Abstract:
:Musculoskeletal problems remain among the main limitations of the quality of life of renal failure patients, in particular of those treated with long-term maintenance dialysis. Renal osteodystrophy continues to receive great attention. The mechanisms of uremic skeletal resistance to parathormone (PTH) are further investigated. The assay used for the dosage of "intact PTH" has been found to detect 7-84 fragments with an inhibitory effect on the action of the whole hormone. A decrease in the density of PTH receptor on osteoblasts is another recently evidenced factor. Investigations of the recently described RANK-RANKL system have demonstrated an increase in serum osteprotegerin levels, which, together with the two above-mentioned abnormalities, may explain bone resistance to PTH. These are important advances in the understanding of renal osteodystrophy as skeletal resistance to PTH appears to play an important part in the pathophysiology of secondary hyperparathyroidism and of adynamic bone disease. Because of this skeletal resistance, it has been recommended for several years that serum PTH level be monitored and kept twofold to threefold above the upper value of the normal level to maintain normal bone turnover in dialysis patients. Relative hypoparathyroidism has recently been found to be associated with increased spontaneous fracture rate and mortality, so this recommendation appears to hold adequate, despite the demonstration that serum PTH levels in this range are a poor predictor of bone turnover and that chronic parathyroid gland hyperplasia is likely to favor parathyroid gland autonomization. Recent publications have insisted on the role that hyperphosphatemia plays not only in the development of secondary hyperparathyroidism, but also of vascular, especially coronary, calcification and as a predictor of mortality. This "silent killer" of uremic patients is one of the main targets for therapeutic intervention. Extensive use of calcium-containing phosphate binders has been recently criticized as calcium overload appears to favor vascular calcification. Sevelaner (RenaGel) is a calcium- and aluminum-free phosphate binder that is an important advance in the management of renal osteodystrophy, especially in patients with extraskeletal calcification and hypercalcemia. The use of vitamin D derivatives has also raised concern because they enhance calcium and phosphorus absorption and reduce bone turnover. New metabolites with fewer hypercalcemic effects have been developed. Calcium-sensing receptor agonists are stimulating interest and are likely to take an important place in the future management of renal osteodystrophy. Uremic myopathy has received recent attention. Impaired muscle capillary oxygen transfer has been identified as a pathophysiologic factor, and progressive resistance training has been shown to improve the condition. Finally, a new entity, nephrogenic fibrosing dermopathy, has been described, which must be distinguished from calciphylaxis and scleromyxedema.
journal_name
Curr Opin Rheumatoljournal_title
Current opinion in rheumatologyauthors
Bardin Tdoi
10.1097/00002281-200301000-00009keywords:
subject
Has Abstractpub_date
2003-01-01 00:00:00pages
48-54issue
1eissn
1040-8711issn
1531-6963journal_volume
15pub_type
杂志文章,评审abstract:PURPOSE OF REVIEW:This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset. RECENT FINDINGS:Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated p...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000711
更新日期:2020-05-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of this review is to provide an update on cardiovascular involvement in idiopathic inflammatory myopathy (IIM). Studies from the past 18 months are identified and reviewed. Finally, the clinical impact of these findings is discussed. RECENT FINDINGS:Epidemiological studies have revealed a...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000442
更新日期:2017-11-01 00:00:00
abstract::Bacterial infections can clinically mimic a primary vasculitic syndrome and can directly cause a vasculitis that may respond to prompt recognition and treatment of the infection. Increasing direct and indirect evidence is establishing links between certain infections and vasculopathies, including aortitis, atheroscler...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199801000-00008
更新日期:1998-01-01 00:00:00
abstract:PURPOSE OF REVIEW:To summarize the recent literature on the association of infection with early arthritis, and to discuss the possible role of such infections with respect to the development of chronic rheumatic complications. RECENT FINDINGS:Viral infections are frequently associated with arthritis. Alphaviruses belo...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/01.bor.0000166388.47604.8b
更新日期:2005-07-01 00:00:00
abstract::The evolution of total knee replacement designs and techniques has made possible predictable and long-lasting pain relief in the treatment of knee arthritis. Excellent long-term results have been obtained with cemented knee replacement, with or without preservation of the posterior cruciate ligament. Attempts to achie...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199503000-00007
更新日期:1995-03-01 00:00:00
