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Firestein & Kelley’s Textbook of Rheumatology, 2-Volume Set
- 11th Edition - July 5, 2020
- Authors: Gary S. Firestein, Ralph C. Budd, Sherine E Gabriel, Iain B McInnes, James R. O'Dell
- Editor: Gary Koretzky
- Language: English
- Hardback ISBN:9 7 8 - 0 - 3 2 3 - 6 3 9 2 0 - 0
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 6 3 9 2 1 - 7
Through 10 outstanding editions, Kelley & Firestein’s Textbook of Rheumatology has provided authoritative, in-depth guidance in rheumatology with an ideal balance of basic sci… Read more
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Request a sales quoteThrough 10 outstanding editions, Kelley & Firestein’s Textbook of Rheumatology has provided authoritative, in-depth guidance in rheumatology with an ideal balance of basic science and clinical application. The 11th Edition of this classic text continues this tradition of excellence, while keeping you abreast of recent advances in genetics and the microbiome, new therapies such as biologics and biosimilars, and other rapid changes in the field. It provides comprehensive, global coverage of all aspects of diagnosis, screening, and treatment in both adults and children, in a user-friendly, full color reference.
- Instructions for online access
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- Contributors
- Preface
- VOLUME I
- Part 1. Structure and Function of Bone, Joints, and Connective Tissue
- 1. Biology of the Normal Joint
- Classification of Joints
- Developmental Biology of the Diarthrodial Joint
- Interzone Formation and Joint Cavitation
- Cartilage Formation and Endochondral Ossification
- Development of Articular Cartilage
- Development of the Joint Capsule, Synovial Lining, Menisci, and Intracapsular Ligaments
- Development of Nonarticular Joints
- Organization and Physiology of the Mature Joint
- Synovium
- Joint Innervation
- Synovial Fluid and Nutrition of Joint Structures
- Generation and Clearance of Synovial Fluid
- Synovial Fluid as an Indicator of Joint Function
- Lubrication and Nutrition of the Articular Cartilage
- Mature Articular Cartilage
- Subchondral Bone
- Tendons
- Ligaments
- Bursae
- Menisci
- Conclusion
- 2. Synovium
- Structure
- Function
- Conclusion
- 3. Cartilage and Chondrocytes
- Introduction
- Cartilage Structure
- Structure-Function Relationships of Cartilage Matrix Components
- Morphology, Classification, and Normal Function of Chondrocytes
- Interactions of Chondrocytes With the Extra-cellular Matrix
- Angiogenic and Antiangiogenic Factors
- Roles of Growth and Differentiation (Anabolic) Factors in Normal Cartilage Metabolism
- Epigenetic Regulation of Cartilage Homeostasis
- Role of the Chondrocyte in Cartilage Pathology
- Conclusion
- 4. Biology, Physiology, and Morphology of Bone
- Structure and Composition of Bone
- Conclusion
- 5. Muscle: Anatomy, Physiology, and Biochemistry
- Introduction
- Structure
- Events During Muscle Contraction
- Transmission of Force to the Exterior
- Energetics
- Fatigue and Recovery
- Plasticity
- Aging
- Conclusion
- 6. Biomechanics
- Introduction
- Kinematics
- Kinetics
- Joint Biomechanics
- Joint Constraint and Stability
- Mechanical Loading on Tendon
- 7. Regenerative Medicine and Tissue Engineering
- Introduction
- Intrinsic Repair
- Emerging Clinical Applications Targeting Endogenous Repair
- Extrinsic Repair: Current Therapeutic Interventions
- Regenerative Medicine and Tissue Engineering in Arthritis
- Conclusion
- 8. Proteinases and Matrix Degradation
- Introduction
- Extra-cellular Matrix-Degrading Proteinases
- Regulation of Proteinase Activity
- Inhibition of Proteinases by Endogenous Inhibitors
- Part 2. Cells Involved in Autoimmune Diseases and Inflammation
- 9. Dendritic Cells
- Introduction
- Dendritic Cell Subsets and Development
- New Developments in Dendritic Cell Classification
- Impairment of Dendritic Cell Biology in Disease
- Immunotherapeutic Strategies and Clinical Trials
- Future Directions
- 10. Mononuclear Phagocytes
- Introduction
- Steady-State Development of Synovial Macrophages
- Transcriptional Regulation of Synovial Macrophages
- Synovial Macrophage Production of Cytokines and Chemokines
- Conclusion
- 11. Neutrophils
- Overview
- Neutrophil Development, Morphology, and Content
- Neutrophil Activation and Signal Transduction
- Neutrophil Function
- Heritable Disorders of Neutrophil Function
- Neutrophil Relevance to Rheumatic Disease
- Conclusion
- 12. T Lymphocytes
- Introduction
- T Cell Development
- Peripheral Migration and Homeostatic Proliferation of T Cells
- T Cell Subsets
- Future Directions
- 13. B Cells
- Introduction
- Immunoglobulins: Structure and Function
- B Cell Development
- Sites of B Cell Homing and Activation
- B Cell Activation and Differentiation
- Repertoire Selection
- B Cell–Mediated Autoimmunity
- Conclusion
- 14. Fibroblasts and Fibroblast-like Synoviocytes
- What Is a Fibroblast?
