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Introduction: There are several treatment controversies that have emerged in spondyloarthritis and psoriatic arthritis. These are related to the nature of the conditions as well as to the use of medications. Areas covered: This review, which included a search of PubMed database as well as the references within the articles provides an overview of the nature of spondyloarthritis, controversy over the inclusion of psoriatic arthritis (PsA) as a peripheral spondyloarthritis, and a summary of current treatments for both PsA and axial spondyloarthritis (axSpA), with special emphasis on targeted therapy. The review highlights the differences in response to certain medications, particularly biologic therapy and summarizes the randomized controlled trials in psoriatic arthritis and axial spondyloarthritis providing data about the responses in table format. Expert opinion: There is a need for better outcome measures in axSpA. Currently, the measures are subjective. Imaging may be more appropriate but there is a need for research into the reliability and responsiveness of imaging techniques. In PsA, there may also be better response measures and research into the reliability and responsiveness of available measures is underway. There is also a need for novel therapies as well as biomarkers for response in both diseases. [ABSTRACT FROM AUTHOR]

Keywords: ANCA-associated vasculitis; idiopathic inflammatory myopathy; myalgia; myositis; rituximab EN ANCA-associated vasculitis idiopathic inflammatory myopathy myalgia myositis rituximab 1 5 5 11/04/22 20221001 NES 221001 INTRODUCTION Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare systemic small-vessel disease, with heterogeneous clinical manifestations. Abbreviations AAV ANCA-associated vasculitis ANCA anti-neutrophil cytoplasmic antibodies CNS central nervous system CT computed tomography IIMs idiopathic inflammatory myopathies IMNM immune-mediated necrotizing myopathy MAC membrane attack complex MHC-I major histocompatibility complex-I MRI magnetic resonance imaging p perinuclear SRP signal recognition peptide. Fraser et al. found that signal intensity scores on short tau inversion recovery (STIR) were more sensitive in detecting myositis disease activity than was the presence of pathologic changes on muscle biopsy.[8] Anti-SRP antibody was positive in our patient. [Extracted from the article]

In our previously published article, The Osteosclerosis Challenge: Toothpaste Unveiling Secrets ([1]), we reported the case of a tricenarian female patient with severe osteosclerosis, secondary to prolonged intentional fluoride consumption through toothpaste and mouthwash. Upon analysis, a very high fluoride content was found. gl Laboratory analysis was performed on the stones, revealing an extremely high fluoride concentration, approaching 22.6 parts per million. Chronic fluoride ingestion can lead to skeletal fluorosis, with the unfortunate effects on bone lasting for several years, and sometimes mimicking rheumatic diseases. [Extracted from the article]

Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with various joint and skin manifestations and multiple associated comorbidities. The management of PsA is important not only in controlling disease activity and preventing subsequent damage but also in improving the quality of life and reducing mortality. Over the years, numerous drugs have been introduced into the therapeutic armamentarium of the disease. While non-steroidal anti-inflammatory drugs (NSAIDs) and conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) have contributed to management, it was not until the advent of biologics (and later on targeted synthetic DMARDs) that therapy was revolutionized, with the achievement of significantly better clinical and radiographic outcomes. Several drugs and treatment approaches are currently being tested in clinical trials at different phases. Despite all the success, there are still various challenges and unmet needs in the field of PsA, reflected by difficult-to-treat disease course, secondary failure of therapy, and lack of consensus on accepted treatment withdrawal protocols, among others. In this review, we have discussed the most recent advances in the therapy of psoriatic disease, with a particular focus on phase III studies completed (or ongoing) since 2020. We also mentioned the challenges and unmet needs in our clinical practice, which we expect current and future research to provide answers to., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Psoriatic arthritis is an inflammatory arthritis