Targeted Treatment of the Rheumatic Diseases

Cover......Page 1
Contributors......Page 4
Foreword......Page 8
1. Management of Rheumatoid Arthritis: Principles and Strategies for Antirheumatic Pharmacotherapy......Page 9
Mono- or combination treatment with conventional drugs?......Page 10
Individualized Treatment Aiming at Remission With Conventional Treatments......Page 16
Biologics or disease-modifying antirheumatic drugs as first-line therapy?......Page 17
Oral or parenteral methotrexate? And what about folate supplementation?......Page 20
Identifying Patients at Risk......Page 21
Summary......Page 22
References......Page 23
Initial Evaluation and Investigation......Page 25
Discussion of Prognostic Factors\r......Page 26
Initial Treatment Strategy in the Patient with Newly Diagnosed Rheumatoid Arthritis......Page 27
Benefits of Earlier Disease-Modifying Antirheumatic Drug Intervention in the Patient with Newly Diagnosed Rheumatoid Arthritis......Page 28
Is There an Optimal Use of Methotrexate in the Newly Diagnosed Rheumatoid Arthritis Patient?......Page 29
Is There a Role for Induction Regimens in the Treatment of the Newly Diagnosed Rheumatoid Arthritis Patient?......Page 30
When Should Biologic Therapies Be Initiated in the Patient with Newly Diagnosed Rheumatoid Arthritis?......Page 31
References......Page 32
Considerations with a Suboptimal Response to Methotrexate......Page 35
Strategies for Pharmacologic Management of Patients with Rheumatoid Arthritis with a Suboptimal Response to Methotrexate......Page 36
Rheumatoid Arthritis–Associated Comorbidities \rand Complications......Page 38
Nonpharmacologic Management Strategies......Page 41
Case 1 Revisited: A 27-Year-old Female School Teacher with Rheumatoid Arthritis and a Suboptimal Response to Weekly Methotrexat......Page 42
References......Page 43
4. Management of Rheumatoid Arthritis: \nThe Patient with Extra-Articular Disease......Page 46
Treatment of Rheumatoid Arthritis–Associated Vasculitis......Page 49
Treatment of Rheumatoid Arthritis–Associated Lung Disease......Page 50
Treatment of other Extra-Articular Manifestations......Page 51
References......Page 52
Uncomplicated Early Akylosing Spondylitis......Page 54
Disease-Modifying Antirheumatic Drugs......Page 55
Established as Unresponsive to Conservative Therapies......Page 56
Anti-Tumor Necrosis Factor-a–Directed Therapies......Page 57
Second-Line Therapies......Page 58
Summary of Management Recommendations for Prototypic Case of Established Ankylosing Spondylitis Complicated by Extraspinal Mani......Page 59
Management of Complications of Ankylosing Spondylitis......Page 60
References......Page 61
6. Management of Psoriatic Arthritis......Page 63
Screening Tools for Psoriatic Arthritis......Page 65
Dactylitis......Page 66
Skin Psoriasis......Page 67
Assessment of Patients With Psoriatic Arthritis......Page 68
Should Patients With Psa be Treated Aggressively?......Page 69
Symptom-Modifying Therapy......Page 70
Leflunomide......Page 71
Adalimumab......Page 72
Treatment Guidelines......Page 73
References......Page 74
Differential Diagnosis of Oligoarthritis......Page 78
Treatment of Juvenile Arthritis: Oligoarthritis......Page 81
Treatment of Juvenile Arthritis: Uveitis......Page 82
Differential Diagnosis of Polyarthritis......Page 83
Treatment of Juvenile Arthritis: Polyarthritis......Page 84
Treatment of Juvenile Arthritis: Systemic Onset Disease......Page 87
Juvenile Arthritis: Prognosis......Page 88
References......Page 89
Initial Evaluation......Page 91
Investigations......Page 92
Formulating Treatment Plans......Page 93
Education and Counseling......Page 94
Disease Activity Indices......Page 95
References......Page 96
Symptoms and Signs: Fatigue, Fever, Adenopathy, Weight Loss......Page 99
Mucocutaneous Lupus......Page 100
Management of Chronic Cutaneous Lupus Erythematosus......Page 101
Management of Other Forms of Cutaneous Lupus......Page 102