- Physiologic Characteristics and Functions of Fibroblasts
- Fibroblasts in Rheumatic Diseases
- Fibroblast-like Synoviocytes in Rheumatoid Arthritis
- Conclusion
- 15. Mast Cells
- Introduction
- Basic Biology of Mast Cells
- Role of Mast Cells in Health and Disease
- Conclusions
- 16. Innate Lymphoid Cells and Natural Killer Cells
- Introduction
- Biology of ILCs and NK Cells
- ILCs and Potential Contributions to Rheumatologic Disease
- Summary
- 17. Platelets and Megakaryocytes
- Introduction
- Platelet Structure
- Platelet Production
- Platelets and Hemostasis
- Signaling Pathways in Platelet Activation
- The Platelet as an Inflammatory Cell
- The Megakaryocyte as an Inflammatory Cell
- Platelets, Megakaryocytes, and Rheumatic Diseases
- Conclusion
- Part 3. Effector Mechanisms in Autoimmunity and Inflammation
- 18. Principles of Signaling
- Introduction
- Receptors With Enzymatic Activity
- Receptors That Recruit Molecules With Enzymatic Activity
- Innate Receptor Signaling
- Intra-cellular Receptor Signaling
- Adaptor Molecules
- Signaling Pathways
- Transcription Factors
- Conclusion
- 19. The Immunologic Repercussions of Cell Death
- Introduction
- Types of Cell Death
- Molecular Mechanisms of Caspase Activation
- Molecular Pathways of Regulated Necrosis
- Cell Death and Immunity
- Conclusion and Clinical Potential
- 20. Innate Immunity
- Introduction
- Evolutionary Origins of Innate Immunity
- Pathogen Recognition by the Innate Immune System
- PAMPs and DAMPs: Patterns for Innate Immune Recognition
- Effector Mechanisms of Innate Immune Responses
- Cell Types Mediating Innate Immunity
- Influence of Innate Mechanisms on Adaptive Immunity
- Disease Associations Involving Innate Immunity
- Future Directions
- Connection to the Clinic
- 21. Adaptive Immunity
- Introduction
- Phylogenetic Appearance of the Adaptive Immune System
- Cardinal Features of the Adaptive Immune System
- Cells of the Adaptive Immune System
- Development of Adaptive Immune Cells
- Anatomic Organization of the Peripheral Adaptive Immune System
- Trafficking of Adaptive Immune Cells
- Cell-to-Cell Interactions That Support Development of an Immune Response
- Consequences of Failed Development or Activation of the Adaptive Immune System
- Conclusion
- 22. Autoimmunity and Tolerance
- Introduction
- Definition and Classification of Pathogenic Autoimmunity
- Animal Models of Autoimmunity
- Tolerance Mechanisms
- Theories of Autoimmunity
- Immunologic Mechanisms of Tissue Inflammation and Dysfunction
- Pathophysiology of Autoimmune Rheumatic Diseases
- Genetics of Autoimmune Diseases
- Sex and Autoimmunity
- Microbial and Other Environmental Triggers
- Conclusion
- 23. The Microbiome in Health and Disease
- The Human Microbiome
- What Is the Microbiome?
- Principles of Host-Microbiome Interaction
- What Affects the Microbiome?
- How Is the Microbiome Determined From a Sample?
- How Are Microbiome Data Interpreted?
- What Can the Microbiome Be Used for Today?
- What Microbiome Principles From Other Areas of Medicine or Biology Can Be Applied to Rheumatology?
- How Will the Microbiome Be Useful to Rheumatologists in the Future?
- 24. Metabolic Regulation of Immunity
- Introduction
- Metabolic Rewiring in Innate Immunity
- Metabolic Rewiring in Adaptive Immunity
- Mitochondria and Immunity
- Metabolic Interplay in the Immune Microenvironment
- Conclusion
- 25. Genetics of Rheumatic Diseases
- Introduction
- Evidence for a Genetic Component to Rheumatic Diseases
- Study Design
- Identification of High-Risk Groups
- 26. Epigenetics of Rheumatic Diseases
- Introduction
- Epigenetic Regulation
- Epigenetics and the Immune Response
- Challenges Faced in Translational Epigenetics Research
- Epigenetics in Rheumatic Diseases
- Epigenetic Modifications as Biomarkers of Rheumatic Disease
- Future Directions
- 27. Complement System
- Introduction
- Functions of the Complement System
- Terminology Used to Describe Complement and Its Activation Fragments
- Activation Pathways
- Regulation of Complement Activation
- Receptors for Complement Fragments
- Functions of the Complement System
- Complement Deficiency
- Targeted Complement Therapeutics
- Complement in Rheumatic Diseases
- Conclusion
- 28. Prostaglandins, Leukotrienes, and Related Compounds
- Introduction
- Biosynthesis of Eicosanoids
- Products of the Cyclooxygenase Pathway
- Eicosanoid Receptors
- Platelet-Activating Factor
- Eicosanoids as Regulators of Inflammation and Immune Responses
- Modulation of Eicosanoid Synthesis by Administration of Precursor Fatty Acids
- 29. Chemokines and Cellular Recruitment
- Introduction
- Defining Membership of the Chemokine Family
- The Chemokine Nomenclature System
- The Inflammatory and Homeostatic Chemokine Model
- The Chemokine Receptor Family
- Atypical Chemokine Receptors
- Chemokines in an Evolutionary Context
- How Chemokines Attract Cells to Particular In Vivo Destinations
- Chemokines and Their Receptors in Disease
- Conclusion
- 30. Angiogenesis
- Introduction
- Endothelial Cells
- 31. Cytokines
- Introduction
- Classification of Cytokines
- Assessing Cytokine Function In Vitro and In Vivo
- Cytokine Receptors
- Regulation of Cytokine Expression
- Effector Function of Cytokines
- Cytokine Effects Beyond Immune Regulation
- Conclusion
- 32. Experimental Models for Rheumatoid Arthritis
- Introduction
- Arthritis Caused by Infectious Agents
- Arthritis Caused by Bacterial Fragments
- Adjuvant-Induced Arthritis
- Cartilage Protein-Induced Arthritis
- Spontaneous Arthritis
- Use of Animal Models
- Ethical Considerations
- Conclusion
- 33. Neuronal Regulation of Pain and Inflammation
- Introduction
- Primary Afferent Fibers
- Efferent Functions of Primary Afferent Fibers
