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 26, 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 26, 2020 Category: Rheumatology Source Type: research

Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey
AbstractObjectiveTo investigate the prevalence of overweight and obesity, as well as the association between body mass index (BMI) and disease activity in patients with axial spondyloarthritis (axSpA).MethodsNorwegian axSpA patients from the European Map of Axial Spondyloarthritis (EMAS) survey were included in this analysis. Sociodemographic, anthropomorphic, and disease-related variables (HLA-B27, comorbidities, BASDAI, and self-reported spinal stiffness) were reported. Patients were categorized into under/normal weight (BMI  
Source: Current Rheumatology Reports - June 23, 2020 Category: Rheumatology Source Type: research

Sonographic Features of Salivary Glands in Sj ögren’s Syndrome and its Mimics
AbstractPurpose of ReviewFor 30  years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren’s syndrome, the scoring systems used for this purpose, and the ultrasound similarities and differences between Sjögren’s syndrome and some of its potential salivary gland mimics.Recent FindingsHypo/anechoic glandular lesions are the major ultrasound characteristic found in Sj ögren’s syndrome. Most studies have reported such ultrasound abnormalities...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Polymyalgia Rheumatica: a Common Disease in Seniors
AbstractPurpose of the ReviewPolymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50  years of age along with evidence of an intense systemic inflammatory response. Although the above clinical symptoms are very characteristic for the condition, it can be mimicked by other autoimmune, infectious, malignant, and endocrine disorders chief among which are giant cell arteritis (GCA) and elderly-onset rheumatoid arthritis (EORA). Recently, PMR w...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

How to Interpret Antiphospholipid Laboratory Tests
AbstractPurpose of the ReviewThis review focuses on the laboratory tests necessary for the diagnosis of antiphospholipid syndrome (APS). For the interpretation of the results of the tests for antiphospholipid antibodies (aPL), understanding of all pitfalls and interferences is necessary.Recent FindingsProgress has been made on the standardization of aPL tests and current guidelines for detection of lupus anticoagulant (LAC), anticardiolipin antibodies (aCL), and antibeta2-glycoprotein I antibodies (a β2GPI) are useful tools. LAC measurement remains a complex procedure with many pitfalls and interference by anticoagula...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

