Current opinion in rheumatology最新文献_第10页

Antiphospholipid syndrome management: a 2023 update and practical algorithm-based approach. 抗磷脂综合征管理：2023 年更新和基于算法的实用方法。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 Epub Date: 2023-03-02 DOI: 10.1097/BOR.0000000000000932

Amala Ambati, Jason S Knight, Yu Zuo

{"title":"Antiphospholipid syndrome management: a 2023 update and practical algorithm-based approach.","authors":"Amala Ambati, Jason S Knight, Yu Zuo","doi":"10.1097/BOR.0000000000000932","DOIUrl":"10.1097/BOR.0000000000000932","url":null,"abstract":"Purpose of review: Antiphospholipid syndrome (APS) is an acquired thrombo-inflammatory disease that has morbid and sometimes devastating effects on patients and their families. This review will discuss the most recent international societal treatment guidelines and propose practical management algorithms for various APS sub-types.Recent findings: APS represents a disease spectrum. Although thrombosis and pregnancy morbidities are traditional hallmarks of APS, a variety of extra-criteria clinical phenotypes can often be seen, which makes clinical management more challenging. Primary APS thrombosis prophylaxis should take a risk-stratified approach. Although vitamin K antagonists (VKAs) or heparin/low molecular weight heparin (LMWH) remain the preferred treatment for secondary APS thrombosis prophylaxis, some international society guidelines support the use of direct oral anticoagulants (DOACs) in certain circumstances. Careful monitoring and individualized obstetric care with the use of aspirin and heparin/LMWH will improve pregnancy outcomes among pregnant individuals with APS. Treatment of microvascular and catastrophic APS remains challenging. While the addition of various immunosuppressive agents is often utilized, further systemic evaluations of their use are warranted before definitive recommendations can be made. Several new therapeutic strategies are on the horizon that might enable more personalized and targeted APS management in the near future.Summary: Although the knowledge of APS pathogenesis has grown in recent years, the management principles and strategies are largely unchanged. There is an unmet need for evaluating pharmacological agents, beyond anticoagulants, that target diverse thromboinflammatory pathways.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fibromyalgia and centralized pain in the rheumatoid arthritis patient. 类风湿性关节炎患者的纤维肌痛和集中性疼痛。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 Epub Date: 2023-02-10 DOI: 10.1097/BOR.0000000000000929

Deeba Minhas, Anne Murphy, Daniel J Clauw

{"title":"Fibromyalgia and centralized pain in the rheumatoid arthritis patient.","authors":"Deeba Minhas, Anne Murphy, Daniel J Clauw","doi":"10.1097/BOR.0000000000000929","DOIUrl":"10.1097/BOR.0000000000000929","url":null,"abstract":"Purpose of review: Individuals with rheumatoid arthritis (RA) have traditionally been characterized as having nociceptive pain, leading to the assumption that effective immunosuppression should be enough to provide effective pain management. However, despite therapeutic advancements providing excellent control of inflammation, patients continue to have significant pain and fatigue. The presence of concurrent fibromyalgia, driven by augmented central nervous system processing and largely unresponsive to peripheral therapies, may contribute to this pain persistence. This review provides updates on fibromyalgia and RA as relevant for the clinician.Recent findings: Patients with RA have high levels of concomitant fibromyalgia and nociplastic pain. The presence of fibromyalgia can lead to higher scores on disease measures, erroneously indicating that worse disease is presently leading to the increased use of immunosuppressives and opioids. Disease scores that provide a comparison between patient-reported and provider-reported and clinical factors may be helpful to indicate centralized pain. IL-6 and Janus kinase inhibitors, in addition to targeting peripheral inflammation, may provide pain relief by acting on peripheral and central pain pathways.Summary: Central pain mechanisms that may be contributing to pain in RA are common and should be distinguished from pain directly arising from peripheral inflammation.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10065919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10478997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification. 超声检查对CPPD的治疗有何帮助?从诊断到临床亚群鉴定。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 DOI: 10.1097/BOR.0000000000000939

