COVID-19: What Do Rheumatologists Need to Know?
AbstractPurpose of ReviewSevere acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) emerged in December 2019, rapidly reaching global pandemic proportions. Coronavirus disease 2019 (COVID-19) has presented unique challenges to the rheumatology community. It is known that many individuals with rheumatic disease are at increased risk of severe disease from other infections, sparking a similar fear for COVID-19. In addition, medications routinely used in rheumatology practice are being trialled as treatments, with the potential for drug shortages for rheumatology patients.Recent FindingsUnderlying comorbidities and ...
Source: Current Rheumatology Reports - January 5, 2021 Category: Rheumatology Source Type: research

Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020
AbstractPurpose of ReviewGout is the most common inflammatory arthritis in the USA, affecting about 4% of all adults. The American College of Rheumatology (ACR) released a new guideline in 2020 to help with the management of gout. This guideline serves as an update to the previous set of guidelines which the ACR published in 2012. The purpose of this review is to compare the 2012 ACR gout guidelines to the newly released 2020 ACR gout guidelines.Recent FindingsThere are many similarities between the two guidelines, and also several key differences. The 2020 guidelines assist in the clinical management of gout by healthcare...
Source: Current Rheumatology Reports - November 27, 2020 Category: Rheumatology Source Type: research

Skin Histology in Systemic Sclerosis: a Relevant Clinical Biomarker
AbstractPurpose of ReviewSystemic sclerosis (SSc) is a life-threatening autoimmune disease that causes debilitating skin fibrosis. The skin in SSc is easily accessible, and skin biopsies may provide rich biological data regarding underlying disease pathophysiology. Here, we review literature relevant to the potential for skin histology to serve as a diagnostic, pharmacokinetic/response, and predictive biomarker in SSc.Recent FindingsMultiple histologic parameters correlate with SSc severity, including alpha smooth muscle actin (aSMA), CD34, collagen density, thickness, and inflammatory cell infiltration. Recent clinical tr...
Source: Current Rheumatology Reports - November 26, 2020 Category: Rheumatology Source Type: research

Self-Management of Rheumatoid Arthritis: Mobile Applications
AbstractPurpose of ReviewTo review the self-management of rheumatoid arthritis (RA) using mobile applications.Recent FindingsRecent research supports that self-management not only can be an empowering behavior for an individual but also has been shown to improve health outcomes in RA. Mobile health applications are growing in popularity and adoption. Emerging evidence supports that using a mobile application for RA self-management may reduce disease activity and improve health outcomes.SummaryThis review discusses mobile applications designed to improve self-management of RA as well as applications not specific to RA that ...
Source: Current Rheumatology Reports - November 26, 2020 Category: Rheumatology Source Type: research

Beyond Medical Treatment: Surgical Treatment of Gout
AbstractPurpose of ReviewMedical treatment with urate-lowering therapy (ULT) is efficacious. A recent publication suggested that surgery in gout is more prevalent than previously reported. This revelation led us to review what is known about surgical treatment of gout.Recent FindingsThe Google Scholar database (January 1, 2014 –January 1, 2020) found 104 publications with a total of 169 gout patients, with an average disease duration of 6.7 years. Most (68%) were not on ULT. The mean pre-operative serum urate levels were 9.19 mg/dL. One hundred thirteen patients underwent tophi excision, while in 33 patient...
Source: Current Rheumatology Reports - November 24, 2020 Category: Rheumatology Source Type: research

Beyond Giant Cell Arteritis and Takayasu ’s Arteritis: Secondary Large Vessel Vasculitis and Vasculitis Mimickers
AbstractPurpose of ReviewTo provide an overview of mimickers of large vessel vasculitis (LVV), by the main presenting manifestation, i.e., systemic, vascular, and cranial manifestations.Recent FindingsThe main differential diagnoses in patients with giant cell arteritis (GCA) and Takayasu arteritis (TAK) presenting with systemic manifestations (i.e., fever, anorexia, weight loss, night sweats, arthralgia/myalgia, and/or increased inflammatory indexes) are neoplastic, infectious, or other inflammatory conditions. In patients with vascular manifestations (such as peripheral ischemia, vascular stenoses, or aneurysms), atheros...
Source: Current Rheumatology Reports - November 7, 2020 Category: Rheumatology Source Type: research

