Rheumatology Commons^™

When Tnf Inhibition Backfires: A Rare Case Of Etanercept Induced Pyoderma Gangrenosum, Don Woody, Julio Paoli-Gonzalez, Adam Grunbaum

West Florida Division GME Research Day 2026

No abstract provided.

Systemic Sclerosis-Associated Interstitial Lung Disease: Improved Understanding And Advances In Management, Amit Syal, Chris T. Derk

Student Papers, Posters & Projects

Interstitial lung disease (ILD), a common manifestation of systemic sclerosis (SSc), has the highest organ-specific morbidity and mortality, particularly in patients with diffuse cutaneous SSc (dcSSc). Recent advances in diagnostics-including artificial intelligence (AI)-enhanced high-resolution computed tomography (HRCT) and biomarkers such as Krebs van den Lungen (KL)-6-have enabled earlier detection and monitoring of disease progression. Therapeutically, the approval of antifibrotics like nintedanib (NINT) and immunomodulators such as tocilizumab (Toci) has significantly expanded treatment options. Updated international guidelines from the American College of Rheumatology (ACR), American College of Chest Physicians (CHEST), American Thoracic Society (ATS), and European league against Rheumatism (EULAR) now …

Neutrophil Lymphocyte Ratio As A Marker Of Skin Disease Activity In Older Children With Juvenile Dermatomyositis, Shreya Swaminathan, Nidhi Naik, Susan Shenoi, Sarah Vandenbergen, Jessica L. Turnier, Zilan Zheng, Jessica Neely, James S. Andrews, Christian Lood

Student Papers, Posters & Projects

BACKGROUND: Neutrophils contribute to the pathogenesis of many autoimmune diseases. While the neutrophil to lymphocyte ratio (NLR) is associated with disease activity in adult dermatomyositis, its clinical utility in juvenile dermatomyositis (JDM) is unknown.

METHODS: Demographic, medication use, autoantibody profile, disease activity markers, and laboratory data from 97 JDM patients was collected using retrospective chart review. Patients were age-stratified (0–9 vs. 9–21 years of age), as white blood cell count stabilizes at 9 years. The relationships between NLR with JDM disease activity measures were analyzed using spearman’s correlation.

RESULTS: Patients were primarily white (56.7%) and female (71.1%). Older children had …

Delayed Diagnosis Of Systemic Lupus Erythematosus Presenting As Autoimmune Hemolytic Anemia: A Case For Heightened Clinical Suspicion, Diana Acosta Pozo, Luis Álvarez Pérez

Research Colloquium

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, including hematologic manifestations. Autoimmune Hemolytic Anemia (AIHA), though an established feature, is relatively uncommon and may occur early or in isolation. When AIHA presents without overt systemic symptoms, the underlying autoimmune etiology may be overlooked, resulting in delays in diagnosis and treatment. Prompt recognition is essential to prevent unnecessary interventions and prolonged morbidity.

Case Presentation: A 39-year-old woman residing in Texas presented to the Rheumatology office with persistent synovitis and severe transfusion-dependent anemia, requiring red blood cell transfusions every 48 hours for over three months. She …

A Systematic Review On Belimumab’S Effectiveness, Improved Health Outcomes And Quality Of Life In Patients With Lupus Syndromes, Emily Meale, Alexandra Fontaine

Rowan-Virtua Research Day

Autoimmune diseases are prevalent disorders that many individuals within the United States suffer from. Systemic lupus erythematosus (SLE) is a common autoimmune disease that has a high incidence in women of child-bearing age. Management for lupus depends on the anatomical location SLE manifests, the severity of disease, and the tolerance that one has for certain adverse effects. Glucocorticoids are commonly used to manage lupus. Currently, long term glucocorticoid usage is associated with devastating adverse effects, so current treatment options aim to mitigate corticosteroids use to improve quality of life while maintaining favorable health outcomes. New management for SLE include biologics …

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

“Lupus, Marijuana, And Takotsubo: A Perfect Storm”: An Unusual Presentation Of Takotsubo Cardiomyopathy, Matthew Orap, Parth Patel, Haitham Dib

