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RHEUMATOLOGY (76 journals)

Showing 1 - 76 of 76 Journals sorted alphabetically
ACR Open Rheumatology     Open Access   (Followers: 5)
Advances in Rheumatology     Open Access   (Followers: 3)
African Journal of Rheumatology     Full-text available via subscription  
Aktuelle Rheumatologie     Hybrid Journal   (Followers: 2)
Annals of Rheumatology and Autoimmunity     Open Access   (Followers: 3)
Annals of the Rheumatic Diseases     Hybrid Journal   (Followers: 34)
Archives of Osteoporosis     Hybrid Journal   (Followers: 1)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 64)
Arthritis Care & Research     Hybrid Journal   (Followers: 37)
Arthritis Research & Therapy     Open Access   (Followers: 14)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 5)
Best Practice & Research Clinical Rheumatology     Hybrid Journal   (Followers: 17)
BMC Musculoskeletal Disorders     Open Access   (Followers: 29)
BMC Rheumatology     Open Access   (Followers: 4)
Case Reports in Rheumatology     Open Access   (Followers: 10)
Clinical and Experimental Rheumatology     Full-text available via subscription   (Followers: 3)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3)
Clinical Rheumatology     Hybrid Journal   (Followers: 21)
Current Opinion in Rheumatology     Hybrid Journal   (Followers: 13)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 13)
Current Rheumatology Reports     Hybrid Journal   (Followers: 3)
Current Rheumatology Reviews     Hybrid Journal   (Followers: 4)
Current Treatment Options in Rheumatology     Hybrid Journal  
Egyptian Rheumatologist     Open Access   (Followers: 1)
Egyptian Rheumatology and Rehabilitation     Open Access   (Followers: 2)
Forum Reumatologiczne     Hybrid Journal  
Future Rheumatology     Full-text available via subscription   (Followers: 1)
Gait & Posture     Hybrid Journal   (Followers: 17)
Indian Journal of Rheumatology     Open Access   (Followers: 1)
Indonesian Journal of Rheumatology     Open Access  
International Journal of Clinical Rheumatology     Open Access   (Followers: 4)
International Journal of Rheumatic Diseases     Hybrid Journal   (Followers: 2)
International Journal of Rheumatology     Open Access   (Followers: 6)
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 7)
Internet Journal of Rheumatology and Clinical Immunology     Open Access   (Followers: 4)
JCR Journal of Clinical Rheumatology     Hybrid Journal   (Followers: 7)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 9)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Rheumatology     Open Access   (Followers: 32)
Modern Rheumatology     Hybrid Journal   (Followers: 4)
Modern Rheumatology Case Reports     Hybrid Journal  
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 8)
Musculoskeletal Care     Hybrid Journal   (Followers: 19)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 16)
Nature Reviews Rheumatology     Full-text available via subscription   (Followers: 25)
OA Arthritis     Open Access   (Followers: 1)
OA Inflammation     Open Access  
Open Access Rheumatology: Research and Reviews     Open Access   (Followers: 3)
Open Journal of Orthopedics and Rheumatology     Open Access  
Open Journal of Rheumatology and Autoimmune Diseases     Open Access   (Followers: 4)
Open Rheumatology Journal     Open Access  
Orthopädie & Rheuma     Full-text available via subscription  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 20)
Osteoarthritis and Cartilage Open     Open Access  
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
Pain. Joints. Spine     Open Access   (Followers: 1)
Reumatismo     Open Access  
Reumatología Clínica (English Edition)     Full-text available via subscription  
Revista Argentina de Reumatología     Open Access  
Revista Colombiana de Reumatologia     Open Access  
Revista Colombiana de Reumatología (English Edition)     Hybrid Journal  
rheuma plus     Hybrid Journal  
Rheumatic Disease Clinics of North America     Full-text available via subscription   (Followers: 4)
Rheumatica Acta: Open Access     Open Access  
Rheumatology     Hybrid Journal   (Followers: 33)
Rheumatology & Autoimmunity     Open Access   (Followers: 3)
Rheumatology Advances in Practice     Open Access   (Followers: 1)
Rheumatology and Therapy     Open Access   (Followers: 3)
Rheumatology International     Hybrid Journal   (Followers: 3)
Rheumatology Practice and Research     Open Access  
RMD Open     Open Access   (Followers: 1)
Scandinavian Journal of Rheumatology     Hybrid Journal   (Followers: 5)
Seminars in Arthritis and Rheumatism     Hybrid Journal   (Followers: 8)
The Lancet Rheumatology     Hybrid Journal  
Zeitschrift fur Rheumatologie     Hybrid Journal   (Followers: 6)
Similar Journals
Journal Cover
Current Treatment Options in Rheumatology
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Online) 2198-6002
Published by Springer-Verlag Homepage  [2469 journals]
  • Understanding and Therapeutically Targeting the Scleroderma Myofibroblast

