Current Rheumatology Reviews - Volume 7, Issue 1, 2011

Welcome to 2011 from the editorial staff of Current Rheumatology Reports! As Henry David Thoreau eloquently stated, “Could a greater miracle take place than for us to look through each other's eyes for an instant?” While the eyes are a fascinating window into the systemic manifestations of rheumatic diseases, a surprising lack of awareness of the ocular manifestations of rheumatic diseases exists. In this issue of the journ Read More

The eye can be involved in many different rheumatological and vasculitic disorders. Most rheumatological diseases have ocular complications, many of which are specific to the particular disease and the occurrence of which may help in diagnosis. Indeed, ocular involvement may be the presenting feature of systemic disease, or the involvement of the eye may help to bring together a variety of symptoms and signs and t Read More

Dry eyes are a frequent feature of routine ophthalmic clinical practice, but also form one of the commonest ocular manifestations of rheumatological disease. The spectrum of dry eye disease ranges from mild tear film instability through to severe dry eye which can threaten the integrity of the ocular surface and even lead to ocular perforation. This article discusses the disease pathophysiology and clinical manife Read More

Episcleritis and scleritis describe chronic inflammation of the outermost coats of the eye, and frequently occur as ocular complications of rheumatological disease. It is important to distinguish them, as episcleritis is usually a mild, self-limiting condition, but scleritis is frequently painful and has vision-threatening complications. Necrotising scleritis is a variant which is associated with the vasculitides, especially Wegener's Read More

Uveitis is a common extra-articular manifestation of many rheumatic diseases and can be associated with considerable morbidity, both in terms of vision loss and the need for systemic immunosuppression. Anterior uveitis is symptomatic in adults, presenting as a red, painful eye with photophobia, and is most commonly associated with HLAB27 disease. In contrast, chronic anterior uveitis can be silent in children with ju Read More

Retinal vascular disease often occurs in conjunction with systemic inflammatory disease, particularly Behcet's disease and Systemic Lupus Erythematosus. In contrast to other manifestations of vasculitides, those affecting the posterior segment of the eye are accessible to direct visualisation by ophthalmoscopy, enabling a number of the features to be distinguished on clinical examination. Retinal vascular disease Read More

Ophthalmic involvement in the rheumatic diseases may take the form of a broad range of orbital manifestations. Indeed, orbital involvement can be the sole or major feature of some diseases such as Wegener's granulomatosis, in which orbital masses and proptosis are common. These complications can have cosmetic implications, but can also lead to sight-threatening disease, if severe corneal exposure occurs, of if co Read More

Systemically administered medications have long been known to produce detectable ophthalmic signs. Some of these are benign, asymptomatic phenomena that do not require screening or regular follow-up, such as the vortex keratopathy characteristic of amiodarone use, but other medications are potentially toxic to the eye and can damage vision. Ocular toxicity is an established side-effect of several of the immun Read More

The treatment options for patients with rheumatoid arthritis have undergone revolutionary changes over the last decade, in particular with the introduction of so-called biologicals. Moreover, the pipeline for new targets is still growing. This evolution has brought new perspectives for patients, with clearly improved functional and structural prognosis. The portfolio of options is growing so fast that rheumatologists face a particul Read More

Over the last decade, protein-based pharmaceuticals, so called “biologics”, have greatly expanded the therapeutic armamentarium for the treatment of rheumatoid arthritis (RA). Because antiinflammatory therapies with biologics do have multifaceted interactions with pathways involved in carcinogenesis, concerns have been raised that these agents may induce or accelerate malignant growth. Safety analyses based on c Read More

Biologicals revolutionized the treatment of Rheumatoid Arthritis (RA). The targeted suppression of key inflammatory pathways involved in joint inflammation and destruction allows better disease control, which, however, comes at the price of an elevated infection risk due to relative immunosuppression. The disease-related infection risk and the infection risk associated with the use of TNF-α inhibitors (infliximab, adali Read More

Tumour necrosis factor inhibitors (anti-TNF) improve considerably the signs and symptoms of severe rheumatoid arthritis (RA) in the majority of patients. Nonetheless, about a third of patients do not respond satisfactorily to this class of biological agents and many more loose response over time or can not tolerate them. In this clinical setting, randomized trials have demonstrated that a second anti-TNF or a biological agent o Read More