A new guideline developed by the ACR and the American Association of Hip and Knee Surgeons addresses the perioperative use of antirheumatic drug therapy. Specifically, it provides recommendations on the use of traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib and glucocorticoids in adults with RA; SpA, including ankylosing spondylitis and psoriatic arthritis; JIA; or SLE undergoing elective THA or TKA. The guideline provides recommendations regarding when to continue, when to withhold and when to restart these medications, and the optimal perioperative dosing of glucocorticoids…
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How Global Geographic Disparities Affect Healthcare Outcomes
Your home & your health: Does geography impact medicine? Does it matter whether a region is surrounded by large bodies of water, encircled by towering mountain peaks or that its residents share a common ancestry? Consider Switzerland, a nation with a highly developed economy replete with advanced technological and medical infrastructure. Despite these advantages, less…

A Stiff Man: A Case Study in Ankylosing Spondylitis
First Appearances I watched the old man, his back painfully bent, shuffle toward the scale. A blocky rigidity draped over him. His feet seemed stuck to the floor. His head hung heavily over his chest. Observing him from the end of the hallway, instead of a face, I saw only a mound of shaggy, matted…

Adenosine Treatment Promotes Cartilage Homeostasis
A recent study in mice examined the role of adenosine A2A receptors in joint health. Researchers specifically found that as extracellular levels of adenosine fall, individuals may become at risk for osteoarthritis…

Rheumatologists Treating Patients with HIV Face Treatment, Diagnostic Challenges
Rheumatologists treating HIV patients in 2017 must think through many important factors as this population ages. As we continue to learn, rheumatologists must consider important drug–drug interactions, relatively uncommon rheumatological presentations of HIV, as well as specific diagnostic challenges. Working closely with infectious disease specialists is the best way to achieve optimum care for this…

Rheumatologist Dr. Sandra Pagnussat Recalls Journey from Patient to Physician
When she was in elementary school, Sandra Pagnussat, MD, began experiencing unrelenting pain and stiffness, first in her pinky and then in her other fingers. Her pediatrician diagnosed her with polyarticular juvenile idiopathic arthritis (JIA). In high school, Sandra decided to pursue a career in medicine and began taking advanced placement classes in biology and chemistry….

The Immune Checkpoint Inhibitors Unleashed to Fight Cancer
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…

Rheumatology Case Report: Immune-Related Aortitis Associated with Ipilimumab
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…

Strategies for Successful Joint Replacement Surgery
Collaboration among all providers—surgeon, rheumatologist, physical therapist, etc.—is essential for patients with a rheumatic disease who are about to undergo total joint arthroplasty to reach their goals, including reduced pain and improved mobility…
Lifetime Risk of Hand Arthritis May Be More Than 40%
(Reuters Health)—A new study finds that as many as four in 10 people may develop hand osteoarthritis. Among women, researchers found the lifetime risk was 47% while for men it was about 25%. Obese people also had 11% higher lifetime risk than those who were not obese. Hand osteoarthritis can cause disability and problems with…
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