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      Abstract: Purpose of Review Myofibroblasts represent matrix-producing effector cells which both produce and maintain the pro-fibrotic microenvironment in scleroderma and other fibrotic diseases. This review first explores the origins, function, regulators, interactions, and death of myofibroblasts in fibrotic tissue and then utilizes this information to guide understanding of current and future treatments which may target these cells. Recent Findings. Beyond existing immunomodulatory therapy for SSc, there are an increasing number of anti-fibrotic therapies which are either under clinical study or development which may be able to effectively target myofibroblasts. Summary The role of myofibroblast modulation in treatment of scleroderma is a promising field with data supporting multiple new agents which may modulate myofibroblasts as anti-fibrotic therapy.
      PubDate: 2022-04-01
      DOI: 10.1007/s40674-021-00189-8
       
  • The Effectiveness of Fracture Liaison Services in Improving Fragility
           Fracture Outcomes

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      Abstract: Purpose of review Fragility fractures are associated with significant morbidity, mortality, and societal costs. A fracture liaison service (FLS) is a multidisciplinary approach that identifies people with fragility fractures with the goal to ensure optimal osteoporosis treatment. In this review, we summarize recent data on the FLS effectiveness in improving osteoporosis diagnosis, bone density testing, and osteoporosis treatment, as well as reducing the rates of secondary fragility fracture, subsequent fall, and mortality in individuals with fragility fractures. Recent Findings We identified one randomized controlled trial and ten observational studies published within the last 5 years that reported on relevant outcomes. FLS was associated with favorable outcomes, depending on the intensity of the FLS approach used. Secondary fragility fracture rate was the most common reported outcome. Most studies were conducted outside of the USA, included highly variable duration of follow-up and comparators, and focused on heterogeneous patient populations. Most recent studies of FLS have important limitations given the study design and risk of bias. Summary Our findings support the need for randomized controlled trials of FLS in the USA to rigorously examine to what extent the implementation of FLS in the complex US healthcare system may improve outcomes of patients with fragility fracture.
      PubDate: 2022-03-31
      DOI: 10.1007/s40674-021-00190-1
       
  • Dysregulation of Type I Interferon Signaling in Systemic Sclerosis: a
           Promising Therapeutic Target'

