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Current rheumatology diagnosis & treatment
A practice-pertinent reference for primary care providers, the book simplifies the treatment of difficult-to-manage rheumatologic diseases and disorders, such as arthritis, lupus, and sarcoidosis. Provides updated review of NSAIDs in light of current controversies and developments, expanded coverage of rheumatoid arthritis, added material in the increasingly relevant area of clinical genetics, and new chapter on Pearls in Hospital Rheumatology, filled with no-nonsense diagnostic and treatment advice for the student, trainee, or clinician.
Book
Hyperlipidemia in Saudi Arabian Patients With Systemic Lupus Erythematosus
Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with increased cardiovascular risk, partly due to dyslipidemia. This study aimed to evaluate the lipid profiles of Saudi Arabian patients with SLE and examine the impact of hydroxychloroquine (HCQ) and steroid use on these profiles, with a particular focus on patients with lupus nephritis. Methods A retrospective observational study was conducted at King Saud Medical City, Riyadh, Saudi Arabia, including SLE patients treated at the hospital's rheumatology clinic between July 2023 and December 2023. Patients aged 15-80 years diagnosed with SLE per the American College of Rheumatology revised criteria were included. Exclusion criteria comprised menopausal or pregnant women, individuals with significant comorbid conditions, and those on specific medications. Lipid profiles, including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and very low-density lipoprotein (VLDL) cholesterol, were analyzed, and correlations with disease activity parameters were assessed using STATA software (StataCorp LLC, College Station, TX, US). Statistical analyses included Wilcoxon signed-rank tests and Spearman rank correlations. Results The study included 138 SLE patients (84.5% females, mean age 37.13 ± 12.9 years). Lipid profiles showed varied results: mean total cholesterol was 4.48 mmol/L, LDL 2.56 mmol/L, HDL 1.32 mmol/L, triglycerides 1.40 mmol/L, and VLDL 0.63 mmol/L. HCQ use was associated with higher, albeit not statistically significant, lipid levels. Steroid use did not show significant effects on lipid levels. Patients with lupus nephritis had higher triglyceride and VLDL levels compared to those without nephritis (p = 0.02). No significant differences were observed in lipid profiles between patients with and without anti-double-stranded DNA (dsDNA) antibodies. Significant correlations were found between triglycerides and C-reactive protein (CRP), creatinine, and erythrocyte sedimentation rate (ESR). Conclusion This study highlights the complex relationship between SLE, dyslipidemia, and treatment. While HCQ use did not significantly alter lipid profiles, lupus nephritis was associated with worse lipid abnormalities. These findings underscore the need for ongoing monitoring and targeted management of lipid profiles in SLE patients to mitigate cardiovascular risk.
Journal Article
The Sjögren's book
\"The Sjögren's Book is a comprehensive guide for patients and their families about Sjögren's syndrome. This text, which is sponsored by the Sjögren's Syndrome Foundation, provides medical and practical information about the disease including treatment options, coping mechanisms, and questions for patients to ask their doctors. The book also contains a summary of useful medical terms for patients\"-- Provided by publisher.
Book
False Positive Babesia microti Result in New-Onset Systemic Lupus Erythematosus Manifesting With Febrile Illness
False positive serologic results are common in systemic lupus erythematosus (SLE) due to the presence of autoantibodies. We present a case of a young patient initially suspected of having a tick-borne disease with a false positive Babesia microti antibody result, and later diagnosed with SLE. Acute babesiosis was excluded after additional laboratory tests such as Babesia polymerase chain reaction (PCR) and blood smear for parasites. The patient's symptoms were then thought to be a new manifestation of SLE and prompted the initiation of systemic steroids with subsequent improvement. False positive serologic Babesia microti test result was attributed to SLE autoantibodies.
Journal Article
Not Just Myocarditis: Mixed Connective Tissue Disease (MCTD) and Overlap Myositis With Anti-Ku Positivity in a Young Male With Shortness of Breath
Mixed connective tissue disease (MCTD) is an autoimmune disorder characterized by high levels of anti-U1 ribonucleoprotein (RNP) antibodies and overlapping clinical features of autoimmune diseases, such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis (PM). Anti-Ku antibodies have been associated with overlap syndromes, which can present with symptoms such as Raynaud's phenomenon, arthritis, and myositis. A 19-year-old male athlete presented with myositis, notable for cardiac involvement. Diagnostic testing revealed elevated anti-RNP and anti-Ku antibodies, and a muscle biopsy indicated scleromyositis/overlap myositis. The patient was treated with high-dose corticosteroids, intravenous immunoglobulin (IVIG), rituximab, and mycophenolate mofetil, which led to significant improvement in muscle strength and cardiac function. This case highlights the diagnostic complexity of MCTD when associated with positive anti-Ku antibodies, overlap syndromes, and cardiac involvement. Successful management emphasizes the importance of a tailored, multi-modal therapeutic approach.
