Background/Purpose Polymyalgia rheumatica (PMR) treatment is primarily based on long-term corticosteroids, which results in significant toxicities. Studies have shown that patients with PMR are exposed to years of corticosteroid treatment.1,2 In a single academic center cohort, we found that 76% of patients remained on steroids at the end of two years.3 In a second cohort…
SAN DIEGO—In a study titled Real-Life Use of the PEXIVAS Reduced-dose Glucocorticoid Regimen in Granulomatosis with Polyangiitis and Microscopic Polyangiitis, Nagle et al. evaluated the efficacy and safety of the reduced-dose glucocorticoid regimen in a real-world setting. Background/Purpose Glucocorticoids (GCs) in combination with rituximab (RTX) or cyclophosphamide are the cornerstone of treatment for patients with…
As rheumatologists, we have a love-hate relationship with the corticosteroid prednisone, a feeling many of our patients share. It’s our most effective medication to quickly shut down an overactive immune system. When we have a patient with life- or organ-threatening autoimmune disease—severe lupus affecting the kidneys or vasculitis causing hemorrhage in the lungs, for example—large…
Relapsing polychondritis (RPC) is a systemic and, in some cases, fatal disease. Dyspnea with findings of small airway disease—even in the absence of the more commonly associated tracheobronchial abnormalities or pathognomonic clinical findings, such as saddle nose and cauliflower ear—may be presenting signs and symptoms of relapsing polychondritis. Below, we present a case demonstrating that…
BALTIMORE—Rheumatologists may not think about osteoporosis on a daily basis, but they should, said Dr. Karl Insogna, the Ensign Professor of Medicine at Yale University School of Medicine and director of the Yale Bone Center in New Haven, Conn., in his recent lecture at the Maryland Society for the Rheumatic Diseases. With approximately 75 million…
A recent study found that dermatology patients taking long-term steroids are not always evaluated for steroid-induced osteoporosis…
Treatment with oral methylprednisolone may be associated with an increased risk of serious adverse events, specifically infection, in patients with IgA nephropathy. Despite the five-times higher risk, study results also showed a three-times lower risk of kidney failure for the treatment group…
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…
Depending on stage, severity and rate of progression of disease, systemic corticosteroids are commonly used to treat pulmonary sarcoidosis. However, a review of the literature suggests they have limited usefulness in advanced stage IV pulmonary sarcoidosis. Once sarcoidosis has advanced to this degree, steroid use may unnecessarily expose a patient to life-threatening complications, as demonstrated…
When I started my rheumatology practice 40 years ago, it quickly became apparent that many referrals of presumed polymyalgia rheumatica (PMR) patients and presumed giant cell arteritis (GCA) patients were the recipients of devastating side effects from long-term corticosteroid (CS) use that could not be discontinued due to prompt recurrence of inflammatory phenomena. It was…