Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.
{"title":"An unusual case of tenosynovitis in Hansen's disease.","authors":"Pankaj Das, Sandeep Arora, Gautam Kumar Singh, Amit Bahuguna, Neelam Singh, Prachi Verma, Akanksha Gupta","doi":"10.5152/eurjrheum.2022.21125","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21125","url":null,"abstract":"<p><p>Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"212-214"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10537795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eurjrheum.2022.21120
Anna Farazilah Mohd Salleh, Cheng Lay Teh, Sharifah Aishah Wan Mohamad Akbar, Yaw Kiet Cheong, Benjamin Sachdev Manjit Singh, Kar Hoo Lee, Wendy Wan Hui Lee, Sivaraj Xaviar, Mohammad Amirul Shahril Ahmad
{"title":"Systemic Lupus Erythematosus Following COVID-19 Vaccination.","authors":"Anna Farazilah Mohd Salleh, Cheng Lay Teh, Sharifah Aishah Wan Mohamad Akbar, Yaw Kiet Cheong, Benjamin Sachdev Manjit Singh, Kar Hoo Lee, Wendy Wan Hui Lee, Sivaraj Xaviar, Mohammad Amirul Shahril Ahmad","doi":"10.5152/eurjrheum.2022.21120","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21120","url":null,"abstract":"","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"229-230"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/27/ejr-9-4-229.PMC10089130.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eujrheum.2022.21133
Jonathan S Hausmann, Kevin Kennedy, Salman Surangiwala, Maggie J Larche, Rashmi Sinha, Karen Durrant, Gary Foster, Mitchell Levine, Lehana Thabane, Wendy Costello, Philip C Robinson, Jean W Liew, Jinoos Yazdany, Emily Sirotich
Objectives: The experiences of children with pediatric rheumatic diseases (PRD) during the initial phase of the COVID-19 pandemic have not been well-documented. We sought to determine the effects of the COVID-19 pandemic on protective behaviors, healthcare access, medication management, and education among an international cross-sectional parental survey of children with PRDs.
Methods: The COVID-19 Global Rheumatology Alliance Patient Experience Survey was distributed online, and parents of children with parental-reported PRD, with or without COVID-19 infection, were eligible to enroll. Respondents described their child's demographics, adoptions of protective behaviors, healthcare access, changes to immunosuppression, and disruptions in schooling.
Results: A total of 427 children were included in the analyses. The most common rheumatic disease was juvenile idiopathic arthritis (40.7%), and most children were taking conventional synthetic diseasemodifying antirheumatic drugs (DMARDs) (54.6%) and/or biologic DMARDs (51.8%). A diagnosis of COVID-19 was reported in five children (1.2%), none of whom required hospitalization. Seventeen children (4.0%) had stopped or delayed their drugs due to concern for immunosuppression, most commonly glucocorticoids. Almost all families adopted behaviors to protect their children from COVID-19, including quarantining, reported by 96.0% of participants. In addition, 98.3% of full-time students experienced disruptions in their education, including cancelations of classes and transitions to virtual classrooms.
Conclusion: Despite the low numbers of children with PRDs who developed COVID-19 in this cohort, most experienced significant disruptions in their daily lives, including quarantining and interruptions in their education. The drastic changes to these children's environments on their future mental and physical health and development remain unknown.
