Podcasts about arthritis rheum

In this episode, we dig through the data of lupus in Africa and speak with experts on the Lupus Gradient, the impact of malaria and what we can learn from it all. ·       Intro 0:12 ·       In the previous episode 0:30 ·       Lupus Gradient 2:01 ·       Back to Dr. Brian Greenwood 3:48 ·       Polyarthritis 4:04 ·       Rates of autoimmune diseases 6:00 ·       Malaria and mouse models 7:33 ·       Back to lupus 8:48 ·       First case of lupus 15:14 ·       Prevalence of lupus 17:15 ·       Papers on lupus 21:23 ·       Dr. Mickael Essouma 23:38 ·       Dr. Essouma, how did you conduct this study? 24:01 ·       Did you ever believe there was a gradient? 26:09 ·       Dr. Sandro Vento 30:56 ·       Dr. Vento, do you believe there was a lupus gradient? 31:51 ·       What are the connections to infectious disease? 38:51 ·       That's a wrap! 43:04 ·       Coming up in part 4 44:55 ·       Thanks for listening 45:05 Disclosures: Brown reports no relevant financial disclosures. Healio could not confirm relevant financial disclosures for Essouma and Vento at the time of posting. Mickael Essouma, MD, is physician from Cameroon specialized in internal medicine at the University of Yaounde I in Cameroon, with a complimentary certificate on rheumatology from the EULAR online course and a certificate on lupus from the European Lupus Society (SLEuro). He is an advocate of lupus and other autoimmune diseases in Africans. Sandro Vento, MD, is the dean of faculty of medicine at the University of Puthisastra, Phnom Penh, Cambodia and a consultant and collaborating specialist at Mayo Clinic Center for Tuberculosis, WHO Collaborating Center. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bae SC, et al. Arthritis Rheum. 1998;doi:10.1002/1529-0131(199812)41:123.0.CO;2-D. Bryc K, et al. Am J Hum Genet. 2015;doi:10.1016/j.ajhg.2014.11.010. Essouma M, et al. J Autoimmun. 2020;doi:10.1016/j.jaut.2019.102348. Gilkeson GS, et al. Lupus. 2011;doi:10.1177/0961203311404915. Micheletti SJ, et al. Am J Hum Genet. 2020;doi:10.1016/j.ajhg.2020.06.012. Symmons DP. Lupus. 1995;doi:10.1177/096120339500400303. Vento S, et al. Front Med. 2020;doi:10.3389/fmed.2020.00202.

Quando o paciente vem com queixa de dor articular, seu diagnóstico é "junta tudo e joga fora"? No sétimo episódio do Medicina Arretada, falamos das definições de artrite/artralgia e abordagem diagnóstica inicial dos quadros de poliartrite. Também apresentamos e discutimos uma questão da prova de R3 de clínica médica sobre artrite reumatoide. Guia Rápido - Poliartralgias Medicina Arretada, um podcast sobre educação em clínica médica, com um bocado de sotaque, uma pitada de humor e muita ciência. Sigam e acompanhem a gente, nas redes: Insta: @medicinarretada Tiktok: @medicinarretada Youtube: @medarretada Site: ⁠⁠https://medicinarretada.com.br/⁠⁠ E-mail: ⁠⁠suporte@medicinarretada.com.br⁠⁠ Um "xêro" e até a próxima!

Nerw błędny jest kluczowym elementem autonomicznego układu nerwowego, który unerwia większość narządów, zwłaszcza tych w obrębie przewodu pokarmowego. Nerw błędny jest głównym składnikiem osi neuroendokrynnoimmunologicznej, która zapewnia regulację wrodzonej odpowiedzi odpornościowej przed zakażeniami i stanem zapalnym, pomagając organizmowi przywrócić równowagę. Z tego powodu stymulacja nerwu błędnego jest aktualnie intensywnie badany pod kątem przeciwzapalnego potencjału terapeutycznego w niektórych chorobach. Gość: dr Maciej Duczyński – fizjoterapeuta i student osteopatii. Od lat pasjonuje się układem nerwowym i możliwościami poprawy jego funkcjonowania poprzez terapię manualną. Maciek popularyzuje metodę elektrostymulacji nerwu błędnego w leczeniu pacjentów ze schorzeniami autoimmunologicznymi, zaburzeniami funkcji przewodu pokarmowego i depresją. Misją Maćka jest przede wszystkim edukacja i pokazywanie ludziom, że osiągnięcie zdrowia nie musi być bardzo skomplikowane. Na co dzień pracuje z pacjentami w gabinecie Triada Zdrowia na warszawskich Włochach oraz prowadzi szkolenia dla fizjoterapeutów w firmie Neuroprojekt. Oprócz tego Maćka znajdziecie na instagramie pod nickiem @duczynski.m W odcinku znajdziesz odpowiedzi m. in. na następujące pytania: Na czym polega praca fizjoterapeuty i osteopaty? Czym jest terapia manualna? Dlaczego chorujemy? Jak emocje i stres wpływają nasze ciało? Czym jest zmienność rytmu zatokowego (HRV)? Czym jest nerw błędny i czy ma związek z chorobami? Czym jest teoria poliwagalna? Jak możemy stymulować nerw błędny? Czy elektrostymulacja nerwu błędnego jest metoda leczenia chorób autoimmunologicznych i metabolicznych? Lista publikacji o których wspominamy w podcaście: Bonaz B. i wsp. Anti-inflammatory properties of the vagus nerve: potential therapeutic implications of vagus nerve stimulation. J Physiol. 2016 Oct 15;594(20):5781-5790. Kelly M.J. i wsp. Manipulation of the inflammatory reflex as a therapeutic strategy. Cell Rep Med. 2022 Jul 19;3(7):100696. Kuzior K. i Gorczyca W. Odruch zapalny jako przykład współzależności pomiędzy układem odpornościowym i nerwowym. Chemistry, environment, biotechnology 2010, XIV, 139–151. Bellocchi Ch. i wsp. The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases. Int J Mol Sci . 2022 Feb 23;23(5):2449. Adlan A.M. i wsp. Autonomic function and rheumatoid arthritis—A systematic review. Semin. Arthritis Rheum. 2014, 44, 283–304. Ghia J.-E. i wsp. Vagus nerve integrity and experimental colitis. Am. J. Physiol. Liver Physiol. 2007, 293,G560–G567. Koopman F.A. i wsp. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc. Natl. Acad. Sci. USA 2016, 113, 8284–8289 Sorski L. i Gidron Y. The Vagal Nerve, Inflammation, and Diabetes-A Holy Triangle. Cells. 2023 Jun 15;12(12):1632. Fang J. i wsp. Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biol Psychiatry . 2016 Feb 15;79(4):266-73. de Moraes T.l. i wsp. Brief periods of transcutaneous auricular vagus nerve stimulation improve autonomic balance and alter circulating monocytes and endothelial cells in patients with metabolic syndrome: a pilot study. Bioelectron Med. 2023 Mar 31;9(1):7. Hilz M.J. Transcutaneous vagus nerve stimulation - A brief introduction and overview. Auton Neurosci. 2022 Dec;243:103038. Inbaraj G. i wsp. Immediate Effects of OM Chanting on Heart Rate Variability Measures Compared Between Experienced and Inexperienced Yoga Practitioners. Int J Yoga. 2022 Jan-Apr;15(1):52-58. Black D.S. i Slavich G.M. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials.Ann N Y Acad Sci. 2016 Jun;1373(1):13-24.

Listen in as Dr. Nally discussed the history of gout, why Hippocrates only thought it happened to royalty and how you can treat and prevent it with a ketogenic or carnivorous lifestyle. Show Note Sources: Kanbara A., Seyama I. Effect of urine pH on uric acid excretion by manipulating food materials. Nucleosides, Nucleotides Nucleic Acids. 2011;30(12):1066–1071. Towiwat P., Li Z.G. The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout. Int J Rheum Dis. 2015;18(5):495–501. Bedir A., Topbas M., Tanyeri F., Alvur M., Arik N. Leptin might be a regulator of serum uric acid concentrations in humans. Jpn Heart J. 2003;44(4):527–536. Garrod AB. The Nature and Treatment of Gout and Rheumatic Gout, 2nd ed, Walton and Maberly, London 1863. Dalbeth N, Phipps-Green A, Frampton C, et al. Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis. Ann Rheum Dis 2018; 77:1048. Hall AP, Barry PE, Dawber TR, McNamara PM. Epidemiology of gout and hyperuricemia. A long-term population study. Am J Med 1967; 42:27. Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987; 82:421. Zalokar J, Lellouch J, Claude JR, Kuntz D. Epidemiology of serum uric acid and gout in Frenchmen. J Chronic Dis 1974; 27:59. BRILL JM, MCCARTY DJ. "STUDIES ON THE NATURE OF GOUTY TOPHI" BY MAX FREUDWEILER, 1899. (AN INFLAMMATORY RESPONSE TO INJECTED SODIUM URATE, 1899). AN ABRIDGED TRANSLATION, WITH COMMENTS. Ann Intern Med 1964; 60:486. McCarty DJ, Hollander JL. Identification of urate crystals in gouty synovial fluid. Ann Intern Med 1961; 54:452. Seegmiller JE, Howell RR, Malawista SE. The inflammatory reaction to sodium urate: its possible relationship to the genesis of acute gouty arthritis. JAMA 1962; 180:469. Hutton J, Fatima T, Major TJ, et al. Mediation analysis to understand genetic relationships between habitual coffee intake and gout. Arthritis Res Ther 2018; 20:135. Fanning N, Merriman TR, Dalbeth N, Stamp LK. An association of smoking with serum urate and gout: A health paradox. Semin Arthritis Rheum 2018; 47:825. Lin KC, Lin HY, Chou P. Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kinmen. J Rheumatol 2000; 27:1045. Zhang Y, Woods R, Chaisson CE, et al. Alcohol consumption as a trigger of recurrent gout attacks. Am J Med 2006; 119:800.e13. Hunter DJ, York M, Chaisson CE, et al. Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. J Rheumatol 2006; 33:1341. Chhana A, Lee G, Dalbeth N. Factors influencing the crystallization of monosodium urate: a systematic literature review. BMC Musculoskelet Disord 2015; 16:296. Loeb JN. The influence of temperature on the solubility of monosodium urate. Arthritis Rheum 1972; 15:189. Horvath SM, Hollander JL. INTRA-ARTICULAR TEMPERATURE AS A MEASURE OF JOINT REACTION. J Clin Invest 1949; 28:469. Martinon F, Pétrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 2006; 440:237. Guerne PA, Terkeltaub R, Zuraw B, Lotz M. Inflammatory microcrystals stimulate interleukin-6 production and secretion by human monocytes and synoviocytes. Arthritis Rheum 1989; 32:1443. Terkeltaub R, Zachariae C, Santoro D, et al. Monocyte-derived neutrophil chemotactic factor/interleukin-8 is a potential mediator of crystal-induced inflammation. Arthritis Rheum 1991; 34:894. di Giovine FS, Malawista SE, Thornton E, Duff GW. Urate crystals stimulate production of tumor necrosis factor alpha from human blood monocytes and synovial cells. Cytokine mRNA and protein kinetics, and cellular distribution. J Clin Invest 1991; 87:1375. Guerne PA, Terkeltaub R, Zuraw B, Lotz M. Inflammatory microcrystals stimulate interleukin-6 production and secretion by human monocytes and synoviocytes. Arthritis Rheum 1989; 32:1443.

What we talked about: 1:10- Example case of lateral hip pain 2:30- Diagnosis of lateral hip pain 7:50- Differential diagnoses 12:00- Exercises for rehabbing lateral hip pain 13:30- Management of pain 19:45- Treatments References: -Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001 Sep;44(9):2138-45. -Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J. 2002 Jul-Aug;2(4):251-4. -Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomized clinical trial. BMJ 2018; 361:k1662. -Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed. 2000 May;28(5):38-48. -Fitzpatrick J, Bulsara MK, O'Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. Am J Sports Med. 2018 Mar;46(4):933-939.

What does the PAPA spectrum disorder teach us about SAPHO? Is SAPHO an autoinflammatory condition or part of the SpA spectrum? Why have antibiotics been used to treat this condition? Find out in this episode! Intro :01 Welcome to another exciting episode of Rheuminations :11 About today's episode :17 A summary of SAPHO Part 1 :24 What to expect in this episode 1:28 Earlier long-term data 2:27 A more recent paper from Italy 6:47 Therapeutics in detail 12:17 Summary so far 21:39 IL-1 inhibition in SAPHO 22:32 Monogenic pediatric conditions 33:58 Why can't we check the genes in SAPHO? 40:00 Episode summary 41:55 We went through a lot in this paper 45:29 Thanks for listening 43:53 Disclosure: Brown reports no relevant financial disclosures. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Agak GW, et al. J Invest Dermatol. 2014;134:366-373. Aksentijevich I, et al. N Engl J Med. 2009;360:2426-2437. Assmann G, Simon P. Best Pract Res Clin Rheumatol. 2011;25:423-434. Boursier G, et al. J Invest Dermatol. 2021;141:1141-1147. Cai R, et al. Front Cell Dev Biol. 2021;doi:10.3389/fcell.2021.643644. Colina M, et al. Arthritis Rheum. 2009;61:813-821. Daoussis D, et al. Semin Arthritis Rheum. 2019;48:618-625. Eun IS, et al. J Clin Neurosci. 2021;92:153-158. Ferguson PJ, El-Shanti H. Biomolecules. 2021;11:367. Grosse J, et al. Blood. 2006;107:3350-3358. Guignard S, et al. Joint Bone Spine. 2002;69:392-396. Hayem G, et al. Semin Arthritis Rheum. 1999;29:159-171. Holzinger D, Roth J. Curr Opin Rheumatol. 2016;28:550-559. Hurtado-Nedelec M, et al. J Rheumatol. 2010;37:401-409. Liao HJ, et al. Rheumatology (Oxford). 2015;54:1317-1326. Lindor NM, et al. Mayo Clin Proc. 1997;72:611-615. Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265. Trimble BS, et al. Agents Actions. 1987;21:281-283. Yeon HB, et al. Am J Hum Genet. 2000;66:1443-1448. You H, et al. J Clin Immunol. 2021;41:565-575.

What is SAPHO? What does the ‘H' stand for, again? This episode explores some basics about the condition and delves into the history of how this disease came to be. Intro :01 Welcome to another exciting episode of Rheuminations :11 About today's episode :17 What does the acronym ‘SAPHO' stand for? :37 How do you define this condition? 2:35 So, what is SAPHO syndrome? 4:59 Are any of the letters specific for SAPHO syndrome? 15:20 How the puzzle pieces were put together 15:48 Over the next ensuing decades, when did we start realizing that patients could have dermatologic manifestations? 23:00 So, what about hyperostosis? 30:46 Why isn't the Sonozaki group getting the credit? 39:22 So, how did we get SAPHO? 40:26 How did they get 85 patients? 42:50 We went through a lot in this paper 45:29 Next episode preview 46:29 Thanks for listening 47:03 Disclosure: Brown reports no relevant financial disclosures. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Chamot AM, et al. Rev Rheum Mal Osteoartic. 1987;54:187-196. Giedion A, et al. Ann Radiol (Paris) 1972;15:329-342. Köhler H, et al. Ann Intern Med. 1977;87:192-194. Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265. Raposo I, Torres T. Am J Clin Dermatol. 2016;17:349-358.  Romani M, et al. Clin Podiatr Med Surg. 2021;38:541-552.  Sonozaki H, et al. Ann Rheum Dis. 1981;40:547-553. Windom RE, et al. Arthritis Rheum. 1961;4:632-635. 

