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Orbital Inflammatory Syndromes
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Jaspreet Sukhija, Savleen Kaur
The following points should be kept in mind while taking history of these patients: Age of patientChildren are more susceptible to suffer from an infection, whereas the elderly are more likely to develop neoplasia.DurationA relatively short duration of hours to days favors infection. An insidious presentation of days to weeks is more characteristic of diseases like thyroid or neoplasia.History of painPainful diplopia is seen in myositis.Associated diseaseAny features suggestive of history of rheumatologic disease such as systemic lupus erythematosus (SLE) or polyarteritis nodosa should be asked. History of trauma or insect bites and compromised immune status, for example, due to diabetes, may further point toward infection. Mucor mycosis constitutes a life-threatening emergency and should be suspected in immune-suppressed patients, particularly in those with poorly controlled diabetes.
Crystalline Arthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
In 2020, the American College of Rheumatology updated guidelines for the treatment of gout.28 The 2020 guidelines differ from earlier ones in considering costs of care and including the input of gout patients themselves. Highlights include a strong recommendation for a treat-to-target strategy. The 2020 guidelines conditionally recommend continuing ULT indefinitely, pointing to observational data that most patients will experience recurrent flares when ULT is discontinued. Additionally, the guidelines no longer specify a urate goal of less than 5 mg/dL for those with more severe disease, owing to a lack of high-quality evidence. Research supports more rapid dissolution of tophi at lower serum urates; however, the risk-benefit ratio of targeting a lower goal has not been substantiated. Dose titration, per 2020 ACR guidelines, should be on the scope of “weeks to months, not years.” This is an example of how the 2020 guidelines are less prescriptive and promote shared decision-making between patients and providers compared with prior guidelines.29
Temporomandibular Joint Disorders
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Rheumatoid disease can occur in the child, adolescent, or adult. It usually presents with signs and symptoms of synovitis, namely pain, swelling, heat, and restriction of movement. Progression can lead to joint collapse, resulting in malocclusion with anterior open bite and retrusive contact. Diagnosis is made in coordination with the rheumatology team and is guided by the presence of other affected joints.
JAK inhibitors in rheumatology
Published in Immunological Medicine, 2023
Rheumatology is a field in medicine that covers diseases presenting with painful musculoskeletal problems encompassed as rheumatic diseases. Therefore, rheumatic diseases overlap with other fields such as dermatology or gastroenterology which are also covered in a different section of this special issue. The pathophysiology involves autoimmunity and/or autoinflammation of unknown causes. Due to unknown etiology, specific treatment for a specific disease does not exist and glucocorticoid (GC) is still the primary treatment tool for most of the diseases. Unfortunately, aiming cure for rheumatic diseases is still not a realistic treatment goal. However, targeting specific molecules involved in the inflammatory process with biologics has revolutionized the treatment of rheumatic diseases which also lead to revolutionary change in other medical fields. The most recent advance in rheumatology is the efficacy of JAKis for rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) which demonstrated superiority over biologics. The convenience of an orally available JAKis as opposed to biologics that require parenteral injection is innovative from the patient’s perspective. Another aspect of JAKis that makes it unique is that the mechanism of action is conceptually selective to JAKs as an orally available small molecule compound however, very complex.
Rare forms of inflammatory myopathies - part II, localized forms
Published in Expert Review of Clinical Immunology, 2023
Claudio Galluzzo, Ilaria Chiapparoli, Ada Corrado, Francesco Paolo Cantatore, Carlo Salvarani, Nicolò Pipitone
Macrophagic myofasciitis is considered a reaction to hepatitis A, B or tetanus toxoid vaccines containing aluminum. It has mainly been described in middle-aged patients and is clinically characterized by diffuse myalgia and fatigue, although few patients fulfill the 1990 American College of Rheumatology criteria for fibromyalgia. Muscle weakness is rare. Myopathic EMG changes and (mostly modest) CK elevation are found in fewer than half of patients. Histology shows focal infiltration of the epimysium, perimysium and perifascicular endomysium by macrophages with a minor lymphocytic component, mainly consisting of CD8 + T cells forming perivascular cuffs; occasionally B cells (rarely forming lymphoid follicles) and CD138+ plasma cells may be detected. Giant multinucleated cells are absent, and muscle fiber necrosis inconspicuous or lacking. There is no widespread HLA-I expression on muscle fibers nor MAC deposition on capillaries. Aluminum salts are stained by hematoxylin, although not in formalin-fixed material, probably due to artifacts. Macrophagic myofasciitis tends to persist if untreated, but responds to glucocorticoids at doses ranging from 0.3 mg to 1 mg/kg/day of prednisone-equivalent tapering [65].
Animal models of systemic lupus erythematosus and their applications in drug discovery
Published in Expert Opinion on Drug Discovery, 2022
Yue Xin, Bo Zhang, Junpeng Zhao, Qianmei Liu, Haoyuan Yin, Qianjin Lu
SLE is a heterogeneous disease with a chronic, relapsing and remitting disease course that can last a lifetime. Patients may present a series of clinical phenotypes affecting multiple organs, including the skin, joints, kidneys, vasculature, and nervous and hematological systems. Some of them may be catastrophic and cause death mainly due to infection, corticosteroid-mediated injury, and cardiovascular disease [3]. The variety of disease presentations increases the difficulty of classification and diagnosis. To date, three main classification criteria have been established, European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)-2019, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and ACR-1997 criteria, all of which are based on clinical manifestations and autoimmune serology [4,5].