{"title":"Early impacts of the COVID-19 pandemic on children with pediatric rheumatic diseases.","authors":"Jonathan S Hausmann, Kevin Kennedy, Salman Surangiwala, Maggie J Larche, Rashmi Sinha, Karen Durrant, Gary Foster, Mitchell Levine, Lehana Thabane, Wendy Costello, Philip C Robinson, Jean W Liew, Jinoos Yazdany, Emily Sirotich","doi":"10.5152/eujrheum.2022.21133","DOIUrl":"https://doi.org/10.5152/eujrheum.2022.21133","url":null,"abstract":"<p><strong>Objectives: </strong>The experiences of children with pediatric rheumatic diseases (PRD) during the initial phase of the COVID-19 pandemic have not been well-documented. We sought to determine the effects of the COVID-19 pandemic on protective behaviors, healthcare access, medication management, and education among an international cross-sectional parental survey of children with PRDs.</p><p><strong>Methods: </strong>The COVID-19 Global Rheumatology Alliance Patient Experience Survey was distributed online, and parents of children with parental-reported PRD, with or without COVID-19 infection, were eligible to enroll. Respondents described their child's demographics, adoptions of protective behaviors, healthcare access, changes to immunosuppression, and disruptions in schooling.</p><p><strong>Results: </strong>A total of 427 children were included in the analyses. The most common rheumatic disease was juvenile idiopathic arthritis (40.7%), and most children were taking conventional synthetic diseasemodifying antirheumatic drugs (DMARDs) (54.6%) and/or biologic DMARDs (51.8%). A diagnosis of COVID-19 was reported in five children (1.2%), none of whom required hospitalization. Seventeen children (4.0%) had stopped or delayed their drugs due to concern for immunosuppression, most commonly glucocorticoids. Almost all families adopted behaviors to protect their children from COVID-19, including quarantining, reported by 96.0% of participants. In addition, 98.3% of full-time students experienced disruptions in their education, including cancelations of classes and transitions to virtual classrooms.</p><p><strong>Conclusion: </strong>Despite the low numbers of children with PRDs who developed COVID-19 in this cohort, most experienced significant disruptions in their daily lives, including quarantining and interruptions in their education. The drastic changes to these children's environments on their future mental and physical health and development remain unknown.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"185-190"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eurjrheum.2022.21090
Reima Bakry, Med A Klein, Gerd Horneff
Objective: Subcutaneous methotrexate injections are considered to be more effective or work faster than oral methotrexate. Therefore, the extent and the kinetics of response were analyzed in juvenile idiopathic arthritis patients treated with oral versus subcutaneous methotrexate.
Methods: The BIKER databank was searched for biologics-naive juvenile idiopathic arthritis patients treated with methotrexate as initial treatment. The Juvenile Arthritis Disease Activity Score-10 defini- tion of remission and the pediatric American College of Rheumatology's response parameters were utilized as outcome criteria.
Result: A total of 410 polyarticular juvenile idiopathic arthritis patients receiving oral methotrexate were compared to 384 patients receiving subcutaneous methotrexate. Rheumatoid factor-negative polyarthritis was the most common juvenile idiopathic arthritis category (50%/51%) in this cohort followed by extended oligoarthritis (27%/26%), polyarticular psoriatic arthritis (18%/16%), and few had rheumatoid factor-positive polyarthritis (5%/8%). The oral cohort's disease duration (2.3 ± 3.0 vs. 1.9 ± 2.7) was significantly longer (P=.04), although their age at onset and baseline were similar. Furthermore, at baseline, disease activity (Juvenile Arthritis Disease Activity Score-10 16.5 ± 7.2 vs. 14.7 ± 8.2; P = .001 due to a higher active joint count 9.0 ± 10.1 vs. 7.4 ± 7.7; P = .011) was higher in the subcutaneous cohort. The weekly methotrexate doses were comparable with 13.6 ± 5.4 mg/m2 and 13.3 ± 4.5 mg/m2, respectively. With oral/subcutaneous methotrexate, a pediatric American College of Rheumatology's 90 was achieved in 98(38.3%)/128(40.4%), while 96(38.1 %)/75(40.1%) attained Juvenile Arthritis Disease Activity Score remission after 12 months of therapy. There was no difference in the early kinetics of response according to Kaplan-Meyer analysis. Adverse events including nausea, vomiting, and increased transaminases were considerably more common after methotrexate subcutaneous administration than after oral treatment.
Conclusion: In terms of effectiveness, but not safety, our retrospective analysis found some advan- tages of subcutaneous methotrexate. Adverse effects limit treatment continuance and thus must be considered a disadvantage. Furthermore, oral methotrexate eliminates the need for injections, which is especially essential for younger children. Controlled, randomized prospective trials in children and juvenile patients are necessary for definitive recommendations for the subcutaneous route of admin- istration of methotrexate therapy.
