Pamela E. Prete

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

To provide evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

Pleuropulmonary manifestations of rheumatoid arthritis

Ces manifestations sont diverses: infections des poumons et de la plevre, pleuresie, pneumopathie interstitielle, nodules pulmonaires et vascularite

Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B.

There are no previous studies on the use of abatacept in patients with chronic hepatitis B. This medical record review assessed the safety and efficacy of abatacept in 8 patients with rheumatoid arthritis (RA) and chronic hepatitis B.

Development and validation of a case ascertainment tool for ankylosing spondylitis.

Ankylosing spondylitis (AS) diagnosis is often delayed. The availability of effective biologic agents for treating AS has increased the importance of early diagnosis. We tested questions derived from a comprehensive literature review and an advisory board in a case–control study designed to identify patients with AS from among patients with chronic back pain (CBP).

SYNOVIAL FLUID LIPIDS AND APOLIPOPROTEINS: A CONTEMPORARY PERSPECTIVE

Normal human synovial fluid contains extremely low concentrations of lipoproteins and apolipoproteins, in sharp contrast to those found in plasma. Increased amounts of cholesterol and other lipids have been found in the synovial fluid of a chronic inflammatory joint disorder, rheumatoid arthritis (RA). More recently, apolipoproteins AI, B and E have also been found in increased amounts in RA synovial fluid. Theories have been proposed to account for this increase in the amount of apolipoproteins and for the source of lipids and lipoproteins in normal synovial fluid; however, the mechanisms have not yet been established. Lipoproteins may play dual roles in synovial fluid: A functional one in normal synovial fluid and, as some suggest, a pathologic one in the abnormal synovial fluid of certain arthritic diseases. The recent data prompt the need to define synovial fluid lipids, lipoprotein particle subfractions and their constituent apolipoproteins, as well as their respective roles in synovial fluid.

Systemic lupus erythematosus in men: a retrospective analysis in a Veterans Administration Healthcare System population.

Systemic lupus erythematosus (SLE), a connective tissue disease of unknown etiology, is generally considered to occur in women of child-bearing age and to be uncommon among men (1-5). Because of the female predominance in most studies, less is known about the disease in men. To begin to better understand lupus in men, we retrospectively analyzed all the SLE patients from all the hospitals in the Department of Veterans Affairs (VA) system, a population that is predominantly male. Between 1987 and 1996, 2614 SLE patients were retrieved from the VA databank; 2144 were male, making this the largest group of male patients with SLE reported in United States of America. Age, racial and geographic distribution, comorbidities, and mortality of the SLE patients are reported. This study suggests that SLE men in this population are older at onset of disease, have different comorbidities, and have a higher mortality at 1 year than women with SLE. These findings suggest that men with SLE have a more complex clinical course than women, although the data do not illuminate whether the comorbidities are due to or coincident with SLE. On the basis of these data, practitioners are reminded to consider SLE in the differential diagnosis for older men and be attentive to the frequent presence of comorbidities such as cardiac ischemia and neoplasms. Because of the identified regional variations in demographics, comorbidities, and mortality, this study suggests the need for future SLE studies to include data from multiple geographic areas.

Synovial fluid lipoproteins: Review of current concepts and new directions

Recent developments in plasma lipoprotein and apolipoprotein research have been striking, but few studies have focused on the analysis of lipoproteins in synovial fluid (SF). SF contains small amounts of lipoproteins and apolipoproteins. The lipid concentration of normal human SF is extremely low and is in sharp contrast to the concentrations found in plasma. Little is known about the lipids in pathological SF, but studies have noted increased cholesterol and lipoprotein content in rheumatoid arthritis (RA) SF ranging from 40% to 60% of the total plasma lipoproteins. Recently apolipoproteins AI, B and E have also been found to be in increased amounts in RA SF. Several theories have been proposed to account for the increased presence of SF lipids in RA. Animal and human studies indicate the SF cholesterol, lipoproteins, and apolipoproteins may aggravate the inflammatory reaction within the synovial space. Research suggests an immunologic role for plasma lipoproteins on lymphocyte and monocytes in the blood and lymph. SF lipoproteins and apolipoproteins should be studied to define their actions within the synovial space.

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: ACR/SAA/Spartan Treatment Recommendations in AS

To provide evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).

Antiphospholipid antibodies in malignancy: are these pathogenic or epiphenomena?

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial and venous thrombotic events associated with antiphospholipid antibodies. Antiphospholipid syndrome is commonly seen with collagen vascular diseases; however, other entities that can cause APS include chronic viral infections, certain medications, and malignancies. We present an interesting patient with an atypical presentation and course of presumed APS, which lead us to perform an exhaustive search for a secondary cause. The patient was ultimately found to have splenic marginal zone lymphoma. Analysis of the current data in the literature is presented for APS, antiphospholipid antibodies, and malignancy. Based on the literature findings and our experience, we recommend a thorough and repeated evaluation for an underlying malignancy in patients who have an atypical presentation and features of APS.

Randomized trial of switching rheumatoid arthritis patients in remission with injectable gold to auranofin

SummaryThis prospective unblinded 24-month-study compared the therapeutic value of oral gold with injectable gold to maintain rheumatoid arthritis (RA) patients in clinical remission and prevent the progression of erosive disease. Forty-six patients with definite RA in remission with injectable gold were randomized into two groups: a control group, continued on maintenance injectable gold (Solganal, aurothioglucose, 50–100 mg, intramuscularly, 2 to 4 weeks); and an experimental group, switched to oral gold (6–9 mg auranofin by mouth daily).Only 29% of the original 24 oral gold patients remained on assigned treatment at 24 months compared with 64% of the injectable gold group. By six months, over one-half of the oral gold patients had electively stopped their randomized therapy. Sixty-seven percent of the oral gold patients had adverse reactions, mostly gastrointestinal complaints, compared with one proteinuria in the injectable gold group. The oral gold group experienced significantly more deterioration in all the primary measures of treatment effect over the follow-up period. At the termination of the trial, 88% of the group had increases of 5 or more points in radiographic scores suggesting progression of erosive disease compared with only 29% of the control group.These data suggest that oral gold is not an effective substitute for injectable gold in maintaining remission in rheumatoid arthritis.