On this episode of the PAIN POD, Mark Pain Guy Garofoli will take you on a journey of a pain guy in pain, and just what our patients hear from us as healthcare professionals, and what the healthcare system experience can be like when not being the one wearing the stethoscope, and rather being the patient in pain. Can anyone imagine being dropped off at the ER by your Wife and toddler on Friday the 13th during a pandemic to only begin a 3 month long excruciating journey of pain? Pain Guy Garofoli can tell you all about it, and provide a few clinical pearls to improve patient care along the way! This is not a campfire conversation, but you can feel free to download and listen while camping, swimming, biking, walking, or however, you'd like, just be forewarned that Mark will not be sparing any painful details. You're welcome and he's sorry, all at once! COVID & NSAIDs Info https://www.bbc.com/news/51929628 Jeong HE, et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study. Clin Infect Dis. 2020 Jul 27. https://clinicaltrials.gov/ct2/show/record/NCT04334629 NSAID COX-1 & COX-2 Studies Feldman, M, et al. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity. Ann Intern Med. 2000; 132: 134-143 Herndon, C. et al. Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs. Pharmacotherapy. 2008; 28 (6): 788-805. Masso Gonzalez EL, et al. Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-601. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark Pain Guy Garofoli will take you on a journey of a pain guy in pain, and just what our patients hear from us as healthcare professionals, and what the healthcare system experience can be like when not being the one wearing the stethoscope, and rather being the patient in pain. Can anyone imagine being dropped off at the ER by your Wife and toddler on Friday the 13th during a pandemic to only begin a 3 month long excruciating journey of pain? Pain Guy Garofoli can tell you all about it, and provide a few clinical pearls to improve patient care along the way! This is not a campfire conversation, but you can feel free to download and listen while camping, swimming, biking, walking, or however, you'd like, just be forewarned that Mark will not be sparing any painful details. You're welcome and he's sorry, all at once! COVID & NSAIDs Info https://www.bbc.com/news/51929628 Jeong HE, et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study. Clin Infect Dis. 2020 Jul 27. https://clinicaltrials.gov/ct2/show/record/NCT04334629 NSAID COX-1 & COX-2 Studies Feldman, M, et al. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity. Ann Intern Med. 2000; 132: 134-143 Herndon, C. et al. Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs. Pharmacotherapy. 2008; 28 (6): 788-805. Masso Gonzalez EL, et al. Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-601. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark Pain Guy Garofoli will take you on a journey of a pain guy in pain, and just what our patients hear from us as healthcare professionals, and what the healthcare system experience can be like when not being the one wearing the stethoscope, and rather being the patient in pain. Can anyone imagine being dropped off at the ER by your Wife and toddler on Friday the 13th during a pandemic to only begin a 3 month long excruciating journey of pain? Pain Guy Garofoli can tell you all about it, and provide a few clinical pearls to improve patient care along the way! This is not a campfire conversation, but you can feel free to download and listen while camping, swimming, biking, walking, or however, you'd like, just be forewarned that Mark will not be sparing any painful details. You're welcome and he's sorry, all at once! COVID & NSAIDs Info https://www.bbc.com/news/51929628 Jeong HE, et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study. Clin Infect Dis. 2020 Jul 27. https://clinicaltrials.gov/ct2/show/record/NCT04334629 NSAID COX-1 & COX-2 Studies Feldman, M, et al. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity. Ann Intern Med. 2000; 132: 134-143 Herndon, C. et al. Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs. Pharmacotherapy. 2008; 28 (6): 788-805. Masso Gonzalez EL, et al. Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-601. See omnystudio.com/listener for privacy information.

Referências:1.Alizai H, Walter W, Khodarahmi I, Burke CJ. Cartilage Imaging in Osteoarthritis. Semin Musculoskelet Radiol. 2019; 23 (5): 569-78.2.Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019; 393 (10182): 1745-59.3.Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology. 2011; 260 (2): 332-54.4.Mcgonagle D, Tan AL, Grainger AJ, Benjamim M. Heberden's nodes and what Heberden could not see: the pivotal role of ligaments in the pathogenesis of early nodal osteoarthritis and beyond. Rheumatology 2008; 47: 1278–12855.Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health. 2009; 1 (6): 461-8.6.Pathria MN, Chung CB, Resnick DL. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Radiology 2016; 280 (1): 21-38.7.Huber M, Trattnig S, Lintner F. Anatomy, biochemistry, and physiology of articular cartilage. Invest Radiol. 2000; 35 (10): 573-80.8.Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J et al. Biomechanical Considerations in the Pathogenesis of Osteoarthritis of the Knee. Knee Surg Sports Traumatol Arthrosc 2012; 20: 423-4359.Martinez-Moreno D, Jimenez G, Galvez-Martin P, Rus G, Marchal JA. Cartilage biomechanics: A key factor for osteoarthritis regenerative medicine. Biochim Biophys Acta Mol Basis Dis. 2019; 1865 (6): 1067-75.10.Wang X, Hunter DJ, Jin X, Ding C. The importance of synovial inflammation in osteoarthritis: current evidence from imaging assessments and clinical trials. Osteoarthritis and Cartilage 2018; 26 (2): 165e17411.Haugen IK, Boyesen P. Imaging modalities in hand osteoarthritis – status and perspectives of conventional radiography, magnetic resonance imaging, and ultrasonography. Arthritis Res Ther 2011; 13 (6): 24812.Ridley WE, Xiang H, Han J, Ridley LJ. Gull-wing Deformity: Osteoarthritis. J Med Im Rad Onc 2018; 62 (S1): 141.13.Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol. 2002; 156 (11): 1021-7.14.N S. Hand Osteoarthritis — Clinical Presentation, Phenotypes and Management. 2015.15.Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum. 2005; 52 (8): 2355-65.16.Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis. 2016; 75 (5): 825-30.17.Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med. 2019; 124 (11): 1101-11.18.Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, et al. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis. 2016; 75 (2): 402-7.

Why is hemochromatosis so common? What is iron actually doing to the joint? Does phlebotomy help? What’s going on with iron and Popeye? These are the questions we tackle in the second episode of hemochromatosis: Iron and Bone! Brought to you by GSK. Intro :19 Today’s episode :29 Why is hemochromatosis so common? 1:06 The history of Popeye the Sailor Man 3:37 Treatment with phlebotomy 8:35 Why doesn’t join pain improve? 12:03 What is Kashin-Beck disease? 14:18 Mouse studies from the 1970s 19:45 What about histology? 25:36 Episode wrap-up 28:34 Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Adams PC, et al. Hepatology. 1997;25:162-166. Adams PC, et al. N Engl J Med. 2005;352:1769-1778. Brighton CT, et al. Arthritis Rheum. 1970;13:849-857. Heiland GR, et al. Ann Rheum Dis. 2010;69:1214-1219. Hiyeda, K. Jap Med Sci. 1939;4:91-106. Powell LW, et al. Lancet. 2016;388:706-716. Rametta R, et al. Int J Mol Sci. 2020;21:3505. Sella EJ, Goodman AH. J Bone Joint Surg Am. 1973;55:1077-1081. Sutton M. Internet Journal of Criminology. 2010;1-34.

In this episode, we dig into hemochromatosis to better understand what it is, how it affects the joints, available screening methods, as well as clues to presentation and physical exam findings. Brought to you by GSK. Intro :10 Today’s episode :26 What is hemochromatosis? 1:42 What does the iron do? 3:03 How much iron is in the body? 5:30 When do you suspect it? 7:46 What do we want to know about the joints? 9:33 About Ralph Schumacher Jr., MD, and his work 12:15 How have Schumacher’s observations held up? 14:42 What about radiographs … can they help? 16:09 What about hand OA and the gene mutation? 16:44 So, what about people with undiagnosed hemochromatosis? What do their hands look like? 18:09 What about chondrocalcinosis? 19:13 Tune in next time for part two 21:59 Episode wrap-up 22:25 Disclosures: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bulaj ZJ, et al. N Engl J Med. 2000;343:1529-1535. Carroll GJ, et al. Arthritis Care Res. 2012;64:9-14. Hamilton EB, et al. Q J Med 1981;199:321–329. Jordan JM. Curr Opin Rheumatol. 2004;16:62-66. Rametta R, et al. Int J Mol Sci. 2020;21:3505. Ross JM, et al. J Rheumatol. 2003;30:121-5. Schumacher HR. Arthritis Rheum. 1964;7:41–50. Timms AE, et al. Ann Rheum Dis. 2002;61:745–747. Ulvik RJ. Tidsskr Nor Laegeforen. 2016;136:2017-2021.

¡Gracias por escuchar! Los nuevos criterios de clasificación EULAR-ACR de 2019 para el lupus eritematoso sistémico (LES) se desempeñaron bien en las cohortes de validación y derivadas iniciales. Pero, ¿superan estos criterios los criterios de clasificación previos entre género, duración de la enfermedad o etnias? Están son algunas referencias cuya lectura se recomienda: Adamichou, C. et al. In an early SLE cohort the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria classify non-overlapping groups of patients: use of all three criteria ensures optimal capture for clinical studies while their modification earlier classification and treatment. Ann. Rheum. Dis. 79, 232–241 (2020). Aringer, M. et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann. Rheum. Dis. 78, 1151–1159 (2019).   Aggarwal, R. et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 67, 891–897 (2015). Dahlström, Ö. & Sjöwall, C. The diagnostic accuracies of the 2012 SLICC criteria and the proposed EULAR/ACR criteria for systemic lupus erythematosus classification are comparable. Lupus 28, 778–782 (2019). Johnson, S. R. et al. Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities. Ann. Rheum. Dis. 79, 1333–1339 (2020). Pons-Estel, G. J., Alarcón, G. S., Scofield, L., Reinlib, L. & Cooper, G. S. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin. Arthritis Rheum. 39, 257–268 (2010). Petri, M. et al. A Comparison of 2019 EULAR/ACR SLE classification criteria with two sets of earlier SLE classification criteria. Arthritis Care Res. https://doi.org/10.1002/acr.24263 (2020). Pons-Estel, G. J. et al. Applying the 2019 EULAR/ACR lupus criteria to patients from an established cohort: a Latin American perspective. RMD Open 6, e001097 (2020). Ugarte-Gil, M. F. et al. Applying the 2019 EULAR/ACR Lupus criteria to patients from the LUMINA cohort. Arthritis Care Res. https://doi.org/10.1002/acr.24367 (2020). Uribe, A. G., McGwin, G. Jr, Reveille, J. D. & Alarcón, G. S. What have we learned from a 10-year experience with the LUMINA (Lupus in Minorities: Nature vs. nurture) cohort? Where are we heading? Autoimmunity Rev. 3, 321–329 (2004).  

¡Gracias por escuchar! Una pregunta importante para los pacientes y médicos es si, y en qué medida, las intervenciones dietéticas, los suplementos dietéticos o la pérdida de peso pueden ayudar a prevenir la gota incidente o controlar la gota existente. En este episodio se revisará evidencia evidencia reciente en este sentido, derivada de uno de los pocos ensayos clínicos relacionados a este tema. Algunas referencia útiles: Singh, J. A., Shah, N. & Edwards, N. L. A cross-sectional internet-based patient survey of the management strategies for gout. BMC Complement. Altern. Med. 16, 90 (2016). Juraschek, S. P. et al. Effects of dietary patterns on serum urate: results from the DASH randomized trial. Arthritis Rheumatol. https://doi.org/10.1002/art.41614 (2020). Appel, L. J. et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N. Engl. J. Med. 336, 1117–1124 (1997). Jacobs, D. R. Jr. & Steffen, L. M. Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am. J. Clin. Nutr. 78, 508s–513s (2003). Juraschek, S. P. et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) diet and sodium intake on serum uric acid. Arthritis Rheumatol. 68, 3002–3009 (2016). Li, C., Hsieh, M. C. & Chang, S. J. Metabolic syndrome, diabetes, and hyperuricemia. Curr. Opin. Rheumatol. 25, 210–216 (2013). Stamp, L. K. et al. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial. Arthritis Rheum. 65, 1636–1642 (2013). Stamp, L. K. et al. Lack of effect of tart cherry concentrate dose on serum urate in people with gout. Rheumatology 59, 2374–2380 (2020). Singh, J. A. et al. A randomized internet-based pilot feasibility and planning study of cherry extract and diet modification in gout. J. Clin. Rheumatol. 26, 147–156 (2019). Rai, S. K. et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ 357, j1794 (2017).

Dernier épisode et certainement le plus controversé de notre série sur la goutte! Dans ce 62ème épisode du Pharmascope, Nicolas, Sébastien et Isabelle tentent de répondre à plusieurs questions croquantes: Quand initier un traitement prophylactique contre la goutte? Comment ajuster les doses? Suivre les niveaux d’acide urique, est-ce pertinent? Et la prophylaxie de la prophylaxie,c’est utile? Les objectifs pour cet épisode sont: Discuter du moment idéal pour débuter un traitement prophylactique de la goutteExpliquer les avantages et les inconvénients d’une approche d’ajustement de dose d’hypouricémiant selon l’atteinte de niveaux cibles d’acide uriqueExpliquer les bénéfices et les risques d’une prophylaxie anti-inflammatoire concomitante à l’initiation d’un traitement hypouricémiant Ressources pertinentes en lien avec l’épisode Lignes directrices portant sur la prise en charge de la goutteFitzGerald JD et coll. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol. 2020;72:879-95. Richette P et coll. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020;79:31-8. Qaseem A et coll. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:58-68. Articles de revue portant sur la prise en charge de la goutteDrug and Therapeutics Bulletin. Latest guidance on the management of gout. BMJ. 2018;362:k2893. Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45:213-36. Dugré N. L’hyperuricémie et la goutte. Québec Pharmacie. Juin/juillet 2015. 25p. Initiation d’un traitement hypouricémiant pendant une crise de goutteTaylor TH et coll. Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial. Am J Med. 2012;125:1126-34.e7. Hill EM et coll. Does starting allopurinol prolong acute treated gout? A randomized clinical trial. J Clin Rheumatol. 2015;21:120-5. Ajustement des doses d’hypouricémiants selon des niveaux ciblesStamp LK et coll. A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout. Ann Rheum Dis. 2017;76:1522-8. Stamp L et coll. Serum urate as surrogate endpoint for flares in people with gout: A systematic review and meta-regression analysis. Semin Arthritis Rheum. 2018;48:293-301. Prophylaxie anti-inflammatoire concomitante avec la colchicinePaulus HE et coll. Prophylactic colchicine therapy of intercritical gout. A placebo-controlled study of probenecid-treated patients. Arthritis Rheum. 1974;17:609-14. Borstad GC et coll. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31:2429-32.

On continue notre série goutteuse! Dans ce 61ème épisode du Pharmascope, Nicolas, Sébastien et Isabelle discutent des mesures non pharmacologiques et du traitement prophylactique de la goutte. Les objectifs pour cet épisode sont les suivants: Expliquer les mesures non pharmacologiques utilisées dans le traitement chronique de la goutteIdentifier les indications pour débuter un traitement prophylactique en goutteExpliquer les bénéfices et les risques associés aux traitements prophylactiques en goutte Ressources pertinentes en lien avec l’épisode Lignes directrices portant sur la prise en charge de la goutteFitzGerald JD et coll. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol. 2020;72:879-95. Richette P et coll. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020;79:31-8. Qaseem A et coll. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:58-68. Articles de revue portant sur la prise en charge de la goutteDrug and Therapeutics Bulletin. Latest guidance on the management of gout. BMJ. 2018;362:k2893. Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45:213-36. Dugré N. L’hyperuricémie et la goutte. Québec Pharmacie. Juin/juillet 2015. 25p. Études portant sur les traitements chroniques de la goutteBadve SV et coll. Effects of Allopurinol on the Progression of Chronic Kidney Disease. N Engl J Med. 2020;382:2504-13. Doria A et coll. Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes. N Engl J Med. 2020;382:2493-2503. Kimura K et coll. Febuxostat Therapy for Patients With Stage 3 CKD and Asymptomatic Hyperuricemia: A Randomized Trial. Am J Kidney Dis. 2018;72:798-810. Schumacher Jr HR et coll. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 2008;59:1540-8. Seth R et coll. Allopurinol for chronic gout. Cochrane Database Syst Rev. 2014;10:CD006077. Ramasamy SN et coll. Allopurinol Hypersensitivity: A Systematic Review of All Published Cases, 1950–2012. Drug Saf. 2013;36:953-80. White WB et coll. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med 2018;378:1200-10.

