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PAD4 Antibodies May Help Predict Treatment Response in Rheumatoid Arthritis

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A study published in Arthritis & Rheumatology highlights how the presence of autoantibodies to peptidylarginine deiminase (PAD) may eventually be used to influence treatment decisions in the management of rheumatoid arthritis (RA), sharpening our understanding of disease subtypes.1 Although follow-up prospective studies are needed, these findings underline some intriguing areas for future investigations in immunobiology….

Figures 1 & 2: Transverse and longitudinal ultrasound views, respectively, of the left posterior knee, revealing a cystic mass with heterogeneous internal echotexture and no stalk.

Ultrasound Aids Diagnosis of Man with Knee Pain & Swelling

Mark H. Greenberg, MD, RMSK, RhMSUS, Prem Patel, Elijah Mitcham, MD, James W. Fant Jr., MD, & Frank R. Voss, MD  |  

A 56-year-old automobile mechanic was referred to our rheumatology service by his orthopedist to evaluate left posterior knee pain and swelling that had been present for three months. The patient had undergone bilateral total knee arthroplasties (TKAs) for sports-related osteo­arthritis three years before. In addition to the knee pain, the patient described several years of…

Dual-Energy CT May Help Detect Gout Patients at Risk for Heart Disease

Marilynn Larkin  |  

NEW YORK (Reuters Health)—Dual energy computed tomography (DECT) can differentiate cardiovascular monosodium urate (MSU) deposits from calcium deposits in patients with gout, potentially identifying those at risk of heart disease, researchers say. Sylvia Strobl, MD, of Medical University Innsbruck and colleagues analyzed calcium scores and MSU deposits in 59 patients with gout (mean age: 59;…

Case Report: Not All Crystals Are Gout

Katherine Yates, MD, Erin H. Penn, MD, & Minna J. Kohler, MD   |  

Patients with chronic kidney disease (CKD) often experience joint pain due to various etiologies, including crystalline arthropathies, renal osteodystrophy, amyloid arthropathy, erosive osteoarthritis, avascular necrosis and even erosive spondylarthrosis.1 Below, we present a case of crystalline arthropathy in a patient with chronic kidney disease, mistaken for gout. The Case A 29-year-old man was admitted to…

Coding Corner Question: Interprofessional Consultations

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A 68-year-old patient reports that her eyes have been itchy and red for approximately one month. She was treated with erythromycin gel on Jan. 10; while the itching did not stop, the redness resolved. She denies any matting and has not used any other type of eye drops. She states there has been no change…

This CT scan demonstrates a mass causing partial occlusion of the esophagus.

Case Report: An Adult-Onset Still’s Disease Mimic

Theodore Korty, DO, Ken Baxa, DO, Kiren Sahni, DO, Adam Grunbaum, DO, & Maria Soto-Aguilar, MD  |  

A 53-year-old man was hospitalized for pericarditis, abdominal lymphadenopathy of unknown origin and non-bloody diarrhea. He was admitted for four days, and then he was discharged home without incident. Two months after his initial presentation, he was readmitted for the evaluation of several new issues, including symmetric arthralgias, hypovolemia with associated electrolyte abnormalities and concurrent…

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Case Report: Sjögren’s Syndrome Plus Neuromyelitis Optica Spectrum Disorder

Swosti Roka Magar, MD, Gita Verma, MD, & Aaroop Haridas, MD   |  

Sjögren’s syndrome is a chronic multi-system autoimmune disease characterized by inflammation and subsequent destruction of exocrine glands. Sjögren’s syndrome can present with glandular or extra-glandular manifestations. Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system (CNS) autoimmune disease that can present as the initial manifestation in less than 5% of patients with Sjögren’s….

Cardiovascular Risk in Rheumatoid Arthritis: Pathogenesis, Screening & Prevention

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SNOWMASS VILLAGE, COLO.—Even in the era of treat to target, cardiovascular disease risk remains elevated and is a major source of mortality and morbidity in patients with rheumatoid arthritis (RA). Screening and management of cardiovascular risk in these patients is critical to ensure these patients are identified and treated. At the 2019 ACR Winter Rheumatology…

Osteoporosis Experts Discuss Bisphosphonates, Chronic Kidney Disease

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CHICAGO—The osteoporosis session at the 2018 ACR/ARHP Annual Meeting opened with a discussion by Kenneth Saag, MD, MSc, professor of medicine at the University of Alabama, Birmingham, in which he highlighted adverse events associated with osteoporosis medications. Dr. Saag began his presentation by emphasizing that, above all, the audience should keep in mind that the…