Central Nervous System Vasculitis and Organic Brain Syndrome......Page 103
Peripheral Neuropathies......Page 104
The Cardiopulmonary System......Page 105
Managing Other Presentations of Pulmonary Lupus: Pleurisy, Interstitial Lung Disease, Pulmonary Embolus, Pulmonary Hypertension, Pulmonary Hemorrhage......Page 106
Pericardial, Myocardial and Endocardial Involvement......Page 107
Myalgias and Myositis......Page 109
Associated Conditions: Fibromyalgia, Osteopenia, Osteoporosis, and Avascular Necrosis......Page 110
Vasculitis......Page 111
Hematologic Abnormalities......Page 112
References......Page 113
Laboratory Tests......Page 116
Renal Biopsy......Page 117
General Approach......Page 119
Cyclophosphamide......Page 120
Alternatives to Pulse Induction Therapy......Page 121
Maintenance Therapy......Page 122
Monitoring Disease Activity......Page 123
Lupus Nephritis and Pregnancy......Page 124
Biologic Therapies......Page 125
References......Page 128
Diagnostic Considerations......Page 132
Therapy......Page 134
Diagnostic Considerations......Page 135
Diagnostic Considerations......Page 136
Diagnostic Considerations......Page 138
Diagnostic Considerations......Page 139
References......Page 140
Introduction......Page 142
Classification and Diagnosis of Sjögren’s Syndrome......Page 143
Diagnostic Work-Up......Page 145
Ocular Manifestations......Page 146
Oral Manifestations......Page 148
Enlargement of the Salivary Glands......Page 149
Preventive Measures......Page 151
Symptomatic Treatment......Page 152
Preventive and General Measures for Oral Complications......Page 153
Symptomatic Treatment......Page 154
Anti-inflammatory and \nDisease-Modifying Drugs......Page 155
Anti–Tumor Necrosis Factor Biologics......Page 157
Anti-CD20 Monoclonal Antibodies......Page 158
Nephritis......Page 160
Mucosa-Associated Lymphoid Tissue Lymphoma......Page 161
References......Page 162
Differential Diagnosis......Page 165
Therapy......Page 166
Other Vasodilators......Page 167
Cutaneous Manifestation in Scleroderma......Page 168
Other Therapies......Page 169
Prostacyclins......Page 170
Azathioprine......Page 171
References......Page 172
14. Targeted Treatment of the Idiopathic Inflammatory Myopathies......Page 174
Pulmonary Disease......Page 177
Other Extramuscular Manifestations......Page 178
Muscle Biopsy......Page 179
Immunosuppressive Agents......Page 182
Biologic Treatments......Page 183
Exercise......Page 185
Approach to the Patient with Newly Diagnosed Idiopathic Inflammatory Myopathies......Page 188
Prognosis......Page 190
References......Page 191
Diagnosis......Page 194
Differential Diagnosis......Page 195
The Question of Giant Cell Arteritis......Page 196
Toxicities of Corticosteroids......Page 197
Giant Cell Arteritis......Page 198
Diagnosis: The Temporal Artery Biopsy......Page 199
The Performance of the Temporal Artery Biopsy as a Diagnostic Test......Page 200
Other Diagnostic Modalities: Imaging Procedures......Page 202
Initial Treatment: Corticosteroids......Page 204
Adjunctive Treatments for Giant Cell Arteritis......Page 206
Large Vessel Giant Cell Arteritis: Aneurysms of the Aorta......Page 208
Large Vessel Giant Cell Arteritis: Involvement of the Great Vessels......Page 209
Conclusion......Page 210
References......Page 211
16. Management of Medium and Small Vessel Vasculitis, Including the Antineutrophil Cytoplasmic Antibody–Associated Dis......Page 214
Overall Aspects on the Management of Medium and Small Vessel Vasculitis, Including the Diseases Associated With Antinuclear Antibodies......Page 215
Clinical Assessment and Evaluation of Vasculitis and Disease Scoring......Page 216
The Role of High Dose Glucocorticoids in Remission-Induction Therapy......Page 222
Induction of Remission in Generalized Primary Small and Medium Vessel Vasculitis......Page 223
Remission-Maintenance Therapy......Page 225
