Biologics and DMARDs are hailed as miracles and almost-cures for rheumatoid arthritis, if you can catch the patient quickly enough. But Jon Lampa MD of Karolinska Hospital in Sweden has noticed that many studies use inflammation, not pain relief, as their criterion for success.
So: How many patients "adequately" treated for RA continue to suffer pain nonetheless? He and his coworkers decided to look at the magnitude of the problem, with noteworthy results.
It's time to pay more attention to pain from baseline, he says in this brief video, and to find ways to do something about it when the best modern treatments don't.
A 48-year-old woman with seropositive rheumatoid arthritis presents with this solitary, rapidly expanding and very painful (analog scale 9 out of 10) ulcer on the pretibial surface of her leg. Can you choose the correct diagnosis from the differentials? More »
PML and Rituximab: What Rheumatologists Should Know
The risk for progressive multifocal leukoencephalopathy among RA patients on rituximab is extremely low, about 5/100,000. For MS patients on long-term (>24 months) natalizumab and infected with relevant pathogen, the JC virus, it is cited as 1/100. . ..
Pharmacogenetics in Rheumatology: Disappointment, Success, and a Few Challenges
The enzyme that prevents toxic reactions to the lupus drug azathioprene has little or no activity in 0.3% of individuals and only intermediate activity in 10%. The test for this, advised on the label, is a rare example of effective pharmacogenetics in rheumatology. . ..
EMG is a very helpful to differentiate myositis from disorders of the brain, nerves, or spinal cord, but among children MRI is often used to avoid the morbidity associated with muscle biopsy and EMG. Absent skin manifestations, muscle biopsy is the gold standard. . ..
Systemic Lupus Erythematosus With Features of Castleman Disease
Lymphadenopathy, fever, anemia, elevated ESR, and hypergammaglobulinemia occur often in the plasma cell type of Castleman Disease. Unlike another cause in the differential, malignancy, these are completely reversible in Castleman Disease. . ..
All About Gout and Pseudogout: Meeting A Growing Challenge
Most patients with hyperuricemia do not go on to have gout, and it may be seen with any other cause of acute monoarthritis. On the other hand, serum uric acid levels may drop to normal values during an acute gout attack, due to an increase in renal excretion, so a normal value does not exclude this diagnosis. . ..
Joint Aspiration and Injection: A Look at the Basics
Cellulitis overlying a swollen joint is not a contraindication if it is the only portal for intra-articular access. The risk of introducing infection by aspirating through cellulitic skin is far less than the risk of unmanaged septic arthritis. . ..
Limited Joint Mobility in Diabetes Mellitus: The Clinical Implications
Take care not to be overenthusiastic about the prayer-sign test for limited joint mobility, for instance in patients with diabetes. One study found that 26% of healthy controls were not able to make complete contact of the palmar surfaces. . ..
Viral causes are implicated in potentially deadly A-DRESS SYNDROME (dermatitis, hepatitis, interstitial nephritis, and eosinophilia) among allopurinol users. Skin biopsy and a wide panel of viral titers are well advised. . ..
Search for studies:. Study Record Detail. Analysis of Birth Outcomes of Swedish and Danish Women Exposed to Remicade With Inflammatory Bowel Disease, RheumatoidArthritis, Psoriatic Arthritis, Ankylosing Spondylitis, and Psoriasis.
Relaxation Response Training for the Treatment of RheumatoidArthritis. This study has been completed. ... Study NCT00056667 Information provided by National Institute of Arthritis and Musculoskeletal and Skin Diseases ( NIAMS).
The armamentarium of treatment modalities available to physicians seeing patients with rheumatoid arthritis (RA) and other forms of inflammatory arthritis has increased dramatically in recent years. In particular, the introduction of the biologic disease-modifying antirheumatic drugs (DMARDs), most notably the tumor necrosis factor a (TNF-a) inhibitors, has afforded clinicians new opportunities to mitigate disease progression.
Rheumatoid arthritis (RA) often presents late, when irreversible damage has occurred. More than half of primary care consultations are for joint pain, but the average time from initial presentation with symptoms to confirmation of diagnosis of RA is 18 weeks.
How Physicians Can Manage Unexpected Free Time Jennifer Frank, MD, October 22, 2013 Whether you have an unexpected patient no-show, or two hours before bed, figuring out how to spend spurts of free time can be a work-life balance stressor.