During the peak of the coronavirus pandemic in Washington, D.C., we were asked to evaluate a 14-year-old boy admitted to the pediatric hospitalist service. He had been healthy until two weeks before, when he noted a sore throat, and soon after he developed fevers and rashes without congestion, shortness of breath, conjunctivitis or swollen lymph…
On Dec. 27, 2017, RaDonda Vaught killed Charlene Murphey, allegedly. Ms. Murphey was a lifelong resident of Gallatin, a suburb of Nashville, Tenn. She was well known from having worked at the local Walmart for 24 years, before she retired in 2012, when she was 65 years old.1 On Dec. 24, 2017, she was helping…
After months of hard work—and with insightful input from many ACR/ARP members, staff, committees and the Board of Directors—we are pleased to introduce the ACR’s 2022–27 strategic plan. This plan sets the stage for our numerous activities in the next few years and cultivates innovational approaches to support our diverse membership. This new plan will…
Two new ACR Clinical Practice Guidelines provide recommendations on the pharmacologic management of JIA, focusing on treatment of oligoarthritis, temporomandibular arthritis & systemic JIA, as well as nonpharmacologic therapies, medication monitoring, immunizations & imaging.
Erosive Polyarticular Chronic Tophaceous Gout in a Young Man A 27-year-old man was referred to us for joint pain and nodular swelling over multiple joints. His symptoms started when he was 13 years old, but he was sub-optimally treated. On examination, we found marked digital deformity, with multiple large tophi over the small joints of…
Lee et al. examined the use of a smartphone application to monitor longitudinal electronic patient-reported outcomes on satisfaction and disease activity in patients with RA.
Lupus & Perinatal Outcomes Adverse perinatal outcomes before & after diagnosis with systemic lupus erythematosus among African American Women By Meghan Angley, PhD, & S. Sam Lim, MD Why was this study done? Previous studies have suggested that women with systemic lupus erythematosus (SLE) may experience adverse perinatal outcomes, including preterm and small-for-gestational-age birth, in…
In certain ethnic populations and geographic locations, being a genetic carrier of sickle cell trait is common. Despite its prevalence, a recent report studied 100 mothers who were informed their newborn child had tested positive for sickle cell trait, and of these mothers less than half were aware of their carrier status prior to conception.1…
Cannabis arteritis mirrors thromboangiitis obliterans in its clinical and arteriographic presentation, but its relevant exposure is cannabis rather than tobacco.1 Whether cannabis arteritis is a subset of thromboangiitis obliterans or a unique pathologic entity is debatable. Delta-9-tetrahydrocannabinol, the primary psychoactive component of cannabis, is a peripheral vasoconstrictor.2 This offers mechanistic insight into how cannabis may…
Lipoma arborescens is a rare, benign intra-articular lesion characterized by diffuse replacement of synovial tissue by mature adipocytes, causing a villous lipomatous proliferation of the synovial membrane.1 Typically, this is a monoarticular condition, with the knee being the most commonly affected although it has been rarely reported to occur in an oligo-/polyarticular fashion and in…
The COVID-19 pandemic has filled hospitals with patients with rapidly progressive respiratory failure and diffuse bilateral opacities on chest X-ray.1 Additionally, many patients with severe COVID-19 develop acute kidney injury and require dialysis.2 Pulmonary-renal syndromes are also important to consider in this setting. Although alveolar hemorrhage is a cardinal feature of this syndrome, many patients…
The research presented at ACR Convergence 2021 had a broad scope. Below are details on three studies that addressed cardiovascular safety in treat-to-target strategies, phase 2 study results on the efficacy of tigulixostat and the impact of patient preference on treatment adherence. Take our quiz after you read this article. Treat to Target Abstract L06:…
In March A&R, Remaeus et al. reported on the results of their study, which evaluated pregnancy outcomes in relation to anti-rheumatic treatment before and during pregnancy, as a proxy of disease severity in pregnant women with psoriatic arthritis (PsA), compared with those without PsA.
At the 17th Annual Advances in the Diagnosis and Treatment of the Rheumatic Diseases meeting, Ana-Maria Orbai, MD, MHS, discussed lessons learned from the cases of several patients with psoriatic arthritis.
When it comes to systemic lupus erythematosus (SLE) and cardiovascular events (CVEs), the rheumatology community is woefully lacking in information, say researchers from the University of California, Los Angeles (UCLA) David Geffen School of Medicine and Cedars-Sinai Medical Center. Their recent work on biomarkers associated with an increased risk for cardiovascular events in women with…
A clinical conundrum that rheumatologists often face is making a diagnostic or therapeutic decision in the absence of evidence-based data to guide clinical decision making. MedNet is a digital community of physicians created to improve knowledge sharing among physicians and help ensure patients get the highest quality care. The goal of the platform, according to…
Advisors of the American Medical Association (AMA) Current Procedural Terminology (CPT) and Relative Value Update (RUC) Committees play a crucial role in the code creation and valuation process. These positions allow the ACR to have a significant voice in influencing changes and ensuring rheumatology services are effectively represented.
Since starting the ACR on Air podcast in 2019, Mohammad Ursani, MD, FACP, RhMSUS, has become chair of the Committee on Communications and Marketing. Here, he shares some plans for the ACR website, podcast and more.