目的:甲氨蝶呤皮下注射被认为比口服甲氨蝶呤更有效或见效更快。因此,对口服甲氨蝶呤与皮下甲氨蝶呤治疗的青少年特发性关节炎患者的反应程度和动力学进行了分析。方法:检索BIKER数据库中以甲氨蝶呤为初始治疗的幼年特发性关节炎患者的生物制剂。儿童关节炎疾病活动度评分-10缓解定义和儿科美国风湿病学会的反应参数被用作结果标准。结果:410例接受口服甲氨蝶呤治疗的多关节幼年特发性关节炎患者与384例接受皮下甲氨蝶呤治疗的患者进行了比较。在该队列中,类风湿因子阴性的多发性关节炎是最常见的青少年特发性关节炎类型(50%/51%),其次是扩展性寡关节炎(27%/26%),多关节银屑病关节炎(18%/16%),少数类风湿因子阳性的多发性关节炎(5%/8%)。口腔组的疾病持续时间(2.3±3.0 vs 1.9±2.7)明显更长(P= 0.04),尽管他们的发病年龄和基线年龄相似。此外,在基线时,疾病活动性(青少年关节炎疾病活动性评分-10为16.5±7.2比14.7±8.2;P = 0.001,因为活动关节计数(9.0±10.1 vs. 7.4±7.7)较高;P = 0.011)在皮下组中更高。每周甲氨蝶呤剂量分别为13.6±5.4 mg/m2和13.3±4.5 mg/m2。口服/皮下甲氨蝶呤治疗12个月后,美国风湿病学会(American College of Rheumatology)的90名儿童中,98名(38.3%)/128名(40.4%)获得缓解,96名(38.1%)/75名(40.1%)获得青少年关节炎疾病活动评分缓解。根据Kaplan-Meyer分析,早期反应动力学没有差异。甲氨蝶呤皮下给药后,恶心、呕吐和转氨酶升高等不良事件比口服给药后更为常见。结论:从有效性而非安全性来看,我们的回顾性分析发现皮下甲氨蝶呤有一些优势。不良反应限制了治疗的持续,因此必须将其视为不利因素。此外,口服甲氨蝶呤消除了注射的需要,这对年幼的儿童尤其重要。有必要对儿童和青少年患者进行对照、随机前瞻性试验,以明确推荐甲氨蝶呤皮下给药途径。
{"title":"Oral or Parenteral Methotrexate for the Treatment of Polyarticular Juvenile Idiopathic Arthritis.","authors":"Reima Bakry, Med A Klein, Gerd Horneff","doi":"10.5152/eurjrheum.2022.21090","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21090","url":null,"abstract":"<p><strong>Objective: </strong>Subcutaneous methotrexate injections are considered to be more effective or work faster than oral methotrexate. Therefore, the extent and the kinetics of response were analyzed in juvenile idiopathic arthritis patients treated with oral versus subcutaneous methotrexate.</p><p><strong>Methods: </strong>The BIKER databank was searched for biologics-naive juvenile idiopathic arthritis patients treated with methotrexate as initial treatment. The Juvenile Arthritis Disease Activity Score-10 defini- tion of remission and the pediatric American College of Rheumatology's response parameters were utilized as outcome criteria.</p><p><strong>Result: </strong>A total of 410 polyarticular juvenile idiopathic arthritis patients receiving oral methotrexate were compared to 384 patients receiving subcutaneous methotrexate. Rheumatoid factor-negative polyarthritis was the most common juvenile idiopathic arthritis category (50%/51%) in this cohort followed by extended oligoarthritis (27%/26%), polyarticular psoriatic arthritis (18%/16%), and few had rheumatoid factor-positive polyarthritis (5%/8%). The oral cohort's disease duration (2.3 ± 3.0 vs. 1.9 ± 2.7) was significantly longer (P=.04), although their age at onset and baseline were similar. Furthermore, at baseline, disease activity (Juvenile Arthritis Disease Activity Score-10 16.5 ± 7.2 vs. 14.7 ± 8.2; P = .001 due to a higher active joint count 9.0 ± 10.1 vs. 7.4 ± 7.7; P = .011) was higher in the subcutaneous cohort. The weekly methotrexate doses were comparable with 13.6 ± 5.4 mg/m2 and 13.3 ± 4.5 mg/m2, respectively. With oral/subcutaneous methotrexate, a pediatric American College of Rheumatology's 90 was achieved in 98(38.3%)/128(40.4%), while 96(38.1 %)/75(40.1%) attained Juvenile Arthritis Disease Activity Score remission after 12 months of therapy. There was no difference in the early kinetics of response according to Kaplan-Meyer analysis. Adverse events including nausea, vomiting, and increased transaminases were considerably more common after methotrexate subcutaneous administration than after oral treatment.</p><p><strong>Conclusion: </strong>In terms of effectiveness, but not safety, our retrospective analysis found some advan- tages of subcutaneous methotrexate. Adverse effects limit treatment continuance and thus must be considered a disadvantage. Furthermore, oral methotrexate eliminates the need for injections, which is especially essential for younger children. Controlled, randomized prospective trials in children and juvenile patients are necessary for definitive recommendations for the subcutaneous route of admin- istration of methotrexate therapy.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"197-205"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/05/ejr-9-4-197.PMC10089132.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9285010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eurjrheum.2022.20246
Nazife Şule Yaşar Bilge, Sultan Özkurt, Mustafa Fuat Açıkalın, Timuçin Kaşifoğlu
Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.
