Latest news with #rheumatology
Health Line
09-07-2025
- Health
- Health Line
Managing Your Day-to-Day with Ankylosing Spondylitis
Key takeaways Understanding ankylosing spondylitis is essential, as gaining knowledge about the condition and its varied symptoms can empower you to take control and improve your quality of life. Joining a support group can provide emotional support and practical tips from others facing similar challenges, helping to reduce feelings of isolation and improve your overall mood. Regular visits to a rheumatologist are crucial for managing AS, as they can monitor the disease's progression, share new research, and recommend exercises to maintain or improve your mobility. Life with ankylosing spondylitis (AS) can be, well, burdensome to say the least. Learning how to adapt to your progressive disease can take some time and bring about a whole set of dilemmas. But by breaking up your AS management into workable chunks, you too can live a productive life. Here are three management tips from others with AS on coming to terms and handling life with the disease. 1. Learn everything you can about the condition Ankylosing spondylitis is just as hard to pronounce as it is to understand. Everyone experiences different symptoms and challenges, but knowing as much as you can about it can provide a sense of relief. Doing your own research and arming yourself with knowledge is liberating. It puts you in the driver seat of your own life and your condition, providing you with the tools you need to feel better and, more importantly, live better too. 2. Join a support group Because there's no known cause of the disease, it's easy for those diagnosed with AS to blame themselves. This can trigger a wave of emotions, including feelings of sadness, depression, and overall moodiness. Finding a support group of other patients who are experiencing similar challenges can be both empowering and inspiring. By talking with others, you'll be able to confront your condition directly while also learn tips from others. Ask your healthcare provider about local groups, or contact a national organization such as the Spondylitis Association of America to find an online AS group. Social media is another way to connect with other patients. 3. See your rheumatologist regularly Nobody really enjoys going to the doctor. But when you have AS, it quickly becomes an essential part of your life. Your rheumatologist specializes in arthritis and related conditions, so they truly understand AS and how to best treat and manage it. By seeing your rheumatologist regularly, they will have a better sense of your disease progression. They can also share with you new research and promising studies about treating AS, and suggest certain strengthening exercises to maintain or increase your mobility.
Medscape
04-07-2025
- Health
- Medscape
AxSpA Maintained OK via Remote Monitoring, Patient-Led Care
TOPLINE: Remote monitoring and patient-initiated care matched usual care in maintaining low disease activity in patients with axial spondyloarthritis (axSpA) on stable TNF inhibitor therapy. METHODOLOGY: Researchers conducted a randomized, noninferiority trial at a hospital in Norway between September 2021 and June 2022 to assess whether remote monitoring or patient-initiated care was noninferior to usual care in maintaining low disease activity in patients with axSpA. They enrolled 243 patients (mean age, 43 years; 75% men) with axSpA who had been on stable TNF inhibitor treatment for the past 6 months and had low disease activity (Axial Spondyloarthritis Disease Activity Score [ASDAS] < 2.1). Participants were randomly allocated to one of three groups: Patient-initiated care (n = 81): This arm did not include scheduled visits. Patients submitted their outcomes via a mobile application and contacted the rheumatology nurse if they felt worse. Remote monitoring (n = 80): This arm also did not include scheduled visits. A nurse reviewed the entries of patient-reported outcomes submitted through the application daily and decided whether an in-person visit was needed. Usual care (n = 82): Standard practice was followed, with face-to-face nurse-led visits under rheumatologist supervision every 6 months. The primary outcome was the probability of achieving low disease activity compared between groups at 6, 12, and 18 months, with a 15% noninferiority margin. TAKEAWAY: Both remote monitoring and patient-initiated care were noninferior to usual care, with estimated differences in the probability of achieving an ASDAS < 2.1 of -4.1% (97.5% CI, -9.9% to 1.8%) and -1.1% (97.5% CI, -7.2% to 4.9%), respectively. Patient-initiated care demonstrated noninferiority to remote monitoring, with a difference of 2.9% in the probability of achieving an ASDAS < 2.1 (95% CI, -1.5% to 7.4%). Secondary outcomes, including measures of disease activity, physical function, and patient satisfaction, were comparable across