Pascale Schwab

Cause-Specific Mortality in Male US Veterans With Rheumatoid Arthritis

There has been limited investigation into cause‐specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all‐cause and cause‐specific mortality in men with RA, examining determinants of survival.

Cause‐Specific Mortality in US Veteran Men with Rheumatoid Arthritis

There has been limited investigation into cause‐specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all‐cause and cause‐specific mortality in men with RA, examining determinants of survival.

Adherence with bisphosphonate therapy in US veterans with rheumatoid arthritis

Pharmacy Benefits Management program data for patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were linked with clinical data to determine bisphosphonate adherence and persistence among US veterans with rheumatoid arthritis (RA) and to determine factors associated with adherence.

IgG4-related disease manifesting as pachymeningitis and aortitis.

To the Editor: A 57-year-old Iraqi woman presented with a 3-year history of right temporal headache, weight loss, and fatigue. She denied fevers, chills, night sweats, visual changes, jaw claudication, joint pain, or focal neurologic symptoms. Her medications included aspirin and captopril. She had received 1 month of oral prednisone (dose unclear) 4 months prior to presentation. Her vital signs were unremarkable, including symmetric blood pressures in all 4 limbs. She had scalp tenderness without temporal artery nodularity and had bruits of the right carotid, right brachial, and bilateral femoral arteries. The examination was otherwise unremarkable. She was anemic (hematocrit 27.2%) with erythrocyte sedimentation rate (ESR) 115 mm/h and C-reactive protein (CRP) 3.3 mg/dl. Cerebrospinal fluid (CSF) was clear and colorless and showed a lymphocytic pleiocytosis (24 white blood cells with 93% lymphocytes) with mildly elevated protein (71 mg/dl) and normal glucose (51 mg/dl). Negative infectious studies of CSF included bacterial, fungal, and mycobacterial cultures, as well as venereal disease research laboratory test, PCR for herpes simplex virus, and cryptococcal antigen. Magnetic resonance imaging of the brain showed diffuse pachymeningeal thickening and enhancement (Figure 1A) without venous sinus thrombosis by computed tomography (CT) venogram. CT of the chest, abdomen, and pelvis revealed thoracic … Address correspondence to Prof. Schwab; E-mail: schwabp{at}ohsu.edu

Neoplasm Mimics of Rheumatologic Presentations: Sialadenitis, Ocular Masquerade Syndromes, Retroperitoneal Fibrosis, and Regional Pain Syndromes

IgG4-RSD should be suspected in any patient presenting with lacrimal or salivary gland enlargement, particularly if male and manifesting mild glandular dysfunction. A serum IgG4 level, if increased, may be helpful, although a gland biopsy staining for IgG4-positive plasma cells is the definitive test. Primary low-grade B cell lymphomas of the glandular tissue, specifically MALT lymphoma and other glandular malignancy, should be considered, particularly in patients with asymmetric glandular enlargement. Patients with idiopathic uveitis should have a thorough evaluation to exclude malignancy, in particular PIOL and melanoma in adults, and diffuse retinoblastoma and ALL in children. RF remains a diagnostic challenge and atypical features such as outward displacement of the retroperitoneal structures should raise the suspicion for a malignant infiltrative process. CRPS rarely may be the first presentation of an occult malignancy and requires a thorough review of age-appropriate cancer screening. Carpal tunnel syndrome, if bilateral or associated with other systemic features, should prompt a search for amyloidosis.

Rheumatologic sequelae and challenges in organ transplantation

Despite the increasing success of transplantation, graft recipients experience a high burden of musculoskeletal symptoms that may hinder quality of life. Post-transplant musculoskeletal problems may result from sequelae of the organ dysfunction that indicated the transplant or from the subsequent anti-rejection therapy. Rheumatology consultants need to be familiar with the spectrum of musculoskeletal syndromes presenting in these unique patients and their appropriate treatment in the context of complex drug regimens and immunosuppression.

Vascular calcifications on hand radiographs in rheumatoid arthritis and associations with autoantibodies, cardiovascular risk factors and mortality.

OBJECTIVE To examine whether vascular calcifications on hand films in RA might aid in determining mortality risk. METHODS Hand radiographs from 906 RA patients were scored as positive or negative for vascular calcifications. Patient characteristics associated with vascular calcifications were assessed using multivariable logistic regression, and associations with mortality were examined using Cox proportional hazards regression. Cytokines and multiplex ACPA were measured in both groups. RESULTS A total of 99 patients (11%) demonstrated radiographic vascular calcifications. Factors independently associated with vascular calcifications included diabetes [odds ratio (OR) 2.85; 95% CI 1.43, 5.66], cardiovascular disease at enrolment (OR 2.48; 95% CI 1.01, 6.09), prednisone use (OR 1.90; 95% CI 1.25, 2.91), current smoking (OR 0.06; 95% CI 0.01, 0.23) and former smoking (OR 0.36; 95% CI 0.27, 0.48) vs never smoking. In cytokine and ACPA subtype analysis, IL-4 and anti-citrullinated apolipoprotein E were significantly increased in patients with vascular calcifications in fully adjusted multivariable models. After multivariable adjustment, vascular calcifications were associated with an increase in all-cause mortality (hazard ratio 1.41; 95% CI 1.12, 1.78; P = 0.004). CONCLUSION Vascular calcifications on hand radiographs were independently associated with increased all-cause mortality in RA. Mechanisms underpinning the associations of IL-4 and select ACPA with vascular calcifications and their utility as biomarkers predictive of cardiovascular disease risk in RA merit further study.

Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis

Many veterans enrolled in Veterans Affairs (VA) health care systems also receive care through other health care systems. Both VA and non‐VA health care use must therefore be considered when conducting research in this population. This study characterized dual‐care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity.

Associations of Circulating Cytokines and Chemokines With Cancer Mortality in Men With Rheumatoid Arthritis

To examine the potential of circulating cytokines and chemokines as biomarkers of cancer mortality risk in patients with rheumatoid arthritis (RA).

A 55-year-old woman with orbital inflammation

History of the present illness A 55-year-old woman presented to the emergency department for a 2-day history of progressive right eye pain, redness, and swelling. She denied antecedent trauma, sinus congestion, rhinorrhea, diplopia, diminished vision, headache, fevers, or chills. Extraocular movements worsened her pain. She had recently been diagnosed with postmenopausal osteoporosis and received her first infusion of zoledronic acid by her rheumatologist 4 days prior to symptom onset. A review of systems was otherwise unremarkable.