Robyn Lawley is an international fashion model who has been modeling for over a decade and was the first "plus-sized" model ever to appear both in the pages of Sports Illustrated and on the cover of an Australian publication. Listen to Dr. Allie and Bridget Malcolm in conversation with Robyn Lawley as they speak about her experience as a "plus-sized" model, on being a mother, on her diagnosis of Lupus and on her journey to a healthier way of living. Robyn is originally from Australia and has been on the cover of Italian Vogue, French Elle and Australia's Madison magazine, and has appeared in ads for Ralph Lauren, Calzedonia, H&M and Mango. Please note that the contents of Model Mentality are for informational purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your condition. Never disregard professional advice or delay in seeking it because of something you have heard on Model Mentality. As always, if you are in crisis or you think you may have an emergency, call your doctor or 911 immediately. If you're having suicidal thoughts, call 1-800-273-TALK (8255) to talk to a skilled, trained counselor at a crisis center in your area at any time (National Suicide Prevention Lifeline). If you are located outside the United States, call your local emergency line immediately. The views and opinions expressed by guests of the podcast are those of each individual guest and do not reflect the views and opinions of Mind Studios or Dr. Allie Sharma and do not constitute an endorsement of such views and opinions. Thank you for listening to Model Mentality. Model Mentality is brought to you by Mind Studios. Links: Follow Robyn Lawley on Instagram @robynlawley. Follow Mind Studios on Instagram @mindstudiosny or www.mind-studios.com References for the 'Let's Get Clinical' segment: Centers for Disease Control (CDC) on Lupus https://www.cdc.gov/lupus/facts/detailed.html#symptoms Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis Rheum. 2008;58(1):15–25. National Institute of Mental Health (NIMH) on Chronic Illness and Mental Health https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml WHO on Preventing Non-Communicable Diseases https://www.who.int/activities/preventing-noncommunicable-diseases/ --- Support this podcast: https://anchor.fm/modelmentality/support

Votre patience est maintenant récompensée, voici notre tant attendue série goutteuse! Dans ce 60ème épisode du Pharmascope, Nicolas, Sébastien et Isabelle discutent épidémiologie, facteurs de risque, manifestations cliniques et prise en charge des crises de goutte. Les objectifs pour cet épisode sont: Identifier les facteurs de risque de goutteExpliquer les manifestations aiguës et chroniques de la goutteExpliquer les bénéfices et les risques associés aux traitements utilisés en crise de goutte Ressources pertinentes en lien avec l’épisode Lignes directrices portant sur la prise en charge de la goutteFitzGerald JD et coll. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol. 2020;72:879-95. Richette P et coll. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020;79:31-8. Qaseem A et coll. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:58-68. Articles de revue portant sur la prise en charge de la goutteDrug and Therapeutics Bulletin. Latest guidance on the management of gout. BMJ. 2018;362:k2893. Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45:213-36. Dugré N. L’hyperuricémie et la goutte. Québec Pharmacie. Juin/juillet 2015. 25p. Études portant sur le traitement aigu de la gouttevan Durme CMPG et coll. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev. 2014;9:CD010120. Terkeltaub RA et coll. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 201062:1060-8. Roddy E et coll. Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. Ann Rheum Dis. 2020;79:276-84.

Osteoarthritis of the hands;Whole joint disease;Benjamin concepts' about osteoarthritis;References:1.Alizai H, Walter W, Khodarahmi I, Burke CJ. Cartilage Imaging in Osteoarthritis. Semin Musculoskelet Radiol. 2019;23(5):569-78.2.Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59.3.Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology. 2011;260(2):332-54.4.Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health. 2009;1(6):461-8.5.Pathria MN, Chung CB, Resnick DL. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Radiology. 2016;280(1):21-38.6.Huber M, Trattnig S, Lintner F. Anatomy, biochemistry, and physiology of articular cartilage. Invest Radiol. 2000;35(10):573-80.7.Martinez-Moreno D, Jimenez G, Galvez-Martin P, Rus G, Marchal JA. Cartilage biomechanics: A key factor for osteoarthritis regenerative medicine. Biochim Biophys Acta Mol Basis Dis. 2019;1865(6):1067-75.8.Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, et al. The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum. 2005;52(10):3152-9.9.Braun HJ, Gold GE. Diagnosis of osteoarthritis: imaging. Bone. 2012;51(2):278-88.10.Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand-Gastineau MP, Keen H, et al. Imaging in osteoarthritis. Rheum Dis Clin North Am. 2008;34(3):645-87.11.Argentieri EC, Burge AJ, Potter HG. Magnetic Resonance Imaging of Articular Cartilage within the Knee. J Knee Surg. 2018;31(2):155-65.12.Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol. 2002;156(11):1021-7.13.N S. Hand Osteoarthritis — Clinical Presentation, Phenotypes and Management. 2015.14.Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum. 2005;52(8):2355-65.15.Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis. 2016;75(5):825-30.16.Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med. 2019;124(11):1101-11.17.Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, et al. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis. 2016;75(2):402-7.18.Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat. 2001;199(Pt 5):503-26.19.McGonagle D, Tan AL, Carey J, Benjamin M. The anatomical basis for a novel classification of osteoarthritis and allied disorders. J Anat. 2010;216(3):279-91.20.McGonagle D, Hermann KG, Tan AL. Differentiation between osteoarthritis and psoriatic arthritis: implications for pathogenesis and treatment in the biologic therapy era. Rheumatology (Oxford). 2015;54(1):29-38.21.Grainger AJ, Farrant JM, O'Connor PJ, Tan AL, Tanner S, Emery P, et al. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol. 2007;36(8):737-45.

REFERENCES1. ​Alizai H, Walter W, Khodarahmi I, Burke CJ. Cartilage Imaging in Osteoarthritis. Semin Musculoskelet Radiol. 2019;23(5):569-78.2. ​Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59.3. ​Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology. 2011;260(2):332-54.4. ​Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health. 2009;1(6):461-8.5. ​Pathria MN, Chung CB, Resnick DL. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Radiology. 2016;280(1):21-38.6. ​Huber M, Trattnig S, Lintner F. Anatomy, biochemistry, and physiology of articular cartilage. Invest Radiol. 2000;35(10):573-80.7. ​Martinez-Moreno D, Jimenez G, Galvez-Martin P, Rus G, Marchal JA. Cartilage biomechanics: A key factor for osteoarthritis regenerative medicine. Biochim Biophys Acta Mol Basis Dis. 2019;1865(6):1067-75.8. ​Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, et al. The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum. 2005;52(10):3152-9.9. ​Braun HJ, Gold GE. Diagnosis of osteoarthritis: imaging. Bone. 2012;51(2):278-88.10. ​Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand-Gastineau MP, Keen H, et al. Imaging in osteoarthritis. Rheum Dis Clin North Am. 2008;34(3):645-87.11. ​Argentieri EC, Burge AJ, Potter HG. Magnetic Resonance Imaging of Articular Cartilage within the Knee. J Knee Surg. 2018;31(2):155-65.

This episode dives into the rare Whipple’s disease, focusing on the articular manifestations of this infectious masquerader and when a rheumatologist should consider it in the differential. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro :20 In this episode :28 Background on the organism 5:25 An important point when making the diagnosis 7:48 Who gets infected? 8:55 What is Whipple’s disease? 11:48 This disease is fatal 15:53 A look at the joints 16:28 What happens when you give these patients immunosuppression? 26:36 How to diagnose 28:38 Summary so far 31:00 Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Other organ manifestations of Whipple’s disease 32:08 Summary and take-home 44:36 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bousbia S, et al. Emerg Infect Dis. 2010;16:258-63. Chan RY, et al. Ophthalmology. 2001;108:2225-2231. Dobbins 3rd WO, et al. Arthritis Rheum. 1987;30:102-105. Durand DV, et al. Medicine (Baltimore). 1997;76:170-84. Fenollar F, et al. BMC Infect Dis. 2011;11:171. Feurle GE, et al. Eur J Clin Invest. 1979;9:385-389. Geissdörfer W, et al. J Clin Microbiol. 2012;50:216-22. Guérin A, et al. Elife. 2018;7:e32340. Heffner DK. Lancet. 2007;370:738-9; author reply 739. Keita AK, et al. PLoS Negl Trop Dis. 2011;5:e1403. Lagier JC, et al. Medicine (Baltimore). 2010;89:337-345. Lozupone C, et al. Am J Respir Crit Care Med. 2013;187:1110-7. McAllister Jr. HA, Fenoglio Jr. JJ. Circulation. 1975;52:152-6. O’Duffy JD, et al. Arthritis Rheum. 1999;42:812-817. Puéchal X. Joint Bone Spine. 2016;83:631-635. Puéchal X, et al. Arthritis Rheum. 2002;46:1130-1132. Puéchal X, et al. Arthritis Rheum. 2007;56:1713-1718. Raheja AA, et al. Clin Imaging. 2010;34:143-147. Ramos JM, et al. J Med Case Rep. 2015;9:165. Raoult D, et al. Emerg Infect Dis. 2010;16:776-82. Schöniger-Hekele M, et al. Appl Environ Microbiol. 2007;73:2033-2035. Stein A, et al. Am J Respir Crit Care Med. 2013;188:1036-7. Additional resource: Neurosigns.org’s video on oculomasticatory myorhythmia can be viewed at: https://www.youtube.com/watch?v=Zwb5bt749Jo

This episode explores the history of cryoglobulinemic vasculitis, from the first person who froze a tube of blood and noticed something strange happened, to the discovery of hepatitis C. We also throw in how the lab test for cryoglobulins is performed and some of the data we have on therapy. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro :20 In this episode :45 How is this test done? 1:30 What is the first description of cryoglobulins? 4:15 The first time “cryoglobulins” is used 10:26 Hepatitis C is discovered and linked to cryoglobulinemia 16:28 What do we know about the pathophysiology? 19:38 Why does HCV do this? 22:12 Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. What’s in the blood as a result of immune complex? 24:52 What do we know about autoimmune diseases and the prevalence of cryoglobulins? 26:03 What about treatment? 28:25 Summary of this three-part series 36:16 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Brouet JC, et al. Am J Med. 1974;57:775-788. Cacoub P, et al. Clin Gastroenterol Hepatol. 2019;17:518-526. De Vita S, et al. Arthritis Rheum. 2012;64:843-853. Fuentes A, et al. Curr Rheumatol Rep. 2019;21:doi:10.1007/s11926-019-0859-0. Lerner AB, Watson CJ. Am J Med Sci. 1947;214:410-415. Lospalluto J, et al. Am J Med. 1962;32:142-147. Meltzer M, Franklin EC. Am J Med. 1966;40:828-836. Pascual M, et al. J Infect Dis. 1990;162:569-570. Ragab G, Hussein MA. J Adv Res. 2017;8:99-111. Tzioufas AG, et al. Arthritis Rheum. 1986;29:1098-1104. Wintrobe MM, Buell, MV. Bull. Johns Hopkins Hosp. 1933;52:156-165.

¡Gracias por escuchar! La artritis reumatoide (AR) es la causa más frecuente de artritis crónica en todo el mundo y representa una carga de salud y costos socioeconómicos sustanciales, problemas que aumentan con el envejecimiento de la población. En este episodio se presentarán algunas ideas sobre las áreas actuales de incertidumbre en los estudios de prevención de la AR, las lecciones que se pueden aprender de los ensayos de prevención en otros estados de enfermedad y las direcciones futuras a considerar.Estos trabajos pueden resultar de interés:Alpizar-Rodriguez D, Finckh A (2020) Is the prevention of rheumatoid arthritis possible? Clin Rheumatol:1–7.Emery P, Durez P, Dougados M, Legerton CW, Becker JC, Vratsanos G, Genant HK, Peterfy C, Mitra P, Overfield S, Qi K, Westhovens R (2010) Impact of T-cell costimulation modulation in patients with undifferentiated inflammatory arthritis or very early rheumatoid arthritis: a clinical and imaging study of abatacept (the ADJUST trial). Ann Rheum Dis 69:510–516Gerlag DM, Safy M, Maijer KI, Tang MW, Tas SW, Starmans-Kool MJF, van Tubergen A, Janssen M, de Hair M, Hansson M, de Vries N, Zwinderman AH, Tak PP (2019) Effects of B-cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study. Ann Rheum Dis 78:179–185van Dongen H, van Aken J, Lard LR, Visser K, Ronday HK, Hulsmans HM, Speyer I, Westedt ML, Peeters AJ, Allaart CF, Toes RE, Breedveld FC, Huizinga TW (2007) Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 56:1424–1432

PADRÃO DE ACOMETIMENTO ESPONDILOARTROPÁTICO NA F. CHIKUNGUNYA: O RETORNO ÀS IDEIAS DE BENJAMIM E MACGONAGLE. PARTE I: ANATOMIA DAS ENTESESEste podcast e o webinar sobre o tema que vai acontecer na próxima sexta, 17/04/2020, estão intrinsicamente ligados. Esta parte I do podcast discute conceitos básicos, modernos e importantes sobre as enteses. Sem isso, não se entende o que F. Chikungunya tem a ver com o tema.Referências Bibliográficas:1- Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 2001; 199(Pt 5): 503–5262- Shaw HM, Benjamin M. Structure-function relationships of entheses in relation to mechanical load and exercise. Scand J Med Sci Sports 2007; 17(4): 303–3153- Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S. The "enthesis organ" concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum 2004; 50(10): 3306–33134- McGonagle D, Marzo-Ortega H, Benjamin M, Emery P. Report on the Second international Enthesitis Workshop. Arthritis Rheum 2003; 48(4): 896–9055- Eshed I, Bollow M, McGonagle DG, et al. MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 2007; 66(12): 1553–15596- Kaeley GS, Eder L, Aydin SZ et al. Enthesitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018; 48(1): 35–43. 7- Watad A, Eshed I, McGonagle D. Lessons Learned from Imaging on Enthesitis in Psoriatic Arthritis. Isr Med Assoc J 2017; 19(11): 708–7118- McGonagle D, Lories RJ, Tan AL, Benjamin M. The concept of a "synovio-entheseal complex" and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007; 56(8): 2482–24919- Benjamin M, McGonagle D. Histopathologic changes at "synovio-entheseal complexes" suggesting a novel mechanism for synovitis in osteoarthritis and spondylarthritis. Arthritis Rheum 2007; 56(11): 3601–360910- Benjamin M, Qin S, Ralphs JR. Fibrocartilage associated with human tendons and their pulleys. J Anat 1995; 187 ( Pt 3)(Pt 3): 625–63311- Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 2015; 74(1): 185–189

¡Gracias por escuchar! En este episodio se revisan 4 publicaciones recientes que presentan evidencia en diferentes tópicos de Reumatología.Por favor dejen sus comentarios en tukua.podbean.com, youtube.com y sus calificaciones en iTunes.Estas son las referencia revisadas: Adam, S. et al. Sci. Transl Med. 12 , eaay4447 (2020)Kissel, T. eT al. Ann. Rheum. Dis. https: // doi.org/10.1136/annrheumdis-2019-216499 (2020)Smolen, JS el al. Ann. Rheum. Dis. https://doi.org/10.1136/annrheumdis-2019-216655 (2020)Kolasinski , SL et al. Arthritis Rheum. https://doi.org/10.1002/art.41142 (2019)

¡Gracias por escuchar! Los pacientes con artralgia clínicamente sospechosa tienen síntomas articulares como dolor y rigidez de las articulaciones pequeñas sin signos clínicos de artritis. Algunos de estos pacientes progresan y desarrollan una enfermedad 'verdadera', pero ¿cómo podemos diferenciar la enfermedad crónica en evolución de la enfermedad que se resolverá? En este episodio se comentará un estudio reciente que pretende ayudar con la respuesta a esta pregunta.Estas son algunas referencias de utilidad:Al-Laith, M. et al. Arthritis prevention in the pre-clinical phase of RA with abatacept (the APIPPRA study): a multi-centre, randomised, double-blind, parallel-group, placebo-controlled clinical trial protocol. Trials 20, 429 (2019).Brulhart, L. et al. Ultrasound is not associated withthe presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis. RMD Open. 5, e000922 (2019).Gerlag, D. M. et al. Effects of B cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study. Ann. Rheum. Dis. 78, 179–185 (2019).Kleyer, A. et al. High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA-A combined MRI/CT study. Semin. Arthritis Rheum. 46, 143–150 (2016).Kleyer, A. et al. Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann. Rheum. Dis. 73, 854–860 (2014).Raza, K. et al. Early rheumatoid arthritis is characterized by a distinct and transient synovial fluid cytokine profile of T cell and stromal cell origin. Arthritis Res. Ther. 7, R784–R795 (2005).Sahbudin, I. et al. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development. Rheumatology (Oxford). 57, 1243–1252 (2018).ten Brinck, R. M. et al. Improvement of symptoms in clinically suspect arthralgia and resolution of subclinical joint inflammation: a longitudinal study in patients that did not progress to clinical arthritis. Arthritis Res. Ther. 22, 11 (2020).van Steenbergen, H. W. et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann. Rheum. Dis. 76, 491–496 (2017).