all groups, with ≥ 90% of patients reporting satisfaction. The number of adverse events was similar across groups. Few serious adverse events occurred, and none resulted in study discontinuation. IN PRACTICE: 'The lower resource use in patient-initiated care can liberate time for healthcare providers to care for patients with high disease activity or more complex diseases and thus facilitate more targeted use of healthcare resources in rheumatology,' the authors wrote. SOURCE: This study was led by Inger Jorid Berg, MD, Diakonhjemmet Hospital, Oslo, Norway. It was published online on May 23, 2025, in Annals of the Rheumatic Diseases. LIMITATIONS: Selection bias may have influenced results as patients motivated for alternative follow-up were more likely to participate. The open-label design and reliance on patient-reported outcomes could have been influenced by participants' enthusiasm for their assigned follow-up method. Using patient-reported outcomes as the main benchmark for clinical action in remote monitoring may affect interpretation of the results in this noninferiority trial. DISCLOSURES: This study received funding from South-Eastern Norway Regional Health Authority and The Research Council of Norway. Three authors reported receiving research grants, consulting fees, or other forms of financial or nonfinancial support from pharmaceutical companies, including AbbVie, Amgen, Biogen, Janssen, MSD, Pfizer, and UCB. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
03-07-2025
- Health
- Medscape
Fast Five Quiz: Management of GPA
Granulomatosis with polyangiitis (GPA) is a variant of anti-neutrophil cytoplasmic antibody ( ANCA)-associated vasculitis that most commonly presents with proteinase 3 (PR3) serology and distinct clinical features that necessitates swift identification and therapeutic intervention. Prompt treatment plays a crucial role in minimizing permanent organ damage, particularly in the renal and pulmonary systems. What do you know about the management of GPA? Check your knowledge with this quick quiz. The latest guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) and European Alliance of Associations for Rheumatology (EULAR) both recommend initiating immunosuppressive therapy in patients with suspected PR3 positive ANCA vasculitis, which is indicative of GPA, even if clinicians are still awaiting biopsy results. Further, EULAR specifically acknowledges that collecting biopsies might not be feasible for each patient with ANCA vasculitis and treatment should 'not be delayed while awaiting histological information.' Learn more about biopsy for GPA. KDIGO recommends maintaining therapeutic intervention for 18 months to 4 years following successful remission, which is similar to the EULAR guidelines recommending maintenance therapy for 24-48 months in patients with GPA. They also state, 'longer duration of therapy should be considered in relapsing patients or those with an increased risk of relapse, but should be balanced against patient preferences and risks of continuing immunosuppression.' Learn more about remission maintenance in GPA. Infection is a significant concern in ANCA vasculitis, especially regarding immunosuppressive therapies including glucocorticoids that are used to manage the clinical manifestations of the disease. Recent research has shown that chronic nasal carriage of S aureus is significantly higher in patients with the GPA subtype; it has also been shown to be associated with increased endonasal activity and risk for relapse. Although M catarrhalis, H influenzae, and S pneumoniae do not appear to have a specific association with GPA, data have shown that infection is among the most common causes of death in GPA. Learn more about infection in GPA. Data indicate that the GPA subtype is an independent risk factor for disease recurrence. Additionally, KDIGO also considers lower serum creatinine, more extensive disease, PR3 histology (which is associated with higher relapse rates than MPO-positive disease commonly seen in MPA) and ear, nose, and throat involvement as 'baseline factors' for disease recurrence. Factors after diagnosis include history of relapse, ANCA positivity at the end of induction, and rise in ANCA. Treatment-related relapse factors include lower cyclophosphamide exposure, immunosuppressive withdrawal, and glucocorticoid withdrawal. Learn more about prognosis in GPA. To ensure disease does not recur into the transplanted tissue, KDIGO specifically recommends delaying kidney transplantation until patients have achieved complete clinical remission for at least 6 months. Further, ANCA positivity or negativity should not factor into this decision, with KDIGO stating, 'the persistence of ANCA should not delay transplantation.' Although a serum creatinine of > 4 mg/dL is a significant predictor of relapse, guidelines recommend considering combination of a monoclonal antibody and an alkylating agent for this indication. Similarly, induction and maintenance of dialysis should also be done under various separate conditions. Learn more about kidney transplantation for GPA. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Yahoo
