The HCPLive Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.
October 23rd 2024
Patients exposed to screening were also more likely to receive vaccinations and consult a cardiologist and/or a pneumologist.
Tackling Inequities in IBD: Inclusive Solutions for Elevated Patient Care
October 26, 2024
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6th Annual Advanced Practice Collaborative
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SimulatED™: Personalizing Treatment Choices to Achieve Glycemic and Weight Management Goals
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Cases and Conversations™: Keeping Up with Novel Approaches to Managing ANCA-Associated Vasculitis
November 18, 2024
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Shaping the Management of COPD with Biologic Therapy
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Elevating Care for PAH: Applying Recommended Management Approaches to Maximize Outcomes
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Clinical Consultations™: Managing Depressive Episodes in Patients with Bipolar Disorder Type II
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Expert Illustrations & Commentaries™: Exploring the Role of Novel Agents for the Management of IgA Nephropathy
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Medical Crossfire®: Understanding the Advances in Bipolar Disease Treatment—A Comprehensive Look at Treatment Selection Strategies
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'REEL’ Time Patient Counseling: The Diagnostic and Treatment Journey for Patients With Bipolar Disorder Type II – From Primary to Specialty Care
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‘REEL’ Time Patient Counseling™: Navigating the Complex Journey of Diagnosing and Managing Fabry Disease
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Expert Illustrations & Commentaries™: Envisioning Novel Therapeutic Approaches to Managing ANCA-associated Vasculitis
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Clinical ShowCase™: Finding the Best Path Forward for Patients with COPD
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A Tethered Approach to Type 2 Diabetes Care – Connecting Insulin Regimens with Digital Technology
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Surv.AI Says™: What Clinicians and Patients Are Saying About Glucose Management in the Technology Age
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Clinical ShowCase™: Forming a Personalized Treatment Plan for a Patient With ANCA-Associated Vasculitis
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Addressing Healthcare Inequities: Tailoring Cancer Screening Plans to Address Inequities in Care
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SimulatED™: Diagnosing and Treating Alzheimer’s Disease in the Modern Era
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Patient, Provider & Caregiver Connection™: Implementing an Effective Management Plan to Improve Outcomes in IgA Nephropathy
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MRI for Evaluating Knee Pain in Older Patients: How Useful Is It?
October 29th 2008Knee pain is a common complaint in older patients, andosteoarthritis is the leading cause.We prospectively evaluated the diagnosticpatterns of nonorthopedic physicians in 100 consecutive patientsolder than 60 years who had knee pain. Our study shows thatthere is a lack of consensus about the use radiographic studies for diagnosisof knee pain in older patients.Weight-bearing radiographs areideal for evaluating knee pain. MRI frequently is overly sensitive in detectingpathology and often underestimates joint-space narrowingand arthrosis. MRI also represents a much larger cost and burden onthe health care system. MRI is indicated when the cause of knee painis not readily apparent after careful physical and radiographic evaluation.(J Musculoskel Med. 2008;25:500-504)
Heart failure differs in patients with RA
October 26th 2008The clinical presentation and outcome of heart failure differ significantly in patients who have rheumatoid arthritis (RA) and those who do not.The presentation of heart failure is more subtle in patients with RA, and mortality is significantly higher.