The Role of Musculoskeletal Ultrasound in the Rheumatoid Arthritis Continuum
AbstractPurpose of ReviewRheumatoid arthritis (RA) is no longer considered a fixed phenotype but rather a disease continuum. This review outlines the current and potential value of applying ultrasound (US) along this continuum: from the prediction of progression to RA in at-risk individuals, to confirmation of the early diagnosis of RA, as well as the consideration of differential diagnoses, and the use in disease monitoring and defining remission.Recent FindingsIn individuals at-risk of RA (i.e., positive autoantibodies with symptoms but without synovitis), US has shown a promising predictive value for the development of ...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Mitochondria, Aging, and Cellular Senescence: Implications for Scleroderma
AbstractPurpose of ReviewThe etiology of systemic sclerosis (SSc), which is a rare immune-mediated inflammatory disease characterized by vascular damage and fibrosis, is still unknown. However, different intrinsic (genetics) and extrinsic (environmental) factors play a part in the progression of the disease. This review focuses on the role of aging, mitochondrial dysfunction, and senescence in SSc.Recent FindingsMitochondrial dysfunction and senescence have been linked to the age-related susceptibility to other interstitial lung diseases (ILD) such as idiopathic pulmonary fibrosis (IPF). SSc is not regarded as an age-relat...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Spondyloarthritis on the Move: Biomechanical Benefits or Harm
AbstractPurpose of ReviewPhysical activity is beneficial in several diseases including spondyloarthritis despite mechanical stress being suggested as a trigger of disease onset or activity. Moreover, there is no clear answer as to where physiological loading of the joints ends and pathological overloading begins. The aim of this review is to provide an overview of what is known about exercise and biomechanical loading in spondyloarthritis.Recent FindingsRecent studies focused on the impact of mechanical loading in healthy individuals and spondyloarthritis patients, demonstrating an overlap between the groups and pointing o...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Current and Potential New Targets in Systemic Sclerosis Therapy: a New Hope
AbstractPurpose of ReviewSystemic sclerosis (SSc) is an autoimmune connective tissue disease in which there is an activation of fibroblast to a myofibroblast that secretes huge amounts of extracellular matrix. Currently, no treatment exists that modifies the fibrosis elements and new therapeutic targets are badly needed. This review examines the current state of treatments and emerging therapeutics.Recent FindingsNintedanib was found to significantly reduce the rate of decline in SSc associated FVC, although it has no benefit on skin fibrosis. New cannabinoid receptor2 agonist has shown superb effects in phase II and resul...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Is There a Brain/Heart Interaction in Rheumatoid Arthritis and Seronegative Spondyloartropathies? A Combined Brain/Heart Magnetic Resonance Imaging Reveals the Answer
AbstractPurpose of ReviewTo present the interaction between brain/heart and emphasize the role of combined brain/heart magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and other seronegative spondyloarthropathies (SNA).Recent FindingsBoth traditional cardiovascular disease (CVD) risk factors and intrinsic RA/SNA features contribute to the increased CVD-related morbidity/mortality. CVD in RA usually occurs a decade earlier than age- and sex-matched controls, and RA patients are twice more likely to develop myocardial infarction irrespective of age, history of prior CVD, and traditional CVD risk fa...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Imaging in Vasculitis
AbstractPurpose of ReviewVasculitides are characterized by mostly autoimmunologically induced inflammatory processes of vascular structures. They have various clinical and radiologic appearances. Early diagnosis and reliable monitoring are indispensable for adequate therapy to prevent potentially serious complications. Imaging, in addition to laboratory tests and physical examination, constitutes a key component in assessing disease extent and activity. This review presents current standards and some typical findings in the context of imaging in vasculitis with particular attention to large vessel vasculitides.Recent Findi...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Dissecting Fibroblast Heterogeneity in Health and Fibrotic Disease
AbstractPurpose of ReviewFibroblasts, the major cell population in all connective tissues, are best known for their role in depositing and maintaining the extracellular matrix. Recently, numerous specialised functions have been discovered revealing unpredicted fibroblast heterogeneity. We will discuss this heterogeneity, from its origins in development to alterations in fibrotic disease conditions.Recent FindingsAdvances in lineage tracing and single-cell transcriptional profiling techniques have revealed impressive diversity amongst fibroblasts in a range of organ systems including the skin, lung, kidney and heart. Howeve...
Source: Current Rheumatology Reports - June 19, 2020 Category: Rheumatology Source Type: research

Type I Interferonopathies: from a Novel Concept to Targeted Therapeutics
AbstractPurpose of the ReviewType I interferonopathies are monogenic autoinflammatory diseases induced by constitutive activation of type I interferon. Here, we provide an overview of these diseases and describe underlying molecular pathways, related phenotypes, suggestive clinical signs and investigations for helping diagnosis process and therapeutic management.Recent FindingsRecent genetic and functional discoveries have enabled deciphering mechanisms involved in the pathogenesis of the type I interferonopathies and considering promising targeted treatments, such as JAK inhibitors, both for monogenic and multifactorial i...
Source: Current Rheumatology Reports - June 16, 2020 Category: Rheumatology Source Type: research

Use of Ultrasound in the Diagnosis and Management of the Vasculitides
In conclusion there is clear evidence for the use of US particularly color duplex US (CDS) in the diagnosis of LVV like GCA and Takayasu ’s arteritis (TAK). Nevertheless, there is urgent need for more data in regard to the use of US in small/medium vessel vasculitis, as well as the role of US in monitoring of patients with LVV. (Source: Current Rheumatology Reports)
Source: Current Rheumatology Reports - June 10, 2020 Category: Rheumatology Source Type: research