Alternative Immunomodulatory Therapy in Patients Refractory to Maximal Doses of Standard Therapy......Page 226
References......Page 227
Definitions and Clinical Subsets......Page 231
Differential Diagnosis......Page 232
Imaging Studies......Page 234
Diagnostic Evaluation Summary......Page 235
Primary Angiitis of the Central Nervous System......Page 236
Case Presentation Follow-Up......Page 237
Definitions and Clinical Subsets......Page 238
Symptoms and Signs......Page 239
Imaging Studies......Page 240
Diagnostic Evaluation and Management Summary......Page 241
Cyclophosphamide......Page 242
Surgical Treatment......Page 243
References......Page 244
Pathogenesis......Page 246
Cardiac......Page 247
Other......Page 248
Treatment......Page 249
Renal and Hypercalcemia......Page 250
Oral Ulcerations......Page 251
Other......Page 252
Treatment......Page 253
References......Page 254
Differential Diagnosis......Page 257
Treatment......Page 258
Corticosteroids......Page 259
Intravenous Immunoglobulin......Page 261
Supportive Measures......Page 262
Systemic Lupus Erythematosus......Page 263
Antimalarials......Page 264
Immunosuppressive Agents......Page 265
Antiphospholipid Antibody Syndrome......Page 266
Kawasaki Disease......Page 267
Aspirin......Page 269
Intravenous Immunoglobulin......Page 270
Henoch-Schönlein Purpura......Page 271
Supportive Care......Page 272
Treatment......Page 273
Polyarteritis Nodosa......Page 274
Differential Diagnosis......Page 275
Treatment......Page 276
References......Page 277
20. Septic Arthritis......Page 283
Organisms Responsible for Septic Arthritis......Page 288
Joint Fluid Analysis......Page 290
The Importance of Blood Cultures......Page 291
Initial Antibiotic Treatment and Duration of Treatment......Page 292
Treatment of Prosthetic Joint Infection......Page 295
Future Treatment......Page 296
References......Page 297
Early Localized Infection......Page 300
Early Disseminated Infection......Page 302
Neurologic Disease......Page 304
Lyme Arthritis......Page 305
Laboratory Testing......Page 306
Case Presentations......Page 307
Prevention......Page 312
Early Disease Treatment......Page 313
References......Page 314
22. Gout and Crystal Deposition Disease......Page 317
Treatment of the Acute Attack......Page 319
Treatment of Hyperuricemia......Page 321
Treatment considerations \rin special patient groups......Page 323
Treatment considerations \rin special patient groups......Page 324
References......Page 325
Safety......Page 327
Conclusion......Page 328
Renal Effects......Page 329
Conclusion......Page 330
Structural Efficacy......Page 331
Symptomatic Efficacy......Page 332
Symptomatic Efficacy......Page 333
Symptomatic Efficacy......Page 334
Bone-Targeted Therapies......Page 335
Nitric Oxide Nonsteroidal Anti-inflammatory \nDrugs......Page 336
References......Page 337
Who Should have bmd Measured?......Page 341
Treatment to reduce \rFracture risk......Page 343
Fall Prevention......Page 344
Vitamin D......Page 345
Alendronate......Page 346
Ibandronate......Page 347
Zoledronic Acid......Page 348
Estrogen......Page 349
Teriparatide (rhPTH 1-34)......Page 350
References......Page 351
Regional Disorders of the Neck......Page 354
Periarticular Etiologies......Page 356
Clinical History and Symptoms......Page 357
Physical Examination......Page 358
Management......Page 359
Introduction......Page 360
Periarticular Etiologies......Page 362
Physical Examination \nof the Shoulder......Page 363
Diagnostic Evaluation......Page 365
Management......Page 366
Regional Disorders \rof the Elbow......Page 367
Introduction......Page 368
Diagnostic Evaluation......Page 369
Regional Disorders of the Hand and Wrist......Page 370
Tenosynovitis......Page 371
Management of Flexor Digital Tenosynovitis and de Quervain’s Tenosynovitis......Page 372
Dupuytren’s Disease......Page 373
Carpal Tunnel Syndrome......Page 374
Management of Carpal Tunnel Syndrome......Page 375
References......Page 376
