Canadian Rheumatology Today

Echoes of Change: How Ultrasound Has Transformed Giant Cell Arteritis Detection

2025-01-06T22:17:10+00:00

Giant cell arteritis (GCA) is the most common form of vasculitis affecting adults. The diagnosis of GCA is suspected in patients older than 50 years of age with a new headache and elevated inflammatory markers. Once the diagnosis of GCA is suspected, patients require urgent treatment with glucocorticoids to prevent ischemic complications such as blindness and stroke. As there are many causes for headache, diagnosing GCA can be a ‘headache’ for many rheumatologists. For years, rheumatologists have relied on the temporal artery biopsy (TAB) as the gold standard for diagnosing GCA, despite the 33–92% sensitivity. As patients with suspected GCA remain on high doses of glucocorticoids, which have multiple side-effects and potential adverse events, rapid access to tests that have a greater impact on clinical decision‑making is essential. Vascular imaging is a non‑invasive tool that can help diagnose, monitor, and predict the course of GCA. This article will focus on how ultrasound has transformed the detection of GCA and its potential to reduce some of the ‘headaches’ faced by both rheumatologists and patients.

Contemporary Management of Raynaud’s Phenomenon

2025-01-06T22:17:09+00:00

Raynaud’s phenomenon (RP) is defined as reversible pallor, and also rubor or cyanosis especially digits and it is very common on the general population. It can be an early sign of a connective tissue disease, especially scleroderma and may negatively impact patients’ quality of life. Lifestyle modifications including smoking cessation, cold-avoidance, and avoidance of medications that could worsen RP should be considered as first-line therapies. For those who are resistant to conservative measures, dihydropyridine calcium channel blockers (CCBs) are the preferred first-line treatment. The majority of treatment trials in RP study nifedipine, but other drugs such as amlodipine and felodipine. Otherwise, there is evidence supporting the use of topical nitrates and oral phosphodiesterase type 5 (PDE5) inhibitors. Intravenous prostaglandins (prostacyclins, PGI2 such as iloprost and PGE1 which is alprostadil) can be used for refractory cases. There remains a paucity of data for the benefit of botulism toxin, fluoxetine, or bosentan for treating RP in these patients.

The 2023 ACR/EULAR Classification Criteria for Antiphospholipid Syndrome: Implications for the Inclusion of Participants in Research vs Diagnosis in Clinical Practice

2025-01-06T22:17:07+00:00

Antiphospholipid syndrome (APS) was first described in patients with systemic lupus erythematosus in 1983, and the primary version in 1989. Multiple clinical manifestations have been associated with antiphospholipid antibodies (aPL) including venous and arterial thromboses, transient ischemic attack (TIA), obstetric complications, thrombocytopenia, hemolytic anemia, livedo reticularis, transverse myelitis, cognitive dysfunction, cutaneous ulcers, Libman-Sacks endocarditis, and a peculiar type of nephropathy. Antiphospholipid antibodies include lupus anticoagulant (LAC), anticardiolipin antibodies (aCL) IgG and IgM, and anti‑beta‑2‑glycoprotein antibodies (aβ₂GPI) IgG and IgM. Other antibodies such as anti-prothrombin and anti-prothrombin/phosphatidylserine have been proposed as biomarkers of APS, particularly in cases where the standard antibodies are negative, but they are not officially accepted.

Since 1999, the original Sapporo Criteria and its revised 2006 version have been used for the classification of patients in research studies and for the diagnosis of patients with APS. Despite the broad spectrum of clinical manifestations and serological markers considered by physicians as part of the APS, the original and revised versions of Sapporo Criteria include only venous, arterial and microvascular thrombotic events and specific obstetric events among the clinical manifestations, and aCL IgG and IgM antibodies, aβ₂GPI-I antibodies IgG and IgM or lupus anticoagulant as the serological markers. Consequently, APS was diagnosed as obstetric and/or thrombotic syndrome, not considering other non-criteria manifestations associated to aPL antibodies. The major limitation of these criteria is that they do not reflect the systemic nature of APS.

Due to the importance of classification criteria in research, the ACR and EULAR assumed the responsibility of encouraging the development and validation of new and improved classification criteria for various rheumatic diseases, including APS, based on the current standards of measurement.

An Update on the Benefits and Safety Profile of Hydroxychloroquine

2025-01-06T22:15:21+00:00

Hydroxychloroquine, an antimalarial drug developed in 1950, has been used for decades in the management of various systemic autoimmune rheumatic diseases. By targeting both the innate and adaptive immune systems, it exerts widespread immunomodulatory effects to attenuate the inflammatory response and exert antirheumatic effects. Its favourable safety profile, coupled with proven benefits in improving disease activity and decreasing morbidity and mortality, especially in patients with systemic lupus erythematosus and rheumatoid arthritis, has solidified its place in the long-term management of patients with rheumatic diseases. Recently, therapeutic drug level monitoring has been used to predict the risks of disease flares and prevent treatment-related toxicity. This review article briefly reviews the benefits of using hydroxychloroquine in the management of systemic autoimmune rheumatic diseases, its common and serious adverse effect profile, and the role of drug blood level monitoring in improving patient-related health outcomes.