 |
Kelly CA, et al. Rheumatology (Oxford). 2014 Apr 23 [Epub ahead of print].
|
| This is the largest study of rheumatoid arthritis-interstitial lung disease (RA-ILD) in the UK. A total of 230 patients were identified from across the UK with proven RA-ILD diagnosed over 25 years. Anti-citrullinated protein (CCP) antibodies were strongly associated with RA-ILD in both sexes. Smoking was strongly associated with ILD in males, which may explain the higher frequency of RA-ILD in men. The predominant high-resolution CT (HRCT) pattern was usual interstitial pneumonia (UIP) and most of the patients had limited disease at presentation...... |
 |
|
 |
| Wailoo A, et al. Rheumatology (Oxford). 2014 Apr 25 [Epub ahead of print]. |
The aim of this study was to estimate the cost-effectiveness of combining disease-modifying anti-rheumatic drugs (DMARDs) with short-term glucocorticoids in early active rheumatoid arthritis (RA) using data from the 2-year Combination of Anti-Rheumatic Drugs in Early RA (CARDERA) trial. This study results show that intensive treatment of early RA with triple therapy (two DMARDs and short-term glucocorticoids) is both clinically effective and cost-effective.......
|
|
|
 |
| Stack RJ, et al. Rheumatology (Oxford). 2014 Apr 11 [Epub ahead of print]. |
| The aim of this study was to explore symptoms and symptom development during the earliest phases of rheumatoid arthritis (RA) in patients with seropositive arthralgia and patients newly diagnosed with RA. Patients with seropositive arthralgia described reddening of the skin and burning sensations. These symptoms were indicative of the onset of swelling. Intense pain appeared to precede the onset of swelling for those with RA, which was often palindromic and traveled between joints until it later became persistent..... |
|
|
 |
| Jamil LH, et al. Dig Dis Sci. 2014 May 7 [Epub ahead of print]. |
| The aim of this study was to evaluate the efficacy of lymph nodes (LNs) echo features and fine needle aspiration (FNA) via endoscopic ultrasound (EUS) to distinguish benign LNs from LNs involved by sarcoidosis, lymphoma, and metastasis in non-lung cancer patients. This study shows that although benign mediastinal lymphadenopathy (MLAD) tends to be smaller than other etiologies, echo features of LNs are not reliable etiologic diagnostic approach to MLAD. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endoscopic ultrasound FNA were 73.7, 100, 100, 72.2, and 84.4%, respectively....... |
|
|
 |
| Ribeiro C, et al. Rev Port Pneumol. 2014 May 1 [Epub ahead of print]. |
| The aim of this study was to evaluate the contribution of endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA) to the diagnosis of stages I and II thoracic sarcoidosis. This was a prospective study that included 39 suspected patients with stages I and II pulmonary sarcoidosis. Data analysis allowed calculating a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 93.9%, 100%, 100%, 75.0% and 94.8%, respectively....... |
|
|
 |
| El Miedany Y, et al. Clin Rheumatol. 2014 May 3 [Epub ahead of print]. |
| This study aims to identify the clinical predictors of arthritis in patients with psoriasis and to evaluate the use of musculoskeletal ultrasonography (US) as a predictor for inflammatory structural progression in psoriatic patients. The study shows that persistent of synovitis/enthesitis at 6 months of therapy was predictive of subsequent structural progression. Family history of psoriatic arthritis, large BMI (>25 kg/m2), high percentage of psoriatic body surface area, and nail involvement were significantly associated with early onset psoriatic arthritis....... |
|
|
 |
| Petri M, et al. Lupus. 2014 Apr 30 [Epub ahead of print]. |
| This study examines the corticosteroid-related adverse event (AE) rates and attempts to identify the associated cost consequences in patients with SLE from the perspective of rheumatologists treating SLE in the United States (US). The estimated rates of all AEs (except for cataracts) were at least doubled in patients receiving corticosteroid doses >20 mg/day compared with ≤20 mg/day. The highest estimated mean total costs of an event (for the required treatment duration for one patient) were for avascular necrosis ($14,460) and serious infection ($11,660)....... |
|
|
 |
| Bonelli M, et al. Arthritis Res Ther. 2014;16(2):R104. |
| In this study, CD4+CD25−Foxp3+ T cells were significantly increased in active SLE patients and the majority expressed Helios. Detailed analysis of this patient cohort revealed increased proportions of CD4+CD25−Foxp3+ T cells in SLE patients with renal involvement. Authors conclude that CD4+CD25−Foxp3+ T cells resemble regulatory rather than activated T cells. Authors report a significant association of this newly described cell population with active nephritis. ...... |
|
|
 |
| De Vita S, et al. Clin Exp Rheumatol. 2014 May 7 [Epub ahead of print]. |
