Case Presentation The patient was a 42-year-old African American female diagnosed with systemic lupus erythematosus (SLE) based on the findings of polyarthritis, malar and discoid rash, fatigue, positive double-stranded DNA (dsDNA) ribonucleoprotein and Smith antibodies, and low serum complement levels. Her SLE had been well controlled on hydroxychloroquine 400 mg daily, oral methotrexate 25 mg…
Diagnosis of Acute Gouty Arthritis Obscured by Anchoring Bias
A 56-year-old African American man presents to the emergency department with polyarthralgias and a fever of 103ºF. One month prior to admission, he presented with right knee pain and swelling. Blood cultures grew S. epidermidis. He was treated for presumed septic arthritis complicated by MSSE bacteremia. He was treated with meropenem and a prolonged course…
Rheumatology Case Report: Deep Vein Thrombosis Detected by Point-of-Care Ultrasound
Case A 46-year-old Caucasian female presented to the outpatient rheumatology clinic where she had been followed for several years. Her chief complaint was pain in her right knee, posterior right thigh and right hip that had begun gradually over the previous three weeks. Her past medical history was significant for rheumatoid arthritis (RA), obesity and…
Clinical Trial Data Provides Insight into Muscle Biology, Myositis, Myopathies
WASHINGTON, D.C.—Ongoing investigation into the disease mechanisms of inflammatory myopathies is generating needed information for the development of potential future therapeutic targets, and current data from clinical trials have shed light on myopathy concerns in different cohorts of patients. These issues were all discussed in a session titled Muscle Biology, Myositis, and Myopathies I during…
How to Diagnose Antisynthetase Syndrome
Antisynthetase syndrome (AS) is strongly associated with the presence of antibodies to aminoacyl-transfer RNA (tRNA) synthetases (ARSs) that are implicated in the pathogenesis of myositis and interstitial lung disease (ILD). Antibodies against eight antisynthetases have been identified and are detected in 16–26% of patients with idiopathic inflammatory myopathies (IIM).1 Serum assays for five of these…
Tips for Handling Less Common Rheumatoid Arthritis-Related Disorders
WASHINGTON, D.C.—As treatments for rheumatoid arthritis (RA) improve, some related conditions that used to be common in patients with RA are not seen very often anymore, but they still exist and physicians need to know how to identify them. Speaking to attendees at the ACR/ARHP Annual Meeting talk titled Rheumatoid Arthritis—A Case-Based Approach to Selected…
Anti-Interleukin-6 Therapy for Erdheim-Chester Disease Warrants Study
Erdheim-Chester disease (ECD) is a rare, non-Langerhan’s cell histiocytosis characterized by tissue infiltration of CD68-positive and CD1a-negative foamy histiocytes.1 ECD was discovered as a lipid granulomatosis in 1930 by Jakob Erdheim and his pupil, William Chester, and approximately 500 cases have been described to date.1 ECD has a heterogeneous course and prognosis ranging from an…
Potential New Maintenance Therapies for Vasculitides Revealed
WASHINGTON, D.C.—New insights into maintenance therapy for patients with vasculitides were covered by several speakers at the 2016 ACR/ARHP Annual Meeting abstract session titled, Vasculitis I: Novel Approaches to Therapy. Expert Hubert de Boysson, MD, MSc, of the Internal Medicine Department at Caen University Hospital in France, led discussion on new therapies for patients with…
The ACR’s Gout Guideline Co-Author Shares Insight on Treating Pain, Ongoing Patient Care
WASHINGTON, D.C.—Despite the value of guidelines, they often “are not read,” said N. Lawrence Edwards, MD, professor of medicine specializing in rheumatology at the University of Florida, at the 2016 ACR/ARHP Annual Meeting talk titled, New & Emerging Therapies for Gout, as part of the ACR Review Course. Or if they are read, they aren’t…
When Interstitial Lung Disease and Connective Tissue Disorder Intersect in Rheumatology Patients
SAN FRANCISCO—Interstitial lung disease (ILD) represents a heterogeneous group of disorders characterized by inflammation or fibrosis of the lungs. The disorders are also associated with a spectrum of connective tissue diseases (CTDs). ILD is a common manifestation of CTDs, such as scleroderma, poly-/dermatomyositis and rheumatoid arthritis—and is a leading cause of morbidity and mortality in…
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