An Update on the Diagnosis and Management of Lupus Nephritis
AbstractPurpose of ReviewUpdate on the diagnosis, treatment, and monitoring of lupus nephritis.Recent FindingsThe recent criteria enable the earlier classification of lupus nephritis based on kidney biopsy and compatible serology. Treatment of active nephritis includes low-dose intravenous cyclophosphamide or mycophenolate, followed by maintenance immunosuppression. Recent trials have suggested superiority of regimens combining mycophenolate with either calcineurin inhibitor or belimumab, although their long-term benefit/risk ratio has not been determined. Encouraging results with novel anti-CD20 antibodies confirm the eff...
Source: Current Rheumatology Reports - June 4, 2020 Category: Rheumatology Source Type: research

Reactive Arthritis: Treatment Challenges and Future Perspectives
AbstractPurpose of the ReviewReactive arthritis is synovitis related to an infection away from the joint. The evolution is variable, frequently self-limited, but with the possible evolution to a prolonged form, generating functional incapacity and sequelae.Recent FindingsNew microbiological families have been incriminated and pathophysiological links have been clarified, highlighting the role of the mucous membranes (gut in particular), specific cell populations, and the production of pro-inflammatory cytokines. First-line pharmacological treatment is based on NSAIDs. In case of failure, synthetic and more recently biologi...
Source: Current Rheumatology Reports - May 26, 2020 Category: Rheumatology Source Type: research

Viewpoint on Time Series and Interrupted Time Series Optimum Modeling for Predicting Arthritic Disease Outcomes
AbstractPurpose of ReviewThe propose of this viewpoint is to improve or facilitate the clinical decision-making in the management/treatment strategies of arthritis patients through knowing, understanding, and having access to an interactive process allowing assessment of the patient disease outcome in the future.Recent FindingsIn recent years, the time series (TS) concept has become the center of attention as a predictive model for making forecast of unseen data values. TS and one of its technologies, the interrupted TS (ITS) analysis (TS with one or more interventions), predict the next period(s) value(s) of a given patie...
Source: Current Rheumatology Reports - May 20, 2020 Category: Rheumatology Source Type: research

New Insights into the Use of Direct Oral Anticoagulants in Non-high Risk Thrombotic APS Patients: Literature Review and Subgroup Analysis from a Meta-analysis
AbstractPurpose of ReviewThe efficacy of direct oral anticoagulants (DOACs) in antiphospholipid syndrome (APS) is discussed. Results from randomized controlled trials are available. It has been stated that a history of arterial thrombosis and triple positivity was associated with a higher risk of thrombosis in APS patients treated with DOACs. However, their efficacy in non-high-risk APS patients with isolated venous manifestations is unsolved. Therefore, we performed a sub-group analysis of a previously published meta-analysis after the exclusion of patients with triple positivity and those with history of arterial or smal...
Source: Current Rheumatology Reports - May 20, 2020 Category: Rheumatology Source Type: research

Clusters in Pediatric Rheumatic Diseases
AbstractPurpose of the ReviewRheumatic diseases usually have very diverse and complex pathophysiology resulting in different clinical phenotypes. Some certain phenotypes cluster together with a common presentation, course, and outcome. Our primary aim is to review the known disease clusters in certain rheumatological conditions.Recent FindingsCluster analysis has been reported in several rheumatic diseases, Behcet disease being the most common. Five individual clusters together with some clinical associations have been reported in Behcet patients. Certain antibody-phenotype associations and damage clusters have been report...
Source: Current Rheumatology Reports - May 20, 2020 Category: Rheumatology Source Type: research

Vaccination for Children on Biologics
AbstractPurpose of ReviewSeveral biologic drugs are available for treatment of immune-mediated diseases, and the number of children treated with biologics is increasing. This review summarises current knowledge about the safety and immunogenicity of vaccines in children treated with biologic therapy.Recent FindingsA recent retrospective, multicentre study reported that the booster dose of live-attenuated vaccine (MMR/V) was safe for patients with rheumatic diseases treated with biologic therapy. Recent publications revealed that immunogenicity of vaccines in children treated with biologics was lower than in the healthy pop...
Source: Current Rheumatology Reports - May 20, 2020 Category: Rheumatology Source Type: research

