Cardiac Tamponade as Initial Presentation of Systemic Lupus Erythematosus in Third-Trimester Pregnancy.

BACKGROUND Systemic lupus erythematosus (SLE) is a common autoimmune disorder in women of childbearing age. It can present during pregnancy and may lead to poor maternal and fetal outcomes with a higher risk of preterm birth and pre-eclampsia. Women are at a higher risk of lupus flares during pregnancy, especially if undiagnosed or disease is poorly controlled. Cardiac tamponade is a rare complication of SLE and can be fatal. CASE REPORT A 21-year-old primigravida African-American female with a history of asthma presented with progressive pleuritic left shoulder pain. She had a recent history of sore throat, facial rash, and depressed mood after sun exposure. Work-up was strongly positive for antinuclear antigen, anti-smith, anti-smith/ribonucleoprotein, anti-chromatin, anti-SSA, anti-SSB, anti-dsDNA, and low C3. Echocardiogram showed hemodynamically stable cardiac tamponade. Patient also had proteinuria and hypertension attributed to pre-eclampsia. However, a renal biopsy confirmed lupus nephritis. The patient was treated with pericardiocentesis, prednisone, azathioprine, and hydroxychloroquine. There was significant clinical improvement with resolution of cardiac tamponade and improvement in renal function. CONCLUSIONS Cardiac tamponade is a rare and life-threatening manifestation of SLE. Prompt work-up and treatment with immunosuppressants and pericardiocentesis is needed to improve maternal and fetal outcomes. SLE patients are at a higher likelihood of exacerbations of the disease during pregnancy. It also important to rule out lupus nephritis in an SLE patient with pre-eclampsia. This report has shown the importance of accurate diagnosis of SLE in pregnancy and the appropriate management to ensure the best outcomes for the mother and fetus.

Red Cell Distribution Width Is Positively Correlated with Atherosclerotic Cardiovascular Disease 10-Year Risk Score, Age, and CRP in Spondyloarthritis with Axial or Peripheral Disease.

BACKGROUND: Red blood cell distribution width (RDW) is a routine hematologic parameter that is a predictor of cardiovascular disease (CVD) events and is independent of combined traditional risk factor scoring systems. The RDW has also been associated with rheumatic disease activity. Whether RDW is associated with traditional CVD risk factors or Atherosclerotic Cardiovascular Disease (ASCVD) 10-year CVD risk score in patients with seronegative spondyloarthritis with axial or peripheral disease has not been previously determined. METHODS: We performed a retrospective, chart review study evaluating the relationship between RDW, albumin, hemoglobin, C-reactive protein (CRP), absolute lymphocyte count (ALC), and ASCVD scoring parameters [age, hypertension status, diabetes mellitus (DM) status, lipid profile, and smoking status] in a cohort of spondyloarthritis patients, taking into consideration their HLA-B27 status, race, and treatment status. RESULTS: RDW was found to positively correlate with ASCVD 10-year score and age, and ASCVD score did not change over time after patients were treated for spondyloarthritis. Albumin was found to negatively correlate with ASCVD 10-year risk score. Both RDW and albumin correlated with CRP. ALC failed to correlate with ASCVD 10-year score but did show a tendency to be associated with CVD, CVD events, and cardiac conduction abnormalities. CONCLUSIONS: These data indicate that further study is warranted to evaluate RDW, albumin level, and ALC as potential predictors of CVD in the spondyloarthritis patient population.

Recent strategies for drug development in fibromyalgia syndrome.

INTRODUCTION: The US Federal Drug Administration (FDA) approved 3 medications for treating fibromyalgia syndrome (FMS). There have been no additional FDA approvals since January 2009 and the efficacy of the FDA-approved medications for FMS has been questioned. Areas covered: The "search for studies" tool using clinicaltrials.gov and PubMed were employed. The term, "fibromyalgia" was used for clinicaltrials.gov. The terms employed for PubMed were "Name-of-Drug Fibromyalgia", "Fibromyalgia Treatment" or "Fibromyalgia Drug Treatment." Clinical trials were reviewed if they were prospective and blinded, and if they employed a comparator, either placebo or another pharmaceutical. Expert commentary: Progress toward standardizing the outcome measures for FMS clinical trials have been made but challenges remain. Several pharmaceutical candidates for FMS have been tested since 2009. The results of these studies with potential novel targets for drug development for FMS were reviewed including the results of trials with sodium oxybate, quetiapine, esreboxetine, nabilone, memantine, naltrexone, and melatonin.

Protein kinase small molecule inhibitors for rheumatoid arthritis: Medicinal chemistry/clinical perspectives.

Medicinal chemistry strategies have contributed to the development, experimental study of and clinical trials assessment of the first type of protein kinase small molecule inhibitor to target the Janus kinase/Signal Transducers and Activators of Transcription (JAK/STAT) signaling pathway. The orally administered small molecule inhibitor, tofacitinib, is the first drug to target the JAK/STAT pathway for entry into the armamentarium of the medical therapy of rheumatoid arthritis. The introduction of tofacitinib into general rheumatologic practice coupled with increasing understanding that additional cellular signal transduction pathways including the mitogen-activated protein kinase and phosphatidylinositide-3-kinase/Akt/mammalian target of rapamycin pathways as well as spleen tyrosine kinase also contribute to immune-mediated inflammatory in rheumatoid arthritis makes it likely that further development of orally administered protein kinase small molecule inhibitors for rheumatoid arthritis will occur in the near future.

Tired, aching, ANA-positive: does your patient have lupus or fibromyalgia?

The symptoms of fibromyalgia and lupus can be similar, but the treatments are very different. Although the antinuclear antibody (ANA) test has often been used to make the distinction, this approach has its pitfalls. This paper offers strategies for more accurate diagnosis.