Simon Helfgott

Brigham and Women's Hospital | BWH · Brigham and Women's Hospital and Harvard Medical School

In a matter of weeks, the COVID19 crisis has totally upended clinical medicine and the practice of rheumatology. Our old ways of seeing patients in person, precepting fellows in clinic or on the consult service, and leading in‐person interactive teaching rounds are gone for now and possibly for good. But how can we replace these critical teaching a...

[This corrects the article DOI: 10.1371/journal.pone.0214981.].

Biologic agents such as therapeutic antibodies, fusion proteins, and biologic response modifiers have revolutionized the treatment of autoimmune diseases by increasing the specificity and efficacy of the therapeutic armamentarium. Just as the first generation of synthetic disease-modifying antirheumatic drugs (DMARDs) (e.g., methotrexate, hydroxych...

Objective: Remission is a key goal in managing rheumatoid arthritis (RA), with sustained remission as the preferred sequelae of short-term remission. However little is known about the predictors of sustained remission for patients reaching remission. Using two independent cohorts, we aimed to evaluate the prevalence and predictors for sustained re...

This detailed, practical textbook focuses on immune mediated disorders of the nervous system with particular focus on systemic autoimmune disorders. Divided into three sections, the first discusses the neuroanatomical and pathophysiologic basis of immune mediated disorders of the nervous system. Following this are 24 chapters devoted to individual...

High-dimensional single-cell analyses have improved the ability to resolve complex mixtures of cells from human disease samples; however, identifying disease-associated cell types or cell states in patient samples remains challenging because of technical and interindividual variation. Here, we present mixed-effects modeling of associations of singl...

The COPA syndrome is a monogenic, autoimmune lung and joint disorder first identified in 2015. This study sought to define the main pulmonary features of the COPA syndrome in an international cohort of patients, analyse patient responses to treatment and highlight when genetic testing should be considered. We established a cohort of subjects (N=14)...

A bstract High dimensional single-cell analyses have dramatically improved the ability to resolve complex mixtures of cells from human disease samples; however, identifying disease-associated cell types or cell states in patient samples remains challenging due to technical and inter-individual variation. Here we present Mixed effects modeling of As...

Objective: To determine the effect of disclosure of rheumatoid arthritis (RA) risk personalized with genetics, biomarkers, and lifestyle factors on health behavior intentions. Methods: We performed a randomized controlled trial among first-degree relatives without RA. Subjects assigned to the Personalized Risk Estimator for RA (PRE-RA) group rec...

CD4+ T cells are central mediators of autoimmune pathology; however, defining their key effector functions in specific autoimmune diseases remains challenging. Pathogenic CD4+ T cells within affected tissues may be identified by expression of markers of recent activation. Here we use mass cytometry to analyse activated T cells in joint tissue from...

The classical presentation of giant cell arteritis (GCA) includes the new onset of headache, scalp tenderness, facial pain or jaw claudication in an older patient. Many patients with GCA have features consistent with the diagnosis of polymyalgia rheumatic (PMR) and nearly all have elevated markers of inflammation such as the erythrocyte sedimentati...

Neurologic complications are frequent and often morbid in systemic lupus erythematosus, Sjögren syndrome, and rheumatoid arthritis. Although all are systemic inflammatory syndromes, each disease affects the nervous system distinctly, such as peripheral neuropathy in Sjögren syndrome, cerebrovascular disease in lupus, and cervical spine subluxation...

Based upon the popular review course from Harvard Medical School, this online resource is a comprehensive study guide for the American Board of Internal Medicine certification or maintenance of certification examination, as well as for general practice review by physicians and residents. Authoritative and thorough, it provides in-depth coverage acr...

Musculoskeletal involvement constitutes the most frequent problem seen in patients with SLE. The majority of patients will describe joint pain and achiness either at the onset of the disease or later during its course. Yet the frequency of arthralgia or arthritis in lupus populations is quiet variable; for example, in one series described by Fries,...