From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention
AbstractPurpose of ReviewTo describe the recent advances in the field towards the prevention and early recognition of Psoriatic Arthritis (PsA).Recent FindingsDefining the preclinical phase of PsA remains challenging since up to 50% of subjects with psoriasis have subclinical imaging enthesopathy, but many of these do not progress to PsA. Nevertheless, there is evidence that subjects with subclinical imaging enthesopathy are at increased risk of developing PsA. In recent years, it has been shown that both PsA and anti-citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA) are characterized by a subclini...
Source: Current Rheumatology Reports - May 16, 2020 Category: Rheumatology Source Type: research

State of the Art Management of Aortic Valve Disease in Ankylosing Spondylitis
AbstractPurpose of ReviewCardiac involvement in patients with ankylosing spondylitis (AS) generally manifests itself as aortic insufficiency, aortitis, disturbance in cardiac conduction, and myocardial dysfunction. We have used a case-based approach to review the current state of the art knowledge regarding the diagnosis and management of aortic valve disease and aortitis in patients with AS.Recent FindingsThe risk for aortic valve disease and aortic valve replacement or repair is significantly higher than in people without AS, and this risk increases with age. Echocardiography, cardiac MRI, and CT can serve as effective t...
Source: Current Rheumatology Reports - May 14, 2020 Category: Rheumatology Source Type: research

Does Belonging to a Patient Association Is of Help for Patients with Axial Spondyloarthritis? Results from the Atlas Survey
The objective of this study was to evaluate the differences in sociodemographic characteristics, lifestyle habits, and patient-reported outcomes (PROs) between axSpA patients belonging to patient associations versus those who do not.Recent FindingsOut of 680 patients, 301 (44.3%) were members of a patient association. A significant proportion of association members were found to engage in physical activities considered appropriate to their condition (48.2% vs. 39.8%,p = 0.03), and smoked significantly less compared with their non-association counterparts (22.7% vs. 33.6%,p = 0.02). In addition, ...
Source: Current Rheumatology Reports - May 14, 2020 Category: Rheumatology Source Type: research

MicroRNAs in Systemic Lupus Erythematosus: a Perspective on the Path from Biological Discoveries to Clinical Practice
AbstractPurpose of ReviewMicroRNAs (miRNAs) play essential roles in immune abnormalities and organ damage of systemic lupus erythematosus (SLE). Current findings have indicated potential clinical applications of miRNAs for combating SLE. Here, we review recent evidence which support the notions that miRNAs can be novel biomarkers and therapeutic agents for SLE.Recent FindingsFollowing years of the studies of the expression patterns of miRNAs in both peripheral blood cells and body fluids, such as plasma and urine, several miRNAs or miRNA combinations have been associated with disease activity and specific organ damage. In ...
Source: Current Rheumatology Reports - May 13, 2020 Category: Rheumatology Source Type: research

Radiological Findings of the Cervical Spine in Rheumatoid Arthritis: What a Rheumatologist Should Know
AbstractPurpose of ReviewRheumatoid arthritis (RA) is a chronic inflammatory disease affecting mainly the peripheral skeleton in a symmetrical manner rather than the axial skeleton, but when it occurs it can affect the cervical spine (CS). Although CS involvement is a frequent radiographic finding in RA, the clinical features are scarce, but potentially life-threatening with severe neurological deficits or even death due to brain stem compression. The commonest site of inflammation of the CS is the articulation between C1 and C2 vertebrae, the atlanto-axial region. The radiological finding observed in this region is the at...
Source: Current Rheumatology Reports - May 13, 2020 Category: Rheumatology Source Type: research

