Systemic capillary leak syndrome (SCLS) is a very rare disorder, characterized by recurrent episodes of severe hypotension, hypoalbuminemia and hemoconcentration.1 Attacks of SCLS occur in three phases: 1) prodrome; 2) hypovolemia with weight gain; and 3) hypervolemia with fluid overload and polyuria often complicated by pulmonary edema. Often, compartment syndrome can lead to rhabdomyolysis as…
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Reinitiating TNF Blockers after Tuberculosis Treatment
A retrospective study showed that patients who have rheumatic disease and develop tuberculosis may be able to resume anti-TNF therapy and other biologic agents…
Rheumatologists Should Discuss with Patients Use of Immunomodulatory Agents During Pregnancy
The decision to continue or discontinue immunomodulatory medications during pregnancy is a difficult one for both patients and physicians. On the one hand, when left untreated, rheumatic conditions can cause harm to an unborn child, as well as to the pregnant mother. On the other hand, medications can be harmful to a developing fetus. In…
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…
New Treatment Guidelines to Be Presented at the 2016 ACR/ARHP Annual Meeting
Two sets of guidelines—one on managing anti-rheumatic drugs perioperatively for patients undergoing total hip and knee replacements, and another that updates glucocorticoid-induced osteoporosis prevention and treatment strategies—will be featured in sessions at the 2016 ACR/ARHP Annual Meeting this month. The Sessions Sunday, Nov. 13, 2:30–3:30 p.m.: Glucocorticoid-Induced Osteoporosis Prevention and Treatment: A New ACR Clinical…
Tocilizumab Designated as Breakthrough Therapy for GCA
To speed the development of tocilizumab to treat giant cell arteritis (GCA), the FDA designated it as a breakthrough therapy earlier this month…
Tacrolimus Use for Lupus Nephritis Raises Debate over Role in North American Population
The following summary regarding use of tacrolimus (TAC) in lupus nephritis highlights a number of debatable points. Although the role of TAC in lupus nephritis remains unproved for North American populations, it might be an excellent option in some clinical situations. These situations include lupus flare during pregnancy and also for lupus nephritis when the…
Rheumatology Coding Corner Question: Gout Visit for Established Patient
A 55-year-old female patient returns to the office with complaints of gout pain. She is complaining of swelling and a burning pain in her left toe. She has been taking an over-the-counter NSAID to treat the pain, but this has done little to alleviate it. This is her second flare this year. The patient denies…
Gout Treatment & Care Remain Suboptimal
A recent analysis compared the care of patients with RA with that received by patients with gout, finding that hospitalization and costs for patients with gout have increased, but both are decreasing for patients with RA. Unlike RA, significant advances in treatment have not been made for gout, despite its increasing prevalence, and patients may land in the hospital unnecessarily…
Chronic Reactive Arthritis Secondary to Intravesical Bacillus Calmette–Guerin in Bladder Carcinoma
A 50-year-old man with history of superficial bladder carcinoma presented to our rheumatology clinic for a three-year history of symmetric polyarthralgias. He had undergone multiple transurethral resection of bladder tumor procedures and bacillus Calmette–Guerin (BCG) treatments. Prior to receiving BCG, he was fully functional and employed. Days after receiving his second BCG treatment, he developed…
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