Elevated Cardiac Troponin T in Patients with Lupus Myositis Presenting with Noncardiac Chest Pain.

Patients with systemic lupus erythematosus (SLE) presenting with chest pain pose a unique diagnostic challenge, with causes ranging from cardiopulmonary disease to esophageal disorders and musculoskeletal chest wall pain. The most common biomarkers for myocardial injury are cardiac troponin T and I (cTnT and cTnI) due to their high sensitivity for the early detection of myocardial infarction. In the idiopathic inflammatory myopathies, cTnT is commonly elevated, and this reflects skeletal muscle breakdown rather than myocardial damage.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.

Objective: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.

Methods: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.

Objective: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.

Methods: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA.

Advocacy 101: Engaging Rheumatology Fellows in Health Policy and Advocacy.

Objective: Rheumatology fellowship programs lack formal curricular content to educate trainees about legislative and regulatory health care policies that have a profound impact on academic and community practices. Advocacy 101 was created as a program to address this gap and engage fellows-in-training (FIT) in health advocacy efforts.

Methods: A web-based survey was sent via the American College of Rheumatology (ACR) FIT listserve in July 2015 and April 2016.

Can Probiotic Supplements Improve Outcomes in Rheumatoid Arthritis?

Purpose Of Review: The purpose of this review is to frame the discussion of the potential use of probiotics for the management of rheumatoid arthritis (RA) in the historical and scientific context linking the human microbiota to the etiology, pathogenesis, and treatment of RA. Given this context, the review then details the clinical trials that have been carried out so far that have tried to address the question.

Recent Findings: A variety of laboratory and clinical observations link the flora of the oral cavity and lower gastrointestinal tract with citrullination, as well as immunological alterations that may contribute to the risk of developing RA.

Association of Chondrocalcinosis in Knee Joints With Pain and Synovitis: Data From the Osteoarthritis Initiative.

Objective: To evaluate the relationship between chondrocalcinosis and pain or synovitis in knee joints by examining data from the Osteoarthritis Initiative (OAI).

Methods: Data were obtained from the OAI public-use data sets. The relationship between chondrocalcinosis on baseline knee radiograph and pain at baseline and at 4 years was examined.

Rheumatology Research Foundation Clinician Scholar Educator Award: Fifteen Years Promoting Rheumatology Educators and Education.

Objective: The Rheumatology Research Foundation's Clinician Scholar Educator (CSE) award is a 3-year career development award supporting medical education research while providing opportunities for mentorship and collaboration. Our objective was to document the individual and institutional impact of the award since its inception, as well as its promise to strengthen the subspecialty of rheumatology.

Methods: All 60 CSE Award recipients were surveyed periodically.

Current Perspectives on Imaging for Systemic Lupus Erythematosus, Systemic Sclerosis, and Dermatomyositis/Polymyositis.

Systemic rheumatic diseases frequently pose diagnostic challenges to the clinician. The precise nature of the disorder can be obscure and different disorders can present with similar symptoms, such as joint pain. Plain radiographs provide an appropriate starting point for detection of joint abnormalities.

Osseous sarcoidosis: a case series.

Sarcoidosis is an inflammatory disorder characterized by noncaseating granulomas infiltrating affected organs. Any organ system can be involved, and more than 90 % of patients have a primary pulmonary manifestation. The incidence of radiographically evident bone involvement has been reported over a wide range: from 3 to 39 % depending on the population studied and imaging modalities used.

Ayurvedic medicine for rheumatoid arthritis.

Ayurvedic medicine is the traditional medicine of India, which originated over 5,000 years ago. Parts of this alternative medical system have become increasingly popular worldwide as patients seek approaches to medical care that they perceive as more holistic and less toxic than those offered by conventional Western medicine. Despite the advent of highly effective pharmacologic therapy, most individuals with rheumatoid arthritis (RA) continue to use alternative therapy at some point in the treatment of their disease.

Food, drink, and herbs: alternative therapies and gout.

Gout was first recognized as a distinct clinical entity in antiquity. Our understanding of the epidemiology and treatment of gout has evolved over millennia intertwined with observations about social class and plant and animal sources of food, beverages and medicines. Investigators have identified various aspects of diet that relate to gout risk and recurrence.

Mycoplasma pneumoniae with atypical stevens-johnson syndrome: a diagnostic challenge.

The Stevens-Johnson syndrome (SJS) classically involves a targetoid skin rash and the association of the oral mucosa, genitals, and conjunctivae. Recently, there have been several documentations of an incomplete presentation of this syndrome, without the typical rash, usually associated with the mycoplasma pneumoniae infection. Our case illustrates that this important clinical diagnosis should not be missed due to its atypical presentation.

Limited cutaneous vasculitis associated with levamisole-adulterated cocaine.

Levamisole is among the many contaminants that have been detected in seized cocaine throughout North America and Europe. Little is known about the association between levamisole-adulterated cocaine and vasculitis. Herein we describe a case of limited cutaneous vasculitis manifested as retiform purpura and skin necrosis in a user of cocaine contaminated with levamisole.

Herbal medicine for rheumatic diseases: promises kept?

Traditional healers throughout the world have relied on herbal medicines in their practices for millennia to treat a wide array of conditions, including arthritis. Present-day patients continue to seek care from complementary and alternative providers and more effective and less toxic treatments. A broad foundation of laboratory studies suggests that many herbal products have pertinent medicinal effects for the management of diseases like osteoarthritis and rheumatoid arthritis.

A review of 32 free flaps in patients with collagen vascular disorders.

Background: Collagen vascular diseases affect multiple organs by the deposition of immunoglobulins along vascular basement membranes. This pathophysiology potentially makes these patients poor free flap candidates, with a possible increased risk of failure. The often concomitant finding of hypercoagulability may also compound the risk.

Fish oil in rheumatic diseases.

In current practice, dietary interventions and over-the-counter dietary supplements, including fish oil, vitamins, and others, comprise a significant proportion of alternate therapy use. The aim of this article is to clarify the appropriate place for the use of fish oil in rheumatologic practice amid the complexities of modern management.

Successful treatment of new onset Wegener's granulomatosis with IVIG (intravenous immunoglobulin) during pregnancy: a case report.

We describe a patient with limited Wegener's granulomatosis (WG) presenting during pregnancy with aggressive cutaneous involvement. She was treated with a combination of high-dose corticosteroids and intravenous immunoglobulin (IVIG) during her third trimester. The patient had otherwise uneventful pregnancy and a satisfactory outcome for both herself and her newborn.

Subspecialty choice: why did you become a rheumatologist?

Objective: To determine the reasons trainees choose rheumatology as a subspecialty and to review the literature on career choices among physicians, particularly regarding the choice of subspecialty.

Methods: A questionnaire was designed to identify and analyze factors that influence rheumatology fellows to join the field of rheumatology. The questionnaire was administered online and answers were collated through the American College of Rheumatology Training and Workforce Committee, Subcommittee on Medical Student and Resident Recruitment.