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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
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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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The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
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Author Spotlight: Evaluating Traditional Chinese Therapy for Ankylosing Spondylitis in Mice
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Recent updates in enthesitis-related arthritis.

R Naveen1, Shivika Guleria1, Amita Aggarwal2

  • 1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.

Rheumatology International
|January 11, 2023
PubMed
Summary
This summary is machine-generated.

Recent advances in enthesitis-related arthritis (ERA) include better disease assessment and targeted therapies like IL-17 inhibitors. New MRI findings aid early axial disease recognition, improving outcomes for children with ERA.

Keywords:
Arthritis, juvenileBiologicsHLA B27Juvenile SpondyloarthropathyOutcome measures

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Area of Science:

  • Pediatric rheumatology
  • Immunology
  • Radiology

Background:

  • Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis within the juvenile spondyloarthropathy spectrum.
  • Understanding of ERA pathogenesis, disease activity assessment, and targeted therapies has significantly evolved.
  • Previous hypotheses linked HLA B27 to ERA via gut dysbiosis, but recent data suggest this link is unlikely.

Purpose of the Study:

  • To review recent advancements in ERA, focusing on pathogenesis, diagnostic tools, and therapeutic strategies.
  • To highlight new findings in early axial disease recognition and treatment options.
  • To discuss the implications of these advances for improving patient outcomes.

Main Methods:

  • Narrative review of recent literature on enthesitis-related arthritis.
  • Analysis of new data on the role of HLA B27 and gut dysbiosis in ERA.
  • Evaluation of novel MRI findings for diagnosing active and chronic ERA.
  • Assessment of updated disease activity scores and emerging targeted therapies.

Main Results:

  • Axial disease is present in 50-60% of children with ERA, identifiable via MRI.
  • Specific MRI findings can now discriminate between active and chronic ERA in pediatric patients.
  • An abridged juvenile spondyloarthropathy disease activity score may improve clinical adoption.
  • Secukinumab (anti-IL-17) shows >75% response rate; tofacitinib data are promising.

Conclusions:

  • New MRI criteria facilitate earlier and more accurate diagnosis of ERA, particularly axial involvement.
  • Novel therapeutic agents, including IL-17 inhibitors and small molecule inhibitors, offer improved treatment options.
  • These advancements collectively promise better long-term outcomes for children diagnosed with ERA.