Rheumatic diseases clinics of North America

Publisher: Elsevier


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    Rheumatic diseases clinics of North America (Online), Rheumatic diseases clinics of North America, Rheumatic disease clinics of North America, Rheumatic disease clinics
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    Document, Periodical, Internet resource
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Publications in this journal

  • Rheumatic diseases clinics of North America 08/2014; 40(3):xiii-xiv.
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    ABSTRACT: Imaging in the crystal arthropathies has undergone great advances in the past decade, with newer techniques having additional benefits for assisting diagnosis, predicting prognosis, and monitoring the treatment of these conditions. Three-dimensional digitized modalities such as computed tomography, dual-energy computed tomography, and magnetic resonance imaging (MRI) offer a multislice view of any anatomic region. Both ultrasonography and MRI reveal features of inflammation and joint damage in all crystal arthropathies, and can be used to monitor the inflammatory response to therapy. The type of imaging used needs to be adapted to the clinical question of relevance.
    Rheumatic diseases clinics of North America 05/2014; 40(2):231-249.
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    ABSTRACT: Calcium pyrophosphate crystal deposition (CPPD) is common and mainly associates with increasing age and osteoarthritis (OA). Recent studies suggest that CPPD occurs as the result of a generalized articular predisposition and may also associate with low cortical bone mineral density. The epidemiology of basic calcium phosphate (BCP) crystal deposition is poorly understood. Although periarticular BCP crystal deposits occurs at all ages and in both sexes, intra-articular BCP crystal deposition tends to associate with increasing age and OA. Calcium pyrophosphate and BCP crystals frequently coexist in joints with OA.
    Rheumatic diseases clinics of North America 05/2014; 40(2):177-191.
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    ABSTRACT: Gout has been academically considered to be a step-up disease consisting of different stages: acute gout, intercritical gout, and chronic gout. This simple approach may lead to misinterpretation and misdiagnosis. In clinical practice, we should consider gout as a single disease with either or both acute (most commonly, episodes of acute inflammation) and persistent clinical manifestations, but not restricted to chronic synovitis. In this article, an innovative, practical, and rational approach to the clinical manifestations and diagnosis of gout is presented, which may be supportive for clinicians involved in everyday care and management of patients with gout.
    Rheumatic diseases clinics of North America 05/2014; 40(2):193-206.
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    ABSTRACT: This article summarizes the structural damage that is observed in advanced gout and current understanding of the mechanisms by which this damage occurs. Interactions between monosodium urate crystals and cells within the joint are described as well as knowledge gained from imaging studies. Future research directions and potential therapeutic strategies for the prevention and treatment of joint damage in gout are also discussed.
    Rheumatic diseases clinics of North America 05/2014; 40(2):291-309.
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    ABSTRACT: Over the past decade much has been learned about the mechanisms of crystal-induced inflammation and renal excretion of uric acid, which has led to more specific targeting of gout therapies and a more potent approach to future management of gout. This article outlines agents being developed for more aggressive lowering of urate and more specific anti-inflammatory activity. The emerging urate-lowering therapies include lesinurad, arhalofenate, ulodesine, and levotofisopam. Novel gout-specific anti-inflammatories include the interleukin-1β inhibitors anakinra, canakinumab, and rilonacept, the melanocortins, and caspase inhibitors. The historic shortcomings of current gout treatment may, in part, be overcome by these novel approaches.
    Rheumatic diseases clinics of North America 05/2014; 40(2):375-387.
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    ABSTRACT: Basic calcium phosphate and pyrophosphate calcium crystals are the 2 main calcium-containing crystals that can deposit in all skeletal tissues. These calcium crystals give rise to numerous manifestations, including acute inflammatory attacks that can mimic alarming and threatening differential diagnoses, osteoarthritis-like lesions, destructive arthropathies, and calcific tendinitis. Awareness of uncommon localizations and manifestations such as intraspinal deposition (eg, crowned dens syndrome, tendinitis of longus colli muscle, massive cervical myelopathy compression) prevents inappropriate procedures and cares. Coupling plain radiography, ultrasonography, computed tomography, and synovial fluid analysis allow accurate diagnosis by directly or indirectly identifying the GRAAL of microcrystal-related symptoms.
    Rheumatic diseases clinics of North America 05/2014; 40(2):207-229.
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    ABSTRACT: Gout results from deposition of monosodium urate (MSU) crystals. Elevated serum urate concentrations (hyperuricemia) are not sufficient for the development of disease. Genome-wide association studies (GWAS) have identified 28 loci controlling serum urate levels. The largest genetic effects are seen in genes involved in the renal excretion of uric acid, with others being involved in glycolysis. Whereas much is understood about the genetic control of serum urate levels, little is known about the genetic control of inflammatory responses to MSU crystals. Extending knowledge in this area depends on recruitment of large, clinically ascertained gout sample sets suitable for GWAS.
    Rheumatic diseases clinics of North America 05/2014; 40(2):279-290.
  • Rheumatic diseases clinics of North America 05/2014; 40(2):xv-xvi.