Osteoarthritis: 20 Clinical pearls
September 30th 2008ABSTRACT: Osteoarthritis (OA) is the leading cause of chronicdisability in older adults. A multitude of factors can contribute to thedisease process. Only a portion of patients who have radiographicevidence of OA have associated pain. Several conditions can mimicOA. Laboratory tests often contribute little to the diagnosis.Treatmentshould be tailored to individual patients. Exercises and joint protectiontechniques are the mainstays of treatment. Patient educationmay be beneficial. Acetaminophen and NSAIDs are effective in manypatients. Cyclooxygenase-2 inhibitors are associated with improvedGI tolerability. Glucosamine and chondroitin sulfate may produceimprovements in pain and function and may be associated with adecrease in the radiographic progression of OA. Corticosteroids canprovide symptomatic relief. Surgery is an option for advanceddisease. (J Musculoskel Med. 2008;25:476-480)
Differentiating low and high ankle sprains
August 28th 2008Differentiation between low and high ankle sprains iscritical to delivering appropriate care.The classic mechanism for a lowankle sprain is inversion and plantar flexion. A history of ankle ligamentinjury predisposes to recurring sprains. The ankle anterior drawertest may be used to evaluate ligamentous instability. Plain radiographsof the foot and ankle may be indicated in a patient who has an acuteankle injury. Clinicians often use the Ottawa ankle rules to determinethe need for radiographs. In the acute phase, the goals of treatment areto alleviate pain, reduce swelling, and protect the ankle from furtherinjury. NSAIDs and rehabilitation are important components of management.Primary prevention may be possible with strengthening andbalance programs. (J Musculoskel Med. 2008;25:438-443)
Identifying and Managing Dermatomyositis: A Case Report and Review
August 25th 2008This detailed review desccribes the heterogeneous idiopathic inflammatory myopathies and their mimics, with criteria for classification, an overview of cardiac, pulmonary and malignant comorbidieis, and guidance for treatment.
Disease outcome prediction rule for arthritis validated
August 22nd 2008A prediction rule for the development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA) has been validated. The rule accurately estimates the risk of RA in more than 75% of patients with recent-onset UA.
Perilunate dislocation: Case studies of a frequently missed diagnosis
July 28th 2008ABSTRACT: If enough force is applied in a wrist ligament injury, aperilunate dislocation may occur. Physicians can readily make thediagnosis, but the injury may be missed in the initial evaluation. Withprompt recognition and intervention, the incidence of permanentdisability may be lessened. Acute carpal tunnel syndrome may accompanyperilunate injuries and frank dislocations. The scapholunateand lunotriquetral ligaments confer significant structural stabilityand help maintain the anatomical relationships of the carpal bones;when they are compromised, structural integrity is lost.Visual inspectionis critical to the physical examination. Neurovascular statusshould be determined and documented. Radiographic evaluationis recommended for all hand injuries. All perilunate dislocationsfirst need to be closed reduced, followed by surgical treatment.(J Musculoskel Med. 2008;25:390-395)
Differentiating osteopoikilosis from osteoblastic metastases
July 27th 2008ABSTRACT: Osteopoikilosis is a rare, benign osteosclerotic dysplasiathat predominantly involves the appendicular skeleton. Radiographicfindings are diagnostic, and the disease often is discovered incidentallyon x-ray films. The importance of recognizing osteopoikilosis liesin differentiating it from osteoblastic metastases. The cause is unclear.Patients typically are asymptomatic. Diagnostic findings include theappearance of numerous small,well-defined, spheroid sclerotic foci.Because evidence suggests an association with skeletal and dermatologicalchanges, evaluation for coexisting pathological conditions maybe warranted. The differential diagnosis for a patient who has radiographiccharacteristics similar to those of osteopoikilosis includes osteoblasticmetastases, mastocytosis, tuberous sclerosis, melorheostosis,and osteopathia striata. (J Musculoskel Med. 2008;25:387-389)
Corticosteroids for painful shoulder conditions: Injection techniques
July 26th 2008ABSTRACT: Corticosteroid/anesthetic injections may be useful diagnosticand therapeutic tools for painful shoulder conditions. The currentdogma is to avoid performing more than 3 injections over a9- to 12-month period, but this rule may be broken. The volume of localanesthetic typically injected might be insufficient for assessing accuracy.Data demonstrating significant advantages of one corticosteroidover another are scarce. For patients with diabetes mellitus, considera somewhat insoluble phosphoric corticosteroid. There is no consensusabout appropriate dosages and techniques.We recommend using1.5-inch 25-gauge needles for most injections. Re-evaluating provocativemaneuvers after each injection is important. The patient's estimatedpain relief always should be documented.Two approaches toinjection may be used, an advanced/detailed method and abasic/quick method. (J Musculoskel Med. 2008;25:375-386)
Questions about tolerance with use of opioids
July 23rd 2008I was very interested in the article "Chronic pain update: Addressing abuse and misuse of opioid analgesics" by Ross et al (The Journal of Musculoskeletal Medicine, June 2008, page 268) because pain management and addiction medicine is my specialty.The article was interesting, useful, and well written and referenced. However, it perpetuated one myth about opioid prescribing for chronic pain when the authors wrote, "Tolerance develops in most patients who receive long-term opioid therapy."