29-06-2025
- Health
- Yahoo
7 Reasons You Might Be Experiencing Joint Pain, According to an Expert
Joint pain can make it difficult to carry out basic tasks, from walking up the stairs to opening a jar and even typing. When it comes to the skeletal system, our joints have some of the most important jobs. A joint refers to any place where two or more bones meet — we have hundreds of them around our body, especially in the limbs. These complex junctions allow for movement and flexibility, while also providing stability. Joints are made up of bones, cartilage, ligaments, tendons, nerves and fluid, per the Cleveland Clinic. All of these work together to give our otherwise rigid skeleton a wide range of motion. Different joints allow different types of movement. There are hinge joints, which allow limbs to bend and straighten, such as the elbows, knees, or fingers. Ball and socket joints, like the hips, allow movement in all directions and pivot joints permit our head to rotate. Joint pain can affect one or more of the body's joints and range from mild discomfort to severe pain, limiting mobility. It may be accompanied by stiffness, swelling, and clicking or grinding sensations. The pain can be constant or worsen with movement. There are many causes for joint pain, from normal aging to autoimmune diseases and infections. spoke with Dr. Natalie Azar, NBC News medical contributor and board-certified rheumatologist at NYU Langone Health, about common types of joint pain and what your achy joints may be telling you about your health. First, it's important to distinguish between joint and muscle pain, which are often confused, Azar tells Muscle pain affects one or multiple muscle groups and is more of a deep aching that occurs with movement and gets better with rest. It may follow overexertion during a workout, poor posture, or stress and tension. Joint pain (arthralgia) specifically affects the joints and can worsen with movement or be present at rest. Joint pain may also be associated with inflammation, swelling, stiffness and limited range of motion, Azar notes. 'It's really important for us to narrow down the diagnosis," she adds. In addition to the severity and duration of pain, a doctor will look at your medical history, age, gender and other symptoms to pinpoint the cause. Arthritis is an umbrella term for hundreds of conditions that cause joint pain and inflammation. "The first thing that we do is try to figure out if the arthritis is inflammatory versus non-inflammatory," Azar says. Inflammatory arthritis occurs when the immune system overacts and mistakenly attacks joint tissue. It often starts in the hands or feet. "We're looking for symptoms of swelling associated with the pain," says Azar. Joints may feel stiff, appear red or feel warm. Common causes for inflammatory arthritis include autoimmune diseases, such as rheumatoid arthritis, psoriatic arthritis or lupus, says Azar. In addition to joint pain, these can cause skin rashes, oral ulcers, hair loss and gastrointestinal issues. "If your symptoms involve more than two organ systems, we may start thinking autoimmune," says Azar. Inflammatory arthritis can occur at any age, per the Mayo Clinic. Risk factors include having a family history of arthritis and being female. "Most types of arthritis are more common in women for a variety of reasons, including hormones, muscle mass and the way our skeleton is formed," says Azar. Sometimes, joint pain is a normal part of aging or overuse. Non-inflammatory arthritis is caused by the breakdown of cartilage between the joints. 'The most common type, osteoarthritis, is the wear and tear, degenerative kind of arthritis,' says Azar. It commonly affects weight-bearing joints like the hips and knees, and joints in the spine. 'Most of us develop a degree of arthritis as we get older, for example, pretty much everyone will have back pain at some point,' says Azar. Repetitive movements — during a sport or a job, for example — can also break down joint cartilage, causing pain. Osteoarthritis often occurs after age 55 and is more common in women, per the Cleveland Clinic. It can be accelerated by lifestyle factors, weight and menopause. In severe cases, osteoarthritis can limit mobility, but many people with osteoarthritis can still live an active life, says Azar. Joint pain can also result from injuries, such as fractures, strains and sprains, says Azar. These can cause acute pain or affect the structure of the joint, increasing the risk of arthritis later on. Post-trauma joint pain is often sudden and is often accompanied by swelling, says Azar. It commonly affects the knees, hips, ankles and shoulders. Injuries to the tissues around joints — such as the ligaments, tendons (tendonitis) and fluid-filled sacs cushioning the bones called bursae (bursitis) — can also cause pain. Joint pain may range from mild to severe, but it's usually temporary. "Any joint pain after trauma that lasts beyond a couple of days, you probably want to get checked out," says Azar. Sometimes, joint pain is associated with more widespread, chronic pain. A possible cause is fibromyalgia, a condition that affects the entire musculoskeletal system, causing pain throughout the body and extreme tiredness, per the Cleveland Clinic. It can cause multiple joints to feel sore, tender and sensitive. 