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…
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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…
Weakness, Fatigue Can Signal Underlying Rheumatologic Disease
As clinicians, we are familiar with pain, stiffness and soreness—subjective nouns that define our métier. These helpful words serve as signposts that direct us along the path to the proper diagnosis. Consider the young man with a stiff, sore back (a case of ankylosing spondylitis?) or the postpartum woman experiencing newly painful, stiff and sore…
fMRI Can Help Diagnose Fibromyalgia
Brain imaging can distinguish fibromyalgia patients from healthy controls with high sensitivity and specificity, according to two papers published nearly simultaneously in Pain late last summer, by groups at the Universities of Colorado and Michigan, respectively. Somewhat surprisingly to the authors and others, in the Colorado study, which used both painful and nonpainful stimuli, the…
Diagnosed by Artificial Intelligence?
“To err is human.” —Alexander Pope (1688–1744) The Wisest Minds in Medicine At some point during our careers, we have the privilege of meeting a physician so talented that everyone else pales in comparison. These are those gifted clinicians whose astonishing mastery of medicine makes everyone in their midst feel like inept, babbling fools. They…
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