Journal Article
The Retention Rate and Safety of Secukinumab as a First-Line Biologic Agent in Axial Spondyloarthritis Compared to a First Tumor Necrosis Factor (TNF) Inhibitor: A Real-World, Longitudinal Study
Background and objective Secukinumab (SECU) is a biologic disease-modifying antirheumatic drug (bDMARD) that has demonstrated effectiveness against axial spondyloarthritis (ax-SpA). However, in clinical practice, secukinumab is most commonly used as a second-line treatment after failure of or intolerance to tumor necrosis factor inhibitors (TNFi). In this study, we aimed to compare the two-year drug retention between secukinumab and TNFi in biologic-naïve patients with ax-SpA, to estimate the remission/low disease activity (LDA) rates in both groups and assess the safety profiles. Methods This was a longitudinal observational study involving patients with ax-SpA who were biologic-naïve and were receiving SECU or TNFi between December 2019 and December 2021. The two-year therapeutic retention rate in both groups was determined. Remission and LDA rates obtained at 24 months according to the Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP) scale, as well as the safety profile, were compared between the two groups. Results Seventy-five patients were included in the study. Of them, 34.6% received SECU, while 65.3% received TNFi; 85.3% were males. The mean age was 37.8 ±9 years, the mean disease duration was 10.2 ±6.1 years, and the initial ASDAS-CRP was 3.5 ±0.8. At 24 months; the therapeutic retention rate was 70% for SECU and 66% for TNFi. The reasons for discontinuation were inefficacy (SECU: 11.5%, TNFi: 20.4%, p=0.33), side effects (SECU: 0, TNFi: 4.1%, p=0.29), and socioeconomic conditions (SECU: 15.5%, TNFi: 10.2%, p=0.51). The rate of patients achieving remission and LDA was comparable between the two groups: (remission - SECU: 23.1%, TNFi: 24.5%, p=0.92; LDA - SECU: 73.1%, TNFi: 73.5%, p=0.16). There was no statistically significant difference in the safety profile. Conclusions Our findings suggest that the effectiveness and safety of secukinumab for ax-SpA in biologic-naïve patients are comparable to those of TNFi.
Journal Article
A Case Report of Atypical Migratory Shulman Syndrome
Eosinophilic fasciitis (EF), or Shulman syndrome, is a rare connective tissue disorder characterized by symmetrical and painful swelling and with progressive thickening of the skin and soft tissues with the potential involvement of internal organs such as the pleura, pericardium, and kidneys. Patients may also present with fever, myositis, arthritis, neuropathies, and other systemic symptoms. This case report describes a unique multifocal asynchronous soft tissue involvement in Shulman syndrome in a 39-year-old patient, highlighting clinical presentation, histopathological findings, differential diagnoses, treatment modalities, and patient outcomes. Atypical migratory skin lesions must be considered in the diagnosis of EF. Timely recognition of the disease is crucial for optimal treatment and better patient outcomes.
Journal Article
THU0659 Eurorheumavision: are the largest european rheumatology societies the ones with the most oral communications?
BackgroundBetween June 14 ant 17,2017, coinciding with the 70th anniversary of its foundation, the annual EULAR congress took place in Madrid. With 14.000 participants from 130 countries,4845 accepted abstracts,2300 posters and more than 800 oral communications, it became a record congress in the history of European rheumatology.Now, EULAR is formed, among others, by 45 national rheumatology societies. Are the various countries proportionally represented at a scientific level? Those with the greatest number of rheumatologists have a greater weiight in communications to the congress?ObjectivesTo assess the scientific weight of the different European rheumatological societies in the EULAR congressSecondary objective: To analyse the characteristics of these societies in terms of the number of rheumatologists, specialists for 100,0000 inhabitants and percentage with the total number of doctorsMethodsThe scientific communications of the 2017 EULAR congress (Madrid) are analysed, according to the country of origin of the speakers.The number of rheumatologists in each country is assessed, their specific weight with respect to the total of European rheumatologists and in relation to the total number of doctors in their respective countries.ResultsResults: The countries with the highest number of rheumatologists in Western Europe are France 2,600, Italy (1800), Spain (1155), UK (950), Germany (800) and Netherlands (775). However, in number of communications The order changes, so the UK is the most productive (121), followed by the Netherlands (101), Germany (91), France (74), Italy (51), Sweden37 and Spain.36 In proportion, the Dutch presented 1 communication for every 7.6 rheumatologists, 1 German for every 8.7, 1 for every 7.8 British. The Mediterranean countries are far away, with 1 communication for every 32 Spanish rheumatologists and 1 for every 35 in the case of France and ItalyOral Communications EULARMadrid 2017 UNITED KINGDOM121GERMANY 91FRANCE 74ITALY 51SPAIN 36NETHERLANDS101REST OF EU250 (37 Swe,17 Port,, Swith, Denma, Norw, Bel, Irel..)REST OF THE WORLD156CountryN° of rheumatologist (N° of comunnications x rheumatologist) UK950 (1 com x 7,82reum)GER800 (1 com x 8.79 reum)FRA2600 (1 com x 35,1 reum)ITA1800 (1 com x 35.29 reum)SPA1155 (1 com x 32 reum)NETHE775 (1 com x 7,6 reum)ConclusionsThere is a marked disparity between the number of rheumatologists by country and number of oral communications. While the Netherlands, United Kingdom and Germany are protagonists of more than a third of the oral communications, nations such as Spain, France or Italy only contribute, together, to the 18% althought nearly 5600 rheumatologists work in their countries. Therefore, with twice as many specialists, they present half of communications.Disclosure of InterestNone declared
Journal Article