CHICAGO—Amid what she called a “dizzying array of choices” for rheumatoid arthritis (RA)—from anti-TNF and anti-IL6-receptor therapies to B cell depletion to new biosimilar options—disease treatment should still revolve around several basic concepts, an expert said at the ACR State-of-the-Art Clinical Symposium in April. Joan Bathon, MD, chief of rheumatology at Columbia University in New…
CHICAGO—About 30 years ago, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) began to outpace renal crisis as the main causes of death in scleroderma (SSc). But treating these lung complications has proved vexing for clinicians. There is no easy way to predict who will develop PAH. There is no telltale antibody and no…
CHICAGO—When a patient with rheumatic disease suffers recurrent infections, has a history of multiple autoimmune diseases or presents with atypical autoimmune syndromes, clinicians should consider the possibility of an immune deficiency, an expert said at the ACR State-of-the-Art Clinical Symposium in April. W. Winn Chatham, MD, professor of medicine at the University of Alabama at…
Many rheumatology patients have complex conditions and require the added expertise of colleagues in other fields, such as pulmonology, neurology or dermatology. This is even more true when patients with complex care issues are referred to academic medical centers. At such centers, patients often travel hours for an appointment and see more than one provider….
A yearlong pilot study that evaluated the safety and efficacy of belimumab in a small group of patients with early diffuse systemic sclerosis found no significant difference in the number of adverse events between those treated with the drug and those who received a placebo. Currently, no drugs are approved specifically for the treatment of…
Patients with scleroderma, systemic sclerosis (SSc), myositis and rheumatoid arthritis (RA) may develop interstitial lung disease (ILD), which affects a patient’s breathing and quality of life. Prospective studies have revealed that in patients with SSc a greater rate of decline of forced vital capacity (FVC) is associated with increased mortality. Although corticosteroids are commonly used…
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…
Despite our best efforts and modern interventions, we still have patients in the intensive care unit with organ failure. Although renal failure can be mitigated by dialysis, patients with cardiac or respiratory failure secondary to active autoimmune disease raise difficult clinical and ethical issues. Two recent cases, both with organ failure, led us to examine…
SAN DIEGO—In Hot Topics in Myositis, a session held Nov. 7 at the 2017 ACR/ARHP Annual Meeting, rheumatologists discussed treating myositis patients in three different clinical scenarios: persistently elevated creatine kinase (CK), immune-mediated necrotizing myopathies and lung disease. Elevated CK Patients with persistently elevated levels of CK enzyme and normal muscle strength “may still have…
4 Patients in 4 Weeks Baltimore is a little over two hours away from Richmond, Va., by car. I know this now because I recently drove to Richmond to attend a memorial service. I drove in silence. Music made me sleepy, and I could not bear to listen to another iteration of how we are…