Comorbidities of antiphospholipid syndrome and systemic lupus erythematosus in children
AbstractPurpose of reviewAntiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are autoimmune diseases that can affect multiple organ systems. Increased awareness and new treatment strategies ultimately improved the survival of patients, and disease-related comorbidities became more important. The purpose of this review is to focus on comorbidities in these diseases that had a negative influence on the course of the disease.Recent findingsThere are limited numbers of studies regarding to comorbidities associated with these diseases during childhood. Infections were found to be the most common comorbidity a...
Source: Current Rheumatology Reports - May 13, 2020 Category: Rheumatology Source Type: research

New Criteria for Lupus
AbstractPurpose of the ReviewClassification criteria define the patient population for clinical trials and translational studies, but also influence current understanding of the disease. This review attempts to delineate the development from the American College of Rheumatology (ACR) 1982 to the European League Against Rheumatism (EULAR)/ACR 2019 classification criteria for systemic lupus erythematosus (SLE).Recent FindingsThe new EULAR/ACR classification criteria use antinuclear antibodies (ANA) as an entry criterion. (Non-infectious) fever is the one new criterion. All criteria items now have individual weights (from 2 t...
Source: Current Rheumatology Reports - May 13, 2020 Category: Rheumatology Source Type: research

Health-Related Quality of Life in Antiphospholipid Syndrome: Current Knowledge and Future Perspectives
AbstractPurpose of ReviewAntiphospholipid syndrome (APS) is a chronic autoimmune disease that can be seen as a burden, with consequences on patients ’ daily life. Health has traditionally been measured using measures of morbidity or mortality. Health-related quality of life (HRQoL) is a concept that includes quality of life through physical, mental, and social domains. As in other autoimmune diseases, HRQoL has been investigated in patients wi th APS. Here, we provide a comprehensive review of the current knowledge of the assessment of HRQoL in APS.Recent FindingsAPS patients have an impaired HRQoL compared with the ...
Source: Current Rheumatology Reports - May 13, 2020 Category: Rheumatology Source Type: research

An Update on the Pathogenesis of Skin Damage in Lupus
AbstractPurpose of ReviewLupus erythematosus (LE) is characterized by broad and varied clinical forms ranging from a localized skin lesion to a life-threatening form with severe systemic manifestations. The overlapping between cutaneous LE (CLE) and systemic LE (SLE) brings difficulties to physicians for early accurate diagnosis and sometimes may lead to delayed treatment for patients. We comprehensively review recent progress about the similarities and differences of the main three subsets of LE in pathogenesis and immunological mechanisms, with a particular focus on the skin damage.Recent FindingsRecent studies on the me...
Source: Current Rheumatology Reports - May 12, 2020 Category: Rheumatology Source Type: research

Utility of Ultrasound and Dual Energy CT in Crystal Disease Diagnosis and Management
The objective of this review is to critically discuss the latest evidence on the use of ultrasound and dual energy computed tomography (DECT) for the assessment of microcrystalline arthritis.Recent FindingsBoth techniques have been included in the classification and diagnostic criteria for gout, while only ultrasound appears in the diagnostic recommendations for CPPD. Regarding the management of the diseases, there is encouraging evidence for the use of both techniques for the follow-up of gout patients, while very few or null data are available for CPPD.SummaryUltrasound has been adequately validated for the diagnosis of ...
Source: Current Rheumatology Reports - April 15, 2020 Category: Rheumatology Source Type: research

Emergence of Musculoskeletal Ultrasound Use in Pediatric Rheumatology
AbstractPurpose of ReviewTo summarize recent international efforts on standardization and validation of pediatric musculoskeletal ultrasound and determine its role in diagnosis and monitoring of disease in pediatric rheumatology.Recent FindingsOver the past decade, significant progress has been made on building the evidence base for musculoskeletal ultrasound in pediatric rheumatology. This includes the clear definition of the sonographic appearance of the normal pediatric joint and enthesis on ultrasonography, definitions for pathology, and the establishment of a specific scoring system for the pediatric knee. Ultrasonogr...
Source: Current Rheumatology Reports - April 14, 2020 Category: Rheumatology Source Type: research

