The disconnect between objective inflammatory response and PROs in AxSpA

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The assessment of disease activity in AxSpA involves the use of objective inflammatory response (OIR) and patient reported outcomes (PROs). In clinics, a combination of OIR and PROs are used to measure disease activity and response to treatment.

Pain in Psoriatic Arthritis

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The prioritisation of pain, and its evaluation, is important in those with psoriatic arthritis, when the already incredibly heterogenous nature of the condition can complicate assessment. Whilst we lean towards all pain in PsA being nociceptive in nature, evidence suggests that a significant proportion of patients with PsA also have nociplastic pain, characterised by fibromyalgia.

RA: MACE Events with Opioids vs. NSAIDs

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Addressing chronic pain often leads general practitioners and specialists to prescribe opioids. However, opioids (weak and strong) have not demonstrated efficacy in long-term pain management; their chronic use could even worsen pain in users. Opioids prescription is often perceived as being safer than NSAIDs prescription, especially in respect to MACE.

Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines

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In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

SLE: Variability in Racial Disparities in Pregnancy Outcomes

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Significant disparities exist in pregnancy outcomes in women with systemic lupus erythematosus (SLE), with previous cohorts identifying Black women as having a higher risk of maternal mortality compared to White women with SLE.

A Multidimensional Approach in the Management of Axial Spondylarthritis

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There has been much focus on the pharmacologic management of axSpA. Despite optimal control of inflammation, symptoms of fatigue and pain can persist. Long term use of analgesics including opioids carries significant risks. Strategies to improve response to treatment in this population is critical.

Rheumatology Roundup: ACR22

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On Thursday, November 21, 2022, Dr. Arthur Kavanaugh and Dr. Jack Cush reviewed the best and most interesting data and sessions presented at ACR22 in Philadelphia, PA. These are the research abstracts discussed:

Why treatment of pre-RA isn't ready for prime time

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The ACR Great Debate was on "To treat or not to treat in pre-RA?". What is the clinician to do?

Imaging in PMR

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Despite the fact that polymyalgia rheumatica is the most prevalent inflammatory rheumatic disease in those over 65 years of age, progress in its diagnosis, monitoring and management have failed to garner momentum in decades past. However, ACR22 has fostered significant promise for its future.

ACR 2022 Appraisal, Praise & Critique (11.18.2022)

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It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 

I loved the city, but not the convention center (not easy to navigate). 

Familial Mediterranean Fever mimics

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Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent attacks of fever and acute inflammation of the membranes lining the abdomen, joints and lungs. These attacks are often short-lasting, around 1-3 days.

Gender Differences in Axial Spondyloarthritis

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Rheumatic conditions such as SLE and RA exhibit female predominance. In contrast, increasing evidence suggests that gender differences occur in axial spondyloarthritis in terms of time to diagnosis, clinical manifestations, treatment outcomes and quality of life.