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

Sulfasalazine

Tags

anti-ccp, arava, cimzia, enbrel, humira, methotrexate, remicade, rheumatoid arthritis, rheumatoid factor, sulfasalazine, synovitis, Xeljanz

Points to remember about Sulfasalazine are:

– This is seventy year old medication.
– It was developed as a combination of an anti-inflammatory and a sulfa antibiotic to treat Rheumatoid Arthritis.
– It is the first disease modifying drug (DMARD) that was actually developed to treat Rheumatoid Arthritis.
– Enteric coated form of Sulfasalazine would minimize stomach side-effects.
– It can be used by itself or along with other DMARDs such as Methotrexate, Plaquinel.
– Periodic blood testing is needed to look for possible toxicity specifically affecting liver and Neutrophils.
– Although never approved by FDA, it is used to treat variety of inflammatory conditions including:
– Rheumatoid Arthritis
– Psoriatic Arthritis
– Spondyloarthropathy
– Ankylosing Spondylitis
– Juvenile Rheumatoid Arthritis
– Ulcerative Colitis
– It can help both bowel and joint symptoms in patients with inflammatory bowel disease who also have associated arthritis.
– It may take up to three months to see an effect.
– At times the improvement is so slow that Sulfasalazine has to be stopped to see if the patient actually becomes worse off of it. Becoming worse off of this treatment would be indication of a response and treatment with Sulfasalazine can thus be resumed.

XELJANZ: The New Rheumatoid Arthritis Drug

Tags

cytokine, interleukin, jak, janus kinase, joints, ra, rheumatoid arthritis, synovitis, tyrosine kinase

XELJANZ ® (tofacitinib) is the new rheumatoid arthritis drug on the market and it is made by Pfizer.

Important points about Xeljanz to remember are:

– It is a biologic therapy therefore infections can occur.
– Therapy should be stopped in case of infection.
– Patients should be screened for TB prior to start of therapy and monitored periodically afterwards.
– It should be used with caution in those with history of diverticulitis.
– No information is available for use in patients with chronic hepatitis B or hepatitis C.
– Monitoring by blood testing is needed for possible effects on blood counts specifically hemoglobin, lymphocytes, neutrophils, liver enzymes, Creatinine, and lipids.
– Xeljanz dose should be reduced to 5 mg daily in patients with moderate liver or kidney involvement and not used in severe liver disease.
– The dose should also be reduced to 5 mg daily in patients on potent inhibitors of Cytochrome P450 3A4 (CYP3A4) (e.g., ketoconazole) and CYP2C19 (e.g., fluconazole).
– Use of live vaccine in patients should be avoided as has not been studied and there were reports of reactivation of herpes zoster in the clinical trials.
– No information is available in terms of multiple sclerosis
– It was recently rejected by european equivalent of FDA as they felt the risks were more than the benefits.

TMJ or Temporomandibular Joint Pain

Tags

Arthritis, disc, displacement, jaw, JCA, JRA, osteoarthritis, psoriatic, rheumatoid arthritis

Key points to remember here are:

1. The first step here is to make sure there is no dental issues causing the TMJ such as the mandible not lining up with maxilla. It is not unusual for this to develop after dental work.

2. MRI often provide the details needed to make proper diagnosis as to what is causing the pain in TMJ.

3. The causes here vary from trauma with damage to the joint structures to various forms of arthritis including:

– Disc displacement
– Meniscal tear
– Juvenile Idiopathic Arthritis (Juvenile rheumatoid arthritis)
– Rheumatoid arthritis
– Psoriatic arthritis
– Traumatic arthropathy
– Gout

4. Treatment obviously depends on the cause. Early treatment of the underlying disease is the key to avoid damage to TMJ.

5. Aggressive and early treatment of Rheumatoid, Psoriatic, and JIA with new biologics treatments such as Enbrel and Humira has resulted in significant decline of TMJ problems in these patients.

6. Oral Surgeons often deal with TMJ when medical therapy is exhausted.

Sjogren’s Syndrome

Tags

dry eyes, Dry mouth, lupus, rheumatoid arthritis, SAA, SSB

Seven points to keep in mind about Sjogren’s Syndrome

1. Lip biopsy is often not necessary as there is no treatment for this condition.

2. SSA and SSB are seen only in 40 and 26% of patients respectively.

3. It can cause arthritis, Raynaud’s, vasculitis, lung disease, nerve damage, kidney disease, liver disease, pancreatitis, and lymph node enlargement.

4. Dry eyes and mouth may be seen in less than 50% of patients at initial presentation.

5. Frequent use of over the counter artificial tears and possibly ointments at night is the main treatment for dry eyes.

6. Monitoring for possible lymphoma with periodic blood testing.

7. Seeing a rheumatologist should help in making proper diagnosis here.

Rheumatoid Factor

Tags

anti-ccp, rheumatoid arthritis

1. Rheumatoid factor can be seen with conditions other than rheumatoid arthritis.

2. Most common cause of false positive rheumatoid factor is hepatitis C.

3. Positive rheumatoid factor can be present years before one develop rheumatoid arthritis.

4. Anti-CCP is the other test for rheumatoid arthritis. This test is more sensitive and more specific than rheumatoid factor.

5. Only 70% of patients with rheumatoid arthritis have a positive test for rheumatoid factor.

6. There is no need to repeat rheumatoid factor test as it often does not change with treatment.

7. Evaluation be a rheumatologist who is a specialist for evaluation and treatment of rheumatoid arthritis is a must.

M. Rezaian, MD

Tofacitinib in Rheumatoid Arthritis

Tags

arava, biologics, cimzia, enbrel, humira, methotrexate, orencia, rheumatoid arthritis, rituxan, simponi

Tofacitinib, the new rheumatoid arthritis drug, appears to be just as effective as Humira for treatment of Rheumatoid Arthritis. However, the side-effects of this treatment may limit its usefulness and these include lowering of white blood cell count, elevated cholesterol, as well as infections. This drug could still be useful in patients who have failed other biologic therapies. NEJM.