The leading Colleges for Rheumatology in the United States and Europe (‘ACR’ & ‘EULAR’) have devised new criteria for patients with joint swelling which combine information on the number and distribution of joint involvement with blood tests indicating inflammation and antibody production. A scoring system based on these factors will help rheumatologists identify which of those patients with a relatively short duration of symptoms may benefit from early treatment with particular anti-rheumatic drugs- ‘DMARDs’. The ‘2010 Rheumatoid Arthritis Classification Criteria’ have just been published in the journal Arthritis & Rheumatism
Patients with gouty arthritis usually require a drug to lower their blood level of uric acid. Drugs that lower uric acid should be carefully supervised in order to avoid causing a flare up of acute gout and may not be suitable for patients with kidney problems. A new drug febuxostat (Adenuric) has recently been approved by the Scottish Medicines Consortium. Febuxostat may be particularly useful in patients who are unable to tolerate existing therapies.
More Information at www.scottishmedicines.org.uk
New guidance highlights the importance of optimising immunity against common infections for patients with some rheumatic conditions. Patients with immune mediated inflammatory disease (eg Rheumatoid arthritis or SLE) are at increased risk of infection partly because of the disease itself but mostly due to treatment with drugs that suppress natural immunity. Only some vaccines are safe for these patients (ie inactivated or inert vaccines); live attenuated vaccines are unsafe and indeed may cause serious infection if given to immuno-suppressed patients. Expert guidance is required in this area.