'If your joint pain is associated with fatigue and non-restorative sleep, it may be fibromyalgia,' Azar adds. Fibromyalgia can also cause mental symptoms, and it's more common in women. Unlike arthritis, fibromyalgia does not directly damage the joints, and the cause is unknown. Hypermobility, often called "double-jointedness" occurs when a person's joints have a greater range of motion than normal. It can affect one or more joints and may be isolated or a symptom of a connective tissue disorder. Hypermobility can be benign, but many patients have joint pain, says Azar. The extra flexibility can cause joints to overstretch or lose stability. This can result in pain, stiffness or swelling, and joints may make a clicking or popping sound. Activities like stretching can worsen pain. 'Exercise is good, but you've got to do a lot of strength training or work with a physical therapist ... and resist the urge to do the deepest downward dog in yoga,' says Azar. Sometimes, joint pain is caused by bacterial or viral infections, says Azar. Infectious arthritis occurs when an infection in one part of the body spreads through the bloodstream to the joints, where it causes inflammation and pain, per the Mayo Clinic. It's often sudden and severe. Possible causes include staphylococcus aureus, a bacteria that lives on the skin, and Neisseria gonorrhoeae, which causes the sexually transmitted infection gonorrhea, Azar says. Joint pain is also a symptom of Lyme disease. "A tick exposure ... and bull's eye rash (are) clues that a patient may have Lyme," says Azar. Viral infections that can cause joint pain include COVID, hepatitis, rubella, parvovirus B19 and chikungunya. The pain may be accompanied by a fever, chills or fatigue. "A detailed medical history, and travel history, is super important," says Azar, adding that testing is necessary to determine the cause and best treatment. Joint pain may be related to deficiencies in nutrients that support bone health, such as vitamin D and calcium, says Azar. Vitamin D allows the body to absorb the mineral calcium. Together, these help us grow and maintain healthy bones. A deficiency in vitamin D or calcium may not cause symptoms in the early stages. However, over time, not getting enough of these nutrients can affect bone health and cause pain in the joints, Azar notes. These deficiencies can also worsen existing arthritis and increase the risk of fractures. Joint pain isn't always a sign of something serious. However, it may be worth checking out if it interferes with daily activities. 'If you have joint pain that lasts for more than one to two weeks without an obvious explanation, you should see a doctor," says Azar. Treatment will vary depending on the cause. In many cases, joint pain can be managed with over-the-counter pain relievers, physical therapy or corticosteroid injections. Physical therapy can also help improve mobility and strengthen joints. There are also lifestyle habits that may help support healthy joints and reduce pain, says Azar. These include: Eating a nutritious, anti-inflammatory diet Exercising (as much as you can tolerate) Maintaining good posture Maintaining a healthy weight Avoiding smoking Getting enough rest Reducing stress This article was originally published on
Medscape
27-06-2025
- Health
- Medscape
New Data at EULAR Signal Advances in RA, Myopathy, Gout
Barcelona has become the world capital of rheumatology by hosting the 2025 Annual Meeting of the European Alliance of Associations for Rheumatology (EULAR) in Spain. 'This is the world's largest rheumatology event,' said Daniel Aletaha, MD, president of EULAR and head of the Department of Rheumatology at the University Clinic for Internal Medicine III, MedUni Vienna, Vienna, Austria, during the conference opening session. He highlighted the scale of participation: 5125 abstracts submitted from 95 countries, 117 sessions, and 350 speakers from 45 nations. Inflammatory and Autoimmune Disease Among the plenary highlights was research led by Jason D. Turner, PhD, a postdoctoral research fellow at the University of Birmingham, Birmingham, England. His comparative analysis of synovial tissue using single-cell and spatial transcriptomics identified overlapping disease pathways in spontaneous inflammatory arthritis and arthritis induced by immune checkpoint inhibitors. 