Micronutrients: Essential Treatment for Inflammatory Arthritis?
AbstractPurpose of ReviewSynovial inflammation is characteristic of inflammatory chronic arthropathies and can cause progressive articular damage, chronic pain, and functional loss. Scientific research has increasingly focused on investigating anti-inflammatory micronutrients present in fruits, vegetables, spices, seeds, tea, and wine. This review aims to examine the anti-inflammatory effect of polyphenols (phytonutrients present in plants) and other micronutrients described in randomized clinical trials conducted in patients with chronic inflammatory arthropathies.Recent FindingsThere is an increasing evidence that differ...
Source: Current Rheumatology Reports - October 26, 2020 Category: Rheumatology Source Type: research

Morbidity and Mortality of Large-Vessel Vasculitides
AbstractPurpose of ReviewGiant cell arteritis (GCA) and Takayasu arteritis (TAK) comprise the primary systemic large-vessel vasculitides. In these conditions, arterial stenosis, occlusion, aneurysm, and dissection can lead to severe disease-related consequences. This review focuses on disease-related manifestations of GCA and TAK, emphasizing the impact of these findings on long-term morbidity and mortality.Recent FindingsVision loss remains a main contributor of morbidity in GCA. Non-invasive imaging allows for recognition of aortic disease in GCA but monitoring and intervention guidelines require further development. TAK...
Source: Current Rheumatology Reports - October 16, 2020 Category: Rheumatology Source Type: research

Treatment of Giant Cell Arteritis and Takayasu Arteritis —Current and Future
AbstractPurpose of ReviewGuidelines for the management of large vessel vasculitides have been recently updated by several scientific societies. We have evaluated the current recommendations for treatment of giant cell arteritis (GCA) and Takayasu arteritis (TA) and addressed potential future therapeutic strategies.Recent FindingsWhile glucocorticoids (GCs) remain the gold standard for induction of remission, many patients relapse and acquire high cumulative GC exposure. Thus, GC-sparing therapies such as methotrexate are recommended for selected patients with GCA and all patients with TA. Recent high-quality evidence shows...
Source: Current Rheumatology Reports - October 12, 2020 Category: Rheumatology Source Type: research

Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis
AbstractPurposeWhile glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need long-term treatment with GCs; therefore, toxicity needs to be expected and countered.Recent FindingsGCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab...
Source: Current Rheumatology Reports - October 12, 2020 Category: Rheumatology Source Type: research

Microbial Influences of Mucosal Immunity in Rheumatoid Arthritis
AbstractPurpose of ReviewThis review will summarize recent data defining the relationship between rheumatoid arthritis (RA) and the microbiome at mucosal sites throughout the body. It will highlight what is known, what is speculated, and current knowledge gaps regarding the microbiome in RA.Recent FindingsAn extensive relationship between the microbiome and immune cell function can influence RA-related inflammation and T cell and B cell biology. Studies are beginning to characterize microbial changes in individuals who are at risk for RA, which is a critical element needed to understand the influence of the microbiome on R...
Source: Current Rheumatology Reports - October 5, 2020 Category: Rheumatology Source Type: research

Diagnostic Value of Muscle Ultrasound for Myopathies and Myositis
AbstractPurpose of ReviewThe purpose of this review is to critically discuss the use of ultrasound in the evaluation of muscle disorders with a particular focus on the emerging use in inflammatory myopathies.Recent FindingsIn myopathies, pathologic muscle shows an increase in echogenicity. Muscle echogenicity can be assessed visually, semi-quantitatively, or quantitatively using grayscale analysis. The involvement of specific muscle groups and the pattern of increase in echogenicity can further point to specific diseases. In pediatric neuromuscular disorders, the value of muscle ultrasound for screening and diagnosis is we...
Source: Current Rheumatology Reports - September 27, 2020 Category: Rheumatology Source Type: research

Complementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a Review
AbstractPurpose of ReviewWhile complementary and alternative medicine (CAM) use is prevalent in the general population and is known to be used in systemic rheumatic disease such as rheumatoid arthritis and systemic lupus erythematosus, its use in psoriatic arthritis (PsA) is less well-studied. The purpose of this review was to identify published data describing the use of CAM in patients with PsA.Recent FindingsPsA patients report frequent use of CAM. Diet is believed to affect disease activity, and dietary approaches are used by patients to mitigate symptoms. Dietary supplements have been studied, especially fatty acids, ...
Source: Current Rheumatology Reports - September 27, 2020 Category: Rheumatology Source Type: research

Adipocytic Progenitor Cells Give Rise to Pathogenic Myofibroblasts: Adipocyte-to-Mesenchymal Transition and Its Emerging Role in Fibrosis in Multiple Organs
AbstractPurpose of ReviewAdipocytes have recently been shown to be able to reprogram to a myofibroblastic phenotype in a process termed adipocyte mesenchymal transition (AMT). This review seeks to discuss the relevance of this process to disease and explore its mechanisms.Recent FindingsAMT occurs in multiple organs and diseases, transdifferentiation goes through a precursor cell and there is a reversible process that can be influenced by metabolic stress, myeloid cells, immune dysregulation, and pharmacological intervention.SummaryAMT is a newly appreciated and highly relevant process in multiple forms of fibrosis. Target...
Source: Current Rheumatology Reports - September 24, 2020 Category: Rheumatology Source Type: research

Acupuncture and Chronic Musculoskeletal Pain
We examined 16 review articles and 11 randomized controlled trials published in the last 5  years on the clinical efficacy of acupuncture in adults with CMP conditions. The available evidence suggests that acupuncture does have short-term pain relief benefits for patients with symptomatic knee osteoarthritis and chronic low back pain and is a safe and reasonable referral option. Acupunct ure may also have a beneficial role for fibromyalgia. However, the available evidence does not support the use of acupuncture for treating hip osteoarthritis and rheumatoid arthritis.SummaryThe majority of studies concluded the superi...
Source: Current Rheumatology Reports - September 24, 2020 Category: Rheumatology Source Type: research

Aiming for Cure and Preventive Initiatives in Psoriatic Disease: Building Synergy at NPF, GRAPPA, and PPACMAN
AbstractPurpose of ReviewTo provide a general overview of the organizations dedicated to advance clinical and translational research in the field of psoriatic disease and to describe the current and future opportunities for team science approaches to overcome unmet needs in the field. Descriptions of initiatives from the NPF, PPACMAN, and GRAPPA are summarized.Recent FindingsProgram projects have recently identified areas of knowledge gaps in diagnosis, treatment, and prevention of psoriasis and psoriatic arthritis (PsA). NPF ’s Psoriasis Prevention Initiative aims to identify interventions that can prevent the onset...
Source: Current Rheumatology Reports - September 20, 2020 Category: Rheumatology Source Type: research

Understanding Fibrosis in Systemic Sclerosis: Novel and Emerging Treatment Approaches
AbstractPurpose of the ReviewOver the years, our perceptions of fibrogenesis in systemic sclerosis (SSc) have advanced a lot. Herein, we review potential targets for SSc discovered in the past 3  years.Recent FindingsIn recent years, metabolites have come into the limelight of SSc research. Anti-oxidants, promotor of adipogenesis, modulator of fatty acid metabolism, regulator of glucose homeostasis, and adenosine deaminase open a new door for SSc treatment. A mosaic of biolipids, especially cannabinoid receptor 2 agonist, represents a rational therapeutic approach in fibrosis. In terms of immune aspects, targeting che...
Source: Current Rheumatology Reports - September 20, 2020 Category: Rheumatology Source Type: research

Imaging for Diagnosis, Monitoring, and Outcome Prediction of Large Vessel Vasculitides
AbstractPurpose of ReviewTo discuss and summarize the latest evidence on imaging techniques in giant cell arteritis (GCA) and Takayasu arteritis (TAK). This is a report on the performance of ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET), and other emerging imaging techniques in diagnosis, outcome prediction, and monitoring of disease activity.Recent FindingsImaging techniques have gained an important role for diagnosis of large vessel vasculitides (LVV). As signs of vasculitis, US, MRI, and CT show a homogeneous arterial wall th...
Source: Current Rheumatology Reports - September 20, 2020 Category: Rheumatology Source Type: research

