Arthritis, and Rheumatic Diseases

Tags

ankylosing spondylitis, Anti-phospholipid antibody syndrome, Arthritis, Autoimmune Disease, biphosphonates, colitis, connective tissue disease, Crohn's disease, Enthesopathy, Granulomatous disease, Infectious Disease, inflammation, Monoclonal antibody, osteoarthritis, Osteonecrosis, osteoporosis, Psoriasis, Rheumatic diseases, rheumatoid arthritis, Rheumatology, Sarcoidosis, Scleroderma, Sjogren's Syndrome, Systemic Lupus, Systemic Sclerosis, ulcerative colitis

Regional problems

Temporomandibular joint disorders
Shoulder pain
Elbow pain
Wrist pain
Hand pain
Neck pain
Mid-Back pain
Back pain
Hip pain
Knee pain
Ankle pain
Foot pain
Fibromyalgia
Chronic Fatigue Syndrome
Reflex Sympathetic Dystrophy (RSD)
Neuropathy

Spondyloarthritis
Psoriatic arthritis
Colitis associated arthritis
Ankylosing Spondylitis
Reactive arthritis (Reiter’s Syndrome)

Infections and Arthritis
Viral Arthritis
Lyme disease
Rheumatic fever
Bacterial arthritis
Fungal arthritis
Gonococcal arthritis
Tuberculosis arthritis
Osteomyelitis

Bone diseases
Osteoporosis
Osteomalacia
Paget’s disease
Osteopetrosis
Osteogenesis Imperfecta
Ehlers-Danlos Syndrome
Parathyroid disorders
Osteonecrosis
Osteochondritis
Marfan Syndrome
Hypermobility

Crystal Induced Arthritis
Gout
Pseudo gout
Crystal arthritis

Systemic Diseases
Rheumatoid arthritis
Seronegative Arthritis
Palindromic Rheumatism
Sjögren’s syndrome
Undifferentiated connective tissue disease
Mixed connective tissue disease
Systemic Lupus
Drug Induced Lupus
Scleroderma (Systemic Sclerosis)
CREST Syndrome
Eosinophilic fasciitis
Adult-onset Still’s Disease
Anti phospholipid antibody syndrome

Vasculitis
Temporal arteritis
Polymyalgia Rheumatica
Takayasu’s arteritis
Polyarteritis Nodosa
Wegener’s granulomatosis
ANCA associated vasculitis
Microscopic polyangiitis
Allergic angiitis
Churg-Strauss syndrome
Henoch-Schönlein purpura
Urticarial Vaculitis
Leukocytoclastic Vasculitis
Cryoglobulinemia

Inflammatory Muscle Diseases
Polymyositis
Dermatomyositis
Inclusion-body myositis
Drug induced myopathy
Infectious myositis

Rheumatic diseases
Relapsing Polychondritis
Behçet’s Syndrome
Amyloidosis
Whipple’s disease
Sarcoidosis
Diabetic arthropathy
Immunodeficiency syndromes
Raynaud’s phenomenon

Pediatric Rheumatic Diseases
Juvenile Idiopathic Arthritis
Juvenile Spondyloarthritis
Juvenile connective tissue diseases
Dermatomyositis
Vasculitis
Scleroderma

Anti-Rheumatic Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Aspirin (Ecotrin, Salicylic Acid) Bufferin
Celecoxib (Celebrex)
Diclofenac (Voltaren, Cataflam, Voltaren-XR)
Diflunisal (Dolobid)
Etodolac (Lodine)
Fenoprofen (Fenopron, Nalfron)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin)
Ketoprofen (Orudis, Oruvail)
Ketorolac (Toradol)
Meclofenamic acid (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)
Oxaporozin (Daypro)
Piroxicam (Feldene)
Salsalate (Salflex, Disalcid, Trilisate)
Sulindac (Clinoril)

Steroids
Prednisone
Methylprednisolone
Hydrocortisone
Solumedrol
Celestone
Kenalog
Decadron
Aristospan
Depomedrol

Disease Modifying Drugs (DMARDs)
abatacept
adalimumab
azathioprine
Certolizumab pegol
chloroquine
Cyclosporin
Cyclophosphamide
D-penicillamine
etanercept
golimumab
gold salts
hydroxychloroquine
infliximab
leflunomide
methotrexate
minocycline
rituximab
sulfasalazine
Tocilizumab
Tofacitinib
Ustekinumab

Hypouricemic Drugs
Allopurinol
Colchicine
Uloric
Probenecid
Sulfinpyrazone

Osteoporosis Drugs
alendronate
risedronate
ibandronate
Pamidronate
zoledronic acid
raloxifene
denosumab
teriparatide

Rheumatology in pictures
Sternoclavicular joint swelling

Hydroxychloroquine (Plaquenil)

Tags

ANA, Anti-malarial drug, Anti-rheumatic drug, Arthritis, Autoimmune Disease, c3, c4, connective tissue disease, Double dtranded DNA, lupus, mixed connective tissue disease, Rheumatic diseases, Scleroderma, Sjogren's Syndrome, ssa, SSB, undifferentiated connective tissue disease

This is an anti-malarial drug that is used primarily to treat:
– Systemic Lupus
– Rheumatoid Arthritis

Hydroxychloroquine (Plaquenil) is started at 6.5 mg/kg of the ideal body weight to no more than 400 mg per day. The usual doses are between 200 to 400 mg daily either once a day or twice daily. The dose should be reduced in liver and kidney disease.

Eye exams are required in patients starting Plaquenil. Patient should have eye examination before starting Plaquenil and then every six to twelve months for as long as taking this treatment.

This treatment is generally well-tolerated. Half life of this drug is 32-50 days. This treatment should be stopped if not effective after six months. Toxicity does increase after five years and it is rare before that. Therefore I usually reduce the dose to 200 mg daily as condition becomes stable and as tolerated. I have even reduced the dose to 2-3 times per week in many patients.

The use in pregnancy is classified as category C where one need to look at risks and benefits in each individual case. It is found in breast milk but amount is very small.

Precautions should be taken in patients with Psoriasis and Porphyria as it may exacerbate these conditions. G6PD deficiency may result in renal failure and hemolysis.

7. Presence of liver disease, kidney disease, obesity, and being older than 70 years of age all increase risk of Plaquenil toxicity. More information here.

A new test for Scleroderma!

Tags

chemokine, CXCL4, interferon, plasmacytoid dendritic cells

Systemic sclerosis (scleroderma) can soon be evaluated as to the severity of the disease by measuring chemokine CXCL4 secreted by plasmacytoid dendritic cells.

A recent study showed that the mean CXCL4 levels were much higher in patients with Systemic sclerosis (over 25000 pg/ml) than those with Lupus, Ankylosing spondylitis, or Liver fibrosis (all under 2000 pg/ml).

This is significant because CXCL4 level correlates with severity of disease in systemic sclerosis including Skin thickening and Respiratory: Non-labored respirations. Lungs with clear lung fields and no rubs noted. Involvement. This means that those with high levels of chemokine CXCL4 may have to be treated more aggressively.

There is also potential for CXCL4 to be developed as a therapeutic target as well.