Serum uric acid (UA) is an important factor in the causal pathway for gout. It has also been implicated as a potential risk factor and/or mediator of cardiovascular disease outcomes and mortality in a large number of observational studies. Although many of the clinical trials targeting serum UA reduction have focused on pharmacologic interventions, diet…
Shingles Vaccination Not at Goal Levels for U.S. Seniors
(Reuters Health)—Just one in five people over age 60 in the U.S. have been vaccinated against a painful eruption of herpes zoster (shingles), despite recommendations that all of them should get the shot. It’s estimated that among people over age 50, one in three will eventually develop shingles. After age 80, half of adults have…
Varicella Zoster Virus Downregulates Programmed Death & Promotes Inflammation
A recent study found that the varicella zoster virus downregulates expression of programmed death ligand 1 and major histocompatibility complex 1 in brain fibroblasts, perineurial cells and lung fibroblasts. These effects may lead to persistent inflammation in the vessels and lungs, as well as promote subsequent infection of T cells and the spread of the virus…
Patients with Parkinson’s Disease Are at Risk for Carpal Tunnel Syndrome
Patients with Parkinson’s disease may be at risk of carpal tunnel syndrome (CTS). New research examined why patients with Parkinson’s have a higher incidence of CTS than that of the general population. The study found that those patients who underwent subthalamic nucleus deep brain stimulation to monitor them for neuropathy may develop CTS…
Myocardial Inflammation Elevated in Active RA, Eases with DMARD Therapy
NEW YORK (Reuters Health)—Patients with active rheumatoid arthritis (RA) and no known heart disease may have subclinical myocardial inflammation, which improves with disease-modifying therapy, new research shows. “We know that patients with RA have higher risk of cardiovascular events, including heart failure and we really don’t know why. Maybe myocardial inflammation is one of the…
Revised Retinopathy Screening Guidelines State Risks Linked to Hydroxychloroquine, Chloroquine
A large medical specialty society for ophthalmologists recently updated its recommendations for the screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy.1 The recommendations from the American Academy of Ophthalmology (AAO) affect patients who may use CQ or HCQ for rheumatoid arthritis or systemic lupus erythematosus (SLE), as well as some inflammatory and dermatologic conditions. The…
2015 Treatment Recommendation Updates for Psoriatic Arthritis Address Comorbidities, New Medications
In May, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published its recommendations for the treatment of psoriatic arthritis (PsA).1 The updated recommendations represent advances in drug development and availability since previous recommendations published in 2009, as well changes in treatment paradigms and the importance of associated aspects of the disease.2…
Systemic Corticosteroid Usage in Stage 4 Pulmonary Sarcoidosis Could Offer Little Benefit, Pose Significant Health Risk
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…
Ocular Disease Monitoring Critical to Avoid Retinal Toxicity from Hydroxychloroquine
Both due to its efficacy and favorable side effect profile when compared with alternative drugs for rheumatologic conditions, hydroxychloroquine is an important agent in rheumatologists’ armamentarium. However, one barrier to hydroxychloroquine use can be its effects on the eye (also see “Revised Retinopathy Screening Guidelines,”). Ocular side effects of hydroxychloroquine can include impact on the…
Fellow’s Forum Case Report: Waldenström Macroglobulinemia
A 73-year-old white male presented with a one-day history of a cold, painful, right foot. The foot had a blue discoloration to it, particularly the toes. The emergency physician suspected an atheroembolic cause, given this patient’s age and history of coronary artery disease. However, the patient also reported a one-year history of painful pallor in…
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