Update on Imaging-Based Measurement of Bone Mineral Density and Quality
AbstractPurpose of ReviewPatients with inflammatory arthropathies have a high rate of fragility fractures. Diagnostic assessment and monitoring of bone density and quality are therefore critically important. Here, we review standard and advanced techniques to measure bone density and quality, specifically focusing on patients with inflammatory arthropathies.Recent FindingsCurrent standard procedures are dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). DXA-based newer methods include trabecular bone score (TBS) and vertebral fracture assessment (VFA). More advanced imaging methods to measur...
Source: Current Rheumatology Reports - April 9, 2020 Category: Rheumatology Source Type: research

Nanotechnological Strategies for Osteoarthritis Diagnosis, Monitoring, Clinical Management, and Regenerative Medicine: Recent Advances and Future Opportunities
AbstractPurpose of ReviewIn this review article, we discuss the potential for employing nanotechnological strategies for the diagnosis, monitoring, and clinical management of osteoarthritis (OA) and explore how nanotechnology is being integrated rapidly into regenerative medicine for OA and related osteoarticular disorders.Recent FindingsWe review recent advances in this rapidly emerging field and discuss future opportunities for innovations in enhanced diagnosis, prognosis, and treatment of OA and other osteoarticular disorders, the smart delivery of drugs and biological agents, and the development of biomimetic regenerat...
Source: Current Rheumatology Reports - April 4, 2020 Category: Rheumatology Source Type: research

Noninfectious Autoimmune Scleritis: Recognition, Systemic Associations, and Therapy
AbstractPurpose of ReviewThe aim of this review is to provide the information necessary for recognizing scleritis in rheumatology patients, recognize associated systemic diseases in scleritis patients referred to rheumatology, and choose the best conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic therapy, based on the most recent data.Recent FindingsScleritis is most often associated with systemic conditions, particularly autoimmune conditions. Rheumatologists should be most vigilant about rheumatoid arthritis and ANCA-associated vasculitis. A recent systemic association has been found with...
Source: Current Rheumatology Reports - March 26, 2020 Category: Rheumatology Source Type: research

Complexities in Genetics of Psoriatic Arthritis
AbstractPurpose of the ReviewTo provide a general overview and current challenges regarding the genetics of psoriatic disease. With the use of integrative medicine, multiple candidate loci identified to date in psoriatic disease will be annotated, summarized, and visualized. Recent studies reporting differences in genetic architecture between psoriatic arthritis and cutaneous-only psoriasis will be highlighted.Recent FindingsFocusing on functional pathways that connect previously identified genetic variants can increase our understanding of psoriatic diseases. The genetic architecture differs between psoriatic arthritis an...
Source: Current Rheumatology Reports - March 12, 2020 Category: Rheumatology Source Type: research

Pediatric APS: State of the Art
AbstractPurpose of ReviewThe purpose of this report is to review recent research findings on APS in children and neonates.Recent FindingsEuropean evidence-based recommendations for diagnosis and treatment of pediatric APS has recently been published by the SHARE Initiative. Recent studies have shown a high prevalence of non-thrombotic manifestations in children with aPL, domains 4/5 specificity of ‘innocent’ anti-β2GPI antibodies in infants, and a higher risk for developmental delays and learning disabilities, hence, the need for neurodevelopmental monitoring in children born to mothers with APS. An Intern...
Source: Current Rheumatology Reports - March 3, 2020 Category: Rheumatology Source Type: research

Carnitine Palmitoyl Transferase Deficiency in a University Immunology Practice
This study identifies clinical features that should alert physicians to the possibility of an underlying metabolic disease. Treatment of the metabolic disease leads to symptomatic improvement. (Source: Current Rheumatology Reports)
Source: Current Rheumatology Reports - February 14, 2020 Category: Rheumatology Source Type: research