- Neuronal Regulation of Inflammation in Acute Inflammatory Models
- Neuronal Regulation of Inflammation in Chronic Models of Inflammation
- Sympathetic Effects on Peripheral Inflammation Are Time Dependent
- Parasympathetic Effects on Peripheral Inflammation
- Role of Pain in Inflammatory Disease
- Part 4. Broad Issues in the Approach to Rheumatic Disease
- 34. Clinical Research Methods in Rheumatic Disease
- Introduction
- Measures of Disease Occurrence
- Measures of Effect
- Data Sources for Research in Rheumatology
- Clinical Research Study Designs
- Biases in Study Design
- Effect Measure Modification
- Screening
- Conclusion
- 35. Economic Impact of Arthritis and Rheumatic Conditions
- Introduction
- Cost-of-Illness Studies of Arthritis and the Rheumatic Conditions
- Summary
- 36. Assessment of Health Outcomes
- Introduction
- Health Outcome Assessments
- What Needs to Be Measured: Defining Measurement Needs
- Outcome Measures in Arthritis
- Deciding on an Instrument for a Health Outcome Assessment
- Examples of Arthritis Instruments
- Areas of Growth in Health Outcome Assessment
- Conclusion
- 37. Biomarkers in Rheumatology
- Biomarker Definitions and Applications
- Defining Patient Heterogeneity
- Pitfalls in Translation From Biomarker Discovery to Clinical Utility
- Surrogate Biomarkers
- Companion Diagnostics Versus CLIA Regulatory Routes
- Safety Biomarkers
- Biomarkers in Rheumatic Diseases
- Biomarkers in Osteoarthritis
- Biomarkers in Rheumatoid Arthritis
- Biomarkers in Systemic Lupus Erythematosus
- Next Horizons for Biomarkers
- 38. Occupational and Recreational Musculoskeletal Disorders
- Introduction
- Occupation-Related Musculoskeletal Disorders
- Occupation-Related Rheumatic Diseases
- Recreation- and Sports-Related Musculoskeletal Disorders
- Performing Arts–Related Musculoskeletal Disorders
- 39. Cardiovascular Risk in Inflammatory Rheumatic Disease
- Introduction
- Biologic Mechanisms: Relationship Between Inflammation and Cardiovascular Disease
- Cardiovascular Morbidity and Mortality in Rheumatoid Arthritis and Systemic Lupus Erythematosus
- Risk Factors for Cardiovascular Disease
- Cardiovascular Mortality, Morbidity, and Risk Factors in Other Rheumatic Diseases
- Managing Cardiovascular Risk in Rheumatic Disease
- Cardiovascular Disease Risk Assessment
- Conclusion
- 40. Cancer Risk in Rheumatic Diseases
- Introduction
- Malignancy in Autoimmune Rheumatic Diseases
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Systemic Sclerosis (Scleroderma)
- Idiopathic Inflammatory Myopathy
- Sjögren Syndrome
- Vasculitis
- Seronegative Spondyloarthritis
- Cancer Risks Associated With Anti-rheumatic Drug Therapies
- Nonbiologic DMARD Therapy
- Biologic Response Modifiers
- Cancer Screening in Patients With Rheumatic Disease
- Conclusion
- 41. Introduction to Physical Medicine and Rehabilitation
- Introduction
- Rehabilitation Interventions
- Specific Disorders
- Alternative, Innovative, and Emerging Therapeutic Approaches
- Conclusion
- 42. Pregnancy and Rheumatic Diseases
- Introduction
- Interplay of Rheumatic Disease and Pregnancy Physiology
- General Principles of Pregnancy and Rheumatic Disease: Pre-pregnancy Assessment
- Systemic Lupus Erythematosus
- Overlap Syndromes and Undifferentiated Connective Tissue Disease
- Sjögren’s Syndrome
- Antiphospholipid Antibody
- Inflammatory Arthritis
- Inflammatory Myositis
- Systemic Sclerosis
- Vasculitis
- Medications During Pregnancy and Breastfeeding
- Paternal Medication Use
- Pregnancy-Related Issues for Rheumatic Disease Patients
- Conclusion
- Part 5. Evaluation of Generalized and Localized Symptoms
- 43. History and Physical Examination of the Musculoskeletal System
- History in a Patient With Musculoskeletal Disease
- Systematic Method of Examination
- Recording the Joint Examination
- Interpreting the Joint Examination
- Examination of Specific Joints
- 44. Ultrasound in Rheumatology
- Introduction
- Technical Aspects
- Artifacts
- Examination Technique
- Ultrasound in Rheumatology Definitions
- Rheumatoid Arthritis
- Osteoarthritis
- Crystalline Arthropathy
- Gout
- Calcium Pyrophosphate Dihydrate Crystal Deposition
- Spondyloarthropathy
- Polymyalgia Rheumatica
- Giant Cell Arteritis
- Sjögren’s Syndrome
- Sclerosing Diseases
- Non-inflammatory Conditions
- Pediatric Rheumatology
- Ultrasound in Rheumatology Intervention
- Conclusion
- 45. Evaluation of Monoarticular and Polyarticular Arthritis
- Introduction
- Approach to the Patient With Arthritis
- Synovial or Bone Biopsy
- Differential Diagnosis
- Formal Criteria and Their Role in Clinical Diagnosis
- Preliminary Diagnoses, Working Diagnoses, Presumptive Treatments, Reassessments, and Future Perspectives
- 46. Skin and Rheumatic Diseases
- Diagnosis of Skin Lesions Associated With Rheumatic Diseases
- Psoriasis
- Reactive Arthritis
- Rheumatoid Arthritis
- Juvenile Rheumatoid Arthritis/Still’s Disease
- Lupus Erythematosus
- Neonatal Lupus Syndrome
- Sjögren’s Syndrome
- Dermatomyositis
- Morphea, Systemic Sclerosis, and Other Sclerosing Conditions
- Primary Vasculitis Involving the Skin
- Infections
- Panniculitis
- Relapsing Polychondritis
- Infiltrative Diseases
- Miscellaneous Skin Diseases and Arthritis
- 47. The Eye and Rheumatic Diseases
- Introduction
- Ocular Anatomy and Physiology
- Ocular Immune Response
- Uveitis
- Scleritis and Corneal Melt
- Orbital Disease
- Optic Neuritis
- Medication-Related Ocular Toxicity
- Conclusion
- Part 6. Differential Diagnosis of Regional and Diffuse Musculoskeletal Pain
- 48. Neck Pain
- Epidemiology
- Anatomy
- Axial Neck Pain
- Radiculopathy and Myelopathy
- Clinical Features
- Diagnostic Evaluation
- Differential Diagnosis and Treatment
