Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases最新文献

{"title":"Psoriatic Nails; Severe Dystrophy and Hyperkeratosis.","authors":"Ciara O'Grady, Anne Marie Tobin","doi":"10.1097/RHU.0000000000001295","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001295","url":null,"abstract":"A 45-year-old gentleman presented with a 6-year history of progressive psoriasis. He reported having initially developed psoriasis 6 years previously. This had progressively worsened, and he developed significant nail involvement. He denied any joint symptoms. He previously had been treated with moderately potent topical steroids with limited response. On initial examination, he was noted to have extensive psoriatic plaques across his body. There was severe dystrophy of the finger and toenails with significant hyperkeratosis. Figure 1 illustrates significant subungal hyperkeratosis, dystrophy, and onycholysis of the right thumbnail. Following screening, the patient was commenced on fortnightly adalimumab 40 mg. At his review clinic visit, 3 months after starting treatment, his skin was clear with significant nail improvement noted (Fig. 2).","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e121"},"PeriodicalIF":3.4,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37575681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tap That Joint.","authors":"","doi":"10.1097/RHU.0000000000001712","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001712","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"129"},"PeriodicalIF":3.4,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25508826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradoxical New Diagnosis of Giant Cell Arteritis While Receiving Ustekinumab.","authors":"Robert David Sandler, Ruth Smith, Panagiota Kitsanta, Michael Hughes","doi":"10.1097/RHU.0000000000001084","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001084","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e215-e216"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37026122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Disparities Among Hispanics With Rheumatoid Arthritis: Delay in Presentation to Rheumatologists Contributes to Later Diagnosis and Treatment.","authors":"Mariam Riad,&nbsp;Daniel P Dunham,&nbsp;Jacquelin R Chua,&nbsp;Najia Shakoor,&nbsp;Sobia Hassan,&nbsp;Sarah Everakes,&nbsp;Joel A Block,&nbsp;Isabel Castrejon","doi":"10.1097/RHU.0000000000001085","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001085","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate referral and treatment delays by ethnicity/race in patients with rheumatoid arthritis (RA) treated at an academic rheumatology center.</p><p><strong>Methods: </strong>We reviewed the medical records of all RA patients evaluated at an outpatient clinic between 2011 and 2016 to identify newly diagnosed and naive-to-treatment patients. We determined the durations between symptom onset and first rheumatology visit and time to initiate treatment. Data extraction included referral source, demographics, treatment, and laboratory tests. Routine use of a multidimensional health assessment questionnaire allowed us to calculate baseline RAPID3 (routine assessment of patient index data 3) scores. Comparisons between self-reported ethnicity/race groups were performed. We used logistic regression models to analyze associations between baseline variables and early referral.</p><p><strong>Results: </strong>Data from 152 disease-modifying antirheumatic drug-naive RA patients were included in the study; 35% were white, 37% black, 20% Hispanic, and 8% other. The range in median time to first rheumatology visit was 6 to 8 months for all patient groups, except Hispanic. This group had a median time of 22.7 months (p = 0.01). The referral pattern was considerably variable between-groups; 40% of Hispanic patients were self-referred (p = 0.01). There were no statistically significant between-group differences for time to treatment initiation according to ethnicity/race. RAPID3 scores (p = 0.04) and erythrocyte sedimentation rates (p = 0.01) were significantly higher in the black and Hispanic groups. A high C-reactive protein value at baseline was associated with earlier referral.</p><p><strong>Conclusions: </strong>There is significant delay in initial presentation to a rheumatologist that was associated with a higher disease severity at presentation, especially for Hispanic patients.