¡Gracias por escuchar! Los medicamentos antimaláricos, hidroxicloroquina y cloroquina, son fármacos moduladores de las enfermedades reumáticas introducidos por serendipia y empíricamente para el tratamiento de diversas enfermedades reumáticas. Ni la cloroquina ni la hidroxicloroquina se sometieron al proceso de desarrollo de fármacos convencional, pero su uso se ha convertido en parte importante de los tratamiento actuales para la artritis reumatoide, lupus eritematoso sistémico, síndrome de anticuerpos antifosfolípido y síndrome de Sjögren primario. En este episodio exploraremos sus principales características desde la perspectiva farmacológica.Les pido amablemente dejen sus comentarios en tukua.podbean.com y la calificación a este y otros episodios en iTunes.Estas son algunas referencias de utilidad:Ruiz-Irastorza, G. et al. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann. Rheum. Dis. 69, 20–28 (2010).Ostensen, M. et al. Pregnancy and reproduction in autoimmune rheumatic diseases. Rheumatology 50, 657–664 (2011).Akhavan, P. S. et al. The early protective effect of hydroxychloroquine on the risk of cumulative damage in patients with systemic lupus erythematosus.Ponticelli, C. & Moroni, G. Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert. Opin. Drug Saf. 16, 411–419 (2017).Wang, S. Q. et al. Is hydroxychloroquine effective in treating primary Sjogren’s syndrome: a systematic review and meta-analysis. BMC Musculoskelet. Disord. 18, 186 (2017).Rainsford, K. D. et al. Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases. Inflammopharmacology 23, 231–269 (2015).Collins, K. P., Jackson, K. M. & Gustafson, D. L. Hydroxychloroquine: a physiologically-based pharmacokinetic model in the context of cancerrelated autophagy modulation. J. Pharmacol. Exp. Ther. 365, 447–459 (2018).Munster, T. et al. Hydroxychloroquine concentrationresponse relationships in patients with rheumatoid arthritis. Arthritis Rheum. 46, 1460–1469 (2002).Carmichael, S. J., Charles, B. & Tett, S. E. Population pharmacokinetics of hydroxychloroquine in patients with rheumatoid arthritis. Ther. Drug Monit. 25, 671–681 (2003).Mok, C. C., Mak, A. & Ma, K. M. Bone mineral density in postmenopausal Chinese patients with systemic lupus erythematosus. Lupus 14, 106–112 (2005).Petri, M. Use of hydroxychloroquine to prevent thrombosis in systemic lupus erythematosus and in antiphospholipid antibody-positive patients. Curr. Rheumatol. Rep. 13, 77–80 (2011).Kingsbury, S. R. et al. Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis: a randomized trial. Ann. Intern. Med. 168, 385–395 (2018).Lee, W. et al. Efficacy of hydroxychloroquine in hand osteoarthritis: a randomized, double-blind, placebocontrolled trial. Arthritis Care Res. 70, 1320–1325 (2018).Rempenault, C. et al. Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann. Rheum. Dis. 77, 98–103 (2018).Ruiz-Irastorza, G. et al. Predictors of major infections in systemic lupus erythematosus. Arthritis Res. Ther. 11, R109 (2009).Flannery, E. L., Chatterjee, A. K. & Winzeler, E. A. Antimalarial drug discovery – approaches and progress towards new medicines. Nat. Rev. Microbiol. 11, 849–862 (2013).Ridley, R. G. Medical need, scientific opportunity and the drive for antimalarial drugs. Nature 415, 686–693 (2002).Minie, M. et al. CANDO and the infinite drug discovery frontier. Drug Discov. Today 19, 1353–1363 (2014).Paddon, C. J. et al. High-level semi-synthetic production of the potent antimalarial artemisinin. Nature 496, 528–532 (2013).Hale, V. et al. Microbially derived artemisinin: a biotechnology solution to the global problem of access to affordable antimalarial drugs. Am. J. Trop. Med. Hyg. 77, 198–202 (2007).Somer, M. et al. Influence of hydroxychloroquine on the bioavailability of oral metoprolol. Br. J. Clin. Pharmacol. 49, 549–554 (2000).Kormelink, T. G. et al. Decrease in immunoglobulin free light chains in patients with rheumatoid arthritis upon rituximab (anti-CD20) treatment correlates with decrease in disease activity. Ann. Rheum. Dis. 69, 2137–2144 (2010).Toimela, T., Tahti, H. & Salminen, L. Retinal pigment epithelium cell culture as a model for evaluation of the toxicity of tamoxifen and chloroquine. Ophthalmic Res. 27, 150–153 (1995).Bannwarth, B. et al. Clinical pharmacokinetics of low-dose pulse methotrexate in rheumatoid arthritis. Clin. Pharmacokinet. 30, 194–210 (1996).Carmichael, S. J. et al. Combination therapy with methotrexate and hydroxychloroquine for rheumatoid arthritis increases exposure to methotrexate. J. Rheumatol. 29, 2077–2083 (2002).van den Borne, B. E. et al. Combination therapy in recent onset rheumatoid arthritis: a randomized double blind trial of the addition of low dose cyclosporine to patients treated with low dose chloroquine. J. Rheumatol. 25, 1493–1498 (1998).Namazi, M. R. The potential negative impact of proton pump inhibitors on the immunopharmacologic effects of chloroquine and hydroxychloroquine. Lupus 18, 104–105 (2009).Jallouli, M. et al. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol. 67, 2176–2184 (2015).Ezra, N. & Jorizzo, J. Hydroxychloroquine and smoking in patients with cutaneous lupus erythematosus. Clin. Exp. Dermatol. 37, 327–334 (2012).Yeon Lee, J. et al. Factors related to blood hydroxychloroquine concentration in patients with systemic lupus erythematosus. Arthritis Care Res. 69, 536–542 (2017).Borden, M. B. & Parke, A. L. Antimalarial drugs in systemic lupus erythematosus: use in pregnancy. Drug Saf. 24, 1055–1063 (2001).Costedoat-Chalumeau, N. et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases. Review of the literature. Autoimmun. Rev. 4, 111–115 (2005).Teng, Y. K. O. et al. An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus. Rheumatology 57, 1707–1720 (2017).Andreoli, L. et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann. Rheum. Dis. 76, 476–485 (2017).Gotestam Skorpen, C. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann. Rheum. Dis. 75, 795–810 (2016).Izmirly, P. M. et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126, 76–82 (2012).Saxena, A. et al. Prevention and treatment in utero of autoimmune-associated congenital heart block. Cardiol. Rev. 22, 263–267 (2014).Friedman, D. et al. No histologic evidence of foetal cardiotoxicity following exposure to maternal hydroxychloroquine. Clin. Exp. Rheumatol. 35, 857–859 (2017).Sammaritano, L. R. & Bermas, B. L. Rheumatoid arthritis medications and lactation. Curr. Opin. Rheumatol. 26, 354–360 (2014).An, J. et al. Antimalarial drugs as immune modulators: new mechanisms for old drugs. Annu. Rev. Med. 68, 317–330 (2017).An, J. et al. Cutting edge: antimalarial drugs inhibit IFN-β production through blockade of cyclic GMP-AMP synthase-DNA interaction. J. Immunol. 194, 4089–4093 (2015).van den Borne, B. E. et al. Chloroquine and hydroxychloroquine equally affect tumor necrosis factor-alpha, interleukin 6, and interferon-gamma production by peripheral blood mononuclear cellFasano, S. et al. Longterm hydroxychloroquine therapy and low-dose aspirin may have an additive effectiveness in the primary prevention of cardiovascular events in patients with systemic lupus erythematosus. J. Rheumatol. 44, 1032–1038 (2017).Towers, C. G. & Thorburn, A. Therapeutic targeting of autophagy. EBioMedicine 14, 15–23 (2016).Rand, J. H. et al. Hydroxychloroquine directly reduces the binding of antiphospholipid antibodyβ2-glycoprotein I complexes to phospholipid bilayers. Blood 112, 1687–1695 (2008).Jancinova, V., Nosal, R. & Petrikova, M. On the inhibitory effect of chloroquine on blood platelet aggregation. Thromb. Res. 74, 495–504 (1994).Bertrand, E. et al. Antiaggregation action of chloroquine. Med. Trop. 50, 143–146 (1990).Nosal, R., Jancinova, V. & Petrikova, M. Chloroquine inhibits stimulated platelets at the arachidonic acid pathway. Thromb. Res. 77, 531–542 (1995).Lazarus, M. N. et al. Incidence of cancer in a cohort of patients with primary Sjogren’s syndrome. Rheumatology 45, 1012–1015 (2006). J. Rheumatol. 21, 375–376 (1994).Wallace, D. J. et al. The relevance of antimalarial therapy with regard to thrombosis, hypercholesterolemia and cytokines in SLE. Lupus 2, S13–S15 (1993).Hjorton, K. et al. Cytokine production by activated plasmacytoid dendritic cells and natural killer cells is suppressed by an IRAK4 inhibitor. Arthritis Res. Ther. 20, 238 (2018).Willis, R. et al. Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort. Lupus 21, 830–835 (2012).Wu, S. F. et al. Hydroxychloroquine inhibits CD154 expression in CD4(+) T lymphocytes of systemic lupus erythematosus through NFAT, but not STAT5, signaling. Arthritis Res. Ther. 19, 183 (2017).Qushmaq, N. A. & Al-Emadi, S. A. Review on effectiveness of primary prophylaxis in aPLs with and without risk factors for thrombosis: efficacy and safety. ISRN Rheumatol. 2014, 348726 (2014).Nuri, E. et al. Long-term use of hydroxychloroquine reduces antiphospholipid antibodies levels in patients with primary antiphospholipid syndrome. Immunol. Res. 65, 17–24 (2017).Dadoun, S. et al. Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Joint Bone Spine 80, 29–33 (2013).van den Hoek, J. et al. Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study. Rheumatol. Int. 37, 487–493 (2017).Avina-Zubieta, J. A. et al. Risk of myocardial infarction and stroke in newly diagnosed systemic lupus erythematosus: a general population-based study. Arthritis Care Res. 69, 849–856. (2017).Srinivasa, A., Tosounidou, S. & Gordon, C. Increased incidence of gastrointestinal side effects in patients taking hydroxychloroquine: a brand-related issue? J. Rheumatol. 44, 398 (2017).Abdel-Hamid, H., Oddis, C. V. & Lacomis, D. Severe hydroxychloroquine myopathy. Muscle Nerve 38, 1206–1210 (2008).Jafri, K. et al. Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review. Clin. Rheumatol. 36, 1437–1444 (2017).Khosa, S. et al. Hydroxychloroquine-induced autophagic vacuolar myopathy with mitochondrial abnormalities. Neuropathology 38, 646–652 (2018).Stein, M., Bell, M. J. & Ang, L. C. Hydroxychloroquine neuromyotoxicity. J. Rheumatol. 27, 2927–2931 (2000). Int. J. Cardiol. 157, 117–119 (2012).Sundelin, S. P. & Terman, A. Different effects of chloroquine and hydroxychloroquine on lysosomal function in cultured retinal pigment epithelial cells. APMIS 110, 481–489 (2002).Jorge, A. et al. Hydroxychloroquine retinopathy implications of research advances for rheumatology care. Nat. Rev. Rheumatol. 14, 693–703 (2018).Marmor, M. F. et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). Ophthalmology 123, 1386–1394 (2016).Yusuf, I. H. et al. The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom: executive summary. Eye 32, 1168–1173 (2018). J. Rheumatol. 44 1841–1849 (2017).Padol, I. T. & Hunt, R. H. Association of myocardial infarctions with COX-2 inhibition may be related to immunomodulation towards a Th1 response resulting in atheromatous plaque instability: an evidencebased interpretation. Rheumatology 49, 837–843 (2010).Hage, M. P., Al-Badri, M. R. & Azar, S. T. A favorable effect of hydroxychloroquine on glucose and lipid metabolism beyond its anti-inflammatory role. Ther. Adv. Endocrinol. Metab. 5, 77–85 (2014).Costedoat-Chalumeau, N. et al. Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus. Arthritis Rheum. 54, 3284–3290 (2006).Costedoat-Chalumeau, N. et al. A prospective international study on adherence to treatment in 305 patients with flaring SLE: assessment by drug levels and self-administered questionnaires. Clin. Pharmacol. Ther. 103, 1074–1082 (2018).Bethel, M. et al. Hydroxychloroquine in patients with systemic lupus erythematosus with end-stage renal disease. J. Investig. Med. 64, 908–910 (2016).Sperati, C. J. & Rosenberg, A. Z. Hydroxychloroquineinduced mimic of renal Fabry disease. Kidney Int. 94, 634 (2018).Yusuf, I. H., Lotery, A. J. & Ardern-Jones, M. R. Joint recommendations for retinal screening in longterm users of hydroxychloroquine and chloroquine in the United Kingdom, 2018. Br. J. Dermatol. 179, 995–996 (2018).Melles, R. B. & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 132, 1453–1460 (2014).Costedoat-Chalumeau, N., Isenberg, D. & Petri, M. Letter in response to the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus by Fanouriakis et al. Ann. Rheum. Dis. https://doi.org/10.1136/annrheumdis-2019215573 (2019).