| Authors used sequential belimumab-rituximab treatment, which was followed by a marked amelioration, with the complete and persistent regression of lymphoma and healing of a refractory skin ulcer. A full cycle of rituximab was then repeated 6 and 12 months later; no further treatment was given in the following 22 months up to now. Serum cryoglobulins and rheumatoid factor became persistently negative and serum BAFF and C4 persistently normal. No relevant side-effects were noticed, except for a marked decrease in serum IgM. The follow-up after belimumab–rituximab sequential therapy is now three and a half years...... |
|
|
 |
| Springer J, et al. Medicine (Baltimore). 2014;93(2):82–90. |
| The study comprised 157 patients with a median follow-up of 3.1 years. Fifty-two percent of relapses occurred while the patients were off maintenance therapy. Among all patients who relapsed on therapy, 52% of those receiving methotrexate were on <15 mg/week, and 67% of those receiving azathioprine were on ≤50 mg/day. There were no differences between the short- and long-term maintenance therapy groups in overall adverse events or granulomatosis with polyangiitis (Wegener's) (GPA)-related morbidity. Discontinuation or use of low doses of maintenance therapy is associated with a higher relapse rate....... |
|
|
 |
| Furie RA, et al. Ann Rheum Dis. 2014 Apr 19 [Epub ahead of print]. |
| Blisibimod is a selective peptibody antagonist of the BAFF cytokine that is being developed as a treatment for lupus. BAFF is a tumor necrosis family member and is critical to the development, maintenance and survival of B-cells. It was evaluated in a dose-ranging phase 2b clinical trial in 547 patients with SLE with anti-double stranded DNA or antinuclear antibodies and Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) score ≥6....... |
|
|
 |
| Bingham D, et al. Arthritis Res Ther. 2014;16(2):R104. |
| Pediatric ANCA-associated vasculitis subtypes (AAV) reports are far and few. Therefore, it has been extremely difficult to classify microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in pediatric population. In this study, authors attempt to use modifications of validated classification algorithms to classify the AAV into two groups of MPA and GPA........ |
|
|
 |
| Hsu VM, et al. Semin Arthritis Rheum. 2014 Mar 5 [Epub ahead of print]. |
| Earlier studies in scleroderma have shown and most of us believe pulmonary hypertension as a dreaded complication of the limited variant of scleroderma. There have also been some autoantibody associations with pulmonary hypertension earlier. It is also believed that pulmonary hypertension (PH) is a late complication in this subset. The PHAROS (Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma) registry here refutes some of these earlier notions. The data herein provides a clue of which patients of scleroderma, be it diffuse or limited is likely to land up with pulmonary hypertension. The earlier belief that it is a late complication though stands reinforced. We need to study this in our own patients and include nailfold capillaroscopy, which again has been shown to be an important tool to pick up the ‘at risk’ population........ |
|
|
 |
| Navon Elkan P, et al. N Engl J Med. 2014;370(10):921–931. |
| The etiology of polyarteritis nodosa is not exactly known with some evidence of the role of hepatitis B in a subset. Herein the authors have studied the genetics of six families with multiple cases of cutaneous and systemic polyarteritis nodosa. They have found an interesting association with the gene encoding the enzyme adenosine deaminase (ADA 2), a nonspecific marker of T cell activation. Earlier work has been done on the same in Behcet’s disease. Cases of PAN running in a family are not common but when there is, this association can be there. It would be interesting to see if such an association is observed in other vasculitides like the ANCA associated vasculitis (within a family) and also the phenotype of these cases if it is different in any way from the ones commonly observed in these vasculitides........ |
|
|
 |
| Jamilloux Y, et al. Eur J Intern Med. 2014;25(2):177–181. |
| Cognitive dysfunction and depression are the most common central nervous system (CNS) manifestations in patients with primary Sjögren’s syndrome. There are also reports of multiple sclerosis-type demyelinating lesions (neuromyelitis optica) reported in primary Sjögren’s syndrome patients whether or not they are associated with any antibody especially anti-Ro is not definitely known. In this study, the authors have reported both CNS and peripheral nervous system (PNS) manifestations in patients with primary Sjögren’s syndrome. Some other groups have also reported painful sensory neuropathies and ataxic sensory neuropathy in these patients. What needs to be done is to differentiate which subset of these patients needs immunosuppressive therapy and which does not, so that overzealous treatment is avoided........ |
|
|
 |
| Carruthers MN, et al. Ann Rheum Dis. 2014 Mar 20 [Epub ahead of print]. |
