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Management of Knee Osteoarthritis
Knee osteoarthritis (OA) is a common and morbid condition. No disease-modifying therapies exist; hence the goals of current treatment are to palliate pain and to retain function. OA pain is significantly influenced by the placebo effect. Nonpharmacologic interventions are essential and have been shown to improve outcomes. Canes, unloading braces, and therapeutic heating/cooling may be valuable. Pharmacotherapy options include topical and oral nonsteroidal anti-inflammatory drugs, duloxetine, and periodic intra-articular glucocorticoids and hyaluronans. Opioids, intra-articular stem cells, and platelet-rich plasma are not r...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Joel A. Block, Dmitriy Cherny Source Type: research

Antinuclear Antibody Testing for the Diagnosis of Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune inflammatory condition that may involve multiple organ systems. Although the antinuclear antibody (ANA) test is positive in nearly every case of SLE, it is not specific for this disease and must be interpreted in the appropriate clinical context. Key features that warrant ANA testing include unexplained multisystem inflammatory disease, symmetric joint pain with inflammatory features, photosensitive rash, and cytopenias. ANA staining patterns and more specific autoantibody testing may be helpful in diagnosis of suspected SLE or ANA-associated disease. For patients with no...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Rand A. Nashi, Robert H. Shmerling Source Type: research

Management and Cure of Gouty Arthritis
Gout is the most common inflammatory arthritis in the United States. Gouty arthritis is associated with significant morbidity and mortality and is the result of chronic hyperuricemia. Gout is effectively managed and potentially cured by decreasing the overall urate burden with serum urate –lowering therapy. When serum urate is maintained at less than 6.0 mg/dL, urate deposition is resolved, and gout can be cured. Unfortunately, because of less than optimal physician monitoring and dose escalation, many patients do not achieve these urate levels. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Sarah F. Keller, Brian F. Mandell Source Type: research

It Takes Oysters to Generate Pearls
For this issue of Rheumatic Disease Clinics of North America, “Rheumatology pearls for the primary care physician,” I have asked a selected group of experienced clinicians with special interests to provide their personal overviews of specific clinical topics. I asked them to direct their comments to seasoned clinicians who do not share the author’s more specific experiences. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Brian F. Mandell Tags: Preface Source Type: research

Rheumatology Pearls for the Primary Care Physician
Brian Mandell has done a masterful job in assembling topics for the primary care physician that correspond to his experience with words of wisdom, called “pearls.” He has provided summaries from extremely knowledgeable specialists that reflect on their clinical experiences, their tough-minded view of the literature, and most importantly, what is not in the literature or in guidelines. He talks about the time it takes for pearls to develop, using the analogy about their generation to point out that decision making by experts is something that is based on how we integrate each experience into the next. (Source: Rheumatic...
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Michael H. Weisman Tags: Foreword Source Type: research

Rheumatology Pearls for the Primary Care Physician
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Authors: Brian F. Mandell Source Type: research

Copyright
ELSEVIER (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Source Type: research

Contributors
MICHAEL H. WEISMAN, MD (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Source Type: research

Contents
Michael H. Weisman (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Source Type: research

Forthcoming Issues
Treatment Guideline Development and Implementation (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 8, 2022 Category: Rheumatology Source Type: research

Systemic Autoinflammatory Diseases
Systemic autoinflammatory diseases (SAIDs) are characterized by unprovoked exaggerated inflammation on a continuum from benign recurrent oral ulceration to life-threatening strokes or amyloidosis, with renal failure as a potential sequela. The ability to discriminate these diagnoses rests on the genetic and mechanistic defect of each disorder, considering potential overlapping autoinflammation, autoimmunity, and immune deficiency. A comprehensive and strategic genetic investigation influences management as well as the consequential expected prognoses in these subsets of rare diseases. The ever-expanding therapeutic armamen...
Source: Rheumatic Disease Clinics of North America - November 17, 2021 Category: Rheumatology Authors: Maria J. Gutierrez, Sivia K. Lapidus Source Type: research

Instrumental Substance Use Among Youth with Rheumatic Disease —A Biopsychosocial Model
This article provides a brief overview of adolescent substance use, its intersection with chronic illness, and pediatric-onset rheumatic disease (PRD). A biopsychosocial model of substance use vulnerability for youth with PRD is presented along with emerging evidence about in strumental use of substances. Implications for PRD clinical practice are discussed. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 17, 2021 Category: Rheumatology Authors: Joe Kossowsky, Elissa R. Weitzman Source Type: research

Using the Electronic Health Record to Enhance Care in Pediatric Rheumatology
The electronic health record (EHR) ecosystem is undergoing rapid evolution in response to new rules and regulations promulgated by the US HITECH Act (2009) and the 21st Century Cures Act (2016), which together promote and support enhanced information use, access, exchange, as well as vendor-agnostic application development. By leveraging emerging new standards and technology for EHR data interchange, for example, FHIR and SMART, pediatric rheumatology clinical care, research, and quality improvement communities will have the opportunity to streamline documentation workflows, integrate patient-reported outcomes into clinica...
Source: Rheumatic Disease Clinics of North America - November 17, 2021 Category: Rheumatology Authors: Alysha J. Taxter, Marc D. Natter Source Type: research

The Emerging Telehealth Landscape in Pediatric Rheumatology
This article provides an in-depth review of telemedicine and its use in pediatric rheumatology. Historical barriers to the use of telemedicine in pediatric chronic care are described, and recent policy changes that have supported the use of telemedicine are discussed. Future directions and suggestions for the evaluation of telemedicine in pediatric rheumatology care are provided with a special focus on clinical outcomes, its use in research, patient acceptability, and health equity. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 17, 2021 Category: Rheumatology Authors: Rajdeep Pooni, Tzielan Lee Source Type: research

Implementation Science in Pediatric Rheumatology: A Path to Health Equity
Implementation science is the study of processes that promote reliable uptake of evidence-based practices into clinical care. The integration of implementation science and health disparities research approaches has been proposed as a method to reduce health inequity through detection, understanding, and implementation of health equity-focused interventions. In this review, we provide an argument for the study of implementation science in pediatric rheumatology in light of previously observed health disparities, present a framework for the study of health equity and implementation science in pediatric rheumatology, and prop...
Source: Rheumatic Disease Clinics of North America - November 17, 2021 Category: Rheumatology Authors: Emily A. Smitherman, Ingrid Goh, Rajdeep Pooni, Sheetal S. Vora, Cagri Yildirim-Toruner, Emily von Scheven Source Type: research