Between the latest online fads and the crazy media headlines, it’s easier than ever to get confused about your health. If you want to make better decisions about your health today so you can feel better and live longer, you’ve come to the right place. Today is the first episode of a three part series that examines the effect of grains on health. I’m joined today by the Gluten-Free Warrior — Dr. Peter Osborne, the founder of the Gluten-Free Society who works to help people with autoimmune and degenerative diseases. He shares some of the experiences and citations that have led him to work so passionately to educate people about the effect of grains on our overall health. Dr. Osborne has helped over 5,000 patients regain overall health and wellness with a grain-free diet, and his approach to healing is focused on individuals with auto-immune diseases.  If you’ve ever suspected that you might have gluten intolerance but aren’t sure if you have Celiac disease, if you’re wondering what environmental factors might be affecting your health, or if you are looking for ways to eliminate painful reactions to gluten, you need to listen to this conversation to help you decide which steps you need to take next.   Key Takeaways: [1:10] Today’s topic is grains — are they harmful to people who don’t have Celiac’s disease? [2:00] Introducing Dr. Peter Osborne, who shares his overall thoughts on the effects of grains on human health, the quality of studies that have been conducted about grains, and the importance of identifying autoimmune diseases when healing for chronic disease. [5:48] Dr. Osborne reacts to the statement that reduced-grain diets contribute to worse health outcomes, including cardiovascular death, and explains how the quality of the diet is a greater factor than the gluten intake itself. [9:52] The correlation between a grain-free diet and autoimmune disease, and a snapshot of the overall history and changing health factors that have an influence on a person's weakened health status. [15:00] The danger of not controlling for variables in a patient, the importance of believing that you can feel better again, and the value of overall body-fuel balance. [18:10] How can you tell if you have non-Celiac gluten sensitivity, and what can you do about it? Dr. Osborne suggests starting with diet change and supporting nutritional deficit. [22:30] Understanding the prevalence of non-Celiac gluten sensitivity and the environmental factors that accelerate it including exposure to pesticides, plastics, antibiotics, chemicals and medications. [27:04] Should all people with a gluten sensitivity be tested for Celiac’s disease?  Dr. Osborne says that it is not necessary, and he explains why. [29:40] What are the pitfalls of making dietary changes that are not accurate relative to the symptoms that are actually present? A look at the variables that affect overall health regardless of gluten-sensitivity. [37:04] If variables such as molds, pesticides and hybridization are present, it becomes increasingly difficult to separate individual aspects of the diet. Here’s what to do about it. [39:24] A list of conditions for non-Celiac gluten sensitivities that are actually caused by gluten and the next steps you should take to begin healing. [43:41] Dr. Osborne’s number one tip for enhancing overall health starts with self observation — pay attention to how your body responds to activity, exercise and food before you decide that your condition is irreversible. [47:14] Do you have a topic you’d like me to cover? Contact me on Facebook or Instagram using #medicalmyths.   To learn more: www.drchristianson.com Dr. Christianson on Instagram Dr. Christianson on Facebook Integrative Healthcare No Grain, No Pain: A 30-Day Diet for Eliminating the Root of Chronic Pain by Dr. Peter Osborne Gluten-Free Society Glutenology on YouTube   Article References: 1. Arbuckle MR, James JA, Kohlhase KF, et al. Development of anti-dsDNA auto-antibodies prior to clinical diagnosis of systemic lupus erythematosus. Scand J Immunol. 2001;54(1–2):211–219. [PubMed] [Google Scholar] 2. Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med. 2003;349(16):1526–1533. [PubMed] [Google Scholar] 3. Arslan S, Erkut B, Ates A, et al. Pseudoaneurysm of left ventricular following left ventricular apical venting. Clin Res Cardiol. 2009;98(4):280–282. [PubMed] [Google Scholar] 4. Majka DS, Deane KD, Parrish LA, et al. 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Things get a little nerdy in this episode, which focuses on the basic science of what makes the inflammasome tick in CAPS, as well as data on the use of interleukin 1 inhibition. Hint: Listen to “The Inflammasome for Dunces” episode first, and this one will make more sense. Intro :20 Recap of Part 1 :33 Overview of this episode 1:56 Familial cold autoinflammatory syndrome 3:04 Muckle-Wells syndrome 6:34 The two checkpoint problem 8:36 What do we know about the inhibition of the inflammasome? 11:13 Back to the trebuchet analogy 11:48 Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com A paper on CARD8 in the setting of CAPS 13:50 Let’s talk about prostaglandins 15:27 There are over 100 mutations in CAPS 18:15 Let’s talk about treatment 18:42 One caveat 25:41 That’s CAPS 26:45 Reach out to me via email and on Twitter 27:03 Episode recap 27:41 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. Disclosure: Brown reports no relevant financial disclosures. References: Agostini L, et al. Immunity. 2004;20:319-325. Brogan PA, et al. Arthritis Rheum. 2019;71:1955-1963. Marsaud C, et al. J Rheumatol. 2014;41:1721-1722. Hawkins PN, et al. NEJM. 2003;348:2583-2584. Hoffman HM, et al. Lancet. 2004;364:1779-1785. Hoffman HM, et al. Clin Ther. 2012;34:2091-2103. Ito S, et al. Arthritis Res Ther. 2014;16:doi:10.1186/ar4483. Kuemmerle-Deschner JB, et al. Ann Rheum Dis. 2011;70:2095-2102. Lachmann HJ, et al. NEJM. 2009;360:2416-2425. Mamoudjy N, et al. Orphanet J Rare Dis. 2017;12:doi:10.1186/s13023-017-0589-1. Rosengren S, et al. J Allergy Clin Immunol. 2007;119:991-996. Ross JB, et al. J Cutan Med Surg. 2008;12:8-16. Tassi S, et al. Proc Natl Acad Sci USA. 2010;107:9789-9794. Thornton BD, et al. Am J Kidney Dis. 2007;49:477-481.

This first episode delves into the clinical aspects of the Cryopyrin-Associated Periodic Syndromes and includes some helpful tips for sorting out some of the autoinflammatory diseases in the spectrum. Intro :10 Cryopyrin-Associated Periodic Syndromes (CAPS) :25 Outline of Part 1 2:25 What is CAPS? 3:12 Case #1 – a 25-year-old female with urticaria after cold exposure 4:25 Case #2 – a 55-year-old female with progressive deafness 5:45 The index case of familial cold autoinflammatory syndrome 9:00 The final disease in the spectrum 11:00 A lot of names for the same disease 13:50 Genetics prove these three diseases are in the same spectrum 14:22 Over 100 mutations have been found to-date 16:31 Let’s talk about mosaicism 17:03 Disease characteristics of CAPS 18:15 Neutrophilic infiltrate in chronic urticaria vs. CAPS 20:00 Schnitzler syndrome 20:45 Sensorineural hearing loss 21:58 Joint pain 24:10 Complication: Amyloidosis 25:29 These diseases were very debilitating 28:38 Episode recap 29:46 Part 2 sneak peek 30:38 Come say hi at ACR! 30:51 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Ahmadi N, et al. Otolaryngol Head Neck Surg. 2011;145:295-302.​ Aksentijevich I, et al. Arthritis Rheum. 2002;46:3340-3348. Alecu M, et al. Romanian Journal of Morphology and Embryology = Revue Roumaine de Morphologie et Embryologie. 2015;56:7-14. Hassink SG, Goldsmith DP. Arthritis Rheum. 1983;26:668–673. Hoffman HM, et al. Nat Genet. 2001;29:301-305.​ Hoffman HM, et al. J Allergy Clin Immunol. 2001;108:615-620. Kile RM, Rusk HA. JAMA. 1940;114:1067-1068. Levy R, et al. Ann Rheum Dis. 2015;74:2043-2049. Marzano AV, et al. Clin Exp Rheumatol. 2018;36 Suppl 110:32-38. Muckle TJ, Wells M. Q J Med. 1962;31:235-248. Prieur AM, Griscelli C. Rev Rhum Mal Osteoartic. 1980;47:645–649. Tran TA. Open Access Rheumatol. 2017;9:123-129.

¡Gracias por escuchar! En este episodio repaso algunos conceptos relevantes sobre la dactilítis, una manifestación común en espondiloartritis. Les pido amablemente que califiquen este episodio en iTunes, o dejen sus comentarios en esta página. El podcast se encuentra disponible también en Spotify y a través de la aplicación gestora de podcasts de su elección.Abajo enlisto referencias útiles, algunas mencionadas en el episodio: Olivieri, I., Scarano, E., Padula, A., Giasi, V. & Priolo, F. Dactylitis, a term for different digit diseases. Scand. J. Rheumatol. 35, 333–340 (2006). Gladman, D. D., Ziouzina, O., Thavaneswaran, A. & Chandran, V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J. Rheumatol. 40, 1357–1359 (2013). Ritchlin, C. T., Colbert, R. A. & Gladman, D. D. Psoriatic arthritis. N. Engl. J. Med. 376, 957–970 (2017). Rothschild, B. M., Pingitore, C. & Eaton, M. Dactylitis: implications for clinical practice. Semin. Arthritis Rheum. 28, 41–47 (1998). Taylor, W. J. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 54, 2665–2673 (2006). Rudwaleit, M. et al. The Assessment of Spondyloarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann. Rheum. Dis. 70, 25–31 (2011). Brockbank, J. E., Stein, M., Schentag, C. T. & Gladman, D. D. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann. Rheum. Dis. 64, 188–190 (2005). Kavanaugh, A., Helliwell, P. & Ritchlin, C. T. Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol. Ther. 3, 91–102 (2016). Kaeley, G. S., Eder, L., Aydin, S. Z., Gutierrez, M. & Bakewell, C. Dactylitis: a hallmark of psoriatic arthritis. Semin. Arthritis Rheum. 48, 263–273 (2018). McGonagle, D., Conaghan Philip, G. & Emery, P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum. 42, 1080–1086 (2001). Tinazzi, I. et al. ‘Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann. Rheum. Dis. 77, 922 (2018). Pattison, E., Harrison, B. J., Griffiths, C. E., Silman, A. J. & Bruce, I. N. Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Ann. Rheum. Dis. 67, 672–676 (2008). Ng, J., Tan, A. L. & McGonagle, D. Unifocal psoriatic arthritis development in identical twins following site specific injury: evidence supporting biomechanical triggering events in genetically susceptible hosts. Ann. Rheum. Dis. 74, 948–949 (2015). Jacques, P. et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann. Rheum. Dis. 73, 437–445 (2014). Jacques, P. & McGonagle, D. The role of mechanical stress in the pathogenesis of spondyloarthritis and how to combat it. Best Pract. Res. Clin. Rheumatol. 28, 703–710 (2014). Thorarensen, S. M. et al. Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann. Rheum. Dis. 76, 521–525 (2017). Wilkins, R. A., Siddle, H. J., Redmond, A. C. & Helliwell, P. S. Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study. Clin. Rheumatol. 35, 2333–2338 (2016). Tan, A. L. & McGonagle, D. The need for biological outcomes for biological drugs in psoriatic arthritis. J. Rheumatol. 43, 3–6 (2016). Mumtaz, A. et al. Development of a preliminary composite disease activity index in psoriatic arthritis. Ann. Rheum. Dis. 70, 272–277 (2011). Helliwell, P. S. et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann. Rheum. Dis. 72, 986–991 (2013). Ramiro, S., Smolen, J. S., Landewe, R., van der Heijde, D. & Gossec, L. How are enthesitis, dactylitis and nail involvement measured and reported in recent clinical trials of psoriatic arthritis? A systematic literature review. Ann. Rheum. Dis. 77, 782–783 (2017). Salvarani, C. et al. A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J. Rheumatol. 28, 2274–2282 (2001). Antoni, C. E. et al. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum. 52, 1227–1236 (2005). Clegg, D. O. et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 39, 2013–2020 (1996). Helliwell, P. S. et al. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J. Rheumatol. 32, 1745–1750 (2005). Healy, P. J. & Helliwell, P. S. Measuring dactylitis in clinical trials: which is the best instrument to use? J. Rheumatol. 34, 1302–1306 (2007). Chandran, V. et al. International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis. Arthritis Rheum. 61, 1235–1242 (2009).Mease, P. et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann. Rheum. Dis. 73, 48–55 (2014). Fournie, B. et al. Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine 73, 527–531 (2006). Benjamin, M. & McGonagle, D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J. Anat. 199, 503–526 (2001). Kane, D., Greaney, T., Bresnihan, B., Gibney, R. & FitzGerald, O. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J. Rheumatol. 26, 1746–1751 (1999). Tinazzi, I. et al. Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin. Exp. Rheumatol. 36, 785–790 (2018). McGonagle, D., Gibbon, W. & Emery, P. Classification of inflammatory arthritis by enthesitis. Lancet 352, 1137–1140 (1998). Olivieri, I. et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum. 39, 1524–1528 (1996).Olivieri, I. et al. Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging. J. Rheumatol. 24, 926–930 (1997). Olivieri, I. et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum. 46, 2964–2967 (2002). Healy, P. J., Groves, C., Chandramohan, M. & Helliwell, P. S. MRI changes in psoriatic dactylitis extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology 47, 92–95 (2008). Tan, A. L. et al. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann. Rheum. Dis. 74, 185–189 (2015). FitzGerald, O., Haroon, M., Giles, J. T. & Winchester, R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res. Ther. 17, 115 (2015). McHugh, K. & Bowness, P. The link between HLA-B27 and SpA—new ideas on an old problem. Rheumatology 51, 1529–1539 (2012). Ritchlin, C. T. et al. Treatment recommendations for psoriatic arthritis. Ann. Rheum. Dis. 68, 1387–1394 (2009). Coates, L. C. et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheum. 68, 1060–1071 (2016). Gossec, L. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann. Rheum. Dis. 75, 499–510 (2016). Coates, L. & Helliwell, P. S. Methotrexate efficacy in the Tight Control in Psoriatic Arthritis study. J. Rheum. 43, 356–361 (2016). Rose, S., Toloza, S., Bautista-Molano, W. & Helliwell, P. S. Comprehensive treatment of dactylitis in psoriatic arthritis. J. Rheumatol. 41, 2295–2300 (2014). Kavanaugh, A. et al. Efficacy and safety of ustekinumab in psoriatic arthritis patients with peripheral arthritis and physician-reported spondylitis: post-hoc analyses from two phase III, multicentre, double-blind, placebo-controlled studies (PSUMMIT-1/PSUMMIT-2). Ann. Rheum. Dis. 75, 1984–1988 (2016). Mease, P. et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N. Engl. J. Med. 377, 1537–1550 (2017). Kavanaugh, A. et al. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis Rheum. 64, 2504–2517 (2012). Kavanaugh, A. & Mease, P. Treatment of psoriatic arthritis with tumor necrosis factor inhibitors: longer-term outcomes including enthesitis and dactylitis with golimumab treatment in the Longterm Extension of a Randomized, Placebo-controlled Study (GO-REVEAL). J. Rheumatol. Suppl. 89, 90–93 (2012). Antoni, C. E. et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). J. Rheumatol. 35, 869–876 (2008). Kavanaugh, A. et al. Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial. Ann. Rheum. Dis. 66, 498–505 (2007). Baranauskaite, A. et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann. Rheum. Dis. 71, 541–548 (2012). Carron, P. et al. Scintigraphic detection of TNF-driven inflammation by radiolabelled certolizumab pegol in patients with rheumatoid arthritis and spondyloarthritis. RMD Open 2, e000265 (2016). Nash, P. et al. Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (FUTURE 3). Arthritis Res. Ther. 20, 47 (2018). Mease, P. et al. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann. Rheum. Dis. 77, 890–897 (2018). Mease, P. J. et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann. Rheum. Dis. 76, 79–87 (2017). Wells, A. F. et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology 57, 1253–1263 (2018). Gladman, D. et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N. Engl. J. Med. 377, 1525–1536 (2017). Mease, P. J. et al. Efficacy and safety of abatacept, a T cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann. Rheum. Dis. 76, 1550–1558 (2017). Genovese Mark, C. et al. Apremilast in patients with active rheumatoid arthritis: a phase II, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 67, 1703–1710 (2015). Smolen, J. S. et al. A randomised phase II study evaluating the efficacy and safety of subcutaneously administered ustekinumab and guselkumab in patients with active rheumatoid arthritis despite treatment with methotrexate. Ann. Rheum. Dis. 76, 831–839 (2017). Kavanaugh, A. et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann. Rheum. Dis. 73, 1020–1026 (2014). Kunwar, S., Dahal, K. & Sharma, S. Anti-IL-17 therapy in treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatol. Int. 36, 1065–1075 (2016). da Silva Junior, G. B., Daher Ede, F. & da Rocha, F. A. Osteoarticular involvement in sickle cell disease. Rev. Bras. Hematol. Hemoter. 34, 156–164 (2012). Braum, L. S. et al. Characterisation of hand small joints arthropathy using high-resolution MRI — limited discrimination between osteoarthritis and psoriatic arthritis. Eur. Radiol. 23, 1686–1693 (2013). Tan, A. L., Grainger, A. J., Tanner, S. F., Emery, P. & McGonagle, D. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum. 54, 1328–1333 (2006). Tuttle, K. S., Vargas, S. O., Callahan, M. J., Bae, D. S. & Nigrovic, P. A. Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity. Pediatr. Rheumatol. Online J. 13, 7 (2015). Nash, P. et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet 389, 2317–2327 (2017).Jeong, H. et al. Spondyloarthritis features in zymosan-induced SKG mice. Joint Bone Spine 85, 583–591 (2018). 