that affects around 30% of patients with psoriasis. The disease spectrum includes peripheral arthritis, enthesitis, tenosynovitis, dactylitis, axial involvement, and skin and nail psoriasis in most patients. In addition to the cutaneous and musculoskeletal manifestations, several comorbidities can complicate the disease course, including cardiovascular disease, diabetes mellitus, metabolic syndrome, gout, anxiety, and depression. The management of patients with psoriatic arthritis begins with a careful assessment of the skin and joints and screening for comorbidities. This review describes the assessment tools and outcome measures used in the evaluation of patients with psoriatic arthritis. It summarizes the approach to therapy, including non-medicinal interventions such as education, lifestyle changes, physiotherapy, and occupational therapy. It discusses the evidence on pharmacologic treatments, including drugs used for symptomatic relief such as non-steroidal anti-inflammatory drugs, and those used to control the disease process; this last group comprises conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), including methotrexate, leflunomide, and sulfasalazine, and biologic and targeted DMARDs, including anti-tumor necrosis factor (TNFα), anti-interleukin-17 (IL-17), anti-IL-12/23, and anti-IL-23 agents, as well as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) antagonists. Although these drugs are usually tailored to the clinical profile of the patient, biomarkers predictive of response to therapy are needed so that a more personalized approach can be followed., Competing Interests: Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: DDG is a consultant to Abbvie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, and UCB and has received grant support from Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, and UCB., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: Chronic kidney disease (CKD) is a comorbidity in psoriatic arthritis (PsA). We aimed to define the prevalence of CKD in patients with PsA, describe their long-term renal outcomes and identify risk factors for CKD development., Methods: We included patients with PsA followed by our prospective observational cohort. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 for at least 3 months. We characterised long-term renal outcomes of CKD cases identified following clinic entry. We used time-dependent Cox regression models to identify factors associated with CKD development., Results: Of 1336 patients included in the study, 123 (9.2%) had CKD. Of these, 25 (20.3%) were observed to have CKD at clinic entry and 98 (79.7%) developed CKD during follow-up at a median (IQR) of 8.2 (2.8-14.0) years from baseline. Doubling of baseline creatinine was observed in 18 of 98 (18.3%) new patients with CKD. 49 (50%) patients developed a sustained ≥40% reduction in baseline eGFR. Two patients developed eGFR <15 mL/min/1.73 m 2 . In the multivariate Cox regression model adjusted for age at study entry, sex and baseline eGFR, factors independently associated with the development of CKD included diabetes mellitus (HR 2.58, p<0.001), kidney stones (HR 2.14, p=0.01), radiographic damaged joint count (HR 1.02, p=0.02), uric acid (HR 1.21, p<0.001; 50-unit increase), daily use of non-steroidal anti-inflammatory drugs (NSAIDs) (HR 1.77, p=0.02) and methotrexate use (HR 0.51, p=0.01)., Conclusion: CKD is not infrequent in PsA. Its development is associated with related comorbidities, joint damage and NSAID use. Methotrexate seems to be protective., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Proteinuria is a marker of lupus nephritis (LN) activity and damage. We aimed to explore the impact of baseline proteinuria level on long-term outcomes., Methods: We included 249 patients diagnosed with their first biopsy-proven LN. We divided patients based on baseline proteinuria into low-level (≤1 g/day, group 1; 62 patients), moderate-level (>1 and <3 g/day, group 2; 90 patients), and high-level proteinuria (≥3 g/day, group 3; 97 patients). Outcomes included complete proteinuria recovery (CPR) at 1 year, an adverse composite outcome (ESKD, a sustained ≥40% decline in eGFR, or death), and LN flares. Cox proportional hazard models were used to examine the association between baseline characteristics and long-term outcomes., Results: At baseline, the median [IQR] age was 33.2 [26.4, 42.4] years; median proteinuria level was 2.2 [1.0, 3.8] g/day. 177 (71%) patients had proliferative lesions on biopsy; 59.7% in group 1, 78.9% in group 2, and 71.4% in group 3.The rate of achievement of