ASH is the largest organization of hypertension researchers and health care providers in the United States committed to preventing and treating hypertension and its consequences. The editors of ConsultantLive bring you updates from the 2013 ASH conference in San Francisco, CA. Read More
Prominent, pigmented polyangular scales on the extensor surfaces of the arms, legs, and trunk suggested recessive X-linked ichthyosis. More in this article.Read More
More than 1300 physicians of all specialties responded to the 2012 survey. Many of the respondents are primary care physicians. See how your colleagues responded and learn what concerns them most.Read more
New in the nonspecialty journals: A new option for patients with autoimmune disease and HCV infection. The value of combined therapy for osteoporosis. Prognosis predictors for chronic pain, a new opioid adverse effect, and more ... More »
The past decade has seen remarkable advances in our understanding of rheumatoid arthritis. However, challenges remain. Resolving them offers hope for even greater success in the future. More »
Is it a form of lupus, myositis, or a drug reaction? Check your knowledge of skin eruptions and the associated rheumatologic conditions in this brief photo essay. More »
The FDA has approved the tumor necrosis factor (TNF) blocker golimumab (Simponi) for treatment of moderate to severe ulcerative colitis in adults. This is the first non-arthritis indication for the biologic, which is already approved for rheumatoid arthritis, psoriatic arthritis, and ankylosing... More »
They may be supported by guidelines and commonly used in practice, but joint injections with glucocorticoids for acute gout are not backed by any randomized controlled clinical trials, according to a new Cochrane report. However, the report backs away from saying they should not be used. More »
In a comprehensive review of clinical trials, combination therapies with biologics offered better chances of long-term remission than monotherapy with a DMARD. More »
New in the non-rheumatology journals: Adverse effects of TNF-α inhibitors, a comment on meniscectomy vs. physical therapy, and the latest on adolescent scoliosis. More »
Quest Diagnostics says the biomarker 14-3-3eta in its new test greatly improves sensitivity in detecting early rheumatoid arthritis. But the data is not yet published. More »
New research has examined 3D motion and muscle activity in knee osteoarthritis, and correlated gait with pain. Result: a better description of knees destined for replacement. More »
Synovitis is present in 90% of painful knees, and emerging data is showing that this inflammation is "not just a bystander" in osteoarthritis-induced damage. Research is revealing the roles of macrophages and T-cells, and signposts toward new drug targets. More »
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To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA).
Methods
The task force comprised an expert group of rheumatologists, radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus. Imaging modalities included were conventional radiog
Anticitrullinated protein antibodies (ACPA) are a major risk factor for bone loss in rheumatoid arthritis (RA). We have recently shown that ACPA directly induce bone loss by stimulating osteoclast differentiation. As ACPA precede the clinical onset of RA by years, we hypothesised that ACPA positive healthy individuals may already show skeletal changes.
Methods
We performed a comparative micro-CT analysis of the bone microstructure in the metacarpophalange
To identify predictors of sick leave and disability pension in patients with early rheumatoid arthritis (RA).
Methods
Individuals aged 19–59 years diagnosed with early RA (≤12 months symptom duration) were identified in the Swedish Rheumatology Quality Register (1999–2007; n=3029). We retrieved days of sick leave and disability pension from the Swedish Social Insurance Agency and baseline predictors of total work days lost during
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathology of Rheumatoid Arthritis (RA), particularly as vulnerable personality types are exposed to chronic stress. Emotions are powerful modulators of stress responses. However, little is known about whether patients with RA process emotions differently to matched controls. In this study we: 1) assessed whether the trait emotional intelligence (trait EI) scores of patients with RA differ from healthy controls at the
Because of the changing dietary habits of an aging population, hyperuricemia is frequently found in combination with other metabolic disorders. Longstanding elevation of the serum uric acid level can lead to the deposition of monosodium urate crystals, causing gout (arthritis, urate nephropathy, tophi). In Germany, the prevalence of gouty arthritis is estimated at 1.4%, higher than that of rheumatoid arthritis. There are no German guidelines to date for the treatment of gout. Its current treatment is based largely on expert opinion.|Selective literature review on the diagnosis and treatment of gout.|Asymptomatic hyperuricemia is generally not an indication for pharmacological intervention to lower the uric acid level. When gout is clinically manifest, however, acute treatment of gouty arthritis should be followed by determination of the cause of hyperuricemia, and long-term treatment to lower the uric acid level is usually necessary. The goal of treatment is to diminish the body's
Nitric oxide (NO), which is produced from L-arginine by the nitric oxide synthase (NOS) family of enzymes, is an important second-messenger molecule that regulates several physiological functions. In endothelial cells, it relaxes smooth muscle, which decreases blood pressure. Macrophage cells produce NO as an immune defense system to destroy pathogens and microorganisms. In neuronal cells, NO controls the release of neurotransmitters and is involved in synaptogenesis, synaptic plasticity, memory function, and neuroendocrine secretion. NO is a free radical that is commonly thought to contribute to oxidative damage and molecule and tissue destruction, and thus it is somewhat surprising that it has so many significant beneficial physiological effects. However, the cell is generally protected from NO's toxic effects, except under certain pathological conditions in which excessive NO is produced. In that case, tissue damage and oxidative stress can result, leading to a wide variety of
Calcium pyrophosphate dihydrate and basic calcium phosphate crystals are the two most common calcium-containing crystals involved in rheumatic diseases. Recent literature concerning their role in the pathogenesis of osteoarthritis is reviewed.|In some instances, these calcium crystals might worsen osteoarthritis cartilage destruction. Laboratory investigations have identified determinants of cartilage calcification, especially a better characterization of matrix vesicle content and a better understanding of the regulation of inorganic pyrophosphate and phosphate concentration. In-vitro studies have highlighted new pathogenic mechanisms of calcium crystal-induced cell activation. Several intracellular signalling pathways are activated by calcium crystals. Recent studies suggested the implication of the inflammasome complex and a pivotal role for IL-1 in pseudogout attacks and chondrocyte apoptosis in basic calcium phosphate crystal-related arthropathies.|Animal models of osteoarthritis
Rheumatoid arthritis (RA) causes pain and serious functional impacts and substantially affects patients' daily lives, including their ability to work.|This review examines recent studies of patients with RA treated with TNF antagonists and the impacts these therapies have on the workplace.|A total of 133 articles and 14 poster abstracts were reviewed that matched specific criteria.|The results of early studies of TNF antagonists varied regarding their effects on patients with RA in the workplace. However, recent studies of adalimumab showed positive impacts across a range of workplace burdens. Treatments such as adalimumab may help employees with RA to remain in the workforce and lead to reduced workplace costs to the employers and employees.
In recent years, pharmaceutical companies have increasingly focused on phosphoinositide 3-kinases delta (PI3Kdelta) and gamma (PI3Kgamma) as therapeutic targets for the treatment of inflammatory and autoimmune diseases. All class 1 PI3-kinases (alpha/beta/gamma/delta) generate phospholipid second messengers that help govern cellular processes such as migration, proliferation, and apoptosis. PI3K delta/ gamma lipid kinases are mainly restricted to the hematopoetic system whereas PI3K alpha/beta are ubiquitously expressed, thus raising potential toxicity concerns for chronic indications such as asthma and rheumatoid arthritis. Therefore, the challenge in developing a small molecule inhibitor of PI3K is to define and attain the appropriate isoform selectivity profile. Significant advances in the design of such compounds have been achieved by utilizing x-ray crystal structures of various inhibitors bound to PI3Kgamma in conjunction with pharmacophore modeling and high-throughput screening.
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