¡Gracias por escuchar! En este episodio se hablará acerca de las alternativas de tratamiento del síndrome de Sjögren primario, tanto glandular como extraglandular.Recuerden que su retroalimentación es bienvenida y les pido amablemente califiquen el podcast en iTunes. Además, Tukua se encuentra disponible en Spotify o a través del gestor de podcasts de su elección.A continuación enlisto algunos de los artículos revisados para este episodio: Vitali, C. et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria 21. proposed by the American-European ConsensusGroup. Ann. Rheum. Dis. 61, 554–558 (2002).Shiboski, S. C. et al. American College of 22. Rheumatology classification criteria for Sjögren’ssyndrome: a data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical 23. Alliance cohort. Arthritis Care Res. (Hoboken) 64, 475–487 (2012).Seror, R. et al. EULAR Sjögren’s syndrome disease activity index: development of a consensus systemic 25. disease activity index for primary Sjögren’s syndrome. Ann. Rheum. Dis. 69, 1103–1109 (2010).Seror, R. et al. Defining disease activity states and clinically meaningful improvement in primary Sjogren’s 26. syndrome with EULAR primary Sjögren’s syndrome disease activity (ESSDAI) and patient-reported indexes (ESSPRI). Ann. Rheum. Dis. 75, 382–389 (2016).Seror, R. et al. EULAR Sjögren’s Syndrome Patient 27. Reported Index (ESSPRI): development of a consensus patient index for primary Sjögren’s syndrome. Ann. Rheum. Dis. 70, 968–972 (2011).Theander, E. et al. Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the 28. development of malignant lymphoma in primary Sjögren’s syndrome. Ann. Rheum. Dis. 70, 29. 1363–1368 (2011).Valim, V. et al. Recommendations for the treatment 33. of Sjögren’s syndrome. Rev. Bras. Reumatol. 55, 446–457 (in Portuguese) (2015).Furness, S., Worthington, H. V., Bryan, G., Birchenough, S. & McMillan, R. Interventions for the management of dry mouth: topical therapies. 34. Cochrane Database Syst. Rev. 12, CD008934 (2011).Steller, M., Chou, L. & Daniels, T. E. Electrical stimulation of salivary flow in patients with Sjögren’s syndrome. J. Dent. Res. 67, 1334–1337 (1988).Vivino, F. B. et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch. Intern. Med. 159, 174–181 (1999).Meijer, J. M. et al. Effectiveness of rituximab treatment in primary Sjögren’s syndrome:a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 62, 960–968 (2010).Forstot, S. L. & Foulks, G. N. Management of Dry Eye (Oxford Univ. Press, 2012).Toda, I., Shinozaki, N. & Tsubota, K. Hydroxypropyl methylcellulose for the treatment of severe dry eye associated with Sjögren’s syndrome. Cornea 15, 120–128 (1996).Marsh, P. & Pflugfelder, S. C. Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren syndrome. Ophthalmology 106, 811–816 (1999).Barber, L. D., Pflugfelder, S. C., Tauber, J. & Foulks, G. N. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology 112, 1790–1794 (2005).Milin, M. et al. Sicca symptoms are associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sjögren’s syndrome. Joint Bone Spine http://dx.doi. org/10.1016/j.jbspin.2015.10.005 (2016).van Leeuwen, N. et al. Psychological profiles in patients with Sjögren’s syndrome related to fatigue: a cluster analysis. Rheumatology (Oxford) 54, 776–783 (2015).Segal, B. et al. Prevalence, severity, and predictors of fatigue in subjects with primary Sjögren’s syndrome. Arthritis Rheum. 59, 1780–1787 (2008).Gottenberg, J. E. et al. Effects of hydroxychloroquine on symptomatic improvement in primary Sjögren syndrome: the JOQUER randomized clinical trial. JAMA 312, 249–258 (2014).Hartkamp, A. et al. Effect of dehydroepiandrosterone administration on fatigue, well-being, and functioning in women with primary Sjögren syndrome: a randomised controlled trial. Ann. Rheum. Dis. 67, 91–97 (2008).Theander, E., Horrobin, D. F., Jacobsson, L. T. & Manthorpe, R. Gammalinolenic acid treatment of fatigue associated with primary Sjögren’s syndrome. Scand. J. Rheumatol. 31, 72–79 (2002).Kruize, A. A. et al. Hydroxychloroquine treatment for primary Sjögren’s syndrome: a two year double blind crossover trial. Ann. Rheum. Dis. 52, 360–364 (1993).Sankar, V. et al. Etanercept in Sjögren’s syndrome: a twelve-week randomized, double-blind, placebo- controlled pilot clinical trial. Arthritis Rheum. 50, 2240–2245 (2004).Koch, M., Iro, H. & Zenk, J. Stenosis and other non- sialolithiasis-related obstructions of the major salivary gland ducts. Modern treatment concepts. HNO 58, 218–224 (in German) (2010).De Vita, S. et al. Efficacy and safety of belimumab given for 12 months in primary Sjögren’s syndrome: the BELISS open-label phase II study. Rheumatology (Oxford) (2015). Kuhn, A. et al. Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database. Br. J. Dermatol. 171, 571–579 (2014).Palm, O. et al. Clinical pulmonary involvement in primary Sjögren’s syndrome: prevalence, quality of life and mortality — a retrospective study based on registry data. Rheumatology (Oxford) 52, 173–179 (2013).Francois, H. & Mariette, X. Renal involvement in primary Sjögren syndrome. Nat. Rev. Nephrol. 12, 82–93 (2016).Evans, R. D., Laing, C. M., Ciurtin, C. & Walsh, S. B. Tubulointerstitial nephritis in primary Sjögren syndrome: clinical manifestations and response to treatment. BMC Musculoskelet. Disord. 17, 2 (2016).Gottenberg, J. E. et al. Efficacy of rituximab in systemic manifestations of primary Sjögren’s syndrome: results in 78 patients of the AutoImmune and Rituximab registry. Ann. Rheum. Dis. 72, 1026–1031 (2013).Colafrancesco, S. et al. Myositis in primary Sjögren’s syndrome: data from a multicentre cohort. Clin. Exp. Rheumatol. 33, 457–464 (2015).Oddis, C. V. et al. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum. 65, 314–324 (2013).Mok, C. C., Ho, L. Y. & To, C. H. Rituximab for refractory polymyositis: an open-label prospective study. J. Rheumatol. 34, 1864–1868 (2007).Carvajal Alegria, G. et al. Epidemiology of neurological manifestations in Sjögren’s syndrome: data from the French ASSESS Cohort. RMD Open 2, e000179 (2016).Yamashita, H. et al. Diagnosis and treatment of primary Sjögren syndrome-associated peripheral neuropathy: a six-case series. Mod. Rheumatol. 23, 925–933 (2013).Chen, W. H., Yeh, J. H. & Chiu, H. C. Plasmapheresis in the treatment of ataxic sensory neuropathy associated with Sjögren’s syndrome. Eur. Neurol. 45, 270–274 (2001).Mekinian, A. et al. Efficacy of rituximab in primary Sjögren’s syndrome with peripheral nervous system involvement: results from the AIR registry. Ann. Rheum. Dis. 71, 84–87 (2012).Terrier, B. et al. Non HCV-related infectious cryoglobulinemia vasculitis: results from the French nationwide CryoVas survey and systematic review of the literature. J. Autoimmun. 65, 74–81 (2015).Singh, A. G., Singh, S. & Matteson, E. L. Rate, risk factors and causes of mortality in patients with Sjögren’s syndrome: a systematic review and meta- analysis of cohort studies. Rheumatology (Oxford) 55, 450–460 (2016).Pollard, R. P. et al. Treatment of mucosa-associated lymphoid tissue lymphoma in Sjögren’s syndrome: a retrospective clinical study. J. Rheumatol. 38, 2198–2208 (2011).Papageorgiou, A. et al. Predicting the outcome of Sjögren’s syndrome-associated non-hodgkin’s lymphoma patients. PLoS ONE 10, e0116189 (2015).Devauchelle-Pensec, V. et al. Improvement of Sjögren’s syndrome after two infusions of rituximab (anti-CD20). Arthritis Rheum. 57, 310–317 (2007).Carubbi, F. et al. Efficacy and safety of rituximab treatment in early primary Sjögren’s syndrome: a prospective, multi-center, follow-up study. Arthritis Res. Ther. 15, R172 (2013).Devauchelle-Pensec, V. et al. Which and how many patients should be included in randomised controlled trials to demonstrate the efficacy of biologics in primary Sjögren’s syndrome? PLoS ONE 10, e0133907 (2015).Jousse-Joulin, S. et al. Brief report: ultrasonographic assessment of salivary gland response to rituximab in primary Sjögren’s syndrome. Arthritis Rheumatol. 67, 1623–1628 (2015).Cornec, D. et al. Development of the Sögren’s Syndrome Responder Index, a data-driven composite endpoint for assessing treatment efficacy. Rheumatology (Oxford) 54, 1699–1708 (2015).

¡Gracias por escuchar! En este episodio se discuten las nuevas estrategias terapéuticas para el manejo del Lupus Eritematoso Sistémico. Agradezco su retroalimentación y les pido amablemente que califiquen el episodio en iTunes y en Spotify. No olviden dejar sus comentarios y sugerencias en tukua.podbean.com. Abajo enlisto las referencias bibliográficas consultadas en este episodio: Piga, M. et al. Failure to achieve lupus low disease activity state (LLDAS) six months after diagnosis is associated with early damage accrual in Caucasian patients with systemic lupus erythematosus. Arthritis. Res. Ther. 19, 247 (2017). Nossent, J. et al. Disease activity and damage accrual during the early disease course in a multinational inception cohort of patients with systemic lupus erythematosus. Lupus 19, 949–956 (2010). Iaccarino, L. et al. Clinical predictors of response and discontinuation of belimumab in patients with systemic lupus erythematosus in real life setting. Results of a large, multicentric, nationwide study. J. Autoimmun. 86, 1–8 (2018). Calixto, O. J., Franco, J. S. & Anaya, J. M. Lupus mimickers. Autoimmun. Rev. 13, 865–872 (2014). Doria, A. & Briani, C. Lupus: improving long-term prognosis. Lupus 17, (166–170 (2008). Bizzarro, N. et al. Anti-prothrombin antibodies predict thrombosis in patients with systemic lupus erythematosus: a 15-year longitudinal study.J. Thromb. Haemost. 5, 1158–1164 (2007). Pengo, V. et al. Efficacy and safety of rivaroxaban versus warfarin in high-risk patients with antiphospholipid syndrome: rationale and design of the Trial on Rivaroxaban in AntiPhospholipid Syndrome (TRAPS) trial. Lupus 25, 301–306 (2016). Arnaud, L. et al. Patient-level analysis of five international cohorts further confirms the efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies. Autoimmun. Rev. 14, 192–200 (2015). Ruiz-Irastorza, G. et al. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th international congress on antiphospholipid antibodies. Lupus 20, 206–218 (2011). Moroni, G. et al. Changing patterns in clinical- histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis. Ann. Rheum. Dis. 77, 1318–1325 (2018). van Vollenhoven, R. et al. A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Ann. Rheum. Dis. 76, 554–561 (2017). Bertsias, G. et al. Joint European League Against Rheumatism and European Renal Association- European Dialysis and Transplant Association (EULAR/ ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann. Rheum. Dis. 71, 1771–1782 (2012). Bruce, I. N. et al. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann. Rheum. Dis. 74, 1706–1713 (2015). Al Sawah, S. et al. Effect of corticosteroid use by dose on the risk of developing organ damage over time in systemic lupus erythematosus-the Hopkins Lupus Cohort. Lupus. Sci. Med. 2, e000066 (2015). Guiducci, C. et al. TLR recognition of self nucleic acids hampers glucocorticoid activity in lupus. Nature 465, 937–941 (2010). Fischer-Betz, R. et al. Renal outcome in patients with lupus nephritis using a steroid-free regimen of monthly intravenous cyclophosphamide: a prospective observational study. J. Rheumatol. 39, 2111–2117 (2012). Merrill, J. T. et al. Lupus community panel proposals for optimising clinical trials: 2018. Lupus. Sci. Med. 5, e000258 (2018). Iaccarino, L. et al. Effects of belimumab on flare rate and expected damage progression in patients with active systemic lupus erythematosus. Arthritis Care Res. (Hoboken) 69, 115–123 (2017). Trentin, F. et al. Effectiveness, tolerability, and safety of belimumab in patients with refractory SLE: a review of observational clinical-practice-based studies. Clin. Rev. Allergy Immunol. 54, 331–343 (2018). Bruce, I. N. et al. Long-term organ damage accrual and safety in patients with SLE treated with belimumab plus standard of care. Lupus 25, 699–709 (2016). Zhang, H. et al. Multitarget therapy for maintenance treatment of lupus nephritis. J. Am. Soc. Nephrol. 28, 3671–3678 (2017). Gladman, D. D., Iban ̃ez, D., Ruiz, I. & Urowitz, M. B. Recommendations for frequency of visits to monitor systemic lupus erythematosus in asymptomatic patients: data from an observational cohort study. Rheumatol. 40, 630–633 (2013). Hsu, C. Y. et al. Adherence to hydroxychloroquine improves long-term survival of patients with systemic lupus erythematosus. Rheumatology (Oxford) 57, 1743–1751 (2018). Chen, W. et al. Outcomes of maintenance therapy with tacrolimus versus azathioprine for active lupus nephritis: a multicenter randomized clinical trial. Lupus 21, 944–952 (2012). Merrill, J. T. et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 62, 222–233 (2010). Kraaij, T., Huizinga, T. W., Rabelink, T. J. & Teng, Y. K. Belimumab after rituximab as maintenance therapy in lupus nephritis. Rheumatology (Oxford) 53, 2122–2124 (2014). Steiman, A. J. et al. Outcomes in patients with systemic lupus erythematosus with and without a prolonged serologically active clinically quiescent period. Arthritis Care Res. 64, 511–518 (2012). Moroni, G., Longhi, S., Gliglio, E., Messa, P. & Ponticelli, C. What happens after complete withdrawal of therapy in patients with lupus nephritis. Clin. Exp. Rheumatol. 31, S75–S81 (2013). Banchereau, R. et al. Personalized immunomonitoring uncovers molecular networks that stratify lupus patients. Cell 165, 551–565 (2016).

