Current Rheumatology Reviews - Volume 6, Issue 3, 2010

This is a very special issue of Current Rheumatology Reviews (CRR), which includes a topic that has fascinated me for years. In this issue, Dr. Bucala and his colleagues shed some light on a very important and relatively new disease, i.e., nephrogenic systemic fibrosis. This condition started appearing in the literature approximately 10 years ago with sporadic cases of fibrosis of the skin seen in patients who had renal failure. I Read More

A little more than 10 years ago, the first cases of an unusual new fibrosing disorder emerged. The condition affected only individuals with significant renal insufficiency and was characterized by a rapid thickening and hardening of the skin of the extremities. Many of these patients experienced extreme disability and became wheelchair-dependent in as little as a few weeks. Biopsies of affected skin showed significant fibrosis, wit Read More

Analysis of Gadolinium (Gd) in tissues has become important since the discovery of the relationship of Gd exposure to the development of nephrogenic systemic fibrosis (NSF). Microanalytical methods including Scanning Electron Microscopy with Energy Dispersive X-Ray Spectrometry (SEM/EDS), Secondary Ion Mass Spectrometry (SIMS) or X-Ray microscopy allow imaging and analysis of insoluble Gd deposits in routinel Read More

Recent studies have focused on the potential role of fibrocytes in the pathogenesis of nephrogenic systemic fibrosis (NSF). Advances in our understanding of the cellular and molecular biology of fibrocytes, which are reviewed herein, now allow for the exploration of specific hypothesis regarding fibrocyte function in NSF. We hypothesize that when the half-life of gadolinium-based MRI contrast agents (GBCA) is prolonged Read More

Nephrogenic systemic fibrosis (NSF) is a serious and potentially life-threatening systemic fibrosing disorder. The condition is strongly linked to renal disease and significant evidence suggests an association with prior exposure to gadolinium-containing contrast agents, especially when used at higher doses for magnetic resonance angiography. This paper describes the clinical spectrum of disease as well as features that should Read More

Effective drug safety surveillance - pharmacovigilance - is dependent on the careful and dedicated actions of many different stakeholders, in particular the pharmaceutical industry, the regulatory authorities and the health care professionals. Also the patients play a key role. The gadolinium-NSF case provides a unique experience, which not only highlights the ideal function of the international pharmacovigilance s Read More

About three and a half years ago, a causal relation between nephrogenic systemic fibrosis (NSF) and exposure to gadolinium based contrast agents (Gd-CAs) was suggested. All evidence now suggests that low stability Gd-CAs can trigger the development of NSF. All studies indicate with no exception that macrocyclic Gd-CAs release significantly less free gadolinium than the linear agents, particularly the non-ionic ones which Read More

Gadolinium based contrast agents (GBCAs) have been linked to nephrogenic systemic fibrosis (NSF) in patients with severe renal dysfunction. This article reviews strategies to prevent this condition in patients at risk. These include administering only single dose GBCA, scheduling MRI for just before the next routine dialysis in dialysis patients, delaying GBCA in acute renal failure while serum creatinine is rising, and making sure Read More

In this issue we have three articles discussing features of pain perception in rheumatic diseases. Dr. Inglis et al. review the evidence for activation of peripheral and central pain pathways from basic science using animal models with particular focus on rheumatoid arthritis and osteoarthritis. Drs. Shaikh and Shenker describe the clinical context of pain syndromes in rheumatic diseases and discuss how an initial inflammatory s Read More

Rheumatoid arthritis (RA) and Osteoarthritis (OA) are both common diseases of the joints. RA is distinguished by inflammation and synovitis leading to joint destruction, whereas OA is typified by degenerative and mostly noninflammatory disease. Although differing in their pathology, both forms can elicit chronic disabling pain in patients. Relief from this pain is an unmet need for many patients, and this has lead to a drive to unde Read More

Pain is a major symptom in rheumatic diseases. Understanding the nature of patients' pain symptoms in a rheumatology setting is integral to their assessment and optimising care. In recent years we have increasingly come to appreciate that not only is pain dependent on the underlying pathological process, but is also influenced by a number of additional factors that include genetics, the environment of the individual, pr Read More

Although musculoskeletal pain is the commonest cause of chronic pain and one of the most common presenting features in rheumatology, it remains poorly managed. The burden of musculoskeletal pain is estimated to have increased between two and fivefold in the last 40 years. Pain in musculoskeletal disease can be inflammatory or degenerative and is often an essential part of the condition and is used by both patients Read More

Early rheumatoid arthritis (ERA) can be defined as the initial phase of the disease and can be considered as a “window of therapeutic opportunity”. It is essential to evaluate the quality of life in addition to the disability levels of these patients to better understand the evolution of the disease. Several instruments have been proposed to assess the quality of life of RA patients that involve detecting changes in health conditions o Read More