Background Disease progression of RA is unpredictable and recurrence occurs frequently even in patients in remission. Since patients with short term remission are more likely to experience radiographic structural progression compared with those achieving long-term remission, sustained remission is likely to improve patient outcomes and quality of l...

The soft tissue pain syndromes are among the most common conditions that a primary care physician encounters in daily practice. They are characterized by local or regional pain and discomfort, often made worse by palpation of the adjacent soft tissue or movement of the nearby joint. When they involve the soft tissues near a joint, they can be assoc...

Current therapies for systemic lupus erythematosus (SLE), a debilitating, potentially lethal, multifactorial systemic autoimmune disease, are limited to suppressing disease activity and are associated with multiple adverse effects. Recent advances in basic and translational sciences have elucidated a crucial role for the interferon-alpha (IFNα) pat...

Introduction Despite recent advances in anti-inflammatory therapy, rheumatoid arthritis (RA) patients continue to rate pain as a priority. The etiology of RA pain is likely multifactorial, including both inflammatory and non-inflammatory components. In this study, we examine the association between disease activity, sleep, psychiatric distress and...

We evaluated the T-SPOT.TB assay to identify latent tuberculosis infection (LTBI) in patients with rheumatic disease receiving immunosuppressive medication including tumor necrosis factor (TNF) antagonists. A total of 200 patients seen in the Arthritis Center at Brigham and Women's Hospital were enrolled for study. Most patients were US-born women...

A 59-year-old woman presented with a 6-week history of pain and swelling in her right knee, which necessitated the use of a cane. Two weeks before presenting for care, she began to experience pain in her left knee, followed by the onset of pain and swelling in her left ankle and left wrist. She also noted fatigue and progressive dyspnea on exertion...

Serum sickness, an illness characterized by fever, rash, and arthralgias, can occur in patients who receive chimeric monoclonal antibody therapy. Rituximab, a B cell-depleting chimeric anti-CD20 monoclonal antibody, has been used with increasing frequency in the treatment of rheumatologic illnesses such as rheumatoid arthritis and systemic lupus er...

To assess the safety and efficacy of etanercept 50 mg administered twice weekly versus 25 mg administered twice weekly as monotherapy in patients with tumor necrosis factor-alpha (TNF-alpha) blocker-naäve active rheumatoid arthritis (RA). Seventy-seven patients with RA were randomized in an unequal allocation (2:1) in a blinded fashion to receive e...

Leflunomide (Arava) is an isoxazole derivative approved by the US Food and Drug Administration (FDA) for the treatment of rheumatoid arthritis (RA). Its mechanism of action is based on the inhibition of dihydro-orotate dehydrogenase, an enzyme that controls the pathway for denovo synthesis of uridine ribose monophosphate (rUMP) in activated T-cells...

To study a group of 29 patients with rheumatoid arthritis (RA) who have been treated with both tumor necrosis factor (TNF)-alpha antagonists, etanercept and infliximab and to determine the correlation of responses and complications seen in these patients. Patients' responses to and complications from either treatment were reviewed retrospectively b...

Objective. To study a group of 29 patients with rheumatoid arthritis (RA) who have been treated with both tumor necrosis factor (TNF)-alpha antagonists, etanercept and infliximab and to determine the correlation of responses and complications seen in these patients. Methods. Patients' responses to and complications from either treatment were review...

This article has no abstract; the first 100 words appear below. Presentation of Case A 21-year-old man was admitted to the hospital because of inflammatory lesions of the foot. The patient had been well until 15 months before admission. At that time, while he was at home in Indonesia, he had diarrhea with fever for several weeks. A diagnosis of typ...

Presentation of Case A 50-year-old man was admitted to the hospital because of fever and arthralgias. The patient had been in excellent health until six weeks earlier, when a sore throat, rhinorrhea, headaches, and low-grade fever developed. Two weeks later, all the symptoms improved for a few days, followed by a recurrence of fever (peak temperatu...