Georgios Filippou, Silvia Sirotti

{"title":"How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification.","authors":"Georgios Filippou, Silvia Sirotti","doi":"10.1097/BOR.0000000000000939","DOIUrl":"https://doi.org/10.1097/BOR.0000000000000939","url":null,"abstract":"Purpose of review: Clinical manifestations of calcium pyrophosphate deposition (CPPD) disease are quite heterogeneous, ranging from asymptomatic presentation to severe forms of arthritis. In recent years, imaging, particularly ultrasound (US) has gained a central role for the diagnosis of CPPD. However, many questions are still open. Aim of this review is to present how US could be a key tool in the diagnosis and assessment of CPPD and for the identification of subsets of the disease.Recent findings: awareness and research interest around CPPD is increasing in the recent years, as several international taskforces are working on the validation of outcome measures and classification criteria for CPPD, but many pieces of the puzzle are still missing. Recent studies demonstrated that CPPD is an underdiagnosed disease, frequently misdiagnosed as rheumatoid arthritis or polymyalgia rheumatica. US has been increasingly used in the past decade for the diagnosis of CPPD and US definitions have been validated by the OMERACT US working group in the recent years, making of US a valuable tool for diagnosis.Summary: The most challenging aspects of CPPD are the differential diagnosis with other form of arthritis of the elderly, and the classification of patients in clinical subsets. In this review, we will present the available data for the use of US in the diagnosis of CPPD and we will provide a mainly experienced-based approach to the potential role of the technique in differential diagnosis and phenotypization of patients.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10115099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Tocilizumab in giant cell arteritis: an update for the clinician. 托珠单抗治疗巨细胞动脉炎:临床医生的最新进展。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 DOI: 10.1097/BOR.0000000000000937

Julia A Ford, Danya Gewurz, Ora Gewurz-Singer

引用次数: 0

Rheumatologic immune checkpoint inhibitor-related adverse events. 风湿病免疫检查点抑制剂相关不良事件。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 DOI: 10.1097/BOR.0000000000000935

Melissa Defoe, Bonnie L Bermas

引用次数: 2

The role of PET/CT in disease activity assessment in patients with large vessel vasculitis. PET/CT在大血管炎患者疾病活动性评估中的作用

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-05-01 DOI: 10.1097/BOR.0000000000000931

Elena Galli, Nicolò Pipitone, Carlo Salvarani

引用次数: 0

Low-dose interleukin-2 therapy: a promising targeted therapeutic approach for systemic lupus erythematosus. 低剂量白介素-2治疗:系统性红斑狼疮的一种有希望的靶向治疗方法。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-03-01 DOI: 10.1097/BOR.0000000000000924

Reza Akbarzadeh, Gabriela Riemekasten, Jens Y Humrich

{"title":"Low-dose interleukin-2 therapy: a promising targeted therapeutic approach for systemic lupus erythematosus.","authors":"Reza Akbarzadeh, Gabriela Riemekasten, Jens Y Humrich","doi":"10.1097/BOR.0000000000000924","DOIUrl":"https://doi.org/10.1097/BOR.0000000000000924","url":null,"abstract":"Purpose of review: Low-dose interleukin-2 (IL-2) therapy is increasingly recognized as a promising novel therapeutic concept in inflammatory and autoimmune diseases, in particular in systemic lupus erythematosus (SLE). As IL-2 is indispensable for the growth and survival of regulatory T cells (Treg), deficiency of this regulatory cytokine plays a significant role in immune dysregulation and breach of tolerance in SLE. Recovery of Treg activity by low-dose IL-2 therapy directly interferes with the immune pathology in SLE and thus can be considered a targeted treatment approach with a unique and physiological mode of action.Recent findings: In this review, the pathophysiological rationales behind the concept of low-dose IL-2 therapy in SLE will be explained and major advances in translational research and the clinical development of low-dose IL-2 therapy focusing on the results from two recent, randomized and placebo-controlled phase 2 trials will be highlighted.Summary: Several clinical studies including two recent randomized trials have proven the very good safety profile of low-dose IL-2 therapy and its capability to selectively recover and expand the Treg population in patients with active SLE. Given the emerging evidence for the clinical potential of low-dose IL-2 therapy in SLE, these studies strongly confirm the pathophysiological concept behind this targeted therapeutic approach in SLE and provide a robust basis for establishing further in-depth and confirmatory clinical trials testing the application of low-dose IL-2 in SLE and other autoimmune diseases.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Challenges of caring for transgender and gender diverse patients with rheumatic disease: presentation of seven patients and review of the literature. 照顾跨性别和不同性别的风湿病患者的挑战:7例患者的介绍和文献回顾。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-03-01 DOI: 10.1097/BOR.0000000000000894

Kristen Mathias, Lauren Mathias, Abhimanyu Amarnani, Tracey Samko, Robert G Lahita, Richard S Panush

