CHICAGO—The promise of precision medicine—the tailoring of treatment to a given patient based on genetics and other factors—has probably been best illustrated in oncology, with therapies targeted specifically to markers expressed on tumors. But rheumatology is in the thick of precision medicine as well, said Judith James, MD, PhD, chair of the arthritis and clinical…
After total hip or knee arthroplasty, flares are common in patients with rheumatoid arthritis (RA), according to a recently published study.1 Higher disease activity at baseline appears to be linked to flares, but use of such medications as biologics and methotrexate did not independently predict flaring. “Contrary to the notion that patients with established RA…
Granulomatosis with polyangiitis (GPA) was first described in the British Medical Journal in 1897 by Scottish otolaryngologist Peter McBride.1 GPA is a relatively rare, systemic necrotizing vasculitis that can make diagnosis challenging. The incidence has been estimated anywhere between two and 12 cases per million.2 GPA mainly affects adults between the ages of 45 and…
A 54-year-old woman is establishing care in your clinic after retirement of her previous rheumatologist. Your review of her records suggests that she was diagnosed with systemic lupus erythematosus seven years ago on the basis of symptoms of body pain and fatigue, and serologic evidence of positive ANA 1:40 (speckled) and borderline anti-SSB antibody. She…
Bad things happen to good rheumatologists—and to their patients—and can have profound personal and professional consequences for the doctor. Sometimes recommended treatments can have predictable, but devastating, side effects. Even if the rheumatologist does everything right according to evidence-based best practice, patients can still have bad outcomes, even die—with resulting feelings of sadness, anger, guilt…
Rheumatologists often rely on magnetic resonance imaging (MRI) in the evaluation of suspected muscular diseases. Here, we describe a case in which unexpected findings on MRI pointed to a diagnosis rarely considered as a mimicker of rheumatologic disease. The Case A 19-year-old man of Middle Eastern descent was admitted to our hospital for evaluation of…
NEW YORK (Reuters Health)—Subcutaneous belimumab improves outcomes in anti-dsDNA-positive hypocomplementemic patients with systemic lupus erythematosus (SLE), according to results from a Phase 3 randomized, controlled trial. Intravenous belimumab is approved by the U.S. Food and Drug Administration and the European Medicines Agency for the treatment of patients with active, autoantibody-positive SLE who are receiving standard…
The year was 1978. I was a newly married, 25-year-old registered nurse working on a medical unit at Mercy Medical Center in Oshkosh, Wis. I began to notice morning stiffness, increasing fatigue, and bilateral heel and ankle pain. Every step hurt as I walked down the halls to care for my patients. My diagnosis was…
A 58-year-old African American woman with a past medical history of hypertension (HTN), hyperlipidemia, severe gastroesophageal reflux disease (GERD) and limited cutaneous systemic sclerosis (lcSSc) presented to the emergency department with shortness of breath (SOB) and progressive bilateral lower extremity swelling for three weeks. She denied any chest pain, but endorsed generalized fatigue and dyspnea…
In this review, the authors address the key pathophysiologic mechanisms that drive acute and chronic chikungunya arthritis, arguably the most incapacitating sequela among long-lasting chikungunya virus disease manifestations, based on recent animal experimental disease models and epidemiologic studies. They explore the latest findings in therapeutic development aimed at limiting viral spread and at immune and…