Osteoarthritis Treatment Guidelines from Six Professional Societies
Despite the high prevalence and burden of osteoarthritis (OA) worldwide, management of OA continues to primarily focus on symptom management due to the lack of approved pharmacologic agents that halt disease progression. Recent recommendations from 6 professional societies support the importance of education, self-management approaches, weight loss, and physical modalities in managing OA. These recent guidelines also highlight the paucity of effective and safe treatment options, with recommendations against ineffective therapies outnumbering those for effective ones. NSAIDs, oral and topical, remain the primary recommended...
Source: Rheumatic Disease Clinics of North America - July 4, 2022 Category: Rheumatology Authors: Chris Overton, Amanda E. Nelson, Tuhina Neogi Source Type: research

How the American College of Rheumatology Develops Guidelines
This article discusses the purpose of clinical practice guidelines, highlighting their strengths and limitations. Policies and procedures of the American College of Rheumatology for the development and endorsement of guidelines are summarized. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 4, 2022 Category: Rheumatology Authors: Sindhu R. Johnson, Amy S. Turner, Susan M. Goodman Source Type: research

The GRADE Method
This article reviews some of the basic principles of the GRADE approach and provides additional resources for use of GRADE. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 4, 2022 Category: Rheumatology Authors: Aydia Mayan Caplan, Liron Caplan Source Type: research

Recommendations for Systemic Lupus Erythematosus
Since the first systemic lupus erythematosus (SLE) guidelines published by the American College of Rheumatology in 1999, accumulating data from observational and randomized-controlled studies, including the advent of biological agents, have stimulated the production of recommendations by various committees and task forces. Still, several areas relating to the diagnosis, treatment, and monitoring of SLE remain uncertain due to limited or inconclusive evidence, therefore emphasizing the role of expert consensus in reaching balanced and informative statements. This review outlines the most recent SLE recommendations highlight...
Source: Rheumatic Disease Clinics of North America - July 4, 2022 Category: Rheumatology Authors: George Bertsias Source Type: research

The Meaningful Role of Patients, and Other Stakeholders in Clinical Practice Guideline Development
Patient participation is an integral component in the development of clinical practice guidelines. However, patient engagement remains suboptimal, which signifies a predicament in guideline ’s legitimacy and transparency. Limited budgets, logistic constraints, and discordance in patients’ and researchers’ perception of a meaningful involvement are some barriers that hinder patient engagement. Advancing skill development across various roles within the guideline’s process will e nrich patient’s contribution and allow them to voice their experience, knowledge, perspective, and concerns. Continuing patient education...
Source: Rheumatic Disease Clinics of North America - July 4, 2022 Category: Rheumatology Authors: Jamal Mikdashi Source Type: research

Vaccinations in Patients with Rheumatic Disease
This article reviews the impact of immunosuppressive therapies and rheumatic disease on vaccine efficacy in this vulnerable patient population as well as discusses best practices. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Cassandra Calabrese Source Type: research

Rheumatic Complications of Immune Checkpoint Inhibitors
This article reviews rheumatic irAEs that may be encountered in the general medicine practice and provides guidance to support prompt recognition, referral, and treatment of these patients. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Nilasha Ghosh, Anne R. Bass Source Type: research

Managing Cardiovascular Risk in Patients with Rheumatic Disease
Individuals with rheumatoid arthritis, systemic lupus erythematosus, or gout have increased risk of cardiovascular disease (CVD) compared with the general population. This risk relates to a combination of traditional cardiovascular risk factors and disease-specific factors. Screening for CVD is important because CVD contributes to significant morbidity and mortality. Management includes tight control of disease activity to reduce inflammation, but with care to minimize use of nonsteroidal anti-inflammatory drugs and prolonged courses of high-dose corticosteroids. Traditional cardiovascular risk factors should be managed wi...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Lyn D. Ferguson, Naveed Sattar, Iain B. McInnes Source Type: research

Statin-Associated Myalgias and Muscle Injury —Recognizing and Managing Both While Still Lowering the Low-Density Lipoprotein
Although statins are generally safe and well tolerated, some patients experience muscle complaints that can be attributed to their use. Those with muscle discomfort but no demonstrable muscle weakness or creatine kinase (CK) elevations may have statin-associated muscle symptoms. Individuals with elevated CK levels, with or without muscle discomfort or weakness, may have statin-associated myotoxicity. Rare patients have statin-associated autoimmune myopathy, a disease characterized by proximal muscle weakness, elevated CK levels, and autoantibodies recognizing hydroxy-methyl-glutaryl coenzyme A reductase. In this review, th...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Andrew L. Mammen Source Type: research

Perioperative Management of Rheumatic Disease and Therapies
Patients with rheumatic disease, including those with systemic lupus erythematous, rheumatoid arthritis, and spondyloarthritis, use total hip and knee arthroplasties at high rates. They represent a particularly vulnerable population in the perioperative setting because of their diseases and the immunosuppressant therapies used to treat them. Careful planning among internists, medical specialists, and the surgical team must therefore occur preoperatively to minimize risks in the postoperative period, particularly infection. Management of immunosuppressant medications, such as conventional synthetic disease-modifying antirhe...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Diane Zisa, Susan M. Goodman Source Type: research

Fibromyalgia
is a chronic pain condition manifested by chronic generalized pain, fatigue, disordered sleep, and cognitive difficulties, persistent for at least 3  months. Other common complaints/conditions include symptoms of irritable bowel syndrome, headaches, intermittent paresthesias, and various mood disorders. Women are more commonly affected than men. The treatment approach should be individualized and focused on associated mood disorders, sleep, exe rcise, correction of maladaptive responses to pain, and coping with stress. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Carmen E. Gota Source Type: research

Update on the Treatment of Giant Cell Arteritis and Polymyalgia Rheumatica
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are considered 2 diseases on the same spectrum due to their many underlying similarities. In recent years, both diseases have witnessed both diagnostic and treatment advances, which shaped the way we manage them. In this article, the authors focus on different diagnostic modalities in GCA as well as the presence of different clinical phenotypes and the role of screening for aortic involvement. The authors also discuss traditional treatments and the role of evolving steroid-sparing agents in the management of both GCA and PMR. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Sarah El Chami, Jason M. Springer Source Type: research

Suspecting and Diagnosing the Patient with Spondyloarthritis and What to Expect from Therapy
This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Philip J. Mease Source Type: research

Pregnancy and Management in Women with Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Obstetric Antiphospholipid Syndrome
Management of women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome (APS) during pregnancy presents unique clinical challenges. Women with both RA and SLE can have disease flares during pregnancy, leading to pregnancy complications, such as preeclampsia, small-for-gestational-age infants, and preterm delivery. Disease should be under control prior to conception. Women with obstetric APS need to be anticoagulated during pregnancy. Many but not all antirheumatic medications can be used during pregnancy and lactation. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Adela Castro-Gutierrez, Kristen Young, Bonnie L. Bermas Source Type: research

Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder that manifests as a symmetric polyarthritis of small and large joints that may lead to joint and periarticular structural damage and the consequences of systemic inflammation. This overview of early RA examines the unmet needs and challenges in RA, how to best diagnose RA, and pitfalls in early diagnosis and treatment. The rules for referral to a rheumatologist are reviewed. Primary care physicians are at the front line of early diagnosis and need to start disease-modifying therapy as soon as a diagnosis of RA is established. (Source: Rheumatic Disea...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: John J. Cush Source Type: research