To determine the frequency of weight loss in patients treated with leflunomide for rheumatoid arthritis at an arthritis referral center. We queried 35 rheumatologists at the Robert Breck Brigham Arthritis Center to determine if weight loss had occurred as an adverse event in patients treated with leflunomide between November 1998 and January 2000....

We examined the medications used by women before and after bone densitometry to determine whether patient or physician factors were associated with appropriate osteoporosis therapy. Appropriate osteoporosis treatment was defined as alendronate, etidronate, calcitonin, or hormone replacement therapy (HRT) for women with any bone mineral density (BMD...

The study of SMS, a rare disease, has resulted in a better understanding of a more common disorder, IDDM, and has allowed investigators to gain insights into the molecular mechanisms of autoimmunity. Many unanswered questions remain, such as the specific site of disease activity in SMS, both at the bedside (cortex, brain stem, or spinal cord) and a...

Objective To examine the safety and pharmacokinetics of and clinical response to leflunomide, a de novo pyrimidine synthesis inhibitor, when administered to patients with active rheumatoid arthritis (RA) who have been receiving long-term methotrexate therapy.Methods This was an open-label, 52-week study in which 30 patients with RA that remained ac...

An unusual pattern of hand involvement in a patient with rheumatoid arthritis (RA) is presented. There is complete sparing of a single digit, despite a severe, destructive polyarthritis involving all the other fingers. Of note, the patient began wearing a treasured family heirloom ring on the nonaffected finger approximately 1 year before the onset...

To ascertain the frequency of polymyalgia rheumatica (PMR) with a normal erythrocyte sedimentation rate (ESR; < or = 30 mm/hour) and to determine any defining clinical characteristics. A retrospective chart review study of all patients meeting the clinical criteria for PMR seen over a 5-year period in a hospital and an office-based rheumatology pra...

To evaluate the efficacy of intravenous immune globulin (IVIG) in the treatment of stiff-man syndrome (SMS). An open, unblinded study of 3 patients with active disease and/or disease refractory to treatment with diazepam and/or corticosteroids. All 3 bedridden patients improved substantially shortly after infusion with IVIG and regained function. I...

Nonsteroidal antiinflammatory drugs (NSAIDs) have long been used as therapy for arthritis patients. However, in some patients these drugs can cause gastrointestinal hemorrhage, perforation, or ulcer through direct topical effects, enterohepatic recirculation, and systemic effects. In an effort to address this problem, new NSAIDs have been developed...

Herpes zoster-related radiculopathy usually can be easily diagnosed in the presence of cutaneous lesions. Before development of the skin rash, the diagnosis may be in doubt, particularly if motor symptoms and signs are a major clinical feature. We report a patient with herpes zoster-related radiculopathy whose clinical features mimicked other spina...

The effects of zileuton, a new 5-lipoxygenase inhibitor, on leukotriene generation and clinical response in rheumatoid arthritis (RA) was studied in a 4-week randomized double blind placebo controlled study at 2 academic rheumatology centers. Zileuton decreased the mean (+/- SEM) ionophore induced synthesis of leukotriene B4 at Week 1 by 70% from 1...

This article has no abstract; the first 100 words appear below. Presentation of Case A 52-year-old man was admitted to the hospital because of asthma, peripheral neuropathy, and eosinophilia. There was a long history of recurrent sinusitis and nasal polyposis. Three years before entry bronchial asthma developed and was triggered by upper respirator...

We report the development of scapholunate ligament rupture after episodes of gout in 2 patients and in association with chondrocalcinosis in another. One patient required surgical fusion for alleviation of pain. The diagnosis should be considered in patients with prolonged wrist pain refractory to conventional therapies for crystal induced arthriti...

Alterations in renal eicosanoid levels have been postulated as a factor in cyclosporin A (CSA) nephrotoxicity. The effects of CSA on renal eicosanoid excretion in rheumatoid arthritis were studied over a 24-week period, during which treatment with nonsteroidal antiinflammatory drugs was discontinued. The initial dosage of CSA was 4 mg/kg/day; at we...