abstract:PURPOSE OF REVIEW:There has been a tremendous interest to understand the mechanisms that regulate gene expression in autoimmunity and their effect on disease phenotypes by exploring different epigenetic mechanisms. In this review, we will introduce lupus epigenetics through reviewing historical key findings, then we wi...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e328364206f
更新日期:2013-09-01 00:00:00
abstract::Estimates of the prevalence and incidence of knee osteoarthritis increase with age and are higher for women. Other differences in such estimates arise due to methodologic variables, including radiographic techniques. The risk for knee osteoarthritis increases with increasing body weight, long-term occupational joint s...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:1992-08-01 00:00:00
abstract::Neoplasia in an important cause of rheumatic disease. The mechanisms are either direct infiltration of the bone and joint, or indirect infiltration with manifestations distant from the site of neoplastic involvement. Many of the reports reviewed in this article center on direct associations. In particular, there is a ...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199102000-00020
更新日期:1991-02-01 00:00:00
abstract::Inherited connective tissue disorders, among them Ehlers-Danlos syndrome, osteogenesis imperfecta, Marfan syndrome, and Larsen syndrome, are characterized by generalized joint hypermobility. Others, such as Morquio syndrome or achondroplasia, have hypermobility in a more limited distribution. Recent clinical and molec...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199609000-00012
更新日期:1996-09-01 00:00:00
abstract:PURPOSE OF REVIEW:To review studies that clarify the rheumatic manifestations of autoimmune hepatitis, elucidate shared pathogenic pathways, and encourage innovative site-specific therapies. RECENT FINDINGS:Autoimmune hepatitis has clinical manifestations, serological markers, pathogenic mechanisms, genetic predisposi...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e328010c56b
更新日期:2007-01-01 00:00:00
abstract::In 1990, there were signs of a renewed interest in clinical studies about several aspects of osteoarthritis. The work-up of classic data and the use of new information from epidemiologic surveys as well as careful radiographic monitoring of selected groups of patients have brought us broader views on the general cours...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199108000-00017
更新日期:1991-08-01 00:00:00
abstract::Replication of similar findings in diverse study populations using different study designs provides important evidence for causal inferences regarding risk factors reported in epidemiologic studies. Risk factors for knee osteoarthritis have been substantiated in a number of cross-sectional and longitudinal cohort stud...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199204000-00002
更新日期:1992-04-01 00:00:00
abstract:PURPOSE OF REVIEW:The intestinal microbiome is increasingly implicated in the pathogenesis of ankylosing spondylitis, reactive arthritis, and other diseases collectively known as the spondyloarthropathies (SpAs). In common with other complex inflammatory diseases, SpAs have both a strong genetic and environmental compo...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000299
更新日期:2016-07-01 00:00:00
abstract:PURPOSE OF REVIEW:The hyper-IgD and periodic fever syndrome (HIDS) is one of the classical monogenetic hereditary autoinflammatory disorders, and together with the more severe mevalonic aciduria it is also known as 'mevalonate kinase deficiency' (MKD). In this study, we will give an overview of the primary research on ...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e328349c3b1
更新日期:2011-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Patients with osteoporosis suffer from the morbidity and mortality associated with resultant fractures. The number of persons at risk for fractures is increasing as the US population ages. This review addresses preventive strategies that can be used to decrease the risk of minimal trauma fractures. R...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e3283439426
更新日期:2011-03-01 00:00:00
abstract:PURPOSE OF REVIEW:Evidence accumulated since 2010 indicates that human osteoarthritis should now be reclassified as a systemic musculoskeletal disease rather than a focal disorder of synovial joints. RECENT FINDINGS:Inflammation was seen as the key component promoting synovitis as well as progression of cartilage and ...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000162
更新日期:2015-05-01 00:00:00
abstract:PURPOSE OF REVIEW:There is an increasing interest in improving the understanding of pathophysiology, outcome measures, and therapies of rheumatic skin disease. Increasingly, studies are using the skin as a primary endpoint for evaluating therapies. This will review the current state of the art for the most common rheum...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e328333b9e2
更新日期:2010-01-01 00:00:00
abstract::The recent literature pertaining to tumors of articular structures and bone is reviewed. In pigmented villonodular synovitis, the bone resorptive cell is a macrophage polykaryon rather than an osteoclast. Complete arthroscopic synovectomy was successful in most diffuse articular forms of the disease. The early synovia...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199305020-00012