High Birth Weight Leads to Rheumatoid Arthritis in Adulthood
July 3rd 2008The fetal environment potentially preprograms the brain or endocrine system to be maladapted later in life and that patients with rheumatoid arthritis are known for having a dysregulated HPA axis, which may be affected in utero.
Injection of the anserine bursa and iliotibial tract
June 26th 2008ABSTRACT: Inflammation of the anserine bursa occurs frequently inathletes who have tight hamstrings, obese patients, patients who haveknee joint pathology, and those who experience direct trauma to thearea. Iliotibial band syndrome results from inflammation of the iliotibialtendon and the bursa. For both injections, the patient may beinjected while lying supine with the leg extended. During anserinebursa injection, the lidocaine and corticosteroid should flow withoutresistance, although some pressure is required. An inability to depressthe syringe plunger requires repositioning of the needle to avoid injectioninto the medial collateral ligament or pes anserinus tendons.(J Musculoskel Med. 2008;25:340-341)
New RA therapy recommendations cover 5 domains
June 23rd 2008Most patients with a confirmed diagnosis of rheumatoid arthritis (RA) use nonbiologic disease-modifying antirheumatic drugs (DMARDs), and the rate of biologic DMARD use is increasing rapidly, according to the American College of Rheumatology (ACR).The organization last updated recommendations for the use of nonbiologic DMARDs in 2002 and had not developed recommendations for using biologic agents.
Addressing patellofemoral pathology: Biomechanics and classification
May 28th 2008There is no clear consensus about which therapiesshould be used for the various underlying pathologies that lead topatellofemoral problems. The major distinction in classification isbetween patellofemoral compression syndrome and patellofemoralinstability. Patients with the former are concerned primarily withpain; those with the latter have instability or pain or both. Patellarpain may manifest in the parapatellar area or radiate to the back ofthe knee. Persons' differing activity and conditioning levels maylead to patellofemoral pain variability. Patients with patellar instabilityinclude those with recurring frank patellar dislocations andthose with symptoms of subluxation. Patients who have patellar instabilitypresent with tears of the medial patellofemoral ligament;this is the "essential lesion" for patellar dislocation. (J MusculoskelMed. 2008;25:297-300)
Tackling football injuries: The lower extremity
May 26th 2008Each position in football requires a specific set of skillsand predisposes the athlete to types of injury. Physicians need to recognizeand understand the most common patterns, make a diagnosisand provide treatment based on history, physical examination findings,and clinical acumen-all while recognizing and handling emergencysituations. Lower extremity injuries are the most common footballinjuries. The "hip pointer"may be mimicked by avulsion of thesartorius origin or the abdominal muscle attachments. Muscle contusionscan cause myositis ossificans or even lead to compartment syndrome.Noncontact knee injuries include anterior cruciate ligament(ACL) tears. Injuries to the ACL or menisci have been shown to lead toearly osteoarthritis. Inversion/eversion injuries include ankle fracturesand subtalar dislocations. Practical solutions have been developedfor injury prevention. (J Musculoskel Med. 2007;24:290-294)
Chronic pain update: Addressing abuse and misuse of opioid analgesics
May 24th 2008Opioid analgesics provide effective treatment for noncancerpain, but many physicians have concerns about adverse effects,tolerance, and addiction. Misuse of these drugs is prominentin patients with chronic pain. Recognition and early prevention ofmisuse helps physicians identify the causes and proceed with patientcare. Most persons with chronic pain have a significant medicalcomorbidity (eg, asthma) that affects treatment decisions. All patientsshould undergo an initial comprehensive evaluation. Patientsoften have a psychiatric comorbidity, such as depression or anxiety.There is no gold standard for risk assessment, but several traditionalmeasures may be used. Pain medicine practitioners increasingly areusing urine drug screens to monitor adherence to long-term opioidtherapy. Controlled substance agreements help improve patient compliance.(J Musculoskel Med. 2008;25:268-277, 302)
New clinical recommendations for low bone mass and osteoporosis
May 23rd 2008The latest version of the Clinician's Guide to Prevention and Treatment of Osteoporosis, updated by the National Osteoporosis Foundation (NOF) earlier this year, represents a major breakthrough in the evaluation and treatment of persons who have low bone mass or osteoporosis, according to the organization. The guide provides evidence-based recommendations to help physicians better identify persons at high risk for osteoporosis and fractures and ensure that they are recommended for treatment. It introduces guidelines that address African American, Asian, Latina, and other postmenopausal women-and men aged 50 years and older-as well as white postmenopausal women.
