Apremilast was first marketed in March 2014 for the treatment of adults with psoriatic arthritis (PsA). An immunoÂmodulating drug, which is a small molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monoÂphosphate (cAMP), apremilast is administered orally. By inhibiting PDE4, intracellular cAMP levels are increased. Although the exact mechanism of action is not…
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…
Hepatitis B virus (HBV) associated polyarteritis nodosa (PAN) is an increasingly rare vasculitis in developed countries due to advances in HBV vaccination and antiviral therapy. However, the condition does persist, and rheumatologists should consider it when evaluating vasculitis cases. Below, we discuss a case that illustrates the varied clinical presentations PAN can encompass. A high…
A 54-year-old African American man arrived at the emergency department with the acute onset of a tender mass on the left side of his neck. It had been getting progressively larger for the preceding two days. History & Examination His history included chronic right hip osteoarthritis with two surgeries performed five years prior. At his…
Systemic sclerosis (SSc) is a multi-system connective tissue disease in which skin and internal organ fibrosis are associated with an obliterative micro-vasculopathy and a degree of inflammation.1 Patients often report it takes one to three years from the appearance of the first signs and symptoms before they receive a diagnosis. The signs and symptoms of…
Recurrent cutaneous eosinophilic vasculitis (RCEV) is a rare autoimmune condition characterized histologically by necrotizing small vessel vasculitis of the skin and almost exclusive eosinophilic infiltration without any systemic involvement.1 Frequently, there is associated peripheral eosinophilia, and a prolonged course of glucocorticoids is required for treatment. To date, only a few RCEV cases have been reported….
Idiopathic inflammatory myopathies are heterogenous, acquired immune-mediated muscle diseases. Over the past decade, immune-mediated necrotizing myopathy has been recognized as a subcategory of idiopathic inflammatory myopathy characterized by myofiber necrosis in the absence of prominent inflammatory cells.1 Autoantibodies against signal recognition particle (SRP) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are thought to be associated with the…
CHICAGO—In the Thieves Market session at the 2018 ACR/ARHP Annual Meeting, rheumatologists from around the country presented a slate of challenging cases that emphasized the importance of clinical persistence and attention to detail, and the need to consider diagnoses that might not be common or obvious. Three of them are summarized below. (Look for more…
Since it was first reported in 1916, a correlation between inflammatory myopathies and cancer has been noted in several studies. Population studies have confirmed this relationship, and the phrase cancer-associated myopathy has entered the vernacular. Over the past decade, research efforts have shifted toward revealing associations between autoantibodies and clinical phenotypes. One subset of auto-antigens…
What does a new patient experience as symptoms develop and diagnosis is confirmed? The ARP Practice Committee is developing persona-based case studies to help answer this and other questions. The latest topic is juvenile idiopathic arthritis…