- 49. Shoulder Pain
- Introduction
- Anatomy and Function
- Diagnosis
- Intrinsic Factors Causing Shoulder Pain
- Extrinsic or Regional Factors Causing Shoulder Pain
- 50. Low Back Pain
- Epidemiology
- Anatomy
- Clinical Evaluation
- Differential Diagnosis
- Spondylolisthesis
- Spinal Stenosis
- Diffuse Idiopathic Skeletal Hyperostosis
- Treatment
- Outcome
- Conclusion
- 51. Hip and Knee Pain
- Introduction
- Knee Pain
- Hip Pain
- 52. Foot and Ankle Pain
- Introduction
- Functional Anatomy and Biomechanics
- Diagnostic Evaluation
- Imaging
- Differential Diagnosis of Ankle Pain
- Differential Diagnosis of Foot Pain
- Nonoperative Treatment
- Operative Treatment
- Conclusion
- 53. Hand and Wrist Pain
- Introduction
- Patient Evaluation
- Physical Examination
- Common Causes of Hand and Wrist Pain
- 54. Temporomandibular Joint Pain
- Introduction
- Arthritis of the Temporomandibular Joint
- Internal Derangements
- Neoplasms
- Myofascial Pain and Dysfunction
- Conclusion
- 55. Fibromyalgia
- Introduction
- Historical Perspective
- Diagnostic Criteria
- Epidemiology
- Clinical Features
- Differential Diagnosis and Comorbidities
- Assessment of Severity
- Mechanisms of Disease
- Social and Psychological Factors
- Treatment Approaches
- Outcome
- Part 7. Diagnostic Tests and Procedures in Rheumatic Diseases
- 56. Synovial Fluid Analyses, Synovial Biopsy, and Synovial Pathology
- Introduction
- Synovial Fluid Analysis
- Biochemical Analysis of Synovial Fluid
- Synovial Biopsy
- Synovial Pathology
- Synovial Immunohistology
- Conclusion
- 57. Arthrocentesis and Injection of Joints and Soft Tissues
- Introduction
- Indications, Contraindications, and Potential Complications of Arthrocentesis and Soft Tissue Injections
- Drugs and Preparations Used for Injection
- Procedures Description
- Upper Limb Injections
- Lower Limbs Injections
- Soft Tissue Injections: Upper Limbs
- Soft Tissue Injections: Lower Limbs
- Conclusion
- 58. Anti-nuclear Antibodies
- Introduction
- History
- Relevance of Anti-nuclear Antibodies to Disease Pathogenesis
- Methods of Detection
- Interpretation of the FANA
- Diseases Associated With Anti-nuclear Antibodies
- Clinical Utility of Anti-nuclear Antibody Testing
- 59. Autoantibodies in Rheumatoid Arthritis
- Introduction
- Citrullination-Associated Autoantibodies
- Antibodies to Citrullinated Proteins
- Anti-citrullinated Protein Autoantibodies (ACPA)
- Antibodies to Peptidylarginine Deiminase Enzymes
- The Etiology and Pathogenesis of Citrullination-Associated Autoantibodies
- Origin and Pathogenesis of Citrullination-Associated Antibodies
- Mechanisms for Citrullination-Associated Autoantigen Production in the Rheumatoid Joint
- Antibodies to Chemically Modified Antigens
- Nonspecific Rheumatoid Arthritis Autoantibodies
- Conclusion
- 60. Acute Phase Reactants
- Introduction
- Acute Phase Response
- Acute Phase Reactants in the Management of Rheumatic Diseases
- Practical Use of Acute Phase Reactants
- C-Reactive Protein and Health: Associations with Nonrheumatologic Conditions
- 61. Imaging in Rheumatic Diseases
- Introduction
- Radiography
- Computed Tomography
- Magnetic Resonance Imaging
- Other Imaging Modalities
- Conclusion
- Part 8. Pharmacology of Anti-rheumatic Drugs
- 62. Therapeutic Targeting of Prostanoids
- Introduction
- History
- Mechanism of Action
- Pharmacology and Dosing
- Therapeutic Effects
- Adverse Effects
- Effects of Concomitant Drugs, Diseases, and Aging
- Choosing Anti-inflammatory Analgesic Therapy
- Conclusion
- 63. Glucocorticoid Therapy
- Introduction
- Characteristics of Glucocorticoids
- Genomic and Nongenomic Modes of Action
- Glucocorticoid Effects on Hypothalamic-Pituitary-Adrenal Axis
- Glucocorticoid Effects on the Immune System
- Pharmacology and Clinical Considerations
- Glucocorticoid Therapy
- Adverse Effects and Monitoring
- Future Directions
- 64. Traditional DMARDs: Methotrexate, Leflunomide, Sulfasalazine, Hydroxychloroquine, and Combination Therapies
- Methotrexate
- Leflunomide
- Anti-malarials
- Combination DMARD Therapy in Rheumatoid Arthritis
- 65. Immunosuppressive Drugs
- Introduction
- Cyclophosphamide
- Azathioprine
- Mycophenolate Mofetil
- Cyclosporine and Tacrolimus
- Conclusion
- 66. Anti-cytokine Therapies
- Introduction
- Tumor Necrosis Factor
- Interleukin-1
- Interleukin-6
- Interleukin-12/23
- Interleukin-17
- Dual Cytokine Inhibition
- JAK-STAT Pathway
- Monitoring When Treating With Cytokine Blockade
- Pregnancy and Breastfeeding
- Vaccinations
- Conclusion
- 67. Cell-Targeted Biologics and Emerging Targets: Rituximab, Abatacept, and Other Biologics
- Introduction
- Targeting B Cells
- Targeting Co-stimulatory Molecules
- Targeting T Cells
- Conclusion
- 68. Intra-cellular Targeting Agents in Rheumatic Disease
- Introduction
- Signal Transduction Pathways
- p38 MAPK Inhibitors
- MEK Inhibitors
- Spleen Tyrosine Kinase Inhibitors
- Janus Kinase Inhibitors
- BTK Inhibitors
- PI3K Inhibitors
- Sphingosine-1-Phosphate Modulators
- Phosphodiesterase Inhibitors
- Conclusion
- 69. Urate-Lowering Therapy
- Introduction
- Nonpharmacologic Treatment of Hyperuricemia
- Xanthine Oxidase Inhibition
- Febuxostat
- Uricosurics
- Uricases
- Future Directions
- 70. Bisphosphonates
- Introduction
- Clinical Pharmacology
- Chemistry of Bisphosphonates
- Pharmacokinetics
- Treatment Effects and Indications
- 71. Analgesic Agents in Rheumatic Disease
- Introduction
- Physiology of Pain Perception (the “Pain Experience”)
- Pain Classification
- Pharmacologic Treatment of Chronic Pain
- Opioids
- Anti-depressants
- Anti-convulsants
- Muscle Relaxants
- Emerging Targets
- 72. Nutrition and Rheumatic Diseases
- Introduction
- Nutrition and Inflammation