¡Gracias por Escuchar! En esta ocasión hablaré acerca del mecanismo de acción del fármaco mas importante y de mayor uso para el tratamiento de varias enfermedades, principalmente Artritis Reumatoide, el Metotrexato. Para este episodio consulté varias fuentes, tratando de presentar evidencia en humanos sobre su interesante funcionamiento. Recuerden que su retroalimentación es bienvenida y muy importante. Les pido amablemente dejen sus calificaciones y comentarios sobre el podcast en iTunes. Próximamente el podcast estará disponible en Google Play y se encuentra disponible en Spotify, pudiendo también acceder a el a través de su gestor de podcasts favorito.A continuación se encuentra una lista de las referencias consultadas para este episodio.Lopez-Olivo, M. A. et al. Methotrexate for treating rheumatoid arthritis. Cochrane Database Syst. Rev. 6, CD000957 (2014).Kavanaugh, A. et al. Clinical, functional and radiographic consequences of achieving stable low disease activity and remission with adalimumab plus methotrexate or methotrexate alone in early rheumatoid arthritis: 26-week results from the randomised, controlled OPTIMA study. Ann. Rheum. Dis. 72, 64–71 (2013).Detert, J. et al. Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann. Rheum. Dis. 72, 844–850 (2013).Horslev-Petersen, K. et al. Adalimumab added to a treat-to-target strategy with methotrexate and intra- articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study: an investigator-initiated, randomised, double-blind, parallel-group, placebo- controlled trial. Ann. Rheum. Dis. 73, 654–661 (2014).O’Dell, J. R. et al. Validation of the methotrexate-first strategy in patients with early, poor-prognosis rheumatoid arthritis: results from a two-year randomized, double-blind trial. Arthritis Rheum. 65, 1985–1994 (2013).Bathon, J. M. et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N. Engl. J. Med. 343, 1586–1593 (2000).Klareskog, L. et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363, 675–681 (2004).Goekoop-Ruiterman, Y. P. et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 52, 3381–3390 (2005).Breedveld, F. C. et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis. Rheum. 54, 26–37 (2006).Soubrier, M. et al. Evaluation of two strategies (initial methotrexate monotherapy versus its combination with adalimumab) in management of early active rheumatoid arthritis: data from the GUEPARD trial. Rheumatology 48, 1429–1434 (2009).Tak, P. P. et al. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. Ann. Rheum. Dis. 70, 39–46 (2011).de Jong, P. H. et al. Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann. Rheum. Dis. 72, 72–78 (2013).Emery, P. et al. Golimumab, a human anti-tumor necrosis factor monoclonal antibody, injected subcutaneously every 4 weeks in patients with active rheumatoid arthritis who had never taken methotrexate: 1-year and 2-year clinical, radiologic, and physical function findings of a phase III, multicenter, randomized, double-blind, placebo- controlled study. Arthritis Care Res. (Hoboken) 65, 1732–1742 (2013).Takeuchi, T. et al. Adalimumab, a human anti-TNF monoclonal antibody, outcome study for the prevention of joint damage in Japanese patients with early rheumatoid arthritis: the HOPEFUL 1 study. Ann. Rheum. Dis. 73, 536–543 (2014).Nam, J. L. et al. A randomised controlled trial of etanercept and methotrexate to induce remission in early inflammatory arthritis: the EMPIRE trial. Ann. Rheum. Dis. 73, 1027–1036 (2014).Emery, P. et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active- controlled AVERT study of 24 months, with a 12-month, double-blind treatment period. Ann. Rheum. Dis. 74, 19–26 (2015).Whittle, S. L. & Hughes, R. A. Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review. Rheumatology 43, 267–271 (2004).Schiff, M. H., Jaffe, J. S. & Freundlich, B. Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration. Ann. Rheum. Dis. 73, 1549–1551 (2014).Hoekstra, M. et al. Splitting high-dose oral methotrexate improves bioavailability: a pharmacokinetic study in patients with rheumatoid arthritis. J. Rheumatol. 33, 481–485 (2006).Wegrzyn, J., Adeleine, P. & Miossec, P. Better efficacy of methotrexate given by intramuscular injection than orally in patients with rheumatoid arthritis. Ann. Rheum. Dis. 63, 1232–1234 (2004).Hasko, G. & Cronstein, B. Regulation of inflammation by adenosine. Front. Immunol. 4, 85 (2013).Baggott, J. E., Morgan, S. L., Sams, W. M. & Linden, J. Urinary adenosine and aminoimidazolecarboxamide excretion in methotrexate-treated patients with psoriasis. Arch. Dermatol. 135, 813–817 (1999).Varani, K. et al. A2A and A3 adenosine receptor expression in rheumatoid arthritis: upregulation, inverse correlation with disease activity score and suppression of inflammatory cytokine and metalloproteinase release. Arthritis Res. Ther. 13, R197 (2011).Peres, R. S. et al. Low expression of CD39 on regulatory T cells as a biomarker for resistance to methotrexate therapy in rheumatoid arthritis. Proc. Natl Acad. Sci. USA 112, 2509–2514 (2015).Nesher, G., Mates, M. & Zevin, S. Effect of caffeine consumption on efficacy of methotrexate in rheumatoid arthritis. Arthritis Rheum. 48, 571–572 (2003).Nesher, G., Osborn, T. G. & Moore, T. L. In vitro effects of methotrexate on polyamine levels in lymphocytes from rheumatoid arthritis patients. Clin. Exp. Rheumatol. 14, 395–399 (1996).Nesher, G., Osborn, T. G. & Moore, T. L. Effect of treatment with methotrexate, hydroxychloroquine, and prednisone on lymphocyte polyamine levels in rheumatoid arthritis: correlation with the clinical response and rheumatoid factor synthesis. Clin. Exp. Rheumatol. 15, 343–347 (1997).Huang, C. et al. Ornithine decarboxylase prevents methotrexate-induced apoptosis by reducing intracellular reactive oxygen species production. Apoptosis 10, 895–907 (2005).Smith, D. M., Johnson, J. A. & Turner, R. A. Biochemical perturbations of BW 91Y (3-deazaadenosine) on human neutrophil chemotactic potential and lipid metabolism. Int. J. Tissue React. 13, 1–18 (1991).Phillips, D. C., Woollard, K. J. & Griffiths, H. R. The anti-inflammatory actions of methotrexate are critically dependent upon the production of reactive oxygen species. Br. J. Pharmacol. 138, 501–511 (2003).Johnston, A., Gudjonsson, J. E., Sigmundsdottir, H., Ludviksson, B. R. & Valdimarsson, H. The anti- inflammatory action of methotrexate is not mediated by lymphocyte apoptosis, but by the suppression of activation and adhesion molecules. Clin. Immunol. 114, 154–163 (2005).Dolhain, R. J. et al. Methotrexate reduces inflammatory cell numbers, expression of monokines and of adhesion molecules in synovial tissue of patients with rheumatoid arthritis. Br. J. Rheumatol. 37, 502–508 (1998).Miranda-Carus, M. E., Balsa, A., Benito-Miguel, M., Perez de Ayala, C. & Martin-Mola, E. IL-15 and the initiation of cell contact-dependent synovial fibroblast-T lymphocyte cross-talk in rheumatoid arthritis: effect of methotrexate. J. Immunol. 173, 1463–1476 (2004).Wijngaarden, S., van Roon, J. A., van de Winkel, J. G., Bijlsma, J. W. & Lafeber, F. P. Down-regulation of activating Fcγ receptors on monocytes of patients with rheumatoid arthritis upon methotrexate treatment. Rheumatology 44, 729–734 (2005).Cooper, D. L. et al. FcγRIIIa expression on monocytes in rheumatoid arthritis: role in immune-complex stimulated TNF production and non-response to methotrexate therapy. PLoS ONE 7, e28918 (2012).Rudwaleit, M. et al. Response to methotrexate in early rheumatoid arthritis is associated with a decrease of T cell derived tumour necrosis factor α, increase of interleukin 10, and predicted by the initial concentration of interleukin 4. Ann. Rheum. Dis. 59, 311–314 (2000).Majumdar, S. & Aggarwal, B. B. Methotrexate suppresses NF-κB activation through inhibition of IκBα phosphorylation and degradation. J. Immunol. 167, 2911–2920 (2001).Mello, S. B., Barros, D. M., Silva, A. S., Laurindo, I. M. & Novaes, G. S. Methotrexate as a preferential cyclooxygenase 2 inhibitor in whole blood of patients with rheumatoid arthritis. Rheumatology 39, 533–536 (2000).Vergne, P. et al. Methotrexate and cyclooxygenase metabolism in cultured human rheumatoid synoviocytes. J. Rheumatol. 25, 433–440 (1998).Novaes, G. S., Mello, S. B., Laurindo, I. M. & Cossermelli, W. Low dose methotrexate decreases intraarticular prostaglandin and interleukin 1 levels in antigen induced arthritis in rabbits. J. Rheumatol. 23, 2092–2097 (1996).Leroux, J. L., Damon, M., Chavis, C., Crastes De Paulet, A. & Blotman, F. Effects of methotrexate on leukotriene and derivated lipoxygenase synthesis in polynuclear neutrophils in rheumatoid polyarthritis. Rev. Rheum. Mal. Osteoartic. 59, 587–591 (in French) (1992).Seitz, M. & Dayer, J. M. Enhanced production of tissue inhibitor of metalloproteinases by peripheral blood mononuclear cells of rheumatoid arthritis patients responding to methotrexate treatment. Rheumatology 39, 637–645 (2000).Tchetverikov, I. et al. Leflunomide and methotrexate reduce levels of activated matrix metalloproteinases in complexes with α2 macroglobulin in serum of rheumatoid arthritis patients. Ann. Rheum. Dis. 67, 128–130 (2008).Stamp, L. K. et al. Methotrexate polyglutamate concentrations are not associated with disease control in rheumatoid arthritis patients receiving long-term methotrexate therapy. Arthritis Rheum. 62, 359–368 (2010).Dervieux, T., Weinblatt, M. E., Kivitz, A. Kremer, J. M. Methotrexate polyglutamation in relation to infliximab pharmacokinetics in rheumatoid arthritis. Ann. Rheum. Dis. 72, 908–910 (2013).Wessels, J. A. et al. Relationship between genetic variants in the adenosine pathway and outcome of methotrexate treatment in patients with recent- onset rheumatoid arthritis. Arthritis Rheum. 54, 2830–2839 (2006).Wessels, J. A. et al. A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent-onset rheumatoid arthritis. Arthritis Rheum. 56, 1765–1775 (2007).Fransen, J. et al. Clinical pharmacogenetic model to predict response of MTX monotherapy in patients with established rheumatoid arthritis after DMARD failure. Pharmacogenomics 13, 1087–1094 (2012).Owen, S. A. et al. Genetic polymorphisms in key methotrexate pathway genes are associated with response to treatment in rheumatoid arthritis patients. Pharmacogenomics J. 13, 227–234 (2013).Aslibekyan, S. et al. Genetic variants associated with methotrexate efficacy and toxicity in early rheumatoid arthritis: results from the treatment of early aggressive rheumatoid arthritis trial. Pharmacogenomics J.14, 48–53 (2014). 

¡Gracias por escuchar! Ahora ya se puede acceder a Tukua a través de iTunes.Agradezco sus comentarios y retroalimentación y les ruego se suscriban al podcast. A continuación se enlistan los artículos mencionados en el episodio 2. Karpouzas, G. A. et al. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann. Rheum. Dis. 73, 1797–1804 (2014). Maki-Petaja, K. M. et al. Anti-tumor necrosis factor therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis. Circulation 126, 2473–2480 (2012). The Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 302, 1993–2000 (2009). van Sijl, A. M. et al. The effect of TNF-alpha blocking therapy on lipid levels in rheumatoid arthritis: a meta- analysis. Semin. Arthritis Rheum. 41, 393–400 (2011). Queiro, R. et al. Prevalence and type II diabetes- associated factors in psoriatic arthritis. Clin. Rheumatol. 37, 1059–1064 (2018). Dubreuil, M. et al. Diabetes incidence in psoriatic arthritis, psoriasis and rheumatoid arthritis: a UK population-based cohort study. Rheumatology 53, 346–352 (2014). Siebert, S. et al. Characteristics of rheumatoid arthritis and its association with major comorbid conditions: cross-sectional study of 502 649 UK Biobank participants. RMD Open 2, e000267 (2016). Coxib and Traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 382, 769–779 (2013). Roubille, C. et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti- inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta- analysis. Ann. Rheum. Dis. 74, 480–489, (2015) Zhang, J. et al. Comparative effects of biologics on cardiovascular risk among older patients with rheumatoid arthritis. Ann. Rheum. Dis. 75, 1813–1818 (2016)

This ripping yarn delves into the history of tumor necrosis factor in relation to rheumatoid arthritis with emphasis on the original studies that set the stage for the use of TNF inhibition in RA.  Intro :11 What we’ll cover here :16 Recap of Part 1 1:25 What I discovered when doing this episode 1:22 What this episode won’t address 2:40 Let the tale begin 3:12 A look at matrix metalloproteinases 3:32 A breakthrough in understanding RA 6:28 Two key players: Dr. Mark Feldman and Dr. Ravinder Maini 6:53 The first cytokine research conducted in RA: IL-1 8:00 The next cytokine: Tumor necrosis factor 11:16 What do we know about cytokine production within the joint? 14:33 IL-6 and TGF-beta 19:16 A bit about IL-10 23:57 *Visit Healio.com/rheum for daily news and updates* How do we choose which cytokines to block to make improvements in RA? 25:16 What about in vivo data? 29:45 The history of infliximab 34:00 Infliximab is approved for RA treatment 45:13 TNF in RA: from bedside, to bench then back to bedside 46:06 It’s important to recognize the researchers who discovered these pathways 46:18 Remember the scientists next time you prescribe a TNF inhibitor 47:05 Read the latest news and commentary on Healio.com/rheumatology and Follow us on Twitter @HealioRheum and @HRheuminations for updates 47:34 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Brennan FM, et al. J Autoimmun. 1989;2 Suppl:177-186. Brennan FM, et al. Lancet. 1989;2:244-247. Butler MD, et al. Eur Cytokine Netw. 1995;6:225-230. Chu CQ, et al. Arthritis Rheum. 1991;34:1125-1132. Dayer JM, et al. J Exp Med. 1985;162:2163-2168. Di Giovine FS, et al. Ann Rheum Dis. 1988;47:768-772. Feldmann, M. Nat Rev Immunol. 2002;2:364-371. Feldmann M, Maini SR. Immunol Rev. 2008;223:7-19. Fontana A, et al. Rheumatol Int. 1982;2:49-53. Haworth C, et al. Eur J Immunol. 1991;21:2575-9. Houssiau FA, et al. Arthritis Rheum. 1988;31:784-8. Keffer J, et al. EMBO J. 1991;10:4025-4031. Kulkarni AB, Karlsson S. Am J Pathol. 1993;143:3-9. Kuruvilla AP, et al. PNAS. 1991;88:2918-2921. Maini RN, et al. Arthritis Rheum. 1998;41:1552-1563. Malaviya AN, Mehra NK. Indian J Med Res. 2018;148:263–278. McInnes IB, Schett G. Nat Rev Immunol. 2007;7:429-442. Mitchison NA, Medawar PB. Proc R Soc Lond [Biol]. 1964;https://doi.org/10.1098/rspb.1964.0093. Pettipher ER, et al. Proc Natl Acad Sci U S A. 1986;83:8749-8753. The Beautiful Cure: The Revolution in Immunology and What It Means for Your Health, University of Chicago Press, Chicago, 2018. Williams RO, et al. Proc Natl Acad Sci U S A. 1992;89:9784-9788. Xu WD, et al. J Clin Invest. 1989;83:876-882.