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"279-284"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37346645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermatomyositis-like Chronic Graft-Versus-Host Disease With MDA5 Autoantibodies.","authors":"D Gutierrez,&nbsp;L Krueger,&nbsp;Erik Peterson,&nbsp;A G Franks,&nbsp;K Lo Sicco","doi":"10.1097/RHU.0000000000001099","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001099","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e240-e241"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37385637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational Risks and Safety Precautions for COVID-19 in Workers With Rheumatic Diseases.","authors":"Abdulsamet Sandal,&nbsp;Dilek Karadogan,&nbsp;Zehra Nur Töreyin,&nbsp;Osman Cüre,&nbsp;Metin Akgün","doi":"10.1097/RHU.0000000000001615","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001615","url":null,"abstract":"C oronavirus disease 2019 (COVID-19) has spread worldwide rapidly and was declared a pandemic on March 11, 2020, by the World Health Organization. Many countries have planned and put into effect various strategies containing different levels of measures against the outbreak. Although the risk for severe COVID-19 increases with age, the measures have also targeted individuals in the working age category. The main reason is that the workplace may be the media where the infection quickly spreads among workers. Several occupational groups related to COVID-19 transmission were identified in China and Singapore, even at the very beginning of the pandemic. The work-related risks, including having a front-line job or using public transportation to go towork, are considered as one of the reasons for racial inequity for COVID-19 risk. In addition, in the presence of risk factors for severe infection, workers and/or their relatives would also be severely affected if appropriate measures were not applied. As mostly occurring in the working-age population, certain rheumatic diseases may be evaluated in this context, particularly when treated with immunosuppressive therapy. In this article, we provide our perspectives on occupational risks and safety precautions for COVID-19 in workers with rheumatic diseases.","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"271-273"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38418936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Perioperative Use of Anticoagulants or Platelet Antiaggregants be Continued for Temporal Artery Biopsy?","authors":"Monica Weinberg,&nbsp;Mahjabeen Haq,&nbsp;Danielle Schwartz,&nbsp;Jillian Cepeda,&nbsp;Erin Taub,&nbsp;Asha Patnaik,&nbsp;Qingping Yao","doi":"10.1097/RHU.0000000000001388","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001388","url":null,"abstract":"G iant cell arteritis (GCA) or temporal arteritis (TA) is a chronic systemic inflammatory vasculitis affecting the large and medium vessels in people aged over 50 years with a peak incidence over the age of 70. Giant cell arteritis patients present with higher rates of selected comorbidities, such as venous thromboembolic diseases and cerebral vascular accidents. Over 1% of GCA patients develop visual complication after the disease onset, of whom 21% develop unilateral or bilateral complete visual loss. The visual change results from an occlusion of the posterior ciliary arteries or central retinal artery. Early diagnosis of GCA is of paramount importance for effective treatment, and temporal artery biopsy (TAB) is considered as the criterion standard diagnostically. The TAB is a common procedure, and its associated complications include ecchymosis, hematoma, infection, scarring, and wound dehiscence. Brow ptosis can result from a surgical damage of the facial nerve. To date, very few studies of the potential TAB-associated complications have been available.Moreover, there are no guidelines on perioperative anticoagulation (AC) and antiplatelet (AP) usage for the TAB. As a result, there is inconsistent practice in this regard. Herein, our study aimed to analyze the TAB-associated complications and to provide meaningful guidance on AC and AP use before the TBA procedure in conjunction with the literature.","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"301-303"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37870359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eltrombopag: Efficacy and Safety in Steroid Refractory Lupus-Associated Immune Thrombocytopenia.","authors":"Vineeta Shobha,&nbsp;Sandra Sanil,&nbsp;Rashmi Roongta","doi":"10.1097/RHU.0000000000001083","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001083","url":null,"abstract":"<p><strong>Background: </strong>Eltrombopag, a thrombopoietin receptor agonist, is effective in chronic immune thrombocytopenia (ITP). The data in lupus ITP are sparse. This study aimed to assess the efficacy and safety of eltrombopag in lupus ITP.