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      Abstract: Purpose of Review There are several lines of evidence at the genetic and gene expression levels linking type I interferon (IFN) activation to systemic sclerosis (SSc) pathogenesis. Herein, we summarize the potential role of type I IFN signaling components as therapeutic targets. Recent Findings All type I IFN cytokines signal through the interferon-α/β receptor (IFNAR). Early phase studies indicate that anifrolumab (a human monoclonal antibody against IFNAR subunit 1) has an acceptable safety profile and can attenuate transforming growth factor beta (TGF-β)-mediated fibrosis in SSc skin, supporting its further clinical development. Janus kinase (JAK) signaling pathways are downstream from IFNAR. Building on their efficacy in hereditary interferonopathies, JAK inhibitors have the potential to block the deleterious IFN and other profibrotic cytokine activation in SSc and are promising drug targets. Moreover, interferon regulator factor (IRF) 5, 7, and 8 have been linked to the profibrotic response in SSc preclinical studies, underscoring their potential as therapeutic targets. Lastly, depletion of plasmacytoid dendritic cells (pDCs) attenuates the IFN activation and fibrotic response in vitro and murine model experiments and can be studied as a viable drug target in future clinical studies. Summary There is increasing evidence linking the prominent type I IFN activation to the observed exaggerated fibrotic response in SSc. Key components of type I IFN signaling are druggable therapeutic targets that can be pursued in future randomized clinical trials, in order to develop more effective therapeutic options for SSc.
      PubDate: 2021-12-01
      DOI: 10.1007/s40674-021-00188-9
       
  • Insights Into the Preclinical Models of SSc

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      Abstract: Purpose of Review In the recent decade, new animal models which phenocopy a broad range of systemic sclerosis (SSc)-like features have been generated. This review article outlines the strengths and limitations of 4 animal models, which were established or further characterized in the recent few years. Recent Findings Inducible SSc animal models, such as hypochlorous acid-treated mice and type V collagen-immunized mice and rabbits, recapitulate multiple organ involvement of SSc, including diffuse skin fibrosis, interstitial lung disease, pulmonary arterial hypertension, and/or kidney involvement. Further characterization of vascular aspects in Psgl1−/− mice shed new light on the endothelium-leukocyte interaction in immune tolerance underlying SSc-like vasculopathy. In vitro studies with dermal microvascular endothelial cells, bone marrow-derived endothelial progenitor cells, and bone marrow-derived mesenchymal stem cells, a precursor of pericytes, derived from Klf5+/−;Fli1+/− mice dissect the aberrant roles of angiogenesis, vasculogenesis, and anastomosis in SSc-like vasculopathy. Summary SSc animal models which reproduce a broad range of organ involvement support our understanding of an SSc-specific pathological cascade, but no current animal models mimic the whole range of SSc pathological features. However, a proper combination of complimentary models can help us better understand the molecular pathogenesis of SSc and promote the development of new therapies.
      PubDate: 2021-12-01
      DOI: 10.1007/s40674-021-00187-w
       
  • Acute Sacroiliac Joint Pain: Clinical Presentation, Causes, and
           Investigations

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      Abstract: Purpose of Review This review focuses on the clinical approach to acute sacroiliac joint (SIJ) pain, to improve clinicians’ ability to identify key features of SIJ-related pain syndromes, risk factors, and underlying etiologies. We review anatomy, common presentations, and etiologies for SIJ pain and its mimics as well as evaluate the workup of SIJ pain. Recent Findings Despite numerous physical exam maneuvers which put stress on the SIJ, no one test is best to identify SIJ as the etiology of pain. Fluoroscopic-guided injection may prove to be a technique helpful in distinguishing this poorly understood joint. Summary Given the complexity of the SIJ anatomy and its inter-individual variation and changes with age, a thorough history, physical exam, and appropriate workup with laboratory studies and imaging will help guide clinicians to properly evaluate SIJ pathology etiology.
      PubDate: 2021-12-01
      DOI: 10.1007/s40674-021-00185-y
       
  • Pharmacologic Treatment of Anti-MDA5 Rapidly Progressive Interstitial Lung
           Disease