Rowan-Virtua Research Day

Takotsubo cardiomyopathy is a type of myocardial injury that is marked with left ventricular contraction dysfunction. Various regions of the left ventricular wall may exhibit hypokinetic or hypercontractile activity. There is no exact mechanism elucidated for Takotsubo cardiomyopathy, but it is often associated with a triggering stressful event that leads to a catecholamine surge. We describe a 38-year-old female who presented with typical Takotsubo cardiomyopathy, likely in the setting of worsening systemic lupus erythematosus (SLE) exacerbations and excessive cannabis use. The patient described her pain as a tight burning sensation that started on her right side and traveled to the …

A Literature Review Of Current Treatments For The Hypermobility Subtype Of Ehlers-Danlos Syndrome, John Gericke, Mary Zsolway, Chelsea Reyes, Pooja Patel, Saad Ahmed, Julia Hwang, Venkateswar Venkataraman

Rowan-Virtua Research Day

Purpose: The purpose of this study is to compare pharmacologic intervention, neurocognitive therapy, physical therapy, and orthotics in treating the hypermobility subtype of Ehlers-Danlos Syndrome (hEDS) and determine which has the most positive effect on symptoms.

Introduction: Ehlers-Danlos Syndrome is an inheritable connective tissue disorder which results from a genetic mutation that alters the body’s ability to produce collagen. The most common subtype of Ehlers-Danlos Syndrome is hEDS, which leads to hypermobility and hyperextensibility and can cause frequent joint dislocations.

Methods: A review of literature was performed to compare each treatment based on reported results. The types of studies reviewed …

Examining The Matrix: A Case Of Anti-Nuclear Matrix Protein 2 (Nxp-2) Positive Dermatomyositis, Victoria Cuello, Ramiro Oquita, Emilia Dulgheru

Research Symposium

Background: Dermatomyositis is a disease characterized by proximal muscle weakness, elevated muscle enzymes and cutaneous skin findings including heliotrope rash, periungual erythema, Gottron’s papules/sign and shawl-sign. Myositis-specific autoantibodies (MSA) can be used to predict disease manifestations, response to therapy and prognosis. Specifically, patients with dermatomyositis with positive anti-nuclear matrix protein (NXP-2) typically present with classical skin findings, subcutaneous edema, profound muscle weakness, severe dysphagia and hypophonia.

Case Presentation: A 21-year-old Hispanic lady presented to the hospital for severe muscle weakness. She reported soreness in her thighs for three months prior to presentation followed by arm soreness. She also developed a …

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Adipocytes And Innate Immunity In Systemic Sclerosis, Nancy Wareing

Dissertations and Theses (Open Access)

Systemic sclerosis (SSc; scleroderma) is a chronic systemic autoimmune and connective tissue disorder characterized by vasculopathy, autoimmune phenomena, and widespread fibrosis. Skin thickening and tightening is the cardinal feature of SSc and is responsible, in part, for the considerable morbidity of this disease. There are currently no targeted treatments for skin manifestations in SSc, primarily due to our fragmented understanding of its pathophysiologic mechanisms. In PART I, we report a previously unappreciated link between aberrant expression of the developmental gene sine oculis homeobox homolog 1 (SIX1) in skin-associated adipocytes in SSc skin and the early loss of dermal white adipose …

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Vasculitides, Julianna S. Kang, Julia Nunley, Tiffany Ho, Mavra Masood, Fnu Nutan, Beth Rubinstein

Open and Affordable Course Content at VCU

No abstract provided.

Dermatologic Manifestations Of Rheumatic Disease: Malignant Cutaneous Tumors, Divya Shan, Julianna S. Kang, Allison Cinats, Julia R. Nunley, Beth Rubinstein

Open and Affordable Course Content at VCU

No abstract provided.

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Sarcoidosis, Sarah Shapiro, Sindhuja Koppu, Mavra Masood, Beth Rubinstein, Huzaefah Syed

Open and Affordable Course Content at VCU

No abstract provided.