Kawasaki Disease: an Update
AbstractPurpose of ReviewProvide the most recent updates on the epidemiology, pathogenesis, and treatment advances in Kawasaki disease.Recent FindingsTreatment advances in complex, IVIG-refractory cases of Kawasaki disease. Multisystem inflammatory syndrome, a newly reported inflammatory condition with Kawasaki-like features and an association with the 2019 Coronavirus (COVID-19).SummaryKawasaki disease (KD) is a rare systemic inflammatory disease that predominately affects children less than 5  years of age. Pathogenesis of KD remains unknown; the leading theory is that an unknown stimulus triggers an immune-mediated...
Source: Current Rheumatology Reports - September 12, 2020 Category: Rheumatology Source Type: research

Impact and Management of Dysphagia in Inflammatory Myopathies
AbstractPurpose of ReviewDysphagia is a common symptom in inflammatory myopathies. This review provides an overview on the epidemiology, clinical impact, and management of dysphagia in myositis. Relevant diagnostic tools and treatment strategies are discussed.Recent FindingsDysphagia can occur in any inflammatory myopathy, particularly in inclusion body myositis (IBM). It can lead to malnutrition or aspiration with subsequent pneumonia or even death. Dysphagia can be explored and monitored by patient-reported outcome scales for swallowing. New diagnostic tools such as real-time MRI and oro-pharyngo-esophageal scintigraphy ...
Source: Current Rheumatology Reports - August 27, 2020 Category: Rheumatology Source Type: research

Cardiovascular Manifestations of Systemic Vasculitides
AbstractPurpose of ReviewVasculitis can cause heart disease and are associated with premature atherosclerosis, causing increased morbidity and mortality. Consequently, it is important to know how they can affect the cardiovascular system in order to detect and treat the abnormalities in earlier phases.Recent FindingsA clear increasing trend of inpatient burden of myocardial infarction and thromboembolic events in granulomatosis with polyangiitis has been observed lately. Beh çet’s disease has been linked to an increased risk of atrial fibrillation. Studies showing increased atherosclerosis and thromboembolic p...
Source: Current Rheumatology Reports - August 26, 2020 Category: Rheumatology Source Type: research

Calcinosis in Systemic Sclerosis: Updates in Pathophysiology, Evaluation, and Treatment
AbstractPurpose of ReviewCalcinosis is a common complication of systemic sclerosis with no known effective pharmacologic therapy. We reviewed the literature regarding systemic sclerosis-related calcinosis as well as other disorders of biomineralization in order to identify targets of future study for calcinosis.Recent FindingsPatients with systemic sclerosis-related calcinosis demonstrate systemic abnormalities in mineralization pathways, including decreased levels of the mineralization inhibitor inorganic pyrophosphate. Insights from other mineralization disorders suggest that local and systemic phosphate metabolism pathw...
Source: Current Rheumatology Reports - August 26, 2020 Category: Rheumatology Source Type: research