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      Abstract: Purpose of the Review Idiopathic inflammatory myopathies are a heterogeneous group of autoimmune disorders. The presence of different autoantibodies allows clinicians to define distinct phenotypes. Antibodies against the melanoma differentiation-associated protein 5 gene, also called anti-MDA5 antibodies, are associated with a characteristic phenotype, the clinically amyopathic dermatomyositis with rapidly progressive interstitial lung disease. This review aims to analyze the different pharmacological options for the treatment of rapidly progressive interstitial lung disease in patients with anti-MDA5 antibodies. Recent Findings Evidence-based therapeutic recommendations suggest that the best initial approach to treat these patients is an early combination of immunosuppressive drugs including either glucocorticoids and calcineurin inhibitors or a triple therapy adding intravenous cyclophosphamide. Tofacitinib, a Janus kinase inhibitor, could be useful according to recent reports. High ferritin plasma levels, generalized worsening of pulmonary infiltrates, and ground-glass opacities should be considered predictive factors of a bad outcome. In this scenario, clinicians should consider rescue therapies such as therapeutic plasma exchange, polymyxin-B hemoperfusion, veno-venous extracorporeal membrane oxygenation, or even lung transplantation. Summary Combined immunosuppressive treatment should be considered the first-line therapy for patients with anti-MDA5 rapidly progressive interstitial lung disease. Aggressive rescue therapies may be useful in refractory patients.
      PubDate: 2021-09-28
      DOI: 10.1007/s40674-021-00186-x
       
  • Adverse Events Associated with Belimumab Therapy in Systemic Lupus
           Erythematosus

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      Abstract: Purpose of Review Belimumab is generally well tolerated; however, several adverse events have been associated with the use of belimumab including infections, haematotoxicity, malignancies, infusion reactions, and psychiatric disorders. The purpose of the review is to appraise the adverse events associated with belimumab therapy in SLE which would then aid clinicians in making informed decisions regarding belimumab therapy in SLE patients. Recent Findings Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder affecting multiple organs with high morbidity and mortality rates. Existing treatment options for SLE include chloroquine, azathioprine, cyclophosphamide, corticosteroids, and nonsteroidal anti-inflammatory drugs. Belimumab is the first-ever targeted biologic product for the treatment of autoantibody-positive SLE patients who are on standard therapy. Belimumab is a monoclonal antibody that can effectively reduce SLE disease activity and disease flares by targeting the soluble form of B lymphocyte stimulators. Belimumab can decrease the production of autoantibodies and B cell survival. Summary Belimumab therapy has a low incidence of adverse events and a favourable safety profile. Therefore, due to the effectiveness of belimumab in SLE, belimumab is recommended for SLE patients in addition to standard therapy.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00179-w
       
  • Consideration of Fibromyalgia in the Assessment and Treatment of SLE

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      Abstract: Purpose of Review Fibromyalgia (FM) is highly prevalent amongst patients with systemic lupus erythematosus (SLE) and can complicate diagnosis and management in patients with both disorders. In this article, we review the current understanding of FM as a disease and highlight how it can impact the assessment and treatment of patients with SLE and comorbid FM. Recent Findings While FM is prevalent amongst patients with SLE, studies do not suggest that FM patients are at increased risk of developing rheumatic disease. A growing body of evidence demonstrates that health-related quality of life (HRQoL) in SLE patients is not strongly associated with disease activity or damage, but rather associated with the presence of comorbid FM. Several new therapies, both pharmacological and non-pharmacological, are under investigation for FM. Summary FM is highly prevalent amongst patients with SLE and negatively impacts HRQoL, independent of disease activity or damage. In patients with both disorders, it is important that thorough assessment by a rheumatologist familiar with SLE is undertaken to avoid misdiagnosis or inappropriate treatment. Current FM therapy includes a combination of both pharmacological and non-pharmacological modalities; emphasis should also be placed on ensuring patient understanding and expectations of the disease course are clear. While a number of new therapies are being investigated for FM, there is not yet strong enough evidence to support their inclusion in clinical care.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00181-2
       