A Comprehensive Update on Kawasaki Disease Vasculitis and Myocarditis
AbstractPurpose of the ReviewKawasaki disease (KD) is a childhood systemic vasculitis of unknown etiology that causes coronary artery aneurysms (CAA), and if left undiagnosed can result in long-term cardiovascular complications and adult cardiac disease. Up to 20% of KD children fail to respond to IVIG, the mainstay of therapy, highlighting the need for novel therapeutic strategies. Here we review the latest findings in the field regarding specific etiology, genetic associations, and advancements in treatment strategies to prevent coronary aneurysms.Recent FindingsRecent discoveries using theLactobacillus casei cell wall e...
Source: Current Rheumatology Reports - February 5, 2020 Category: Rheumatology Source Type: research

Pneumocystis jirovecii Pneumonia and Other Infections in Idiopathic Inflammatory Myositis
AbstractPurpose of ReviewThe management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The continued use of corticosteroids, in addition to the rise of combination immunosuppressive therapy, has contributed to the ongoing concern for infection. Perhaps the most feared infection in IIM patients isPneumocystis jirovecii pneumonia (PJP) given its infrequent occurrence yet high mortality. The field has been, and continues to be, without evidence-based guidelines to help clinicians determine which patients with IIM to prescribe proph...
Source: Current Rheumatology Reports - February 5, 2020 Category: Rheumatology Source Type: research

Eosinophilic Vasculitis
AbstractPurpose of ReviewEosinophilic granulomatosis with polyangiitis (EGPA) represents a rare clinical entity, which is getting increasing attention and relevance in view of our better understanding and newer insights into its pathogenesis. Concomitantly better recognition and understanding of the immune pathophysiologic role of eosinophils provide a solid ground of their role on systemic inflammatory disorders and defense against infectious triggers, especially parasites. This review will focus on describing the physiopathology of eosinophils, as well as providing an in depth description of the natural history, clinical...
Source: Current Rheumatology Reports - January 11, 2020 Category: Rheumatology Source Type: research

The Challenges and Opportunities of Classifying Childhood Arthritis
AbstractPurpose of ReviewChildhood arthritis is in need of a new system of classification, owing to deficiencies in the International League of Associations for Rheumatology (ILAR) criteria. We briefly review the history of classification of childhood arthritis, discuss the major criticisms of the current system, and highlight current initiatives to address those concerns.Recent FindingsRecent studies in both pediatric and adult rheumatology into the biologic basis of disease as well as the clinical patterns of presentation have informed the efforts toward developing a new classification system.SummarySeveral efforts are c...
Source: Current Rheumatology Reports - January 11, 2020 Category: Rheumatology Source Type: research

Challenges in the Diagnosis and Treatment of Lyme Disease
AbstractPurpose of ReviewSince recognition in 1975, Lyme disease has become the most common vector-borne illness in North America and Europe. The clinical features are well-characterized and treatment is usually curative, but misperceptions about morbidity persist. The purpose of this review is to examine advances in the diagnosis and treatment of Lyme disease, as well as ongoing management challenges.Recent FindingsIt is useful to recognize that Lyme disease occurs in stages, with early- and late-stage disease. Clinical expression is in part determined by Borrelial variability. For example, some strains ofBorrelia burgdor...
Source: Current Rheumatology Reports - January 7, 2020 Category: Rheumatology Source Type: research

Anti-neutrophil Cytoplasmic Antibodies (ANCA) as Disease Activity Biomarkers in a “Personalized Medicine Approach” in ANCA-Associated Vasculitis
AbstractPurpose of ReviewANCA-associated vasculitides (AAV) are a group of rare diseases characterized by blood vessel inflammation and the presence of circulating anti-neutrophil cytoplasmic antibodies recognizing proteinase-3 (PR3) (PR3-ANCA) or myeloperoxidase (MPO), MPO-ANCA.Recent FindingsHistorically, ANCAs have been used as biomarkers for disease associations and increases of ANCA levels as predictors of relapse in patients with AAV.SummaryIn this review, we will summarize and highlight the most recent developments for using ANCA as predictive biomarkers and review some of the important disease-specific features in ...
Source: Current Rheumatology Reports - December 26, 2019 Category: Rheumatology Source Type: research