When it comes to experiencing burnout, time spent in an electronic health records (EHR) system appears to be only a minor contributing factor. Although clinicians and other healthcare professionals may log many hours at the keyboard putting information into the EHR, other factors likely play a bigger role in the workplace exhaustion and feelings of…
The growing rheumatologist workforce shortage has loomed over the profession, threatening to undercut the delivery of care to the increasing number of patients with rheumatic conditions. “The workforce shortage is an existential threat to the field of rheumatology and to the care we deliver to our patients,” says ACR President Kenneth Saag, MD, who lauded…
Rheumatologists who are outstanding clinicians, providing consistently exceptional care to patients and serving as role models for colleagues and trainees, are highlighted in our Lessons from a Master Clinician series. Here, we offer insights from clinicians who have achieved a level of distinction in the field of rheumatology. Jonathan Kay, MD, is professor of medicine,…
Neutrophil extracellular traps (NETs) contribute to the pathogenesis of multiple autoimmune diseases. And research has shown that patients with antiphospholipid syndrome (APS) have higher levels of circulating anti-NET antibodies than healthy controls, indicating a potential biomarker.
Research has identified and described a pro-inflammatory cytokine network shared by four rheumatic conditions that may be particularly active in patients with severe disease.
CD19 chimeric antigen receptor T (CAR-T) cell therapies may have the potential to treat rheumatic diseases in which current therapeutic options are limited, such as lupus, interstitial lung disease and systemic sclerosis.
According to research, Pim kinases contribute to the pathogenesis of rheumatoid arthritis (RA) and may have the therapeutic potential for inhibition in patients with RA.
Daily living, such as walking, jumping and going up stairs, can be difficult for patients with osteoarthritis (OA). Research on the regenerative limbs of the axolotl and the human ankle provides insights into the potential of this process in humans and its implications for hip, knee and ankle OA.
Spondyloarthropathy is an ancient form of arthritis shared by multiple orders and classes of the animal kingdom. Camarasaurus, a genus of quadrupedal, herbivorous dinosaur, holds the record for the earliest known case of spondyloarthropathy—147 million years ago.
Editor’s note: RheumMadness is the place for everyone crazy about rheumatology to connect, collaborate, compete and learn together. During RheumMadness, rheumatology concepts represent teams that compete against each other in a tournament, much like basketball teams do in the NCAA’s March Madness tournament. In a series for The Rheumatologist, readers will get a chance to…
Dalmatians have defects in the renal tubular reabsorption of filtered urate and the hepatic conversion of uric acid to allantoin that may provide unique insights into uric acid homeostasis, with implications for the treatment and management of gout.
Machine learning is a tool that may help pediatric rheumatologists distinguish between different subtypes of juvenile idiopathic arthritis (JIA) and predict treatment response.
As the capabilities of machine learning and artificial intelligence improve, rheumatologists have access to more data than ever, which may enable them to better predict which patients will respond to specific treatments, such as tumor necrosis factor inhibitors.
Research has found dual-energy computed tomography (DECT) may be a non-invasive and cost-effective option to help rheumatologists more accurately diagnose gout.
With both impressive sensitivity and specificity in capturing active large vessel vasculitis, a positron emission tomography (PET) scan is a potential tool for determining disease activity and predicting relapse in patients with large vessel vasculitis.
Rheumatologists play a critical role in the reproductive health of their patients, but only half of rheumatologists currently ask their patients about reproductive health or family planning issues. A new guideline seeks to change that.
A study was able to quantify the transference of tumor necrosis factor (TNF) inhibitors from mother to fetus during pregnancy. Overall, the researchers found low levels of transfer for the treatments studied.
Research has revealed how the prevalence of anti-nuclear antibody (ANA) positivity has changed over the past 25 years, raising questions about the role of ANA in autoimmunity and disease.
Spondyloarthropathy (SpA) can be difficult to diagnose, with rheumatologists sometimes relying on classification criteria designed for clinical trials. Research examines how the use of MRIs affects the finding of bone marrow edema and the diagnosis of axial SpA.
In February A&R, Penso et al. reported on the results of their study, which explored whether patients with psoriasis, PsA and AS have a higher risk of developing IBD when treated with an IL-17 inhibitor compared with apremilast, a phosphodiesterase 4 (PDE4) inhibitor, or etanercept, a TNF inhibitor.
Scenario: A patient with rheumatoid arthritis (RA) presents for a follow-up visit. After addressing her inflammatory arthritis symptoms, medications and laboratory results, she is asked if she has any other questions, and she begins describing her chronic low back pain, which has become worse despite physical therapy (PT). She requests stronger medications because her RA…
A practicing rheumatologist for 20 years, Umbreen Hasan, MD, FACP, MBA, Coon Rapids, Minn., knows how challenging it can be to work through pain. Over the years, she has helped many patients learn how to manage chronic pain so they can continue to pursue the activities they love. Five years ago, after suffering a severe…
Two recent trials demonstrated the safety and efficacy of risankizumab-rzaa for the treatment of adults with active psoriatic arthritis.
Secher et al. evaluated the risk of pre-eclampsia in pregnant patients with RA, axSpA or PsA, assessing the effect of disease activity and disease-modifying anti-rheumatic drugs on this risk.