  • Treatment in Antisynthetase Syndrome-Associated Interstitial Lung Disease

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      Abstract: Purpose of review Describe the treatment of antisynthetase syndrome-associated interstitial lung disease (AS-ILD). Recent findings The pathogenesis of AS-ILD involves the abnormal activation of the innate and adaptive immune systems, including activation of NK cells, dendritic cells, T-cells, and B-cells. Immunosuppressive agents targeting these pathways can treat AS-ILD patients; however, there are no randomized clinical trials evaluating the effect of these medications. Current recommendations are based on retrospective studies with therapies that have been shown to stabilize the lung function of other autoimmune-related ILDs. The selection of the agent is based on expert opinion and varies according to center preference and patient profile. Glucocorticoids are the first-line therapy in patients with active AS-ILD disease, typically, in combination with azathioprine or mofetil mycophenolate. Calcineurin inhibitors represent an alternative agent as second-line therapy. Cyclophosphamide, rituximab, and human immunoglobulins may be used for resistant and severe disease, but their role as first-line therapy is unknown. Non-pharmacologic therapies include pulmonary rehabilitation and oxygen supplementation is also frequently used along with the aforementioned medications. Summary Treatment recommendations for AS-ILD are mainly based on retrospective studies of immunosuppressive drugs that have shown benefit in the stabilization of lung function. Further studies, ideally multicentered randomized clinical trials, are required to better guide the treatment in AS-ILD.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00177-y
       
  • A Self-Report Multidimensional Health Assessment Questionnaire (MDHAQ) for
           Face-To-Face or Telemedicine Encounters to Assess Clinical Severity
           (RAPID3) and Screen for Fibromyalgia (FAST) and Depression (DEP)

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      Abstract: Purpose of Review To update the clinical value of a patient self-report multidimensional health assessment questionnaire (MDHAQ). Recent Findings The MDHAQ includes 10 individual quantitative scores for physical function, pain, patient global assessment, fatigue, sleep, anxiety, depression, morning stiffness, change in status, and exercise status, and 5 indices, RAPID3 (routine assessment of patient index data) to assess clinical status in all diseases studied, FAST3 (fibromyalgia assessment screening tool) and MDHAQ-Dep (depression) to screen for fibromyalgia and/or depression, RADAI self-report of specific painful joints and joint count, and a symptom checklist for review of systems, and recognition of flares and medication adverse events. The MDHAQ also uniquely queries traditional “medical” information concerning comorbidities, falls, trauma, new symptoms, illnesses, surgeries, hospitalizations, emergencies, medication changes, and medication side effects. Three MDHAQ versions include long for new patients, short for new and return patients, and telemedicine. An electronic MDHAQ (eMDHAQ) has been developed with software that can interface with any electronic medical record (EMR) through the HL7 FHIR standard. However, EMR collaboration and implementation have proven difficult. Summary An MDHAQ provides a quantitative overview of patient status with far more information and documentation than an interview, involving minimal extra work for the physician.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00175-0
       
  • Inhibiting Interferon Pathways in Dermatomyositis: Rationale and
           Preliminary Evidence

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      Abstract: Purpose of review Dermatomyositis (DM) is a systemic autoimmune disease affecting multiple organs, including the skeletal muscle, skin, and lungs. Although DM disease mechanisms are incompletely understood, accumulating evidence suggests that interferons may play a significant role. Consequently, it is of considerable interest that drugs blocking the activity of interferons by inhibiting the Janus Kinase/Signal Transducer and Activator of Transcription (JAK-STAT) pathway have been approved for use in other autoimmune diseases. This manuscript will examine the IFN pathways and their importance in DM, review the existing literature on the use of JAK-STAT inhibitors in patients with adult or juvenile DM, and discuss the potential utility of JAK-STAT inhibitors to treat this disease. Recent findings Recent reports suggest that muscle and skin involvement in patients with either adult or juvenile DM responds favorably to JAK-STAT inhibitors. Moreover, preliminary data indicates that JAK-STAT inhibitors may be useful to treat clinical manifestations of this disease that are complicated to manage otherwise, such as calcinosis or rapidly progressive interstitial lung disease in DM patients with anti-MDA5 autoantibodies. Summary An increasing number of reports suggest that JAK-STAT inhibitors may be useful to treat the varied manifestations of adult and juvenile DM. However, as most studies were either small or lacked appropriate comparators, further research will be necessary to define the role of these drugs in DM treatment.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00182-1
       