{"title":"Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review.","authors":"Nazife Şule Yaşar Bilge, Sultan Özkurt, Mustafa Fuat Açıkalın, Timuçin Kaşifoğlu","doi":"10.5152/eurjrheum.2022.20246","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.20246","url":null,"abstract":"<p><p>Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"221-224"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/b8/ejr-9-4-221.PMC10089134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9286588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eujrheum.2022.20012
Andrea Pluma, Laia Alsina, Ofelia Baniandres, Rafael Caliz, Manel Casellas, Dolors Grados, Juan Antonio Martınez Lopez, Erika Padron Perez, Ana Polo, Jose Maria Pego Reigosa, Elisa Trujillo, Paloma Vela
Objectives: To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.
Methods: A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.
Results: We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.
Conclusion: Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.
{"title":"Multidisciplinary models for pregnancy care in patients with rheumatic diseases: Clinical experiences and experts opinion.","authors":"Andrea Pluma, Laia Alsina, Ofelia Baniandres, Rafael Caliz, Manel Casellas, Dolors Grados, Juan Antonio Martınez Lopez, Erika Padron Perez, Ana Polo, Jose Maria Pego Reigosa, Elisa Trujillo, Paloma Vela","doi":"10.5152/eujrheum.2022.20012","DOIUrl":"https://doi.org/10.5152/eujrheum.2022.20012","url":null,"abstract":"<p><strong>Objectives: </strong>To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.</p><p><strong>Methods: </strong>A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.</p><p><strong>Results: </strong>We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.</p><p><strong>Conclusion: </strong>Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"191-196"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Macrophage activation syndrome is the most frequent life-threatening complication of adult-onset Still's disease. This is a nearly fatal case of a young patient, which has been refractory to corticoste- roids, anakinra, tocilizumab, cyclosporine A, and etoposide, but eventually responded miraculously to salvage therapy with ruxolitinib. We review recent pertinent data related to the therapeutic value of ruxolitinib for macrophage activation syndrome triggered by adult-onset Still's disease.
{"title":"Ruxolitinib for Refractory Macrophage Activation Syndrome Complicating Adult-Onset Still's Disease.","authors":"Ofer Levy, Arie Apel, Hossam Alhdor, Avraham Mizrachi, Nancy Agmon-Levin, Maya Koren-Michowitz, Mirit Amit-Vazina","doi":"10.5152/eurjrheum.2022.21064","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21064","url":null,"abstract":"<p><p>Macrophage activation syndrome is the most frequent life-threatening complication of adult-onset Still's disease. This is a nearly fatal case of a young patient, which has been refractory to corticoste- roids, anakinra, tocilizumab, cyclosporine A, and etoposide, but eventually responded miraculously to salvage therapy with ruxolitinib. We review recent pertinent data related to the therapeutic value of ruxolitinib for macrophage activation syndrome triggered by adult-onset Still's disease.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"217-220"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/52/ejr-9-4-217.PMC10089131.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9285011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eurjrheum.2022.21119
Joaquin J Barjau-Vallet, Pedro Del Valle Rodriguez-Flores, Yeison Arias Morales
{"title":"Takayasu arteritis early diagnosis by noninvasive imaging.","authors":"Joaquin J Barjau-Vallet, Pedro Del Valle Rodriguez-Flores, Yeison Arias Morales","doi":"10.5152/eurjrheum.2022.21119","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21119","url":null,"abstract":"","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"225-226"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10591688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.5152/eurjrheum.2022.21097
Akash Gupta, Yuliya Afinogenova, Nikolai A Podoltsev, Abhijeet Danve
Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.
{"title":"Concurrent use of tumor necrosis factor inhibitor and tyrosine kinase inhibitor in ankylosing spondylitis and myeloid neoplasm.","authors":"Akash Gupta, Yuliya Afinogenova, Nikolai A Podoltsev, Abhijeet Danve","doi":"10.5152/eurjrheum.2022.21097","DOIUrl":"https://doi.org/10.5152/eurjrheum.2022.21097","url":null,"abstract":"<p><p>Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"9 4","pages":"215-216"},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}