CPR at 1 year was highest for group 1 and lowest for group 3. For long-term outcomes (median follow-up 8.4 years), the frequency of the adverse composite outcome was 27.4%, 26.7%, and 48.5% in groups 1, 2, and 3, respectively; p= 0.003. The corresponding frequency of flares was 27.4%, 38.2%, and 61.9%, respectively; p< 0.001. In the multivariable model for factors associated with long-term outcomes, there was no significant difference between groups 1 and 2; group 3 was associated with the worst prognosis., Conclusions: Low-level proteinuria is commonly associated with proliferative LN and adverse long-term outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Membranous lupus nephritis (MLN) is thought to have a more benign course than proliferative lupus nephritis (PLN). We aimed to determine the differences in short and long-term outcomes between patients with MLN and PLN., Methods: We included patients with first biopsy-proven MLN and PLN. Short-term outcomes included complete proteinuria recovery (CPR), complete renal response (CRR), and primary efficacy renal response (PERR). Long-term outcomes included a sustained ≥40% reduction in baseline estimated glomerular filtration rate (eGFR), end-stage kidney disease (ESKD), cardiovascular (CV) events, ≥2 increase in SDI, and death. Univariable and multivariable Cox proportional hazard models were used to examine the effect of baseline characteristics on long-term outcomes., Results: Of 215 patients, 51 had pure MLN, and 164 had PLN. We found no significant differences between the two groups in achieving CPR, CRR, and PERR at 1 and 2 years. Median time to outcomes was slightly, but insignificantly, longer in the MLN group.For long-term outcomes, PLN was associated with worse renal and non-renal outcomes, but this was not statistically significant.In the multivariable Cox proportional hazard models, ESKD was associated with the following baseline variables: younger age (HR 0.92, 95% CI 0.87-0.97), higher creatinine (HR 1.01, 95% CI 1.01-1.02), low complement (HR 4.0, 95% CI 1.04-11.10), and higher chronicity index (HR 1.28, 95% CI 1.08-1.51)., Conclusion: The resolution of proteinuria in LN is slow. MLN is not a benign disease and may be associated with deterioration of renal function, ESKD, damage, CV events, and death., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Sir William Osler is considered to be one of the fathers of modern medicine who pioneered the practice of bedside teaching of clinical medicine for medical students and residents. Osler was well known as a diagnostician and outstanding therapist with a humanized approach and rare didactic capabilities. Medical training at Hadassah is built on the central tenets of Osler's approach, incorporating the tremendous advances in science and medicine. Training for residents in Internal Medicine is designed to develop a broad base of medical and, if possible, scientific knowledge, as well as skills and competencies to deliver a high standard of patient care. In the past 7 years, 28 residents have undergone specialist training in Internal Medicine B. Among them, 71% were Israeli medical school graduates; 36% were women;18% were recent immigrants to Israel; 78% were Jewish. Among Jewish residents, 32% were religiously observant. Besides the usual assignments of the internal medicine ward, the medical staff of Internal Medicine B excelled in diagnosis of hard to diagnose diseases as described in eleven cases. The diagnosis in some of those cases was a result of listening to the patient, education on clinical reasoning and the use advanced diagnostic tools. The basic unit of the residency is the clinical mission with an emphasis on exposure to novel modalities such as the use of bedside ultra sound along with dealing with end-of-life dilemmas, the management of complex situations and development of communication and interpersonal skills needed to work with close relatives and families facing critical times. The medical training in the internal ward is not just the sum of arbitrary care of the hospitalized patients, but a well-structured plan with gradually increasing demands. Over the past 7 years, residents in Internal Medicine B have achieved successful passing grades of 38/38 on the first attempt oral and written board examinations, a record that attests to the quality of the trainees and the training process. Hadassah has a long history of providing state-of-the-art patient care, and training young physicians to maintain this high standard - but the education process necessitates longstanding efforts and continuous striving for excellence.