  • Mechanisms and Mediators of Pain in Chronic Inflammatory Arthritis

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      Abstract: Purpose of the review Pain in chronic inflammatory joint diseases is a common symptom reported by patients. Pain becomes of absolute clinical relevance especially when it becomes chronic, i.e., when it persists beyond normal healing times. As an operational definition, pain is defined chronic when it lasts for more than 3 months. This article aims to provide a review of the main mechanisms underlying pain in patients with chronic inflammatory joint diseases, discussing in particular their overlap. Recent findings While it may be intuitive how synovial inflammation or enthesitis are responsible for nociceptive pain, in clinical practice, it is common to find patients who continue to complain of symptoms despite optimal control of inflammation. In this kind of patients at the genesis of pain, there may be neuropathic or nociplastic mechanisms. Summary In the context of chronic inflammatory joint diseases, multiple mechanisms generally coexist behind chronic pain. It is the rheumatologist’s task to identify the mechanisms of pain that go beyond the nociceptive mechanisms, to adopt appropriate therapeutic strategies, including avoiding overtreatment of patients with immunosuppressive drugs. In this sense, future research will have to be oriented to search for biomarkers of non-inflammatory pain in patients with chronic inflammatory joint diseases.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00178-x
       
  • Clinical Trials in Myositis: Where Do We Stand'

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      Abstract: Purpose of review There are currently no universally accepted management guidelines for idiopathic inflammatory myopathies (IIM), with only limited clinical evidence available to guide treatment decisions. However, the situation is changing and the number of clinical trials is growing, thanks to the improvement in our understanding of disease pathogenesis and availability of novel immunomodulatory drugs. We provide an overview of completed and ongoing interventional clinical trials evaluating the efficacy of pharmacotherapy in various forms of adult IIMs. Recent findings Unfortunately, the results of many trials are not very encouraging and no single drug seems to be a real breakthrough, reflecting the difficulty associated with studying such rare and heterogenous group of diseases. Several drugs have proven good efficacy in certain IIM subgroups and there are promising novel candidates raising hope for the future. Summary The efficacy of intravenous immunoglobulins in dermatomyositis has been clearly confirmed. Encouraging reports, albeit very preliminary, are coming from trials with JAK inhibitors. We eagerly await the results of a large clinical trial with abatacept or the cannabinoid receptor modulator lenabasum.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00180-3
       
  • Insights Into Systemic Sclerosis from Gene Expression Profiling

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      Abstract: Purpose of review The emergence of genomic data science stands poised to revolutionize our molecular understanding of the heterogeneity of complex diseases including systemic autoimmune diseases. In systemic sclerosis (SSc), bulk and single-cell transcriptomics have provided a new lens into the heterogeneity of this complex condition, both in terms of molecular heterogeneity, treatment response, and cell types important for the disease. Recent findings Transcriptomics has revealed reproducible patterns of gene expression among SSc patients. These conserved patterns of gene expression provide insights into SSc etiology, and evidence suggests that these groups may have important implications for treatment decisions by targeting specific patients. Integration and analyses of publicly available data are providing new insights into the disease. Single-cell technologies are illuminating cell types that may be important in pathogenesis. The disease trajectory for SSc remains difficult to predict, but the interactions between adaptive and innate immune cells with tissue-resident stromal cells may play an important role. Summary The heterogeneity in SSc can be broken down and quantified using molecular methods that range from bulk analysis to single cells. Further study of cellular and molecular dynamics in end-target tissues is likely to result in better disease management through personalized, data-driven treatment decisions.
      PubDate: 2021-09-01
      DOI: 10.1007/s40674-021-00183-0
       
  • Shoulder Pain — Where Are We Now'