- Specialized Proresolving Mediators and N-3 Fatty Acids
- Nutrition in the Etiology of Rheumatic Diseases
- Nutrition in the Management of Rheumatic Diseases
- Conclusion
- 73. Evaluation and Management of Early Undifferentiated Arthritis
- Introduction
- Changing Definitions of Classifiable and Undifferentiated Arthritis
- Definition of “Early” Arthritis
- Evaluation of Early Undifferentiated Inflammatory Arthritis
- Management of Early Undifferentiated Arthritis
- VOLUME II
- Part 9. Rheumatoid Arthritis
- 74. Etiology of Rheumatoid Arthritis
- Introduction
- How Rheumatoid Arthritis Begins
- Genetic Risk
- 75. Pathogenesis of Rheumatoid Arthritis
- Introduction
- Synovial Disease and Biology
- Synovial Fluid and the Synovial Fluid Cartilage Interface
- Peripheral Blood Lymphocytes
- Role of T Cell Cytokines
- Macrophage and Fibroblast Cytokines
- Signal Transduction and Transcription Factors
- Cell Survival and Death in Rheumatoid Synovium
- The Synovial Vasculature
- Cartilage and Bone Destruction
- Conclusion
- 76. Clinical Features of Rheumatoid Arthritis
- Epidemiology and Disease Burden
- Pre-clinical Rheumatoid Arthritis
- Clinical Presentations of Early Rheumatoid Arthritis
- Course and Complications of Established Rheumatoid Arthritis
- 77. Treatment of Rheumatoid Arthritis
- Introduction
- Goal of Rheumatoid Arthritis Treatment
- Classes of Drugs
- Treatment Approaches and Strategies
- Interpreting Radiographic Progression and the Use of Other Imaging Modalities
- Adjuncts to Medications
- Comorbidities and the Interactions of Rheumatologists With Primary Care Physicians
- Perioperative Management of Rheumatoid Arthritis Medications
- Patients With Rheumatoid Arthritis Are Doing Better
- Research Agenda: Unmet Needs
- The Horizon
- 78. Sjögren’s Syndrome
- Historical Perspective
- Definitions and Classification Criteria
- Epidemiology
- Etiology and Pathogenesis
- Clinical Features
- Diagnosis and Diagnostic Tests
- Treatment
- Outcome
- Conclusion
- Part 10. Spondyloarthritis
- 79. Etiology and Pathogenesis of Spondyloarthritis
- Introduction
- Etiology of Spondyloarthritis
- Pathogenesis of Spondyloarthritis
- Structural Damage in Ankylosing Spondylitis
- Current and Future Therapeutic Targets in Spondyloarthritis
- 80. Ankylosing Spondylitis and Other Forms of Axial Spondyloarthritis
- Introduction
- Classification
- Epidemiology
- Genetics
- Pathogenesis
- Structural Remodeling and Ankylosis
- Clinical Manifestations
- Physical Examination
- Laboratory Tests
- Imaging
- Diagnosis
- Ankylosing Spondylitis in Males and Females
- Outcome
- Assessment and Monitoring
- Conclusion
- 81. Reactive Arthritis
- Reactive Arthritis
- Undifferentiated Spondyloarthritis
- 82. Psoriatic Arthritis
- Introduction
- Epidemiology
- Clinical Features
- Differential Diagnosis
- Laboratory Features
- Radiographic Features
- Musculoskeletal Ultrasound
- Diagnosis and Classification Criteria
- Clinical Course and Outcome
- Comorbidities in Psoriatic Arthritis
- Outcome Domains and Instruments
- Pathogenesis
- Pathogenesis Summary
- Treatment
- Biologics (boDMARDs and bsDMARDs)
- Conclusion
- 83. Inflammatory Bowel Disease–Associated Arthritis and Other Enteropathic Arthropathies
- Introduction
- Inflammatory Bowel Disease-Associated Arthritis
- Pathophysiology of Spondyloarthritis and Inflammatory Bowel Disease: From Gut Mucosa and Microbiome to Joint Disease
- Clinical Manifestations and Diagnosis of Inflammatory Bowel Disease-Associated Arthritis
- Assessing and Monitoring Disease Activity
- Other Enteropathic Arthropathies
- Part 11. Systemic Lupus Erythematosus and Related Syndromes
- 84. Etiology and Pathogenesis of Systemic Lupus Erythematosus
- Introduction
- Historic View of Lupus Pathogenesis
- Genetic Contributions to Lupus Pathogenesis
- Female Predominance of Systemic Lupus Erythematosus
- Environmental Triggers of Lupus
- Innate Immune System Activation in Systemic Lupus Erythematosus
- Adaptive Immune System Alterations in Systemic Lupus Erythematosus
- Autoimmunity in Systemic Lupus Erythematosus
- Mechanisms of Target Organ Damage
- Conclusion
- 85. Clinical Features of Systemic Lupus Erythematosus
- Introduction
- Epidemiology
- Clinical Features
- Diagnosis
- Differential Diagnosis
- Neonatal Lupus
- 86. Treatment of Systemic Lupus Erythematosus
- Clinical Course and General Treatment Strategy
- Patient and Physician Preferences
- Drugs Used in the Treatment of Systemic Lupus Erythematosus
- Calcineurin Inhibitors
- Other Nonbiologic Therapies
- Biologic Therapies
- Novel Biologics and Currently Tested Therapies
- Management of Specific Systemic Lupus Erythematosus Manifestations and Treatment Algorithms
- Special Issues: Treat-to-Target, Refractory Disease and Lupus in Pregnancy
- Comorbidities
- Women’s Health Issues
- Evidence and Expert-Based Recommendations in Systemic Lupus Erythematosus
- Current Trends and Future Perspectives
- 87. Antiphospholipid Syndrome
- Introduction
- Epidemiology
- Etiology
- Pathogenesis
- Clinical Features
- Diagnosis and Diagnostic Tests
- Treatment
- Outcome
- Part 12. Systemic Sclerosis, Inflammatory Myopathies, and Overlap Syndromes
- 88. Etiology and Pathogenesis of Systemic Sclerosis
- Introduction
- Etiology
- Infectious Agents and Viruses
- Environmental Exposures, Dietary Factors, Drugs, and Radiation
- Microbiome Alterations in Scleroderma or Systemic Sclerosis
- Microchimerism
- Pathology
- Organ-Specific Pathologic Findings
- Animal Models of Scleroderma
- Pathogenesis
- Inflammation and Immune Dysregulation in the Pathogenesis of Systemic Sclerosis
- Humoral Autoimmunity and B Cells
- Fibrosis
- Cellular Senescence and Fibrosis in Scleroderma or Systemic Sclerosis