{"title":"Challenges of caring for transgender and gender diverse patients with rheumatic disease: presentation of seven patients and review of the literature.","authors":"Kristen Mathias, Lauren Mathias, Abhimanyu Amarnani, Tracey Samko, Robert G Lahita, Richard S Panush","doi":"10.1097/BOR.0000000000000894","DOIUrl":"https://doi.org/10.1097/BOR.0000000000000894","url":null,"abstract":"Purpose of review: As perspectives on sex and gender identity have evolved, there has been an increase in the practice of transgender medicine. Within rheumatology, however, there is a dearth of information about rheumatic disease in transgender and gender diverse (TGGD) individuals. This is important, as sex hormones affect the etiopathogenesis and expression of autoimmune diseases. We therefore sought to identify TGGD patients with rheumatic disease, review their clinical courses, and appraise existing literature about this population.Recent findings: Of 1053 patients seen at the Los Angeles County and University of Southern California Medical Center from 2019 through 2021, five transgender men and two transgender women with rheumatic disease were identified. Most patients' disease courses were not overtly impacted by gender affirming hormone therapy (GAHT). Six of seven patients had psychosocial barriers to care. Our systematic review found 11 studies with 11 transgender women and two transgender men. In 12 of 13 patients, GAHT possibly modulated the patients' rheumatic disease.Summary: Our observations suggest GAHT need not be a strict contraindication in TGGD patients with rheumatic disease. TGGD patients often face significant psychosocial barriers. Additional information about this population and empathy toward their health disparities are needed.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Inflammation in osteoarthritis: the latest progress and ongoing challenges. 骨关节炎中的炎症：最新进展与持续挑战。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-03-01 Epub Date: 2022-12-22 DOI: 10.1097/BOR.0000000000000923

Alexander J Knights, Stephen J Redding, Tristan Maerz

{"title":"Inflammation in osteoarthritis: the latest progress and ongoing challenges.","authors":"Alexander J Knights, Stephen J Redding, Tristan Maerz","doi":"10.1097/BOR.0000000000000923","DOIUrl":"10.1097/BOR.0000000000000923","url":null,"abstract":"Purpose of review: The understanding of inflammation in osteoarthritis is rapidly evolving. This review highlights important basic science, mechanistic, and clinical findings since 2020 that underscore the current notion of osteoarthritis as an inflammatory disease.Recent findings: There exists a disconnect between clinical radiographic findings and patient symptoms in osteoarthritis. Inflammation, in particular synovitis, has been put forward as a potential explanation for this disconnect. New findings have shed light on the temporal dynamics and activation states of joint-resident or systemically derived immune cell populations, notably macrophages, that participate in the inflammatory response. The intricate crosstalk in which they engage may underpin disparate pain and symptoms in patients, for instance during osteoarthritis flares. The role of biological and environmental factors such as exercise, age, and diet, have been the subject of recent studies for their protective or destructive roles in osteoarthritis inflammation. Despite these advances, no disease-modifying osteoarthritis treatments targeting inflammation have emerged.Summary: Osteoarthritis is a debilitating chronic disease that manifests with widely varying symptomatology. Inflammation is now appreciated as a key pathophysiological process in osteoarthritis, but there remain considerable gaps in our understanding of its role in disease progression and how best to target the inflammatory response for therapeutic interventions.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10821795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10814715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insights into the pathogenic role of neutrophils in systemic lupus erythematosus. 中性粒细胞在系统性红斑狼疮中的致病作用。

IF 5.1 2区医学

Current opinion in rheumatology Pub Date : 2023-03-01 DOI: 10.1097/BOR.0000000000000912

Shiliang Ma, Wanlan Jiang, Wei Liu

{"title":"Insights into the pathogenic role of neutrophils in systemic lupus erythematosus.","authors":"Shiliang Ma, Wanlan Jiang, Wei Liu","doi":"10.1097/BOR.0000000000000912","DOIUrl":"https://doi.org/10.1097/BOR.0000000000000912","url":null,"abstract":"Purpose of review: Although dysregulated adaptive immune response has been considered as the main culprit for systemic lupus erythematosus (SLE), emerging studies have indicated that innate immunity, functioning upstream of adaptive immunity, acts as an important trigger of autoimmune diseases and promotes SLE development. Here, we have reviewed the most recent findings to highlight the influence of neutrophils on SLE pathogenesis.Recent findings: Neutrophils participate in SLE development mainly via promoting self-antigen exposure and autoantibody production, advocating the release of type I interferons (IFNs) and other pro-inflammatory cytokines, and mediating systemic tissue injury. A recent study revealed that neutrophil ferroptosis exerts a strong pathogenic effect in SLE, and that dysregulated innate immunity is adequate to disrupt the homeostasis of immune tolerance.Summary: Insights into the pathogenic role of neutrophils in SLE will contribute to a more comprehensive understanding of this disease and may propose novel clinical targets for accurate diagnosis and precision medicine.","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2