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Low-Dose Methotrexate Can Cause Adverse Effects

Will Boggs, MD  |  

NEW YORK (Reuters Health)—Low-dose methotrexate can be associated with gastrointestinal, pulmonary, infectious, hematologic and other adverse effects, according to an analysis of the Cardiovascular Inflammation Reduction Trial (CIRT). “Methotrexate is not a benign drug, even at dosages used for rheumatic diseases,” Daniel H. Solomon, MD, MPH of Brigham and Women’s Hospital, Boston, tells Reuters Health…

Sodium-Glucose Cotransporter-2 Inhibitors May Decrease Gout Risk in Some Patients

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Recent research assessed the risk of gout in patients with type 2 diabetes mellitus prescribed sodium-glucose cotransporter-2 (SGLT2) inhibitors compared with those prescribed a glucagon-like peptide-1 (GLP-1) agonist. The study found patients on the SGLT2 inhibitor had a lower rate of gout, suggesting SGLT2 inhibitors may actually reduce the risk of gout among this patient population…

New Draft Gout Guideline Released

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ATLANTA—The authors of the new draft ACR treatment guideline for the management of gout presented the draft guideline on Nov. 13 at the 2019 ACR/ARP Annual Meeting. Based on evidence from more than 130 published studies, there are 42 recommendations, of which 16 were strong, including 27 for urate-lowering therapy (ULT) management, 13 of which…

Case Report: Tumor Treatment Unleashes Autoimmunity

Shuwei Wang, MD, Gulam A. Manji, MD, PhD, & Anca D. Askanase, MD  |  

Immune checkpoint inhibitors (ICIs) targeting the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) or programmed cell death protein 1 (PD-1) axes have revolutionized therapy and improved survival in advanced cancers. However, these immune system modulators also lead to immune-related adverse events (IRAEs).1,2 In clinical trials, IRAEs mainly involved the gastrointestinal tract, skin, endocrine glands, liver and lung,…

A CT of the abdomen demonstrated numerous hypodense lesions present in both lobes of the liver, with the largest lesion measuring 2.0 x 3.1 cm.

Case Report: A Patient with Gout Develops Granulomatous Hepatitis

Raj Vachhani, MD, & Angelo L. Gaffo, MD, MSPH  |  

Case Presentation A 45-year-old man with crystal-proven gout, poorly controlled diabetes and chronic kidney disease was lost to follow-up for six years and presented back to the VA clinic in the midst of a gout flare. He stated he had continued taking 100 mg of allopurinol daily, but his serum urate level was 13.8 mg/dL….

Case Report: Cardiac Tamponade in a Rheumatoid Arthritis Patient

Case Report: Cardiac Tamponade in a Rheumatoid Arthritis Patient

Sirajum Munira, MD, Mamta Sherchan, MD, & Christopher Collins, MD, FACR  |  

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease. Although RA develops its central pathology within the synovium of diarthrodial joints, many non-articular organs can be involved, particularly in patients with severe joint disease.1 Although most patients are asymptomatic, cardiac involvement is relatively common and includes rheumatic heart nodules, pericarditis (30–50%), pericardial effusion and…