- Molecular Determinants of Fibrosis: Transforming Growth Factor-β
- Cytokines, Growth Factors, Chemokines, and Lipid Mediators
- The Scleroderma Fibroblast
- Conclusion
- 89. Clinical Features and Treatment of Scleroderma
- Historical Perspective
- Epidemiology
- Clinical Features
- General Principles of Disease Evaluation
- Clinical Manifestations
- Treatment
- Conclusion of Current Practical Recommendations for Treatment
- 90. Inflammatory Diseases of Muscle and Other Myopathies
- Introduction
- Epidemiology
- Etiology of Myositis
- Pathogenesis
- Clinical Features
- Classification and Diagnostic Criteria
- Physical Findings
- Laboratory Findings
- Imaging
- Electromyography
- Pulmonary Function Tests
- Differential Diagnosis
- Management and Outcome
- 91. Overlap Syndromes
- Introduction
- Historical Background
- Immunogenetics of Overlap Syndromes
- Autoantibodies in Overlap Syndromes
- Mixed Connective Tissue Disease
- Patients Presenting With Undifferentiated Rheumatic Disease
- Treatment of Overlap Connective Tissue Disease Syndromes
- Part 13. Vasculitis
- 92. Classification and Epidemiology of Systemic Vasculitis
- Introduction
- Classification of Vasculitis
- Epidemiology of Vasculitis
- 93. Giant Cell Arteritis, Polymyalgia Rheumatica, and Takayasu’s Arteritis
- Introduction
- Giant Cell Arteritis and Polymyalgia Rheumatica
- Takayasu’s Arteritis
- 94. Anti-neutrophil Cytoplasmic Antibody–Associated Vasculitis
- Introduction
- Classification Criteria and Nomenclature
- Epidemiology
- Genetics
- Clinical Manifestations
- Diagnostic Testing
- Treatment
- Outcome
- Pathogenesis
- Conclusion
- 95. Polyarteritis Nodosa and Related Disorders
- Polyarteritis Nodosa
- Cogan’s Syndrome
- Buerger’s Disease
- Susac’s Syndrome
- Virus-Induced Vasculitis
- Infections and Vasculitis
- 96. Immune Complex–Mediated Small Vessel Vasculitis
- Introduction
- Pathogenesis
- Cutaneous Manifestations
- Pathology Features
- Differential Diagnosis
- Clinical Syndromes
- 97. Primary Angiitis of the Central Nervous System
- Introduction
- Epidemiology
- Genetics
- Clinical Features
- Clinical Subsets
- Diagnosis and Diagnostic Tests
- Differential Diagnosis
- Treatment
- Outcome
- Conclusion
- 98. Behçet’s Disease
- Introduction
- Epidemiology
- Pathogenesis
- Clinical Features
- Diagnosis
- Treatment
- Prognosis
- Part 14. Crystal-Induced and Inflammasome-Mediated Inflammation
- 99. Pathogenesis of Inflammasome-Mediated Diseases
- Introduction
- Inflammasome Biology
- NLRP1
- NLRP3
- Pyrin
- The Pathogenesis of Mevalonate Kinase Deficiency
- NLRC4
- Other Inflammasomes
- Inflammasomes in Autoimmunity
- Inflammasome-Targeted Therapies
- Conclusion
- 100. Etiology and Pathogenesis of Hyperuricemia and Gout
- Introduction
- Evolutionary Considerations
- Determinants of Serum Urate Levels
- Crystal Formation: The Transition From Hyperuricemia to Gout
- Acute Gout Flares: The Inflammatory Response to Monosodium Urate Crystals
- Asymptomatic Hyperuricemia
- 101. Clinical Features and Treatment of Gout
- Classification
- Clinical Features of Gout
- Gout Management
- Outcome
- 102. Calcium Crystal Disease: Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate
- Introduction
- Epidemiology
- Genetics
- Etiology and Pathogenesis
- Clinical Features
- Articular Basic Calcium Phosphate Crystal Disease
- Diagnosis and Diagnostic Tests
- Treatment
- Outcome
- Conclusion
- 103. Familial Autoinflammatory Syndromes
- Introduction
- Differential Diagnosis
- The Four ‘Classic’ Hereditary Autoinflammatory Syndromes
- Other Hereditary Autoinflammatory Syndromes
- Conclusion
- Part 15. Cartilage, Bone, and Heritable Connective Tissue Disorders
- 104. Pathogenesis of Osteoarthritis
- Introduction
- Etiology
- Pathology
- Alterations in Cartilage Matrix Metabolism
- Proteinases
- Alterations in Matrix Synthesis
- Chondrocyte Senescence
- Biomechanics and Disease Mechanisms
- Mechanotransduction and Gene Expression
- Bone Abnormalities
- Role of Inflammatory Mediators in Disease Progression
- Conclusion
- 105. Clinical Features of Osteoarthritis
- Introduction
- Epidemiology of Osteoarthritis
- Clinical Features
- Diagnostic Testing
- Outcome
- Conclusion
- 106. Treatment of Osteoarthritis
- Introduction
- Therapeutic Pain Targets in Osteoarthritis
- Approach to Management of Osteoarthritis
- 107. Metabolic Bone Disease
- Introduction
- Osteoporosis
- Treatment
- Glucocorticoid-Induced Osteoporosis
- Osteomalacia
- Paget’s Disease of Bone
- Osteoporosis Induced by Other Medications
- 108. Proliferative Bone Diseases
- Introduction
- Diffuse Idiopathic Skeletal Hyperostosis
- Hypertrophic Osteoarthropathy
- SAPHO Syndrome
- 109. Osteonecrosis
- Introduction
- Epidemiology
- Etiology
- Clinical Variants
- Staging Osteonecrosis
- Pathogenesis
- Diagnosis
- The Natural History of Osteonecrosis
- Treatment of Osteonecrosis
- Conclusion
- 110. Relapsing Polychondritis
- Introduction
- Epidemiology
- Pathology
- Pathogenesis
- Clinical Features
- Associated Disorders
- Differential Diagnosis
- Diagnostic Tests
- Treatment
- Outcome
- Conclusion
- 111. Heritable Diseases of Connective Tissue
- Introduction
- Skeletal Dysplasias
- Defects in Extra-cellular Structural Proteins
- Osteogenesis Imperfecta
- Ehlers-Danlos Syndrome
- Marfan Syndrome
- Loeys-Dietz Syndrome
- Congenital Contractural Arachnodactyly
- Conclusion
- Part 16. Rheumatic Diseases of Childhood
- 112. Etiology and Pathogenesis of Juvenile Idiopathic Arthritis
- Introduction
- Epidemiology
- Histopathology
- Environmental Triggers of Disease
- Host Triggers of Disease
- Subtype-Specific Pathogenesis
- Conclusion
- 113. Clinical Features and Treatment of Juvenile Idiopathic Arthritis
