HIV infected patients are at the same, or even greater, risk for developing inflammatory arthritis. However, the nature of their chronic infection and increased susceptibility to opportunistic infection have prompted most clinicians to avoid using TNF inhibitors in this patients population, even in settings in which their use would otherwise be appropriate, since only a few case reports have been published detailing treatment experiences.
Group Exercise, Education, and Combination Self-Management in Women with Fibromyalgia: A Randomized Trial
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Knee Pain from Osteoarthritis related to change in Synovitis
Knee pain from osteoarthritis (OA) tends to be poorly correlated to degree of cartilage loss. Other factors related to knee OA, including bone marrow edema and synovitis, may be more proximal determinants of pain in knee OA. Synovitis is usually quite limited in knee OA and difficult to quantify on physical exam. Magnetic resonance (MR) imaging is a more sensitive technique for assessing synovitis in knee OA.
Novel Genetic Susceptibility Locus for Rheumatoid Arthritis identified from a Genome-Wide Association Study
A handful of genes which confer susceptibility to the development of RA are known, such as the HLA-DR “shared epitope” and variants in the PTPN22 gene. While these genes convey a relatively large degree of risk, identifying important genetic loci that convey more modest levels of risk have been a challenge due to the limitations of genetic research methods. Newer methods, such as the use of genome-wide association studies involving hundreds of thousands of single nucleotide polymorphism (SNP) markers, can aid in the discrimination of genes with modest, yet potentially important and informative, effects on risk.
TNF Inhibitor Use Associated with a Reduced Risk of Myocardial Infarction in Rheumatoid Arthritis Patients?
RA is associated with an increase in cardiovascular (CV) events, such as myocardial infarction (MI) and sudden cardiac death. Inflammatory cytokines, such as TNF-α, are implicated in atherothrombosis and the RA disease state, potentially explaining the increased risk of CV events in RA. The use of TNF inhibitors was associated with a reduced risk of cardiovascular events in RA patients in one study, although it is not clear whether these effects are due to unique features of TNF inhibitors or are a consequence of non-specific suppression of inflammation.
Combination of Methotrexate and Isoniazid Appears Safe for Rheumatoid Arthritis Patients
The potential for hepatotoxicity is a well-recognized feature of therapy with a number of DMARDs in rheumatoid arthritis (RA), with methotrexate (MTX) being the most common utilized. Concomitant use of other hepatotoxic agents has the potential to compound the risk of significant liver damage. Among these, isoniazid (INH) is increasingly used in RA patients receiving MTX with evidence of latent tuberculosis infection (LTBI) or prior active tuberculosis for whom TNF inhibitor therapy is planned.