</p><p><strong>Methods: </strong>This is a single-center study conducted between 2012 and 2017 of 12 subjects with systemic lupus erythematosus-associated ITP. Patients with inadequate or suboptimal response to steroids and other immunosuppressants treated with eltrombopag were included in the study. Time taken for response to therapy (defined as platelets >1 lakh), dose, duration of treatment, and adverse effects of the drug were noted.</p><p><strong>Results: </strong>A total of 12 subjects were included in the study. The median platelet count at initiation of eltrombopag was 19,000 per μL. The time taken for response to therapy was 8 days. The median platelet count at 1-month follow-up was 241,000 per μL. All patients were concurrently treated with steroids and other immunosuppressants. Sustained benefit after stopping eltrombopag was noted in all patients. No adverse events including thrombotic complication were noted.</p><p><strong>Conclusions: </strong>Eltrombopag is a new drug in our arsenal for treatment of ITP in lupus. It is a rapidly effective, safe, and orally administered medication. It indirectly contributes to reduction in the dose of steroids and immunosuppressants, thereby minimizing their cumulative adverse effects. It is a promising and safe option for the treatment of lupus-associated thrombocytopenia, but this needs further confirmation from multicenter, multiethnic, randomized controlled trials.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"274-278"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37306950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Craniofacial Fibrous Dysplasia.","authors":"Arghya Chattopadhyay,&nbsp;Sanjay Jain,&nbsp;Aman Sharma","doi":"10.1097/RHU.0000000000001082","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001082","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e214"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37375193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiarticular Deforming and Erosive Tophaceous Gout With Severe Comorbidities.","authors":"Aurelian Anghelescu","doi":"10.1097/RHU.0000000000001121","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001121","url":null,"abstract":"out is an increasingly common chronic metabolic disorder, G resulting from the inflammatory responses to monosodium urate crystals deposited in tissues. Tophaceous gout can occur years after recurrent attacks of acute inflammatory arthropathies. Microscopically, the tophus (the cardinal feature of advanced gout) is a foreign body, granuloma-like structure that contains lumps of monosodium urate crystals and is surrounded by inflammatory cells and connective tissue. Multiarticular chronic tophaceous gout causes progressive joint damage and the development of multiple, severe destructive ulcerations and reduces the quality of life. Although a few cases of erosive polyarticular tophaceous gout with severe osteolysis that require digital amputation have been identified in the literature, none of these have demonstrated extensive bone destruction. A 57-year-old white man with chronic tophaceous multiarticular gout was referred to our neurorehabilitation clinic. He presented with tophi on the right pinna and left knee, “white bumps” on the left elbow, multiple ulcerated tophi on his feet and hands, and necrotic lesions (distal right thumb and the distal phalanx of the little finger of the right hand). He was recently treated with vancomycin for a methicillin-resistant Staphylococcus aureus infection. He had a medical history of heavy smoking, longstanding and suboptimally treated gout (since 2004), previous partial amputation of the fourth right finger (2015), arterial hypertension (since 2012), renal lithiasis (since 2014), moderate kidney disease, myocardial infarction and coronary stent (2012), left sylvian ischemic stroke, and right hemiplegia and aphasia (in December 2018). Local physical and radiologic examination shows multiarticular deformities and deviations of the fingers and toes, soft-tissue involvement (multiple tophi, erosive and necrotic lesions; Fig. 1, Fig. 2). Laboratory testing revealed uric acid (UA) 7.5 mg/dL (446 μmol/L), erythrocyte sedimentation rate 130mm/h, white blood cells 6300/μL, 65.6% neutrophils, plasma fibrinogen 854 mg/dL, C-reactive protein 20.2 mg/L, and serum creatinine 1.70 mg/dL (glomerular filtration rate 44 mL/min per 1.73m). Patient's participation in the rehabilitation programwas limited by his dysfunctional medical comorbidities and neurologic status. Lifetime diet, long-term colchicine 0.5 mg twice daily and allopurinol 300 mg twice daily, neurotrophic factors, antihypertensive, antiplatelet therapy, and follow-up were indicated at discharge.","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e269-e271"},"PeriodicalIF":3.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/RHU.0000000000001121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37329981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}