NETs in APS: Current Knowledge and Future Perspectives
AbstractPurpose of ReviewAntiphospholipid syndrome (APS) is a thrombo-inflammatory disease that is primarily treated with anticoagulation. Better understanding the inflammatory aspects of APS could lead to safer, more effective, and more personalized therapeutic options. To this end, we sought to understand recent literature related to the role of neutrophils and, in particular, neutrophil extracellular traps (NETs) in APS.Recent FindingsExpression of genes associated with type I interferons, endothelial adhesion, and pregnancy regulation are increased in APS neutrophils. APS neutrophils have a reduced threshold for NET re...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Pregnancy Outcomes in Systemic Vasculitides
AbstractPurpose of ReviewIn recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides.Recent FindingsSuccessful pregnancies in patients with vasculitides are possible, especially when concept...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Complementary and Alternative Medicine Use in Rheumatoid Arthritis
AbstractPurpose of ReviewDespite advances in pharmacologic management of rheumatoid arthritis (RA), complementary and alternative medicine (CAM) remains popular adjuncts to therapy among patients for ongoing symptomatology.Recent FindingsMind-body interventions are becoming increasingly popular, including yoga and meditation. Randomized controlled trials have found these interventions to be helpful regarding pain, mood, and energy in RA patients. Other CAM modalities, such as natural products, special diets, acupuncture, and body-based therapies, also continue to be used by RA patients with limited evidence for efficacy an...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Vasculitides in HIV Infection
AbstractPurpose of ReviewTo review the spectrum of vasculitides in HIV-infected patients and to identify the clinical features that characterize vasculitis in sero-positive HIV.Recent FindingsEpidemiological studies conducted in the post-HAART era described the rarity of vasculitis in the setting of HIV-infected patients. A study identified histopathological features such as leukocytoclastic vasculitis of the vasa vasorum and adventitial inflammation in the large artery pathology of HIV-positive patients compared with HIV-negative patients with critical lower limb ischemia. A recent retrospective cohort study reported that...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Lipid-lowering Therapies in Myositis
AbstractPurpose of ReviewThe use of lipid-lowering therapies in patients with idiopathic inflammatory myopathies (IIM) is complicated and there are no guidelines for diagnosing, monitoring, or treating atherosclerotic cardiovascular disease (ASCVD) in this group of patients.Recent FindingsThe use of lipid-lowering therapies, especially statins, is recommended in patients with increased risk for ASCVD, which includes patients with inflammatory diseases, based on recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines for ASCVD management.SummaryThere is accumulating evidence that patients with ...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Turning the Page in Osteoarthritis Assessment with the Use of Ultrasound
AbstractPurpose of ReviewThis narrative review summarizes the last 5  years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA).Recent FindingsMultiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

The Many Faces of a Monogenic Autoinflammatory Disease: Adenosine Deaminase 2 Deficiency
AbstractPurpose of ReviewWe aim to describe the pathophysiology, clinical findings, diagnosis, and treatment of deficiency of adenosine deaminase 2 (DADA2).Recent FindingsDADA2 is a multi-organ disease of children and less often adults, which can present with wide-ranging manifestations including strokes, medium vessel vasculitis, hematologic disease, and immunodeficiency. Diagnosis is through detection of reduced activity level of the adenosine deaminase 2 (ADA2) enzyme and/or identification of bi-allelic mutations in the ADA2 gene. Outside of high-dose glucocorticoids, conventional immunosuppression has been largely inef...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Lupus Vasculitis
AbstractPurpose of ReviewThe purpose of this manuscript is to review the most recent literature pertinent to the presence of vasculitis in patients with systemic lupus erythematosus (SLE), including previously published landmark articles and studies and to update the different clinical and diagnostic aspects of vasculitic manifestations in patients with this important autoimmune disorder. As a multisystem autoimmune disease, systemic lupus may attack practically any organ system in the human body. Even though vasculitis is not the most common presentation or pathogenic mechanism of disease, it frequently causes significant...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

An Update on the Pathogenesis of Cutaneous Lupus Erythematosus and Its Role in Clinical Practice
AbstractPurpose of ReviewUnderstanding the pathogenesis of cutaneous lupus erythematosus (CLE) is an important step in developing new medications and providing effective treatment to patients. This review focuses on novel research within CLE pathogenesis, as well as some of the medications being developed based on this knowledge.Recent FindingsThe subtle differences between systemic lupus erythematosus (SLE) and CLE pathogenesis are highlighted by differences in the circulating immune cells found in each disease, as well as the specific pathways activated by ultraviolet light. Plasmacytoid dendritic cells and the related t...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