- Introduction
- Classification Criteria for Juvenile Idiopathic Arthritis and Differential Diagnosis
- Oligoarticular Juvenile Idiopathic Arthritis
- Rheumatoid Factor–Negative Polyarticular Juvenile Idiopathic Arthritis
- Rheumatoid Factor–Positive Polyarticular Juvenile Idiopathic Arthritis
- Juvenile Spondyloarthritis andEnthesitis-Related Arthritis
- Juvenile Psoriatic Arthritis
- Systemic Juvenile Idiopathic Arthritis
- Treatment
- Treatment of Juvenile Idiopathic Arthritis Subtypes
- Clinical Features and Management of Juvenile Idiopathic Arthritis-Associated Uveitis
- Imaging
- Outcome
- Special Considerations in Children
- Conclusion
- 114. Childhood-Onset Systemic Lupus Erythematosus, Drug-Induced Lupus in Children, and Neonatal Lupus
- Childhood-Onset Systemic Lupus Erythematosus
- Drug-Induced Lupus
- Neonatal Lupus
- 115. Juvenile Dermatomyositis, Scleroderma, Vasculitis, and Autoimmune Brain Disease
- Juvenile Dermatomyositis
- Pediatric Scleroderma: Systemic and Localized Forms
- Pediatric Vasculitis
- Autoimmune Brain Disease
- Central Nervous System Vasculitis
- Central Nervous System Vasculitis
- Autoimmune Encephalitis
- Definition/Classification
- Epidemiology
- Clinical Manifestations
- Diagnostic Evaluation
- Treatment
- Autoimmune Encephalitis Clinical Syndromes
- Acquired Demyelinating Syndromes
- Part 17. Infection and Arthritis
- 116. Bacterial Arthritis
- Epidemiology
- Etiology
- Pathogenesis
- Clinical Features
- Diagnosis and Diagnostic Tests
- Treatment
- Prosthetic Joint Infections
- Conclusion
- 117. Lyme Disease
- Introduction
- Ecology and Epidemiology of Lyme Disease
- Ticks and Lyme Disease
- Pathogenesis
- Clinical Features
- Lyme Arthritis and Other Musculoskeletal Manifestations of Lyme Disease
- Diagnosis
- Treatment and Outcome
- Outcome
- Prevention
- Conclusion
- 118. Mycobacterial Infections of Bones and Joints
- Introduction
- Clinical Scenarios
- Diagnosis
- Treatment
- Osteoarticular Infections Caused by Nontuberculous Mycobacteria
- Emergence of Nontuberculous Mycobacterial Infections During the Treatment of Rheumatic Diseases
- 119. Fungal Infections of Bones and Joints
- Introduction
- Coccidioidomycosis
- Blastomycosis
- Cryptococcosis
- Candidiasis
- Sporotrichosis
- Aspergillosis
- Histoplasmosis
- Scedosporiosis
- Treatment of Fungal Infection
- Fungal Infection as a Consequence of Anti-rheumatic Therapy
- 120. Rheumatic Manifestations of HIV Infection
- Introduction
- HIV-Associated Bone and Joint Disease
- HIV-Associated Muscle Disease
- Diffuse Infiltrative Lymphocytosis Syndrome
- Vasculitis Associated With HIV Infection
- Primary Pulmonary Hypertension
- HIV-Associated Musculoskeletal Infection
- Response of Other Rheumatic Diseases to HIV Infection
- Highly Active Anti-retroviral Therapy-Related Immune Reconstitution Syndrome
- Rheumatologic Laboratory Abnormalities Associated With HIV Infection
- Conclusion
- 121. Viral Arthritis
- Introduction
- Examples of Arthritogenic Viruses
- Treatment and Prevention
- Conclusion
- 122. Rheumatic Fever and Post-streptococcal Arthritis
- Introduction
- Rheumatic Fever and Rheumatic Heart Disease
- Post-streptococcal Arthritis
- Conclusion
- Part 18. Arthritis Accompanying Systemic Disease
- 123. Amyloidosis
- Introduction
- AA Amyloidosis
- Other Types of Systemic Amyloidosis
- Diagnosis and Diagnostic Tests
- Treatment of AA Amyloidosis
- Outcome
- Conclusion
- 124. Sarcoidosis
- Introduction
- Classification Criteria
- Epidemiology
- Etiology
- Genetics
- Pathogenesis
- Clinical Features
- Diagnosis and Diagnostic Tests
- Treatment
- Outcome and Prognosis
- Conclusion
- 125. Hemochromatosis
- Introduction
- Iron Metabolism in Health and Disease
- Genetics
- Epidemiology
- Influence of Other Genes and Environment
- Pathogenesis
- Clinical Features
- Differential Diagnosis
- Diagnostic Tests
- Screening
- Treatment
- Outcome
- Conclusion
- 126. Hemophilic Arthropathy
- Introduction
- Clinical Features
- Diagnosis
- Pathogenesis
- Treatment of Hemophilia
- Treatment of Musculoskeletal Complications
- Conclusion
- 127. Rheumatic Manifestations of Hemoglobinopathies
- Introduction
- Thalassemias
- Sickle Cell Anemia and Related Disorders
- Diagnosis
- Treatment
- Musculoskeletal Involvement: Sickle Cell Disease
- Musculoskeletal Involvement: Thalassemias
- Comorbid Rheumatic Disease
- Conclusion
- 128. IgG4-Related Disease
- Introduction
- Epidemiology
- Pathology Features
- Serum IgG4 Concentrations
- Pathophysiology
- Clinical Manifestations
- Differential Diagnosis
- Treatment
- 129. Arthritis Accompanying Endocrine and Metabolic Disorders
- Introduction
- Adrenal Gland Disorders
- Acromegaly
- Hypothalamic-Gonadal Axis
- Diabetes Mellitus
- Hyperthyroidism
- Hypothyroidism
- Hypoparathyroidism
- Hyperparathyroidism
- Lipid Disorders
- 130. Rheumatic Paraneoplastic Syndromes—Links Between Malignancy and Autoimmunity
- Introduction
- Paraneoplastic Arthritis (PA)
- Palmar Fasciitis and Polyarthritis Syndrome (PFPAS)
- Remitting Seronegative Symmetrical Synovitis With Pitting Edema (RS3PE)
- Pancreatic Panniculitis and Polyarthritis (PPP)
- Erythromelalgia
- Paraneoplastic Vasculitis
- Cancer-Associated Myositis (CAM)
- Hypertrophic (Pulmonary) Osteoarthropathy (HOA)
- Tumor-Induced Osteomalacia (TIO)
- Conclusion
- 131. Tumors and Tumor-like Lesions of Joints and Related Structures
- Introduction
- Non-neoplastic Lesions
- Neoplasms
- Malignant Tumors of the Joint
- 132. Autoimmune Complications of Immune Checkpoint Inhibitors for Cancer
- Introduction
- Immune-Related Adverse Events (irAEs)
- Rheumatologic Immune-Related Adverse Events
- Treatment of Rheumatologic Immune-Related Adverse Events
