In early June, the ACR released an updated guideline on the management of rheumatoid arthritis, which includes new recommendations for specific high-risk groups.1 The guideline includes 44 recommendations—seven of which are strong and 37 conditional. It underscores the role of methotrexate as a cornerstone therapy and emphasizes minimizing glucocorticoids, when possible. Guideline Development Process At…
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How Immunosuppression May Affect COVID-19 Vaccine Response
Although we can expect to learn much more, preliminary data are now available on the potential safety and effectiveness of COVID-19 vaccines in rheumatology patients. The picture is likely to be nuanced, with not all types of immunosuppressive treatments having identical impacts on vaccine response. Rheumatologists should use caution in interpreting early reports, while continuing…
IgG4-Related Disease: The Latest On Its Presentation, Diagnosis & Management
In 1888, Dr. Jan Mikulicz-Radecki reported a case of chronic, bilateral, painless enlargement of the salivary and lacrimal glands that appeared to be idiopathic.1 In subsequent years, other patients with these findings were reported, and the term Mikulicz syndrome was used to describe these cases. Although Mikulicz syndrome is now known to be associated with…
A 2021 Update on Lupus Management & Treatment
At the 2021 ACR State-of-the-Art Clinical Symposium, Saira Sheikh, MD, associate professor of Medicine and director of the Rheumatology Lupus Clinic, University of North Carolina, Chapel Hill, provided an update on the past, present and future of the management of systemic lupus erythematosus (SLE). This year, hydroxychloroquine received a great deal of attention, given early…
Case Report: A Mycobacterium kansasii Infection
A 61-year-old white woman presented to our rheumatology clinic in New England to establish care in early June 2018, following a move from Texas. She reported a medical history of inflammatory bowel disease, uveitis and seronegative inflammatory arthritis, which was difficult to control and required the use of multiple medications. At her initial visit, she…
Case Study: The Importance of Understanding the Patient’s Perspective
A 26-year-old Peruvian woman presented to the emergency department of a large teaching hospital in Lima, Peru, with epistaxis and hematomas that had occurred over the preceding few days; she was found to have severe thrombocytopenia and a normocytic, normochromic anemia. She was treated with pulse doses of methylprednisolone; however, within two days, she presented…
Study: Can Avacopan Replace Steroids in ANCA-Associated Vasculitis?
A phase 3 trial described in The New England Journal of Medicine (NEJM) highlights the potential of a C5a receptor inhibitor, avacopan, for anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis.1 Avacopan may potentially offer a steroid-sparing option for the treatment of this serious disease. Current Treatment of ANCA-Associated Vasculitis Morbidity and mortality from ANCA-associated vasculitis have…
Late Spring 2021’s Awards, Appointments & Announcements in Rheumatology
AMA Honors Mark Andrejeski with Lifetime Achievement Award In November 2020, the American Medical Association (AMA) presented Mark Andrejeski, the recently retired executive vice president of the ACR, with its Medical Executive Lifetime Achievement Award. The award honors a medical association executive who has contributed substantially to the goals and ideals of the medical profession….
A Team Approach Improves the Transition from Pediatric to Adult Care
Nearly all adolescents and young adults (AYAs) with chronic pediatric rheumatic disease require transfer of care to an adult rheumatologist, yet almost half are lost from care at the time of transfer.1-3 Although sometimes framed as a discrete event, transition refers to the longitudinal process, often spanning several years, in which AYAs and their families…
COVID-19 Vaccination Strategies Suggested for Patients on Anti-Rheumatic Immunosuppressive Therapy
NEW YORK (Reuters Health)—U.K. experts propose evidence-based management strategies for rheumatology patients on immunosuppressive therapy, including delaying/postponing rituximab, as appropriate. “The aim of this viewpoint article is to outline the existing data on the effect of anti-rheumatic therapy on vaccine responses in patients with inflammatory arthritis and to formulate a possible pragmatic strategy for the…
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