How Imaging Can Assist with Diagnosis and Monitoring of Disease in Myositis
AbstractPurpose of ReviewTo summarize recent findings and progression in the field of imaging of inflammatory myopathies. The most commonly used method is magnetic resonance imaging, and the article focuses on this technique, but covers also several other less frequently used or emerging methods.Recent FindingsA relatively good agreement exists regarding some technical parameters, area of investigation, and assessment of inflammatory activity and chronic damage using magnetic resonance imaging. There are inconsistent data available with respect to distribution of involvement in individual IIM subtypes. Ultrasound and other...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Pathogenesis of Giant Cell Arteritis and Takayasu Arteritis —Similarities and Differences
AbstractPurpose of ReviewGiant cell arteritis (GCA) and Takayasu arteritis (TAK) are auto-inflammatory and autoimmune diseases with a highly selective tissue tropism for medium and large arteries. In both diseases, CD4+ T cells and macrophages form granulomatous lesions within the arterial wall, a tissue site normally protected by immune privilege. Vascular lesions can be accompanied by an extravascular component, typically an intense hepatic acute phase response that produces well-known laboratory abnormalities, e.g., elevated ESR and CRP. It is unclear whether GCA and TAK lie on a spectrum of disease or whether they repr...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Promising and Upcoming Treatments in Myositis
AbstractPurpose of ReviewTo highlight new and emerging treatment targets in myositis.Recent FindingsThe landscape of novel therapeutics in myositis has vastly changed in the past 5  years. This is largely due to a greater understanding of the pathogenesis of myositis and validation of more robust outcome measures that standardize the ability to assess treatment response. Clinical trials in dermatomyositis are leading the way with ongoing multicenter, international phase 3 cli nical trials. Proof-of-concept studies targeting the JAK/STAT pathway have also showed early promise in treating refractory dermatomyositis in a...
Source: Current Rheumatology Reports - August 25, 2020 Category: Rheumatology Source Type: research

Opioid Use and Total Joint Replacement
AbstractPurpose of ReviewWe provide an overview of recent research into the relationship between preoperative opioid use and total joint replacement outcomes.Recent FindingsRecent findings indicate that total joint replacement patients with a history of preoperative opioid use experience higher rates of infection, revision, short-term complications, and prolonged postoperative opioid use, along with fewer improvements in pain and function following surgery. These risks are particularly pronounced among chronic opioid users. While the baseline risk profiles of these patients may contribute to higher rates of adverse outcome...
Source: Current Rheumatology Reports - August 16, 2020 Category: Rheumatology Source Type: research

Axial Spondyloarthritis: Overcoming the Barriers to Early Diagnosis —an Early Inflammatory Back Pain Service
AbstractPurpose of ReviewTo discuss the challenges to early diagnosis of axial spondyloarthritis (axSpA) and present the impact an early inflammatory back pain service (EIBPS) had on diagnostic delay in the UK.Recent FindingsDiagnostic delay in axSpA varies greatly worldwide, and has continued in the UK at an average of 8.5  years. Education, public awareness, and accessibility to inflammatory back pain (IBP) pathways are some of the key barriers to achieving a prompt diagnosis. A recent national inquiry has highlighted insufficiencies in the availability of specialist axSpA services and limited provision of education...
Source: Current Rheumatology Reports - August 16, 2020 Category: Rheumatology Source Type: research

Novel Imaging Strategies in Systemic Sclerosis
AbstractPurpose of ReviewImaging modalities such as computed tomography, ultrasound, magnetic resonance imaging, and molecular imaging are being used to evaluate for disease in systemic sclerosis (SSc) patients. Here, we review novel imaging strategies to detect organ and vascular complications of SSc and novel imaging techniques for assessing interstitial lung disease and pulmonary hypertension in other conditions that may have further applicability to SSc.Recent FindingsImaging techniques can be used to identify disease in the lungs, pulmonary vascular system, heart, skin, vascular tissue, and gastrointestinal tract of S...
Source: Current Rheumatology Reports - August 11, 2020 Category: Rheumatology Source Type: research

The Impact of Obesity on Disease Activity and Treatment Response in Rheumatoid Arthritis
AbstractPurpose of the ReviewA growing number of studies have suggested that disease outcomes and response to therapy may be different in patients with rheumatoid arthritis (RA) who are obese. The goal of this review is to examine the most recent literature, with a focus on the impact of obesity on the assessment of disease activity and treatment outcomes in RA.Recent FindingsObesity is common in patients with RA and can have a substantial impact on patient symptoms and outcomes. Obesity is associated with higher rates of chronic pain and opiate use, elevated inflammatory markers, and less reliable physical exam findings, ...
Source: Current Rheumatology Reports - July 31, 2020 Category: Rheumatology Source Type: research

