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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Genome-wide association studies or GWAS are used to identify whether common SNPs are associated with certain diseases. Suppose specific SNPs are more frequently observed in individuals with a particular disease than those without the disease. In that case, those SNPs are said to be associated with the disease. Chi-square analysis is performed to check the probability of the allele likely to be associated with the disease.
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IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
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Rheumatologists' perspective on hydroxychloroquine guidelines.

James Winebrake1, Leila Khalili2, Julia Weiner2

  • 1Weill Cornell Medical College, New York City, New York, USA.

Lupus Science & Medicine
|November 5, 2020
PubMed
Summary
This summary is machine-generated.

Hydroxychloroquine (HCQ) retinal toxicity is rare in SLE patients. Rheumatologists are aware of American Academy of Ophthalmology guidelines and collaborate with ophthalmologists to prevent toxicity.

Keywords:
antirheumatic agentslupus erythematosussystemictherapeutics

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Clinical Practice

Background:

  • Hydroxychloroquine (HCQ) retinal toxicity is a significant concern for rheumatologists.
  • The 2016 American Academy of Ophthalmology (AAO) guidelines on HCQ toxicity have generated debate regarding optimal dosing and evaluation.
  • Understanding current rheumatologist practices is crucial for managing HCQ therapy.

Purpose of the Study:

  • To investigate rheumatologists' current practices concerning hydroxychloroquine (HCQ) dosing and toxicity management.
  • To assess rheumatologists' familiarity with and adherence to the 2016 AAO guidelines.
  • To identify perceived barriers to implementing the AAO guidelines in clinical practice.

Main Methods:

  • A questionnaire-based survey was electronically distributed to rheumatologists.
  • Data collected included HCQ prescribing habits, clinical decision-making, guideline awareness, and perceived guideline-practice discrepancies.
  • Analysis focused on lupus experts to ensure relevant clinical context.

Main Results:

  • Hydroxychloroquine (HCQ) is prescribed to over 75% of SLE patients, typically at 200-400 mg/day.
  • Reported HCQ retinal toxicity and blindness rates were low (1.05% and 1.8 per 10,000 patients, respectively).
  • While 89.1% of rheumatologists were familiar with the AAO guidelines, cited obstacles included limited dosing options and concerns about patient adherence.

Conclusions:

  • Hydroxychloroquine (HCQ) toxicity and associated blindness appear to be infrequent in systemic lupus erythematosus (SLE) patients.
  • Rheumatologists demonstrate awareness of the AAO guidelines and recognize the importance of ophthalmologist collaboration in preventing retinal toxicity.
  • Further research may be needed to reconcile guideline recommendations with clinical practice realities.