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    ABSTRACT: Calcium pyrophosphate dihydrate and basic calcium phosphate (BCP) crystals are the most common calcium-containing crystals associated with rheumatic disease. Clinical manifestations of calcium crystal deposition include acute or chronic inflammatory and degenerative arthritides and certain forms of periarthritis. The intra-articular presence of BCP crystals correlates with the degree of radiographic degeneration. Calcium crystal deposition contributes directly to joint degeneration. Vascular calcification is caused by the deposition of calcium hydroxyapatite crystals in the arterial intima. These deposits may contribute to local inflammation and promote further calcification, thus aggravating the atherosclerotic process. Calcium crystal deposition results in substantial structural consequence in humans.
    Rheumatic diseases clinics of North America 05/2014; 40(2):311-328.
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    ABSTRACT: Gout is a common disorder with clinical signs and symptoms resulting from inflammatory responses to monosodium urate crystals deposited in tissues from extracellular fluids saturated for urate. Long-term management of gout focuses on nonpharmacologic and pharmacologic means to achieve and maintain serum urate levels in a subsaturating range. Despite a firm understanding of gout pathophysiology, means to achieve certain diagnosis, and a variety of effective therapies, treatment outcomes remain suboptimal. In this review, available nonpharmacologic and pharmacologic therapies for chronic gout are discussed and a framework is provided for successful achievement and maintenance of goal-range serum urate levels.
    Rheumatic diseases clinics of North America 05/2014; 40(2):357-374.
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    ABSTRACT: Calcium crystal arthritis is often unrecognized, poorly managed, and few effective therapies are available. The most common types of calcium crystals causing musculoskeletal syndromes are calcium pyrophosphate (CPP) and basic calcium phosphate (BCP). Associated syndromes have different clinical presentations and divergent management strategies. Acute CPP arthritis is treated similarly to acute gouty arthritis, whereas chronic CPP and BCP arthropathy may respond to strategies used for osteoarthritis. Calcific tendonitis is treated with a variety of interventions designed to dissolve BCP crystals. A better understanding of the causes and larger well-planned trials of current therapies will lead to improved care.
    Rheumatic diseases clinics of North America 05/2014; 40(2):343-356.
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    ABSTRACT: This article presents an overview of the treatment of acute gout. Nonpharmacologic and pharmacologic treatments, monotherapy versus combination therapy, suggested recommendations, guidelines for treatment, and drugs under development are discussed.
    Rheumatic diseases clinics of North America 05/2014; 40(2):329-341.
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    ABSTRACT: Any cardiac tissue can be affected in most primary vasculitides. However, certain entities such as eosinophilic granulomatosis with polyangiitis (or Churg-Strauss syndrome) and Takayasu arteritis involve the heart in up to 60% of patients. Vasculitic cardiac complications are important to recognize because they have been linked to increased mortality and impact the treatment decision-making process. This article reviews the spectrum of cardiac manifestations in adults with large-, medium-, and small-vessel primary systemic vasculitides as well as their diagnosis and treatment.
    Rheumatic diseases clinics of North America 02/2014; 40(1):11-26.
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    ABSTRACT: Heart disease, either clinically apparent or silent, is a frequent complication of systemic sclerosis (SSc, scleroderma) and may affect both patients with diffuse cutaneous and limited cutaneous SSc. The availability of more sensitive modalities has led to an increased awareness of scleroderma heart disease, which often involves the pericardium, myocardium, and cardiac conduction system. This awareness of cardiac involvement requires attention and interventions led by internists, cardiologists, and rheumatologists. Although no specific therapy exists for scleroderma heart disease, early recognition of the presence and type of scleroderma heart disease may lead to more effective management of patients with scleroderma.
    Rheumatic diseases clinics of North America 02/2014; 40(1):87-102.
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    ABSTRACT: Cardiac involvement in the idiopathic inflammatory myopathies (IIM) has been reported in 5% to 70% of cases. It is estimated that between 15% and 55% of deaths are related to heart disease in patients with dermatomyositis (DM) and polymyositis (PM). Increased atherosclerotic disease in IIM patients has also been reported and is associated with traditional risk factors such as hypertension and dyslipidemia. In the current article we review some of the more recent literature on clinical manifestations and outcomes of cardiovascular disease in IIM patients.
    Rheumatic diseases clinics of North America 02/2014; 40(1):1-10.
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    ABSTRACT: The association between gout and cardiovascular diseases has been noted for centuries but was not subjected to rigorous epidemiologic studies until recently. The published literature is almost unanimous in the strength and consistency of this association. However, the impact of gout over and above that conferred by hyperuricemia and other risk factors of cardiovascular disease has not been well studied. Future studies are expected to shed light on the pathophysiologic basis of this association.
    Rheumatic diseases clinics of North America 02/2014; 40(1):125-143.
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    ABSTRACT: Recent advances in Kawasaki disease have included attempts to define genes involved in its pathogenesis. There have been recent advances in the studies of rheumatic carditis, leading to a better understanding of the mechanism of the disease. Histologic evaluation of patients with neonatal lupus erythematosus has revealed fibrosis with collagen deposition and calcification of the atrioventricular node. Therapy for cardiac involvement in systemic juvenile idiopathic arthritis should involve treatment of the underlying disease and systemic inflammatory state, and typically includes nonsteroidal antiinflammatory drugs, corticosteroids, disease-modifying drugs, and biologic therapies targeting tumor necrosis factor-alpha, interleukin-1, and interleukin-6.
    Rheumatic diseases clinics of North America 02/2014; 40(1):61-85.

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