- Pre-existing Autoimmune Disease and Immune Checkpoint Inhibitor Use
- Index
- Chapter Acknowledgments
- No. of pages: 2400
- Language: English
- Edition: 11
- Published: July 5, 2020
- Imprint: Elsevier
- Hardback ISBN: 9780323639200
- eBook ISBN: 9780323639217
GK
Gary Koretzky
Gary Koretzky, MD, PhD is Professor of Medicine at Weill Cornell Graduate School. Dr. Koretzky’s research aims to better understand the signal transduction events that occur following engagement of the T cell antigen receptor. He has been continuously funded by the National Institutes of Health since establishing his independent research group, as the laboratory has expanded its interests to study more globally the molecular events important for immune cell development, differentiation and function. Dr. Koretzky has published more than 200 research articles. He is a past President of the American Society of Clinical Investigation (2000) and Councilor of the Association of American Physicians (2008-2012), is a Fellow of the American Association for the Advancement of Science (2004), a member of the Institute of Medicine of the National Academies (2008), a Fellow of the American Academy of Arts & Sciences (2012) and serves as the Editor-in-Chief of Immunological Reviews (2002-present).
Affiliations and expertise
Vice Dean at Weill Cornell Medical College, Frank H.T. Rhodes Distinguished Professor of Cardiovascular Biology and Genetics.GF
Gary S. Firestein
Gary Firestein, MD, is a board-certified rheumatologist who diagnoses and treats patients with autoimmune conditions as well as diseases of the joints, muscles and bones. A professor at UC San Diego School of Medicine, Dr. Firestein is distinguished for his research and serves as director of the Altman Clinical and Translational Research Institute and the senior associate vice chancellor for health sciences. Dr. Firestein's research interest focuses on the pathogenesis and treatment of rheumatoid arthritis.
Dr. Firestein is the recipient of many awards and honors, including the Arthritis Foundation's Jane Wyman Humanitarian Award in 2010 for his contributions to rheumatology; the Arthritis Foundation Lee C. Howley Sr. Prize for Arthritis Research; and the American College of Rheumatology Distinguished Investigator Award. He has been elected to the American Society for Clinical Investigation and the Association of American Physicians. He has served as an editor for the Textbook of Rheumatology for since the 7th edition (2004).
Affiliations and expertise
Distinguished Professor of Medicine, Senior Associate Vice Chancellor for Health Sciences, Director, Altman Clinical & Translational Research InstituteRB
Ralph C. Budd
Affiliations and expertise
Professor of Medicine and Microbiology and Molecular Genetics, Director, Vermont Center for Immunology and Infectious Diseases, University of Vermont College of Medicine Distinguished University Professor, The University of Vermont College of Medicine, Burlington, VermontSG
Sherine E Gabriel
Affiliations and expertise
Professor and Dean, Rutgers Robert Wood Johnson Medical School, CEO, Robert Wood Johnson Medical Group, Emeritus Professor, Mayo Clinic, New Brunswick, New JerseyIM
Iain B McInnes
Iain McInnes is Director of the Institute of Infection, Immunity and Inflammation at the University of Glasgow, UK. He has extensive experience in leading multicenter programs nationally and internationally. He is Director of the Scottish MRC Clinical Pharmacology and Pathology Clinical PhD Training Program, Chief Investigator for the Scottish Early RA Cohort (SERA) and the related SMS-IC biomarker discovery program (PROMISERA), and chief investigator of numerous global phase II and III clinical trials of novel immune therapies. He has served as member or chair of numerous national grant-funding panels and as chair of several European League Against Rheumatism (EULAR) scientific committees – he is now Treasurer and President Elect of EULAR serving on its Steering Committee. He is formerly Chairman of the Foundation for European Rheumatology Research (Foreum) Scientific Committee and leads the EULAR-supported European Roadmap Program that is defining the research agenda for rheumatology for the next decade.
Affiliations and expertise
Muirhead Professor of Medicine, Arthritis Research UK Professor of Rheumatology, Director of Institute of Infection,Immunity, and Inflammation, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, United KingdomJO
James R. O'Dell
James R. O’Dell, MD is the Stokes Shackleford Professor of Internal Medicine, Vice-Chairman of Internal Medicine and Chief of the Division of Rheumatology at the University of Nebraska Medical Center (UNMC) in Omaha. Dr. O’Dell founded and has directed the Rheumatoid Arthritis Investigational Network (RAIN) for the last 25 years. Dr. O’Dell is the PI of the large multinational RA research study based at the VA through their cooperative studies program. Dr. O’Dell has published extensively, mostly in the area of rheumatoid arthritis. He has presented frequently at national and international meetings and has more than 100 published articles in top-level rheumatology journals. He has served on numerous American College of Rheumatology (ACR) committees over the last 20 years, including time on both the ACR and REF BOD, as well as a two-year term as President of the Research and Education Foundation of the ACR and was President of the College (2011-2012). Additionally, he is Editor-in-Chief of Up To Date for Rheumatology.
Affiliations and expertise
Bruce Professor and Vice Chairman of Internal Medicine, University of Nebraska Medical Center, Chief of Rheumatology, Department of Medicine, Omaha Veterans Affairs, Omaha, Nebraska