更新日期:1993-03-01 00:00:00
abstract:PURPOSE OF REVIEW:To review the emergence, clinical features, pathogenesis, and treatment of acute chikungunya (CHIK) fever and chronic CHIK arthritis. RECENT FINDINGS:Since 2004, CHIK, an arboviral infection, has spread throughout the world, infecting millions of people. The illness occurs in two phases: an acute vir...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000486
更新日期:2018-05-01 00:00:00
abstract::This article reviews evidence that subchondral bone plays a role in the degeneration of cartilage in osteoarthrosis. Whether the bony changes precede the cartilage degeneration remains unproven but may best be considered necessary for progression of the disease. Epidemiologic studies clearly show increasing subchondra...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199805000-00017
更新日期:1998-05-01 00:00:00
abstract::With the opportunity for long-term follow-up, it has been appreciated that disease severity may vary considerably in patients with Wegener's granulomatosis, polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome. Although combined therapy with cyclophosphamide and glucocorticoids continues to be th...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199701000-00005
更新日期:1997-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Two diseases associated with chronic kidney disease (CKD) have benefited from advances in the past year which are of great importance for rheumatologists: renal osteodystrophy, which is now clearly associated with vascular calcification and cardiovascular death, and nephogenic systemic fibrosis, which...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0b013e32831ca5c5
更新日期:2009-01-01 00:00:00
abstract::All industrialized nations are facing a crisis in health care financing. Rising expectations coupled with increasing specialization and technologic capacities have forced health care payers to examine their assumptions and to seek data on the outcomes of medical interventions. Clinical investigators who have been taug...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199403000-00006
更新日期:1994-03-01 00:00:00
abstract::During the past year, another disease possibly influenced by intravenous gammaglobulin was identified as dermatomyositis/polymyositis. Additional studies provided further information regarding the use of monoclonal anti-CD4 antibody and combination therapy in rheumatoid arthritis, antithymocyte globulin in scleroderma...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199206000-00006
更新日期:1992-06-01 00:00:00
abstract::The spondyloarthropathies are diseases influenced by genetic predisposition and, to a varying extent, infectious triggers. A causal role for bacterial infections is most clear for reactive arthritis. Recent insights into arthritogenic components of bacteria may set the stage for a better understanding of disease patho...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-200207000-00007
更新日期:2002-07-01 00:00:00
abstract::Churg-Strauss syndrome (CSS) is a form of primary vasculitis characterized by allergy and angiitis. In the organ systems involved (lung, heart, peripheral nervous system, and so forth), eosinophilic infiltration can be found. Eosinophilia and normochromic normocytic anemia are leading laboratory findings together with...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-200201000-00003
更新日期:2002-01-01 00:00:00
abstract::In this review, four areas are discussed: fluoroquinolone-induced tendinitis, volar flexor tenosynovitis (trigger finger), Achilles tendon lesions, and occupational medicine issues. The relationship of fluoroquinolone treatment to musculoskeletal lesions, especially Achilles tendinitis and tear, is most intriguing. Th...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199703000-00012
更新日期:1997-03-01 00:00:00
abstract::The molecular mechanisms of the primary immunodeficiencies have been further explored and provide insights into the regulation of the immune response and its role in autoimmune disease, infection, and malignancy. The critical role of CD40-CD40 ligand-mediated effects in T cell-dependent B cell activation, shown throug...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/00002281-199601000-00010
更新日期:1996-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Systemic lupus erythematosus (SLE) pathogenesis is complex. Aberrancies of immune function that previously were described but not well understood are now becoming better characterized, in part through recognition of monogenic cases of lupus-like disease. RECENT FINDINGS:We highlight here recent descr...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000474
更新日期:2018-03-01 00:00:00
abstract:PURPOSE OF REVIEW:In contrast to the disease remission enjoyed by a majority of rheumatoid arthritis (RA) patients during pregnancy, the immediate postpartum period is generally characterized by flare. Managing symptoms during this time is challenging because the potential transfer of medication into the breast milk of...
journal_title:Current opinion in rheumatology
pub_type: 杂志文章,评审
doi:10.1097/BOR.0000000000000055
更新日期:2014-05-01 00:00:00