Work Disability in Axial Spondyloarthritis
AbstractPurpose of ReviewAxial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people of working age. Work-related outcomes are therefore important to study, both from an individual but also a societal perspective. Through this review of the literature, we explore the impact of axSpA on key work outcomes including work and productivity loss and predictors for these.Recent FindingsRecent evidence confirms that axSpA is associated with substantial consequences on the ability to work. Reassuringly, early treatment and use of biologics have been associated with improved wok outcomes highlight...
Source: Current Rheumatology Reports - July 26, 2020 Category: Rheumatology Source Type: research

Is Axial Spondyloarthritis More Common Than Rheumatoid Arthritis?
AbstractPurpose of ReviewTo discuss the disease incidence and prevalence rates of axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS) relative to those of rheumatoid arthritis (RA).Recent FindingsAccording to the most recently published systematic reviews, pooled prevalence estimates for RA are 0.38% in North America, and 0.21 to 0.25% in European subregions, while that of AS is 0.20% in North America and 0.25% in Europe. The estimated prevalence of axSpA has been reported to be approximately twice as common as AS in a study from the USA. This finding has also been supported by studies from northern Norway, cen...
Source: Current Rheumatology Reports - July 24, 2020 Category: Rheumatology Source Type: research

Hip and Shoulder Involvement and Their Management in Axial Spondyloarthritis: a Current Review
AbstractPurpose of ReviewHip and shoulder disease can occur in patients with spondyloarthritis (SpA). While hip involvement has been widely assessed in axial SpA patients, studies in the overall SpA population as well as studies focused on shoulder involvement are scarce. Here, we review the most recent studies on the epidemiology, evaluation, and treatment of root joint involvement in SpA patients.Recent FindingsRadiological hip involvement can affect up to 25% of patients with SpA, reflecting more severe disease and associated with functional impairment. Shoulder involvement in SpA patients is characterized by cuff tendi...
Source: Current Rheumatology Reports - July 22, 2020 Category: Rheumatology Source Type: research

New Insights into Adult and Paediatric Chronic Non-bacterial Osteomyelitis CNO
AbstractPurpose of ReviewTo describe in detail the clinical synopsis and pathophysiology of chronic non-bacterial osteomyelitis and SAPHO syndrome.Recent FindingsChronic non-bacterial osteomyelitis (CNO) has been identified as a disease entity for almost 50  years. This inflammatory bone disorder is characterized by osteolytic as well as hyperostotic/osteosclerotic lesions. It is chronic in nature, but it can present with episodic flairs and phases of remission, which have led to the denomination “chronic recurrent osteomyelitis”, with its severe multifocal form “chronic recurrent multifocal osteomye...
Source: Current Rheumatology Reports - July 22, 2020 Category: Rheumatology Source Type: research

Management of Non-criteria Manifestations in Antiphospholipid Syndrome
AbstractPurpose of the ReviewTo review the available evidence on the management of a variety of non-criteria manifestations in antiphospholipid syndrome (APS), including valvular disease, alveolar hemorrhage, thrombocytopenia, hemolytic anemia, APS nephropathy, skin ulcers, livedo reticularis, cognitive dysfunction, and epilepsy.Recent FindingsCurrent treatment relies on low-level evidence and mainly on expert consensus due to the rarity and the heterogeneity of non-criteria APS manifestations and the diversity in management approaches. Conventional anticoagulation and/or antiplatelet APS treatment do not adequately contro...
Source: Current Rheumatology Reports - July 21, 2020 Category: Rheumatology Source Type: research

Management of Myocarditis in Myositis: Diagnosis and Treatment
AbstractPurpose of ReviewTo provide a summary of the current knowledge on myocarditis in idiopathic inflammatory myopathies (IIMs).Recent FindingsThere is increasing epidemiological knowledge about heart involvement generally and myocarditis specifically in IIMs. Cardiac magnetic resonance (CMR) plays an important role in this regard.SummaryMyocarditis occupies an important place in the spectrum of pathologies that involve the myocardium in patients with IIMs. Nevertheless, its full impact still remains to be elucidated. A larger cooperation between rheumatologists and cardiologists in the clinical, as well as in the resea...
Source: Current Rheumatology Reports - July 21, 2020 Category: Rheumatology Source Type: research