Author: Ryan Circh, MD Educational Pearls: Myofascial pain syndrome (MFPS) is typically unilateral with discrete points of palpable pain Often secondary to repeated use and poor posture. MFPS typically responds very well to trigger point injections. Fibromyalgia is bilateral and diffuse and is thought to have a psychological component Some of the best pharmacological treatments for fibromyalgia are Tramadol and Flexeril References: Tofferi JK, Jackson JL, O'Malley PG. Treatment of fibromyalgia with cyclobenzaprine: A meta-analysis. Arthritis Rheum. 2004 Feb 15;51(1):9-13. PubMed PMID: 14872449. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004 Nov 17;292(19):2388-95. Review. PubMed PMID: 15547167. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011 Apr;25(2):185-98. doi: 10.1016/j.berh.2011.01.002. Review. PubMed PMID: 22094195. Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014 May;25(2):357-74. doi: 10.1016/j.pmr.2014.01.012. Epub 2014 Mar 17. Review. PubMed PMID: 24787338 Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

This week, we talk about a novel approach to knee injections. We'll also touch base on the NBA draft. We have also launched our twitter page @PMRBlast and our facebook page: facebook.com/PMRBlast  Host: Ben Abramoff Co-Host: Paolo Mimbella Intro Music: Music By Longzijun Outro: Drankin' Song by Kevin Macleod Today's Articles: Tresley, J & Jose, J. "Sonographically Guided Posteromedial Approach for Intra-articular Knee Injection." Journal of Ultrasound Medicine. 2015; 34: 721-726. Zhang, Q., & Zhang, "Effect on Pain and Symptoms of Aspiration Before Hyaluronan Injection for Knee Osteoarthritis: A Prospective, Randomized, Single-blind Study." American Journal of Physical Medicine & Rehabilitation, 2013; 95(5), 366-371. Jackson, et al. "Accuracy of needle placement." J Bone JointSurg Am. 2002; 84-A:1522-1527.Daley, et al, Improving injection accuracy of the elbow,knee, and shoulder: does site and imaging make a difference? Syst Rev. AJSM2011: 39:656-662. Schumacher, HR. "Aspiration and injection therapies for joints." Arthritis Rheum. 2003: 49:413-420. Daley, et al. "Improving injection accuracy of the elbow, knee, and shoulder: Does site and imaging make a difference." Syst Rev. AJSM. 2011: 39:656-662.

A review of Osteoarthritis  for the the Pain Practitioner. To hear about Ankylosing spondylitis please subscribe to our premium episodes Discussed: Joint Replacement DMARDs NSAIDs Syndesmophytes Crepitus Xray findings Bouchards PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.  Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author. References https://en.wikipedia.org/wiki/Ankylosing_spondylitis https://en.wikipedia.org/wiki/Osteoarthritis "Ankylosing Spondylitis -Professional reference for Doctors - Patient UK". Patient UK. Retrieved 26 May 2014. Jump up ^ Jiménez-Balderas FJ, Mintz G (1993). "Ankylosing spondylitis: clinical course in women and men". J Rheumatol 20 (12): 2069–72. PMID 7516975. Jump up ^ Longo, Dan Louis; Fauci, Anthony S.; Harrison, Tinsley Randolph; Kasper, Dennis L.; Hauser, Stephen L.; Jameson, J. Larry; Loscalzo, Joseph (2012). Harrison's Principles of Internal Medicine. Vol. 1 (18th ed.). McGraw-Hill. ISBN 978-0-07-163244-7. Jump up ^ "Ankolysing Spondylitis". Arthritis Action. Retrieved 12 August 2015. Jump up ^ Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR (1998). "Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care". Spine 23 (2): 343–7. doi:10.1097/00007632-199802010-00011. PMID 9507623. Jump up ^ Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994). "A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index". J Rheumatol 21 (12): 2286–91. PMID 7699630. Jump up ^ Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994). "A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index". J Rheumatol 21 (12): 2281–5. PMID 7699629. Jump up ^ Toivanen A, Möttönen T (1998). "Ankylosing spondylitis: current approaches to treatment". BioDrugs 10 (3): 193–200. doi:10.2165/00063030-199810030-00003. PMID 18020595. Jump up ^ Williams RO, Paleolog E, Feldmann M (2007). "Cytokine inhibitors in rheumatoid arthritis and other autoimmune diseases". Curr Opin Pharmacol 7 (4): 412–7. doi:10.1016/j.coph.2007.06.001. PMID 17627887. Jump up ^ Kroon F, Landewé R, Dougados M, van der Heijde D (October 2012). "Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis". Ann. Rheum. Dis. 71 (10): 1623–9. doi:10.1136/annrheumdis-2012-201370. PMID 22532639. Jump up ^ Chen J, Lin S, Liu C (27 November 2014). "Sulfasalazine for ankylosing spondylitis.". The Cochrane database of systematic reviews 11: CD004800. doi:10.1002/14651858.CD004800.pub3. PMID 25427435. Jump up ^ Chen J, Veras MM, Liu C, Lin J (28 February 2013). "Methotrexate for ankylosing spondylitis.". The Cochrane database of systematic reviews 2: CD004524. doi:10.1002/14651858.CD004524.pub4. PMID 23450553. Jump up ^ Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (June 2011). "2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 70 (6): 896–904. doi:10.1136/ard.2011.151027. PMC 3086052. PMID 21540199. Jump up ^ Braun J, Sieper J (2007). "Ankylosing spondylitis". Lancet 369 (9570): 1379–90. doi:10.1016/S0140-6736(07)60635-7. PMID 17448825. Jump up ^ Brulhart L, Nissen MJ, Chevallier P, Gabay C (February 2010). "Mixed response to tocilizumab for ankylosing spondylitis". Annals of the Rheumatic Diseases 69 (12): 2217–2218. doi:10.1136/ard.2009.126706. PMID 20851032. Jump up ^ Rodríguez-Escalera C, Fernández-Nebro A (2008). "The use of rituximab to treat a patient with ankylosing spondylitis and hepatitis B". Rheumatology47 (11): 1732–1733. doi:10.1093/rheumatology/ken362. PMID 18786966. Jump up ^ "Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology". Phys Ther 81 (10): 1629–40. 2001. PMID 11589641. Jump up ^ Dagfinrud H, Kvien TK, Hagen KB (23 January 2008). "Physiotherapy interventions for ankylosing spondylitis.". The Cochrane database of systematic reviews (1): CD002822. doi:10.1002/14651858.CD002822.pub3. PMID 18254008. Jump up ^ Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002). "Ankylosing spondylitis: an overview". Ann. Rheum. Dis. 61 Suppl 3: iii8–18. doi:10.1136/ard.61.suppl_3.iii8. PMC 1766729. PMID 12381506. Jump up ^ Bond D (2013). "Ankylosing spondylitis: diagnosis and management". Nurs Stand 28 (16-18): 52–9; quiz 60. doi:10.7748/ns2013.12.28.16.52.e7807. PMID 24345154. ^ Jump up to: a b Alpert, Joseph S. (2006). The AHA Clinical Cardiac Consult. Lippincott Williams & Wilkins. ISBN 0-7817-6490-4. Jump up ^ Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, Garrett ES, Kostuik JP, Kebaish KM, Sponseller PD (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments". J of Spinal Disorders 14 (5): 427–433. doi:10.1097/00002517-200110000-00009. PMID 11586143. ^ Jump up to: a b Bakland G, Gran JT, Nossent JC (November 2011). "Increased mortality in ankylosing spondylitis is related to disease activity". Ann. Rheum. Dis.70 (11): 1921–5. doi:10.1136/ard.2011.151191. PMID 21784726. Jump up ^ Radford EP, Doll R, Smith PG (September 1977). "Mortality among patients with ankylosing spondylitis not given X-ray therapy". N. Engl. J. Med. 297(11): 572–6. doi:10.1056/NEJM197709152971103. PMID 887115. Jump up ^ Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C (2011). "Impaired gait in ankylosing spondylitis". Med Biol Eng Comput 49(7): 801–9. doi:10.1007/s11517-010-0731-x. PMID 21229328 "Ankylosing Spondylitis -Professional reference for Doctors - Patient UK". Patient UK. Retrieved 26 May 2014. 2.Jump up ^ Jiménez-Balderas FJ, Mintz G (1993). "Ankylosing spondylitis: clinical course in women and men". J Rheumatol 20 (12): 2069–72. PMID 7516975. 3.Jump up ^ Longo, Dan Louis; Fauci, Anthony S.; Harrison, Tinsley Randolph; Kasper, Dennis L.; Hauser, Stephen L.; Jameson, J. Larry; Loscalzo, Joseph (2012). Harrison's Principles of Internal Medicine. Vol. 1 (18th ed.). McGraw-Hill. ISBN 978-0-07-163244-7. 4.Jump up ^ "Ankolysing Spondylitis". Arthritis Action. Retrieved 12 August 2015. 5.Jump up ^ Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR (1998). "Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care". Spine 23 (2): 343–7. doi:10.1097/00007632-199802010-00011. PMID 9507623. 6.Jump up ^ Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994). "A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index". J Rheumatol 21 (12): 2286–91. PMID 7699630. 7.Jump up ^ Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994). "A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index". J Rheumatol 21 (12): 2281–5. PMID 7699629. 8.Jump up ^ Toivanen A, Möttönen T (1998). "Ankylosing spondylitis: current approaches to treatment". BioDrugs 10 (3): 193–200. doi:10.2165/00063030-199810030-00003. PMID 18020595. 9.Jump up ^ Williams RO, Paleolog E, Feldmann M (2007). "Cytokine inhibitors in rheumatoid arthritis and other autoimmune diseases". Curr Opin Pharmacol 7 (4): 412–7. doi:10.1016/j.coph.2007.06.001. PMID 17627887. 10.Jump up ^ Kroon F, Landewé R, Dougados M, van der Heijde D (October 2012). "Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis". Ann. Rheum. Dis. 71 (10): 1623–9. doi:10.1136/annrheumdis-2012-201370. PMID 22532639. 11.Jump up ^ Chen J, Lin S, Liu C (27 November 2014). "Sulfasalazine for ankylosing spondylitis.". The Cochrane database of systematic reviews 11: CD004800. doi:10.1002/14651858.CD004800.pub3. PMID 25427435. 12.Jump up ^ Chen J, Veras MM, Liu C, Lin J (28 February 2013). "Methotrexate for ankylosing spondylitis.". The Cochrane database of systematic reviews 2: CD004524. doi:10.1002/14651858.CD004524.pub4. PMID 23450553. 13.Jump up ^ Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (June 2011). "2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 70 (6): 896–904. doi:10.1136/ard.2011.151027. PMC 3086052. PMID 21540199. 14.Jump up ^ Braun J, Sieper J (2007). "Ankylosing spondylitis". Lancet 369 (9570): 1379–90. doi:10.1016/S0140-6736(07)60635-7. PMID 17448825. 15.Jump up ^ Brulhart L, Nissen MJ, Chevallier P, Gabay C (February 2010). "Mixed response to tocilizumab for ankylosing spondylitis". Annals of the Rheumatic Diseases 69 (12): 2217–2218. doi:10.1136/ard.2009.126706. PMID 20851032. 16.Jump up ^ Rodríguez-Escalera C, Fernández-Nebro A (2008). "The use of rituximab to treat a patient with ankylosing spondylitis and hepatitis B". Rheumatology 47 (11): 1732–1733. doi:10.1093/rheumatology/ken362. PMID 18786966. 17.Jump up ^ "Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology". Phys Ther 81 (10): 1629–40. 2001. PMID 11589641. 18.Jump up ^ Dagfinrud H, Kvien TK, Hagen KB (23 January 2008). "Physiotherapy interventions for ankylosing spondylitis.". The Cochrane database of systematic reviews (1): CD002822. doi:10.1002/14651858.CD002822.pub3. PMID 18254008. 19.Jump up ^ Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002). "Ankylosing spondylitis: an overview". Ann. Rheum. Dis. 61 Suppl 3: iii8–18. doi:10.1136/ard.61.suppl_3.iii8. PMC 1766729. PMID 12381506. 20.Jump up ^ Bond D (2013). "Ankylosing spondylitis: diagnosis and management". Nurs Stand 28 (16-18): 52–9; quiz 60. doi:10.7748/ns2013.12.28.16.52.e7807. PMID 24345154. 21.^ Jump up to: a b Alpert, Joseph S. (2006). The AHA Clinical Cardiac Consult. Lippincott Williams & Wilkins. ISBN 0-7817-6490-4. 22.Jump up ^ Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, Garrett ES, Kostuik JP, Kebaish KM, Sponseller PD (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments". J of Spinal Disorders 14 (5): 427–433. doi:10.1097/00002517-200110000-00009. PMID 11586143. 23.^ Jump up to: a b Bakland G, Gran JT, Nossent JC (November 2011). "Increased mortality in ankylosing spondylitis is related to disease activity". Ann. Rheum. Dis. 70 (11): 1921–5. doi:10.1136/ard.2011.151191. PMID 21784726. 24.Jump up ^ Radford EP, Doll R, Smith PG (September 1977). "Mortality among patients with ankylosing spondylitis not given X-ray therapy". N. Engl. J. Med. 297 (11): 572–6. doi:10.1056/NEJM197709152971103. PMID 887115. 25.Jump up ^ Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C (2011). "Impaired gait in ankylosing spondylitis". Med Biol Eng Comput 49 (7): 801–9. doi:10.1007/s11517-010-0731-x. PMID 21229328 ^ Jump up to: a b c d e f g h i "Osteoarthritis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. April 2015. Retrieved 13 May 2015. ^ Jump up to: a b c d Glyn-Jones, S; Palmer, AJ; Agricola, R; Price, AJ; Vincent, TL; Weinans, H; Carr, AJ (3 March 2015). "Osteoarthritis.". Lancet. PMID 25748615. Jump up ^ Berenbaum F (2013). "Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!)". Osteoarthritis and Cartilage 21 (1): 16–21. doi:10.1016/j.joca.2012.11.012. PMID 23194896. ^ Jump up to: a b Conaghan P (2008). "Osteoarthritis — National clinical guideline for care and management in adults" (PDF). ^ Jump up to: a b March, L; Smith, EU; Hoy, DG; Cross, MJ; Sanchez-Riera, L; Blyth, F; Buchbinder, R; Vos, T; Woolf, AD (June 2014). "Burden of disability due to musculoskeletal (MSK) disorders.". Best practice & research. Clinical rheumatology 28 (3): 353–66. PMID 25481420. Jump up ^ Elsternwick (2013). "A problem worth solving.". Arthritis and Osteoporosis Victoria. Jump up ^ MedlinePlus Encyclopedia Osteoarthritis Jump up ^ de Figueiredo EC, Figueiredo GC, Dantas RT (December 2011). "Influência de elementos meteorológicos na dor de pacientes com osteoartrite: Revisão da literatura" [Influence of meteorological elements on osteoarthritis pain: a review of the literature]. Rev Bras Reumatol (in Portuguese) 51 (6): 622–8. doi:10.1590/S0482-50042011000600008. PMID 22124595. Jump up ^ "Water on the knee". MayoClinic.com. ^ Jump up to: a b Brandt KD, Dieppe P, Radin E (January 2009). "Etiopathogenesis of osteoarthritis". Med. Clin. North Am. 93 (1): 1–24, xv. doi:10.1016/j.mcna.2008.08.009. PMID 19059018. Jump up ^ Bosomworth NJ (September 2009). "Exercise and knee osteoarthritis: benefit or hazard?". Can Fam Physician 55 (9): 871–8. PMC 2743580. PMID 19752252. Jump up ^ Deweber K, Olszewski M, Ortolano R (2011). "Knuckle cracking and hand osteoarthritis". J Am Board Fam Med 24 (2): 169–74. doi:10.3122/jabfm.2011.02.100156. PMID 21383216. Jump up ^ Valdes AM, Spector TD (August 2008). "The contribution of genes to osteoarthritis". Rheum. Dis. Clin. 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An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.

An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.

An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.