Rheumatologists are in the unique position of diagnosing and treating rare auto-inflammatory and autoimmune diseases. Although systemic lupus erythematosus (SLE) often has textbook presentations, it is a heterogeneous condition with a wide variety of disease manifestations. In 2019, the European League Against Rheumatism and the ACR introduced new classification criteria to help diagnose this condition.1…
Medication-related osteonecrosis of the jaw (MRONJ) is a condition that manifests as exposed, necrotic and non-healing jaw bone in patients who have been treated with bisphosphonates, denosumab, chemotherapeutic agents, anti-angiogenic drugs, tyrosine kinase inhibitors, thalidomide and steroids.1-4 These medications are administered via intravenous, subcutaneous and oral routes to manage osteopenia; osteoporosis; hypercalcemia of malignancy; bone…
To say it has been an interesting (the science and the memes), tumultuous (the politics) and heartbreaking (the pandemic and social injustice) year is an understatement. There have been moments of grace and inspiration that we hope have kept everyone going. As we look to 2021, we take lessons from our experiences in 2020. Washington,…
Drug-induced lupus erythematosus and ANCA-associated vasculitis (AAV) are both autoimmune conditions associated with the use of hydralazine, a commonly prescribed drug for hypertension and congestive heart failure. Although the pathogenesis is unknown, it is believed that hydralazine alters neutrophil and lymphocyte function and promotes exposure of antigens, leading to the development of anti-neutrophil antibodies (ANCA)…
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…
Scleroderma renal crisis is a true medical emergency in rheumatology, one that requires prompt diagnosis and treatment. Here, we review the historic introduction of the angiotensin-converting enzyme inhibitors in this context, and highlight management and key questions moving forward. Background Awareness of renal disease in scleroderma dates back many years. The revered physician William Osler…
Our patient was a 33-year-old, 5’2″ Asian woman with a past medical history of systemic lupus erythematosus (SLE). The diagnosis was based on serologies positive for anti-nuclear antibodies (ANAs), as well as antibodies to Sm, RNP and SSA. Her illness included neuropsychiatric and cutaneous involvement. She also had a diagnosis of Hashimoto’s thyroiditis. She presented…
Tumor necrosis factor-α inhibitors (TNFi’s) have emerged as an integral part of therapeutic strategies for several rheumatic diseases. TNF-α is a pro-inflammatory cytokine implicated in the pathogenesis of rheumatoid arthritis (RA), seronegative spondyloarthropathies and inflammatory bowel disease (IBD). It also plays a central role in the immune response to mycobacterial infection. Many biologic agents, particularly…
A recent pilot study explores the feasibility of virtual reality-based pain interventions for people with rheumatic conditions.1 Although the work is in its early stages, it may someday represent a new non-pharmacological tool for patients with chronic pain. VR for Treatment R. Swamy Venuturupalli, MD, FACR, is an associate clinical professor of medicine at the…
As a new year begins, Government Affairs Committee Chair Blair Solow, MD, takes stock of ACR advocacy wins in 2020 and issues to watch in 2021, including workforce issues, continued telemedicine access, prior authorization relief, Medicare reimbursement and drug pricing.