Current rheumatology reports
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Osteoarthritis (OA), low back pain (LBP), and fibromyalgia (FM) are common chronic pain disorders that occur frequently in the general population. They are a significant cause of dysfunction and disability. Why some of these chronic pain disorders remain localized to few body areas (OA and LBP), whereas others become widespread (FM) is unclear at this time. ⋯ Tonic and/or intense afferent nociceptive barrage can result in central sensitization that depends on facilitatory input from brainstem centers via descending pain pathways to the spinal cord. Abnormal endogenous control of these descending pathways can lead to excessive excitability of dorsal horn neurons of the spinal cord and pain. Ineffective endogenous pain control and central sensitization are important features of OA, LBP, and FM patients.
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Churg-Strauss syndrome is an uncommon disease of unknown cause described initially by Churg and Strauss in 1951. Even though it was initially thought to be a variant of polyarteritis nodosa, its pathological, clinical, and laboratory features show that it is related to the small vessel vasculitides, and it is now classified as an antineutrophil cytoplasmic antibody-associated vasculitis. ⋯ Two different clinical subtypes defined by the presence of antineutrophil cytoplasmic antibodies recently have been recognized. Recent advances in the treatment and pathophysiology of Churg-Strauss syndrome are reviewed in this article.
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In addition to rapidly burgeoning data regarding novel genetic risk factors, a growing list of environmental exposures have been implicated in rheumatoid arthritis (RA) susceptibility. Cigarette smoking is chief among the many environmental exposures implicated in disease risk, accounting for approximately one in six new cases of RA, with recent results underscoring the central importance of select gene-smoking interactions in RA development. In this review, we examine data linking several environmental exposures with RA risk, including cigarette smoking, other air pollutants and occupational exposures, reproductive/hormonal influences, alcohol consumption, select infections leading to periodontal disease, and dietary factors. Where applicable, we review the current understanding of biologic mechanisms linking these environmental factors to disease risk.
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Autoantibodies to eight of the aminoacyl-transfer RNA synthetases-the most well-recognized of which is anti-histidyl (Jo-1)-have all been implicated in the pathogenesis of antisynthetase syndrome (AS). AS is characterized by varying degrees of interstitial lung disease, myositis, arthropathy, fever, Raynaud's phenomenon, and mechanic's hands, and the morbidity and mortality of the disease are usually linked to the pulmonary findings. ⋯ Because inflammatory arthritis mimics rheumatoid arthritis, AS should be considered in atypical cases. Corticosteroids are the mainstay of acute therapy, although treatment often requires immunosuppressant medications such as cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, or rituximab.
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Not all fractures heal well. One method that has been used to improve fracture healing is low-intensity pulsed ultrasound (LIPUS). LIPUS has been US Food and Drug Administration approved for several years, and some preclinical and clinical evidence indicates that fracture healing can be improved by this technique, which appears to be generally safe. ⋯ A less-established modality is whole body vibration (WBV), which appears to stimulate bone and muscle growth while suppressing adipogenesis in animal studies. Early studies in humans, including some in children with disabilities, suggest that WBV holds promise as a technique for reducing fracture risk. The exact place of WBV in preventing fracture remains to be established.