, we are familiar with pain, stiffness and soreness—subjective nouns that define our métier. These helpful words serve as signposts that direct us along the path to the proper diagnosis. Consider the young man with a stiff, sore back (a case of ankylosing spondylitis?) or the postpartum woman experiencing newly painful, stiff and sore…
The Phone Call A phone call in the middle of the night can rattle one’s nerves. The rush of adrenaline sets the heart pounding as our ears brace for what we are about to hear next. A distress call from an elderly parent or a child away at college? Is everyone safe? Or may this…
NEW YORK (Reuters Health)—A father’s exposure to methotrexate 90 days or less before conception “should not be of major concern,” researchers say. Prepregnancy paternal methotrexate exposure appears to confer no increased risk of major or minor congenital malformation, stillbirth or preterm birth in his offspring, their study found. Methotrexate is a first-line therapy for rheumatoid…
Antisynthetase syndrome (AS) is strongly associated with the presence of antibodies to aminoacyl-transfer RNA (tRNA) synthetases (ARSs) that are implicated in the pathogenesis of myositis and interstitial lung disease (ILD). Antibodies against eight antisynthetases have been identified and are detected in 16–26% of patients with idiopathic inflammatory myopathies (IIM).1 Serum assays for five of these…
NEW YORK (Reuters Health)—Fluctuations in the gut microbiome over time could underlie inflammatory bowel disease (IBD), including Crohn’s and ulcerative colitis, researchers suggest. “Both the state and the dynamics of the human gut microbiome in healthy individuals are highly personalized. Although cross-sectional studies have revealed dysbiosis of the gut microbiome in IBD, little is known…
NEW YORK (Reuters Health)—Intraocular vancomycin may lead to potentially blinding hemorrhagic occlusive retinal vasculitis (HORV), a new study suggests. “The importance of this study was to present in a number of patients overwhelming evidence that rarely, intraocular vancomycin is associated with sight-threatening retinal vascular occlusion,” says lead author Dr. Andre J. Witkin of Tufts Medical…