Psoriatic Arthritis: Newer and Older Therapies
AbstractPurpose of ReviewPsoriatic arthritis (PsA) is an immune-mediated systemic inflammatory disorder with heterogeneous clinical features. Treatment for PsA has progressed rapidly, especially over the past two decades. Herein we review relevant studies and key developments in treatment options for PsA from the past 5 years.Recent FindingsConventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate showed some efficacy for several domains of PsA, albeit less than that achieved with TNF inhibitors (TNFi). TNFi have been shown to be efficacious in treatment across all domains of PsA, particularly preve...
Source: Current Rheumatology Reports - December 21, 2019 Category: Rheumatology Source Type: research

Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease
AbstractPurpose of ReviewTraditional risk models, such as the Framingham risk score, fail to capture the increased cardiovascular disease risk seen in patients with chronic inflammatory diseases. This review will cover imaging modalities and their emerging applications in assessing subclinical cardiovascular disease for both research and clinical care in patients with chronic inflammatory diseases.Recent FindingsMultiple imaging modalities have been studied to assess for subclinical cardiovascular disease via functional/physiologic, inflammatory, and anatomic assessment in patients with chronic inflammatory diseases.Summar...
Source: Current Rheumatology Reports - December 12, 2019 Category: Rheumatology Source Type: research

Using Registry Data to Understand Disease Evolution in Inflammatory Myositis and Other Rheumatic Diseases
AbstractPurpose of ReviewWhile rheumatic disease registries collect longitudinal patient information, longitudinal analytic methods are usually not applied to these data. This review will showcase advances in longitudinal designs/analyses, and ways to leverage digital technologies to recruit and retain more registry participants.Recent FindingsWe will show how the accelerated cohort and longitudinal multiform methods are more efficient than traditional longitudinal designs. We illustrate how a smartphone app is used to recruit participants for a new rheumatic disease registry in the USA. Examples of newer longitudinal tech...
Source: Current Rheumatology Reports - December 12, 2019 Category: Rheumatology Source Type: research

Juvenile Dermatomyositis —Clinical Phenotypes
AbstractPurpose of ReviewJuvenile dermatomyositis is a heterogeneous disease with variable clinical outcomes. Here, we describe the recognised subtypes of idiopathic inflammatory myositis which occur in children, with particular reference to disease-associated autoantibodies.Recent FindingsLarge cohort studies have demonstrated that myositis autoantibodies are common in juvenile dermatomyositis and can be found in the majority of patients. They identify homogenous clinical subgroups and inform prognosis, particularly the risks of developing interstitial lung disease. Descriptions of immune-mediated necrotising myositis in ...
Source: Current Rheumatology Reports - December 11, 2019 Category: Rheumatology Source Type: research

Advances Toward Precision Medicine in Juvenile Dermatomyositis
AbstractPurpose of ReviewWe seek to provide a summary of the recent advances in juvenile dermatomyositis (JDM) that are moving the field toward precision care and personalized medicine for this uncommon condition.Recent FindingsThere has been a recent international focus on developing uniform classification, disease monitoring, and treatment for juvenile dermatomyositis. In addition, there has been a steady development of translational studies to determine the genetic determinants, transcriptomic profiles, and immune cell phenotypes in JDM.SummaryRecent work toward standardization of disease classification, monitoring, and...
Source: Current Rheumatology Reports - December 7, 2019 Category: Rheumatology Source Type: research

Adipokines: New Therapeutic Target for Osteoarthritis?
AbstractPurpose of the ReviewOsteoarthritis (OA) is an aging-associated and injury-induced joint disease characterized by cartilage degradation, bone sclerosis, and persistent low-grade inflammation in the joint. Aging and injury are triggers of joint pathological changes mediated by pro-inflammatory factors, some of which are secreted by white adipose tissue. Adipokines including adiponectin, leptin, resistin, chemerin, IL-6, and TNF- α are major players not only during inflammation but also in metabolic regulation of joint cells including chondrocytes, osteoblasts, osteoclasts as well as mesenchymal stem cells. The...
Source: Current Rheumatology Reports - December 7, 2019 Category: Rheumatology Source Type: research