JAK Inhibitors: What Is New?
AbstractPurpose of the ReviewThree Janus kinase (JAK) inhibitors are approved for rheumatoid arthritis (RA) with a fourth awaiting approval. Multiple clinical trial results with these molecules have recently been reported. These were the first small molecule oral targeted synthetic DMARDs (tsDMARDs) to be approved for RA.Recent FindingsPreclinical studies have suggested differential affinity for JAK isoform inhibition but it is not presently clear that there is any difference in efficacy in the clinic with these therapies. Preliminary data has suggested that filgotinib may have a modestly different safety profile but lacki...
Source: Current Rheumatology Reports - July 21, 2020 Category: Rheumatology Source Type: research

Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management
AbstractPurpose of ReviewThe purpose of this review is to report on the current status of evaluation of enthesitis with sonography. Sonography can visualize peripheral entheses in great detail since most of them are superficial. Visualization of entheses has provided insights into the pathophysiology of enthesitis and highlighted the interconnectivity of stress dissipation mechanisms about the enthesis. The primary use of entheseal sonography presently revolves around diagnostic use.Recent FindingsThere is increasing awareness of biomechanical confounders that lead to entheseal changes, which are more prevalent in males, p...
Source: Current Rheumatology Reports - July 20, 2020 Category: Rheumatology Source Type: research

Treatment of Axial Spondyloarthritis: What Does the Future Hold?
AbstractPurpose of ReviewTo provide a summary of the recent and expected developments related to the treatment of axial spondyloarthritis.Recent FindingsAn increasing number of interleukin-17 blocking agents show efficacy in axial spondyloarthritis including both non-radiographic and radiographic forms. Janus kinase inhibitors showed promising results in phase II studies in radiographic axial spondyloarthritis and have, therefore, a potential to become a therapeutic option in this indication in the future. Inhibition of structural damage progression in axial spondyloarthritis seems to be possible in the case of effective a...
Source: Current Rheumatology Reports - July 19, 2020 Category: Rheumatology Source Type: research

Epigenetics for Clinicians from the Perspective of Pediatric Rheumatic Diseases
AbstractPurpose of ReviewEpigenetics is the study of inherited phenotype changes that do not involve in alteration of DNA sequence. Epigenetic regulation can be examined under three main headings and study methodologies for all three will be discussed: DNA methylation is the addition of a methyl (CH3) group to DNA, histone modifications is a covalent post-translational modification of histones and non-coding RNAs are a group of functional RNA molecules that is copied from DNA but not converted into proteins. Epigenetic changes are being increasingly studied in the pathogenesis of most diseases including autoimmune and auto...
Source: Current Rheumatology Reports - July 10, 2020 Category: Rheumatology Source Type: research

Therapeutic Options and Cost-Effectiveness for Rheumatoid Arthritis Treatment
AbstractPurpose of reviewDuring the last two decades, the therapeutic decisions and strategies for rheumatoid arthritis (RA) management have improved dramatically. Today, the therapeutic armamentarium is significantly augmented, and by using both old and new drugs, remission or low disease activity is a reasonable goal. The use of conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) in combination with biologic (b) or targeted synthetic (ts) DMARDs has revolutionized RA treatment. Methotrexate administration is considered fundamental among other csDMARDs for the treatment of RA. It is recommended as ...
Source: Current Rheumatology Reports - June 25, 2020 Category: Rheumatology Source Type: research

Treatment in Juvenile Scleroderma
AbstractPurpose of ReviewTreatment of scleroderma in children is challenging since little is known about its pathogenesis. Herein, we review the most recent evidence regarding the treatment of juvenile scleroderma.Recent FindingsAccording to the recent recommendations for Pediatric Rheumatology in Europe (SHARE), systemic treatment in localized scleroderma is needed when there is a risk for disability, such as in generalized or pansclerotic morphea and progressive linear scleroderma. In juvenile systemic sclerosis, the introduction of the severity score, J4S, has standardized the assessment of the patients in the daily pra...
Source: Current Rheumatology Reports - June 25, 2020 Category: Rheumatology Source Type: research