'We found that the synovium in checkpoint inhibitor-associated arthritis is enriched with fibroblasts and T cells, is highly vascularised, and contains large numbers of CXCL9/10/11+ macrophages and CD8+ T cells. These findings support the current use of tumour necrosis factor inhibitors for this condition, although further investigation is needed to understand their applicability to spontaneous arthritis,' Turner explained. Hector Chinoy, PhD, FRCP, professor of rheumatology at the University of Manchester and lead at the Salford Royal Adult Neuromuscular Service, Manchester, England, presented the results of the ALKIVIA phase 2 study. This trial evaluated the efficacy of subcutaneous efgartigimod (PH20) administration in adults with active idiopathic inflammatory myopathy. The drug led to significant improvements in the Total Improvement Score compared with placebo and showed good tolerability and safety. 'These findings demonstrate the mechanistic importance of neonatal Fc receptor inhibition and suggest a potential pathogenic role for autoantibodies. These findings support the continued evaluation of the drug in the ongoing phase 3 trial' Chinoy said. Scleroderma, Preclinical Rheumatoid Arthritis (RA), Gout, and Lupus Adela‑Cristina Sarbu, MD, a researcher specialising in systemic sclerosis and interstitial lung disease at the University Hospital Bern, Bern, European Scleroderma Trials and Research group (EUSTAR), and the University of Zurich, Zurich, Switzerland, presented the findings from the EUSTAR cohort. In conclusion, exposure to prostanoids appeared to be associated with a slower progression of interstitial lung disease in patients with mild vascular disease. In contrast, exposure to endothelin receptor antagonists appeared to be beneficial in preventing symptom worsening in patients with more severe vascular diseases. 'No independent mortality benefit was seen with vasoactive or vasodilator drugs. Their effectiveness seems to depend on the severity of vascular disease' Sarbu noted, calling for further long-term studies. The ALTO study, an extension of the APIPPRA trial, led by Andrew Cope, PhD, of King's College London, London, England, found that a 1-year course of abatacept in individuals at high risk of developing RA could delay disease onset by up to 4 years. 'Individuals with baseline autoantibody profiles are more likely to develop the disease and respond well to T-cell co-stimulation blockade. Abatacept reduces the symptom burden during treatment but does not provide sustained benefits after treatment discontinuation. No new safety concerns were reported,' according to Cope. Edoardo Cipolletta, MD, rheumatologist at the Marche University Hospital, Ancona, Italy, and research associate at the University of Nottingham, Nottingham, England, presented an analysis of data on primary care, hospitalization, and mortality outcomes related to gout, based on cohorts from the UK and Sweden. The study found that achieving serum urate levels below 360 µmol/L within a year of initiating urate-lowering treatment was associated with a significantly lower risk for major adverse cardiovascular events. The 5-year relative risk reduction ranged from 6% to 11%, with an absolute survival benefit of 1.3%-1.4%. 'The association was consistent regardless of prior cardiovascular disease and across all sensitivity analyses,' Cipolletta reported. Richard A. Furie, MD, chief of Rheumatology at Northwell Health in New York, presented results from the REGENCY study, which evaluated obinutuzumab in patients with lupus nephritis. Award Recognition Miriam Ruiz Ponce, MSc, a predoctoral researcher at the Maimonides Biomedical Research Institute in Córdoba, Spain received one of the EULAR award for translational basic science. She developed a mouse model of fatty liver disease associated with inflammatory arthritis to evaluate the anti-inflammatory and metabolic properties of apremilast, a drug commonly used in psoriatic arthritis. 'Early results have shown that the drug has promising effects, as it partially reverses liver damage, as well as inflammation. These are the initial results, but it could be a potential treatment for inflammation and for the deleterious effects on the liver in these patients. It is an honour to receive this award, which motivates us to continue our research under the leadership of my mentor, Nuria Barbarroja Puerto, PhD, the principal investigator of the potential treatment targeting inflammation and liver damage,' she said. Chinoy disclosed financial relationships with AstraZeneca, Pfizer, PTC Therapeutics, and UCB. Furie disclosed the financial relationships with GSK and Genentech; the REGENCY study was funded by F. Hoffmann-La Roche. Sarbu and Cope disclosed having no relevant financial relationships. Turner, Cipolletta, and Ponce did not provide conflict-of-interest disclosures.
