Nature reviews. Rheumatology
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In April 2009, efalizumab was withdrawn from the market for the treatment of psoriasis after reports emerged of an association between long-term therapy and the development of progressive multifocal leukoencephalopathy (PML). This event highlights an urgent need for greater awareness and research into the screening, diagnosis and treatment of this potentially fatal disease in patients undergoing immunosuppressive therapy for chronic inflammatory disorders.
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As of May 1, 2009, Pubmed listed approximately 30,000 citations on the topic of vitamin D in humans, highlighting the medical community's avid interest in this field. Two articles published in the Archives of Internal Medicine diverge with previous reports on the prevalence of hypovitaminosis D and the capability of vitamin D to reduce fractures.
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Rheumatologists are likely to be asked to evaluate patients with recurrent febrile syndromes, so it is important that they are familiar with the clinical and diagnostic features, pathophysiology and therapeutic options for these rare autoinflammatory disorders. These syndromes are all characterized by recurrent episodes of fever and systemic inflammation; however, some syndromes have unique historical and physical features that can help with making a diagnosis. ⋯ Diagnostic testing is mostly limited to genetic testing. NSAIDs, colchicine and corticosteroids have roles in the treatment of some of these disorders, but biologic drugs that target interleukin-1beta are emerging as consistently effective therapies.
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Fibromyalgia is a prevalent disorder that is characterized by widespread pain along with numerous other symptoms, including fatigue, poor sleep, mood disorders, and stiffness. Previous guidelines for the management of fibromyalgia recommended an approach that integrates pharmacologic and nonpharmacologic therapies selected according to the symptoms experienced by individual patients. ⋯ We present a simple, rapid and easily remembered system for symptom quantitation and pharmacologic management of fibromyalgia that combines visual analogue scale symptom scores from a modified form of the disease-neutral Fibromyalgia Impact Questionnaire, with a review of medications that can be used to treat the individual symptoms. This symptom-based approach is amenable to caring for patients with fibromyalgia in a busy clinical practice.