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Case Report: Diagnosing, Treating Hepatitis B-Linked Polyarteritis Nodosa

Naveen Raj, DO, & Lisa Duncan, MD   |  

Hepatitis B virus (HBV) associated polyarteritis nodosa (PAN) is an increasingly rare vasculitis in developed countries due to advances in HBV vaccination and antiviral therapy. However, the condition does persist, and rheumatologists should consider it when evaluating vasculitis cases. Below, we discuss a case that illustrates the varied clinical presentations PAN can encompass. A high…

Case Report: Does a Rapid-Onset Neck Mass Have Rheumatic Origins?

Tej Bhavsar, MD, & Nancy Joste, MD  |  

A 54-year-old African American man arrived at the emergency department with the acute onset of a tender mass on the left side of his neck. It had been getting progressively larger for the preceding two days. History & Examination His history included chronic right hip osteoarthritis with two surgeries performed five years prior. At his…

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Tips for Diagnosing Metabolic Myopathies

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When evaluating patients with possible myopathic symptoms, rheumatologists must consider a rare, but important, group of inherited disorders: the metabolic myopathies. However, their diagnosis often remains a challenge. Early recognition of these primary metabolic myopathies is essential to help prevent disease morbidity and mortality from rhabdomyolysis. Here, we focus on the metabolic myopathies that present…

Rituximab-Induced Serum Sickness Is More Frequent in Autoimmune Diseases

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Recent research into rituximab-induced serum sickness (RISS) reinforces the understanding that patients generally recover quickly. However, the study also found patients with autoimmune disease, especially SLE, had a significantly higher risk for developing RISS than patients using rituximab to treat hematological malignancy…

Case Report: Not All Crystals Are Gout

Katherine Yates, MD, Erin H. Penn, MD, & Minna J. Kohler, MD   |  

Patients with chronic kidney disease (CKD) often experience joint pain due to various etiologies, including crystalline arthropathies, renal osteodystrophy, amyloid arthropathy, erosive osteoarthritis, avascular necrosis and even erosive spondylarthrosis.1 Below, we present a case of crystalline arthropathy in a patient with chronic kidney disease, mistaken for gout. The Case A 29-year-old man was admitted to…

Case Report: RA Patient Suffers Methotrexate-Induced Cutaneous Lesions

Nitasha Kumar, MD  |  

Methotrexate (MTX) remains the predominant medication used by rheumatologists to treat rheumatoid arthritis (RA). Doses of 7.5–25 mg per week with daily folic acid are generally prescribed. Despite its common use, MTX must be prescribed cautiously given the potential adverse effects when taken incorrectly or without folic acid supplementation. Cases of MTX-induced cutaneous ulceration have…

This chest CT shows new left upper lobe groundglass opacity.

Case Report: Could Myocarditis + Shortness of Breath = EGPA?

Ambreesh Chawla, MD, Ashwini Komarla, MD, & Sujatha Vuyyuru, MD  |  

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome or allergic granulomatosis and angiitis, is a rare small- and medium-vessel vasculitis. This disease was first described by American pathologists Jacob Churg and Lotte Strauss in 1951.1 Although the vasculitis is often not apparent in the initial phases of the disease, EGPA can affect any…

Rheumatology Drugs at a Glance, Part 3: Rheumatoid Arthritis

Mary Choy, PharmD, BCGP, FASHP  |  

Over the past few years, bio­similars and other new drugs have been introduced to treat rheumatic illnesses. Some of the conditions we treat have numerous drug options, others have few or only off-label options. This series, “Rheumatology Drugs at a Glance,” provides streamlined information on the administration of biologic, biosimilar and small molecule inhibitor drugs…

Expert Says Vaccines Are Largely Safe for Rheumatology Patients

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CHICAGO—Rheumatologists often come to Brian Schwartz, MD, associate professor of medicine and vice chief for clinical affairs in the Division of Infectious Diseases, University of California, San Francisco, with a concern: A patient on immunosuppression has a family member who needs a live vaccine, but the patient may be vulnerable to the vaccine’s effects. Should…