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      Abstract: Purpose of Review Shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified. Recent Findings Imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit. Summary Much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.
      PubDate: 2021-08-05
      DOI: 10.1007/s40674-021-00184-z
       
  • Update on Maintenance Therapies for ANCA-Associated Vasculitis

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      Abstract: Purpose of review Over the past decades, maintenance therapy in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) has greatly evolved, in a smooth step-wise manner. Refinements are still needed, and more changes will likely occur soon. Here, we review the historical steps that led to the current standard for maintenance therapy and the results of some recent studies that could reshape it further. Recent findings Although older drugs, such as azathioprine or methotrexate, still have a place as possible maintenance agents for AAV, rituximab (RTX) was found the most effective at preventing relapses in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), in combination, at least initially, with low-dose glucocorticoids (GCs). The optimal regimen of maintenance therapy with RTX and its duration remain to be determined. Ideally, it would be based on a patient-individualized approach. Pharmacodynamic and pharmacogenetic studies may eventually help optimize therapy. In parallel, newer agents, such as avacopan, may further revolutionize how we treat GPA and MPA, by replacing or greatly limiting the use of GCs for both induction and maintenance of remission. Fewer studies have investigated eosinophilic granulomatosis with polyangiitis, but more data have been produced recently for the use of mepolizumab or rituximab to maintain good control of asthma and rhino-sinusitis. Summary With more refined approaches and new therapies in AAV, relapse-free survival at 5 and 10 years has significantly improved over the last 20 years. However, many questions about the optimal maintenance treatment remain unanswered, and new questions have emerged with new therapeutic options. There is still a need for further studies to improve disease control and achieve sustained and possibly drug-free remission.
      PubDate: 2021-06-01
      DOI: 10.1007/s40674-021-00176-z
       
  • Therapeutic Management of Immune-Mediated Necrotizing Myositis

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      Abstract: Purpose of review The idiopathic inflammatory myopathies are a heterogeneous group of autoimmune disorders characterized by skeletal muscle inflammation leading to chronic muscle weakness. Immune-mediated necrotizing myopathy (IMNM) is a distinct subgroup of inflammatory myopathy typically characterized by myofiber necrosis with minimal inflammatory infiltrates on muscle biopsy, highly elevated creatine kinase levels, and infrequent extra-muscular involvement. This review provides an overview of currently recommended treatment strategies for IMNM, including discussion of disease activity monitoring and recommended first-line immunomodulatory agents depending on clinical phenotype and autoantibody status. Recent findings IMNM can be divided into three subtypes based on autoantibody positivity: anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) IMNM, anti-signal recognition particle (SRP) IMNM, and antibody-negative IMNM. Autoantibody status in IMNM has considerable correlation with clinical phenotype, prognosis, and recommended choice of immunosuppressive agent. Patients with anti-HMGCR IMNM tend to respond well to intravenous immunoglobulin (IVIG), and IVIG monotherapy may be a sufficient treatment for certain patients. In anti-SRP IMNM, early rituximab is commonly favored. More generally, prompt initiation of aggressive immunosuppression is often indicated, as both anti-SRP and anti-HMGCR IMNM can potentially cause debilitating weakness, muscle atrophy and irreversible fatty replacement happen early in the disease course. Patients with IMNM frequently require combination therapy to achieve disease control and have a high rate of relapse when tapering immunosuppression. Young age of onset is a poor prognostic factor. Summary IMNM can be severely disabling and often requires aggressive immunosuppression. For any given patient, the treatment strategy should be informed by the severity of their presenting features and autoantibody status. While our ability to treat IMNM has certainly improved, there remains a need for more prospective trials to inform optimal treatment strategies.
      PubDate: 2021-06-01
      DOI: 10.1007/s40674-021-00174-1
       
  • Quantity and Quality of Rheumatoid Arthritis and Osteoarthritis Clinical
           Practice Guidelines: Systematic Review and Assessment Using AGREE II