Lumbar Spine Strain......Page 379
Lumbar Herniated Nucleus Pulposus With Radiculopathy......Page 382
Surgical Therapy......Page 384
Lumbar Spine Osteoarthritis......Page 385
Lumbar Spinal Stenosis......Page 386
Treatment......Page 388
Case Study 4 Treatment......Page 389
Artificial Lumbar Disc Replacement......Page 390
References......Page 391
Complex Regional Pain Syndrome is  Neuronal Disease Involving the Central Nervous System......Page 393
Initiating Events......Page 394
Somatic Sensations Including Pain......Page 395
Sympathetically Maintained Pain in Complex Regional Pain Syndrome......Page 396
Somatomotor Changes......Page 398
Conclusions......Page 400
Clinical Criteria......Page 401
Therapy for Complex Regional Pain Syndromes......Page 402
Pharmacologic Therapy......Page 404
Therapy Guidelines of Complex Regional Pain Syndromes......Page 405
References......Page 407
28. Management of Fibromyalgia and Unexplained Generalized Pain Syndromes......Page 409
Principles of Treatment......Page 412
Nonpharmacologic Approaches......Page 413
Pharmacologic Approaches......Page 414
Practical Approach to the Use of Pharmacologic Agents......Page 416
Summary......Page 417
References......Page 418
The Functional and Economic Impact of Arthritis......Page 420
Psychiatric Comorbidity and Psychosocial Factors......Page 421
The Evolution of Behavioral Interventions for Arthritis......Page 422
Conceptualizing the Role of Behavioral Interventions in Arthritis......Page 423
The Efficacy of Behavioral Interventions......Page 424
Why are behavioral interventions effective? How do they work?......Page 426
Dissemination of Behavioral Interventions......Page 427
What Patients Stand to Benefit from Behavioral Interventions?......Page 428
The Importance of Systems Level Change......Page 429
References......Page 430
30. Physical Activity and Exercise in  Rheumatic Disease......Page 431
Health-Enhancing Physical Activity......Page 433
Muscle Training......Page 434
Specific Indications for Exercise......Page 435
Evidence for Physical Activity and Exercise......Page 437
Motivation and Adherence......Page 438
References......Page 440
Complicated Pregnancy......Page 443
Maternal Considerations......Page 444
Differentiation of Systemic Lupus Erythematosus Flare from Pregnancy-Related Complications......Page 445
Prematurity, Intrauterine Growth Restriction, and Other Fetal Complications......Page 446
Maternal Considerations......Page 447
Rheumatoid Arthritis......Page 448
Management and Therapy......Page 449
Pregnancy Outcome......Page 450
Maternal Considerations......Page 451
Pregnancy Outcome......Page 452
Management and Therapy......Page 453
Maternal Considerations......Page 454
Aspirin and Nonsteroidal Anti-inflammatory Drugs......Page 455
Sulfasalazine......Page 456
Anticoagulants......Page 457
The Role Of Effective Contraception......Page 458
Ovulation Induction and in Vitro Fertilization......Page 459
References......Page 460
Health Economics......Page 463
Reimbursement and Health Technology Assessment......Page 464
Formal Guidelines for Economic Evaluation......Page 465
Descriptive Studies......Page 466
Evaluative Studies......Page 468
Costs and Health Effects......Page 469
Modeling......Page 470
Summary......Page 471
References......Page 473
Manufacturing Process......Page 474
Lesson 1: Differences in Glycosylation Patterns Due to Production in Microbial Versus Mammalian Cell Lines: Granulocyte Macrophage/Granulocyte Colony Stimulating Factor......Page 477
Preclinical Data......Page 478
Toxicology Studies......Page 480
First in Man Studies......Page 481
Lesson 5: Lack of Species Homology May Fail to Predict in Vivo Effects in Man: \rSummary of the Tegenero Experience......Page 482
References......Page 483
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C......Page 487
H......Page 488
L......Page 489
N......Page 490
P......Page 491
S......Page 492
V......Page 493
Z......Page 494