Current Rheumatology Reports

Polyarteritis nodosa (PAN), the prototype of systemic vasculitis, is a rare condition characterized by necrotizing inflammation of medium-sized or small arteries without glomerulonephritis or vasculitis in arterioles, capillaries, or venules. Signs and symptoms of this disease are primarily attributable to diffuse vascular inflammation and ischemia of affected organs. Virtually any organ with the exception of the lungs may be affected, with peripheral neuropathy and symptoms from osteoarticular, renal artery, and gastrointestinal tract involvement being the most frequent clinical manifestations. A clear distinction between limited versus systemic disease and idiopathic versus hepatitis B related PAN should be done because there are differences in the implicated pathogenetic mechanisms, their treatment, and prognosis. Currently, corticosteroids plus cyclophosphamide is the standard of care for idiopathic PAN, in particular for patients with adverse prognostic factors (more severe disease), in whom this combination prolonged survival. In contrast for hepatitis B related PAN treatment consists of schemes that include plasmapheresis and antiviral agents.

The purpose of this paper is to review the percutaneous interventions available for the treatment of osteoarthrosis of the knee that address pain and prolong the time to arthroplasty. Corticosteroid injection and viscosupplementation have been the most studied, but there is still no consensus about their value. Thermal nerve ablation, including both radiofrequency ablation and cryoneurolysis, is a promising new modality of therapy that may increase in clinical use given current data showing favorable outcomes. Of the future therapies that are currently under investigation, synovial embolization via the geniculate arteries represents an exciting new approach that may soon be available clinically. There are various percutaneous interventions available for the treatment of osteoarthrosis of the knee that address pain and prolong the time to arthroplasty.

We clarify clinical characteristics of patients with immune checkpoint inhibitor (ICI)-induced myositis. In 13 of 15 cases with ICI-induced myositis, the type of malignancy was melanoma. Eight, 4, and 3 patients received anti-PD-1 alone, anti-CTLA4 alone, and a combination of those, respectively. The mean period to the onset of ICI-induced myositis from the initiation of ICI was 4 weeks. Myocarditis was a complication in five patients. Seven of the patients died. The causes of death were myocarditis in three patients, respiratory muscle paralysis in two patients, and cancer progression in two patients. In patients without myocarditis or respiratory muscle paralysis, the prognosis for myositis was favorable with normalization of the CK levels occurring upon the cessation of ICI and the administration of immunosuppressive agents. Myocarditis and respiratory muscle paralysis are the major causes of death as immune-related adverse events in patients with ICI-induced myositis.

Vasculitides are a heterogeneous group of syndromes characterized by inflammation of the vessel wall. Several microbial pathogens have been known or suspected to cause vasculitis, and the development of molecular biology has promoted the search and confirmation of infectious agents in idiopathic vasculitis. Though several agents present primarily as an infectious process with vasculitis as an occasional manifestation, vasculitis may be the major manifestation of disease. Less definitive, and more controversial, is the role of infection and inflammation of the vessel wall in the pathogenesis of atherosclerotic disease. Clinical features can be nonspecific, and a high index of suspicion is required in order to make a diagnosis of vasculitis. Infection should always be excluded based on appropriate cultures and serologic assays, and, if confirmed, early and aggressive treatment should be instituted. However, in many instances, especially if there is a delay in the diagnosis, surgical intervention becomes necessary to treat the associated anatomic and physiologic sequelae.

Bài báo này cung cấp cái nhìn tổng quát về di truyền học của bệnh psoriatic và các thách thức hiện tại. Với việc áp dụng y học tích hợp, nhiều vùng gen ứng cử đã được xác định cho bệnh psoriatic sẽ được chú thích, tổng hợp và trực quan hóa. Các nghiên cứu gần đây báo cáo sự khác biệt trong cấu trúc di truyền giữa viêm khớp psoriatic và bệnh vẩy nến chỉ trên da sẽ được làm nổi bật. Việc tập trung vào các con đường chức năng kết nối các biến thể di truyền đã được xác định trước đó có thể giúp tăng cường hiểu biết của chúng ta về các bệnh psoriatic. Cấu trúc di truyền giữa viêm khớp psoriatic và bệnh vẩy nến chỉ trên da có sự khác biệt với các tín hiệu đặc trưng cho viêm khớp trong trạng thái liên kết không phụ thuộc vào các tín hiệu bệnh vẩy nến đã được công bố. Y học tích hợp có vai trò quan trọng trong việc hiểu các cơ chế tế bào của các bệnh psoriatic. Việc lựa chọn cẩn thận nhóm đối tượng mắc bệnh psoriatic đã dẫn đến những khác biệt về cơ chế giữa viêm khớp psoriatic và bệnh vẩy nến trên da.

Recent studies involving juvenile dermatomyositis indicate that the majority of affected children have symptoms suggestive of infection prior to disease onset, damage to skin and muscle each have a distinct pathophysiology, certain urinary muscle metabolites may be useful laboratory markers, and methotrexate used as first line therapy with corticosteroids is associated with greater height velocity and smaller increase in body mass index.

This paper reviews the knowledge we continue to gain in the areas of pathogenesis, evaluation of disease activity, and interventional strategies with regards to idiopathic inflammatory myositis. Potential new diagnostic criteria incorporate the use of magnetic resonance imaging and other imaging modalities along with the use of muscle biopsy pathologic features including that of immunologic markers. Specifically, this criterion reflects the upregulation of major histocompatibility complex molecules on muscle tissue during acute inflammation.