| Serum IgG4-related disease requires more than 40% of the IgG+ plasma cells to be IgG4+ and greater than 10% cells/hpf of the biopsy sample for the diagnosis apart from IgG4 levels in serum >135 mg/dL. Just as hypergammaglobulinemia can be observed in many autoimmune and even infectious diseases, IgG4 also can be raised in many diseases, even to the levels and above those mentioned in the criteria. On the other hand, some cases of IgG4-related disease might not fulfill the criteria. Added to this is the problem of prozone phenomenon in estimating IgG4 levels, which shows falsely normal values in some patients. The authors in this study have analyzed these problems in their analysis. Better criteria that have a higher specificity and sensitivity are the need of the hour for the early diagnosis of this entity. It would be equally interesting to study what are the genetic factors, cytokine milieu and environmental agents that seem to drive the IgG4 plasma cells to lead to this phenotype........ |
|
|
 |
| Saad M Alsaadi, et al. Arthritis & Rheumatology. 2014;66(5):1388–1394. |
The aim of this study was to investigate the effect of sleep quality on subsequent pain intensity in patients with recent-onset low back pain. A total of 1,246 patients with acute low back pain were analyzed. Sleep quality was assessed using the sleep quality item of the Pittsburgh Sleep Quality Index, scored on a 0–3-point scale, where 0=very good sleep quality and 3=very bad sleep quality. Pain intensity was assessed on a numerical rating scale (range 0–10). The GEE analysis demonstrated a large effect of poor sleep on subsequent pain intensity, such that for every 1-point decrease in sleep quality (based on a 0–3-point scale), pain intensity (based on a 0–10-point scale) increased by 2.08 points (95% confidence interval 1.99−2.16). This effect was independent of depression and common prognostic factors for low back pain.
This is an important study confirming the author’s clinical impression. Lack of restful sleep does elevate pain levels even in those with acute back pain. Now interventional studies are needed to see if correction of sleep quality improves back pain........ |
|
|
 |
| de Boysson H, et al. Arthritis & Rheumatology. 2014;66(5);1315–1326. |
This is the 6 years data on a cohort study of PACNS. A total of 52 patients (30 males) were analyzed. Brain biopsy was done in only 31 of them and revealed vasculitis in 19. The rest had clinical and angiographic evidence. Corticosteroids and cyclophosphamide were the main stays of therapy. Thirty-two patients responded to the treatment with improved modified Rankin scale scores, 4 patients (8%) did not respond, 14 patients (27%) had relapse of their disease at least once, and 3 patients (6%) died (1 patient after a relapse). Relapse was more common in patients with than in those without meningeal gadolinium enhancements on magnetic resonance imaging (MRI) [8 of 10 (80%) vs. 6 of 32 (19%); p=0.001] and more common in patients with than in those without seizures at diagnosis [8 of 17 (47%) vs. 6 of 35 (17%); p=0.04].
This is an important cohort study of a rare condition. Long-term data from this cohort has to be watched out for........ |
|
|
 |
| Patel S. Rheumatology. 2014;53:785–792 |
| This is an excellent review article on an ill-understood condition. It presents usually with sudden onset pain especially in the lower limb, hip, knee or ankle joint areas. It is uncommon in children and in the upper limbs. It is a diagnosis of exclusion where important conditions like inflammatory diseases, degenerative diseases, infections and malignancy have to be excluded. The MRI hallmark is bone edema without bone necrosis. Treatment is usually conservative and includes analgesics and staying off the affected limb. The natural history is that of gradual resolution of symptoms over a number of months. Evidence for medical treatment is limited, but open-label studies suggest bisphosphonates may help in the resolution of pain and improve radiological findings. Surgical decompression is usually used as a last resort........ |
|
|
 |
| Weber-Schoendorfer C, et al. Arthritis & Rheumatology. 2014;66:1101–1110. |
Pregnancy outcome in women taking methotrexate (MTX; ≤30 mg/week) either after conception or within the 12 weeks before conception (preconception) was evaluated in a prospective observational multicenter cohort study. Pregnancy outcomes in the MTX group were compared to outcomes in a group of disease-matched women and a group of women without autoimmune diseases (neither group was exposed to MTX).
Post-conception administration of MTX at dosages typically used in the treatment of rheumatic diseases was associated with an increased risk of major birth defects and spontaneous abortion. Such evidence was not found among women in this study preconception cohort.
Although as a rule it is advisable to medically terminate pregnancies, which occur within 3 months of exposure to MTX this article seems to suggest that if the patient is unwilling to terminate pregnancy, the chance of abortions and embryopathies is negligible in those with preconception (within 12 weeks) exposure of rheumatological doses........ |
|
|