Our aim was to assess whether "idiopathic" bilateral progressive sensorineural hearing loss (BPSHL) has an immunological cause in some patients; antibodies to native type II collagen were sought by an ELISA in eighteen patients with BPSHL, before and after corticosteroid treatment, and in twelve patients with Menière's disease, fifteen with otoscle...

Diclofenac sodium, a phenylacetic acid-derived nonsteroidal anti-inflammatory drug (NSAID) recently released in the United States, was associated with the development of significant hepatitis in seven patients, with one associated death. Signs and symptoms developed within several weeks of initiation of drug use and generally resolved 4 to 6 weeks...

Diclofenac sodium, a phenylacetic acid—derived nonsteroidal anti-inflammatory drug (NSAID) recently released in the United States, was associated with the development of significant hepatitis in seven patients, with one associated death. Signs and symptoms developed within several weeks of initiation of drug use and generally resolved 4 to 6 weeks...

Total lymphoid irradiation (TLI) was shown to have potent immunosuppressive effects in patients with Hodgkin's disease. In the last decade a handful of studies assessed the efficacy of TLI in patients with rheumatoid arthritis. A correlation between decline in T-helper cell number and a reduction in disease activity was noted in all studies; howeve...

Arthritis resembling human rheumatoid arthritis is produced in rats either by immunization with type II collagen or injection of complete Freund's adjuvant. The development of arthritis in both models may be mediated by a T cell-derived, type II collagen-specific protein that has been termed arthritogenic factor. Here, the morphologic changes produ...

An evocation of arthritis by an Ag-specific lymphokine has recently been considered with the description of arthritogenic factor (AF) in rats with collagen arthritis. Because rats with CFA-induced arthritis also exhibit T cell reactivity to native type II collagen, T cell lines specific for this protein were established from CFA-injected rats. Supe...

A type II collagen-specific arthritogenic lymphokine has been identified in the rat. Arthritogenic factor (AF) is a 65 kD protein generated in vitro by T cells from rats with collagen arthritis, and it induces an erosive, proliferative synovitis when injected into the knee joint of syngeneic naive recipients. Complement does not appear to be requir...

A type II collagen-specific arthritogenic lymphokine has been identified in the rat. Arthritogenic factor (AF) is a 65 kD protein generated in vitro by T cells from rats with collagen arthritis, and it induces an erosive, proliferative synovitis when injected into the knee joint of syngeneic naive recipients. Complement does not appear to be requir...

Sprague-Dawley rats were maintained in environmentally isolated conditions and some of them were injected beginning at birth with rabbit anti-mu serum to suppress B-cell maturation. All rats were subsequently immunized with chick type II collagen. Ten (28%) of 36 rats injected with anti-mu antiserum failed to develop serum hemagglutinating antibodi...

Twelve patients with refractory rheumatoid arthritis were treated with total lymphoid irradiation (TLI) to a total cumulative dose of 3,000 rads. Post-TLI morbidity/mortality included 8 patients with xerostomia, 4 with weight loss of greater than 10 kg, 3 with loss of 4 or more teeth, 3 with herpes zoster, 4 with bacterial infection that was fatal...

Twelve patients with refractory rheumatoid arthritis were treated with total lymphoid irradiation (TLI) to a total cumulative dose of 3,000 rads. Post-TLI morbidity/mortality included 8 patients with xerostomia, 4 with weight loss of >10 kg, 3 with loss of 4 or more teeth, 3 with herpes zoster, 4 with bacterial infection that was fatal in 2, 3 with...

The total body retention (TBR) and the 5- and 24-h lumbar spine to soft tissue (LS/ST) ratios of 99mtechnetium methylene diphosphonate was studied in 19 patients with rheumatoid arthritis (RA), 16 patients with metastatic tumors that did not involve the lumbar spine, 10 patients with chronic renal failure and 17 controls. The TBR was significantly...

A patient with regional migratory osteoporosis had somewhat unusual features in that there was involvement of the small joints of the foot demonstrable by 99mTc-methylene diphosphonate joint imaging.