Multi-Digit Auto-Amputation In Setting Of Mixed Connective Tissue Disease, Kishan P. Patel, Jennifer L. Medlin, Michelene Hearth-Holmes

Graduate Medical Education Research Journal

Raynaud’s disease is a cutaneous manifestation often present in various connective tissue and vascular diseases. Depending on the age of onset and acuity of symptoms, the phenomenon can provide clinicians with some insight as to the severity of underlying disease, including the distinction between primary and secondary Raynaud’s. However, this diagnostic approach seems to have its limitations regarding efficacy and timing of treatment. Traditionally, treatment of Raynaud’s has focused on reestablishing blood perfusion to affected tissue, which has previously been achieved with vasodilatory medications and site-specific surgical intervention. In lieu of the severe sequelae of Raynaud’s in the setting of …

Modulation Of Hedgehog Signaling By Kappa Opioids To Attenuate Osteoarthritis, Alexander E Weber, Omid Jalali, Sean Limfat, Ruzanna Shkhyan, Robert Van Der Horst, Siyoung Lee, Yucheng Lin, Liangliang Li, Erik N Mayer, Liming Wang, Nancy Q Liu, Frank A Petrigliano, Jay R Lieberman, Denis Evseenko

Faculty, Staff and Students Publications

OBJECTIVE: Inhibition of hedgehog (HH) signaling prevents cartilage degeneration and promotes repair in animal models of osteoarthritis (OA). This study, undertaken in OA models and in human OA articular cartilage, was designed to explore whether kappa opioid receptor (KOR) modulation via the inhibition of HH signaling may have therapeutic potential for achieving disease-modifying activity in OA.

METHODS: Primary human articular cartilage and synovial tissue samples from patients with knee OA undergoing total joint replacement and from healthy human subjects were obtained from the National Disease Research Interchange. For in vivo animal studies, a partial medial meniscectomy (PMM) model of knee …

A Case Of Systemic Sclerosis Sine Scleroderma, Adrian Lugo, Andrew Cappiello, Nemer Dabage, Guruswamy Ramamurthy

West Florida Division GME Research Day 2020

• Scleroderma and systemic sclerosis are autoimmune phenomena that can cause progressive and permanent damage to the organs of the human body.
• They can cause fibrosis of various internal organs, including the kidneys, lungs, GI tract, and heart
• Rarely, the only manifestation of systemic sclerosis is severe hypertension with renal failure, a subset known as systemic sclerosis sine scleroderma.

Does Patient-Provider Race/Ethnicity Concordance Impact Outcomes For Adults With Lupus?, Pamela C. Delis Phd, Rn, Cne, Inge B. Corless Phd, Rn, Fnap, Faan, Indigo Young Ms, Ccc-Slp, Mary W. Hildebrand Otd,Otr/L, Jessica G. Bell Ms, Amanda Tarbet Mslis

Journal of Health Disparities Research and Practice

Background: Health disparities exist among the 1.5 million Americans with lupus, with women of color bearing higher disease rates and burden. Complex reasons include genetics, comorbidities, and socioeconomics. These factors may lead to differences in health-related outcomes in lupus.

Aim: To determine if patient-provider racial/ethnic concordance plays a role in outcomes for adults with lupus.

Method: For this scoping review, the authors searched PubMed Medline and CINAHL using keywords and subject headings for lupus, race or ethnicity, and patient-health professional concordance.

Results: Despite an intentionally broadened search of literature, the authors identified a lack of studies examining the topic.

Conclusions: …

The Importance Of Early Arthritis In Patients With Rheumatoid Arthritis, Georgiana Iftimie, Ana Maria Alexandra Stanescu, Mihaela A. Iancu, Anca Pantea Stoian, Razvan Hainarosie, Bogdan Socea, Gheorghita Isvoranu, Dragos Marcu, Tiberiu P. Neagu, Camelia C. Diaconu

Journal of Mind and Medical Sciences

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time.

The management of early arthritis has changed considerably in the past few years, under the …

Assistive Utensil: A Spork For Hand Tremors And Spatial Awareness, Ana Font Hernandez, Jacob Kabariti, Troy Taylor

Publications and Research

In this poster, we present a 3D printed solution for hand tremors and special awareness. Our spork is an assistive device designed and 3D printed for patients suffering from scleroderma, systemic sclerosis, Parkinson's, multiple sclerosis, drug withdrawal, etc. The scale-based handle will act as a counterweight to offset the contents on the other end and reduce shakiness. The larger grip allows an easy and comfortable hold. The product will be 3D printed for a customizable fit and at an affordable price. Lastly, the product will include a haptic feedback sensor to assist the visually impaired in locating food contents on …