Current Rheumatology Reports

Vassilopoulos, Dimitrios; Calabrese, Leonard H.

doi: 10.1007/s11926-013-0319-1pmid: 23436024

Chronic infection with hepatitis B (HBV) or C (HCV) virus, which currently affect approximately 7 % of the world population, is encountered with the same frequency among patients with arthritis starting biological or non-biological disease-modifying anti-rheumatic drugs (DMARDs). Treatment with biological agents, including anti-tumor necrosis factor agents, rituximab, and abatacept, without appropriate antiviral therapy has been associated with reactivation of HBV infection which in some cases can lead to life-threatening complications, indicating the need for appropriate screening and treatment of these patients. In this review, the latest data regarding HBV or HCV-related arthritic complications and treatment of rheumatic diseases in the presence of chronic HBV or HCV infection will be critically presented.

Castillo, Rhina D.; De la Pena, Wendy; Marzan, Katherine A. B.

doi: 10.1007/s11926-013-0322-6pmid: 23443616

Progress in the diagnosis and management of pediatric rheumatic disease has improved complications from underlying disease and the survival of children. However, as a consequence, infection has now become one of the leading causes of morbidity and mortality. Differentiating between infections and disease flares in children with rheumatic conditions can often pose diagnostic quandaries. Children with rheumatic diseases are at risk of infection, not only because of the use of immune-modulating medications but also because of underlying immune dysfunction associated with their disease. Although bacterial infections are the most common, any organism can potentially be a causative agent and, at times, more invasive measures of diagnosis, for example bronchoscopy and tissue biopsies may be necessary. Maintaining a high index of suspicion of infection with prompt diagnosis and treatment are important to further improve patient outcomes.

Taylor, William; Robinson, Philip

doi: 10.1007/s11926-013-0317-3pmid: 23436006

Recent proposals for re-classification of spondyloarthropathies according to the predominance of peripheral and axial manifestations and for non-radiographic ankylosing spondylitis to be re-named axial spondyloarthritis are reviewed. It is argued that such proposals are less likely to advance knowledge in the study of spondyloarthopathies and that accurate classification criteria for defined diseases, for example psoriatic arthritis, remain as necessary now as they ever did. The CASPAR criteria remain the best performing classification criteria for psoriatic arthritis.

Zuily, Stéphane; Huttin, Olivier; Mohamed, Shirine; Marie, Pierre-Yves; Selton-Suty, Christine; Wahl, Denis

doi: 10.1007/s11926-013-0320-8pmid: 23456852

Heart valve disease (HVD) is the most frequent cardiac manifestation in patients with antiphospholipid syndrome (APS), with prevalence of 30 %. The definition is based on the presence of thickening or vegetation of the valves (mainly mitral and aortic) as described by Libman and Sacks for patients with systemic lupus erythematosus (SLE). Transthoracic and/or transoesophageal echocardiography (TTE and TEE, respectively) enable early and accurate diagnosis and help avoid misdiagnosis as rheumatic valve disease. The presence of antiphospholipid antibodies (aPL) in SLE patients is associated with a threefold greater risk of HVD, confirming the crucial importance of these antibodies in the pathogenic process, leading to thrombotic manifestations on valves because of hypercoagulability. Natural history is characterized by worsening of HVD over time with an increased risk for stroke. APS patients undergoing valve-replacement surgery are at high risk of thrombotic and bleeding complications. Thus aPL-associated HVD has affects clinical management of APS patients.

Haddad, Amir; Chandran, Vinod

doi: 10.1007/s11926-013-0321-7pmid: 23430715

Arthritis mutilans is described as the most severe form of psoriatic arthritis. It is characterized by digital shortening associated with severe osteolysis of peripheral joints. Research on arthritis mutilans has been impeded by lack of an accepted case definition. Here we describe the definitions used to date, epidemiology, clinical and radiological features, and clues to pathogenesis of arthritis mutilans. An initiative by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) to develop a consensus definition is described. The purpose of the GRAPPA initiative is to assist studies identifying clinical predictors and biomarkers for arthritis mutilans, so that patients at risk are identified early and appropriate therapeutic intervention is instituted to prevent joint destruction and preserve quality of life and function.

Punnialingam, Sinthiya; Khamashta, Munther

doi: 10.1007/s11926-013-0318-2pmid: 23494857

Antiphospholipid syndrome (APS) is an auto-immune thrombophilia for which anti-thrombotic medication is necessary for long-term management to reduce thrombotic risk or pregnancy morbidity. Choosing the type of pharmacological treatment, i.e. the intensity and duration of anticoagulation, depends on the severity of an individual’s APS and the risk of bleeding. This article reviews the current literature on anticoagulation therapy, provides recommendations on when to initiate therapy, and suggests possible alternatives for optimisation of management.