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      Abstract: Objectives The purpose of this study was to identify the quantity and evaluate the quality of clinical practice guidelines for the treatment and/or management of rheumatoid arthritis (RA) and osteoarthritis (OA). Methods We conducted a systematic review, searching MEDLINE, EMBASE and CINAHL databases from 2008 to 2018. The Guidelines International Network website was also searched. Eligible guidelines were assessed using the AGREE II instrument. Results From 525 unique search results, 12 RA guidelines and 3 OA CPGs were found to be eligible. Scaled domain percentages from highest to lowest were clarity of presentation (89.8%), scope and purpose (88.0%), stakeholder involvement (67.6%), rigour of development (62.2%), editorial independence (56.4%) and applicability (53.3%). Quality varied within and across guidelines. None of the 15 guidelines were recommended by both appraisers; 11 were recommended as Yes or Yes with modifications. Conclusions A number of guidelines for the treatment and/or management of RA or OA are available to support informed decision-making among healthcare practitioners and patients. CPGs were of variable quality; those that received lower scaled domain percentages or overall recommendations could be improved by using the AGREE II instrument, or insight from tools that are available to support guideline development and implementation.
      PubDate: 2021-06-01
      DOI: 10.1007/s40674-021-00172-3
       
  • Updates in the Treatment of Rheumatoid Arthritis

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      Abstract: Purpose of review The treatment of rheumatoid arthritis (RA) is rapidly evolving; there is extensive literature to keep up with each year. The purpose of this review is to summarize the current general approach to rheumatoid arthritis treatment, with an emphasis on recent advances (since 2017). Recent findings There have been three new medications approved for use in RA in the USA (not including biosimilars), new data made available on safety of more established medications, and new RA treatment guidelines published in that time period. Two of the approved medications are JAK inhibitors; indeed, JAK inhibitors are the biggest news in RA management in recent years. Summary Despite these advances, the general treatment strategy—when to start treatment, what medications should be tried first and in refractory cases, treatment goal, and how and when to discontinue medications—remains largely unchanged.
      PubDate: 2021-06-01
      DOI: 10.1007/s40674-021-00173-2
       
  • Soluble Biomarkers for Prediction of Vascular and Gastrointestinal Disease
           Severity in Patients with Systemic Sclerosis

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      Abstract: Purpose of review Disease severity biomarkers in patients with systemic sclerosis (SSc) provide an early and noninvasive screening tool to identify patients at increased risk for internal organ involvement that may impact diagnostic testing and treatment decisions. This review will focus on soluble SSc vascular and gastrointestinal disease biomarkers. Recent findings Due to high morbidity and mortality associated with SSc pulmonary hypertension, multiple biomarkers are currently under investigation including serum autoantibodies, chemistries (such as N-terminal pro-brain natriuretic peptide (NT-proBNP)), proteins (midkine (MDK) and follistatin-like 3 (FSTL3)), chemokines (C-X-C motif ligand 4 (CXCL4) and C-C motif ligand 21 (CCL21)), plasma growth factors (vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)), cell adhesion molecules (vascular cell adhesion molecule 1 (VCAM-1)), and endothelial microparticles (CD144+ endothelial microparticle (CD144+ EMP)). A subset of these has also been proposed as SSc digital ulcer biomarkers (anti-endothelin-1 type A receptor (anti-ETAR), PlGF, and NT-proBNP). A combination of NT-proBNP and high sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) may be useful for assessing primary SSc cardiac involvement. Putative SSc renal disease biomarkers include VEGF and endostatin levels, while anti-U1 and U3 ribonucleoprotein (anti-U1- and anti-U3-RNP) antibodies and fecal-calprotectin (F-calprotectin) are associated with GI involvement. Summary Serum autoantibodies are the mainstay SSc severity biomarkers, but new biomarkers are under investigation.
      PubDate: 2021-03-01
      DOI: 10.1007/s40674-021-00171-4
       
 
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