Injectable corticosteroids for the painful shoulder: Patient evaluation
April 30th 2008ABSTRACT: Management with corticosteroid injections should beconsidered for a variety of painful shoulder conditions, such ascervical, acromioclavicular, subacromial, glenohumeral, and bicepstendon pathology. Several aspects of the physical examination areused to isolate the anatomical source of a patient's shoulder pain.Knowing how to perform provocative maneuvers and evaluate theresults is critical for making the diagnosis and identifying potentialcorticosteroid/anesthetic injection sites. In our comprehensive16-step shoulder examination, radiographs are not viewed initiallyto avoid bias that can lead to inaccurate diagnosis. When commonprovocative maneuvers for shoulder conditions are used in isolation,their sensitivity and specificity typically are lower than whenthey are used in combination. Obtaining high-quality radiographs isessential. (J Musculoskel Med. 2008;25:236-245)
Documenting the burden of pediatric arthritis
April 27th 2008An estimated 294,000 US children younger than 18 years (or 1 in 250 children) have received a diagnosis of pediatric arthritis or another rheumatologic condition, according to a CDC study designed to gauge the prevalence and annual number of ambulatory health care visits for these disorders. Children with one of the diagnoses account for about 827,000 physician visits each year, including an average of 83,000 emergency department (ED) visits, the study showed. The authors concluded that arthritis-related health care visits impose a substantial burden on the pediatric health care system and that a surveillance paradigm will help monitor and predict young patients' health care needs.
Low sex hormone levels increase fracture risk in older men
April 26th 2008Meier C, Nguyen TV, Handelsman DJ, et al, University Hospital Basel, Switzerland, andother centers. Endogenous sex hormones and incident fracture risk in older men: theDubbo Osteoporosis Epidemiology Study. Arch Intern Med. 2008;168:47-54.
Easy, accurate RA diagnosis for general physicians
April 25th 2008Yamane T, Hashiramoto A, Tanaka Y, et al, Kobe University GraduateSchool of Medicine, Japan, and other centers. Easy and accuratediagnosis of rheumatoid arthritis using anti-cyclic citrullinatedpeptide 2 antibody, swollen joint count, and C-reactiveprotein/rheumatoid factor. J Rheumatol. 2008;35:414-420.
Managing hand and finger injuries in ball sports
March 30th 2008Many hand and finger injuries in ball sports are misdiagnosedor mismanaged, possibly leading to disability. Primary carephysicians who obtain a detailed history, conduct a focused examination,and know the indications for referral can manage themeffectively. The chief complaint is pain. In mallet finger, a finger is"jammed" during sports participation; nonoperative treatment oftenis indicated. The ring finger is involved in most reported cases of jerseyfinger; surgical intervention is the treatment of choice. Managementof boutonnière deformity helps patients regain full strengthand range of motion. Collateral ligament injuries may occur at anyinterphalangeal joint. Finger fractures are the fractures most oftenseen in the primary care setting. Malrotation with phalangeal fracturesis unacceptable. (J Musculoskel Med. 2008;25:198-204)