.
Coronary Sinus Reduction: New Analysis Suggests Modest Benefits for Refractory Angina
A novel approach to treating severe chest pain – coronary sinus reduction (CSR) using an hourglass-shaped stent – is facing renewed scrutiny. While initial studies hinted at significant relief for patients with refractory angina (chest pain that doesn’t respond to conventional treatments), a new meta-analysis published in JACC: Cardiovascular Interventions suggests the benefits may be less substantial than previously thought.
The analysis, led by Dr. rasha Al-Lamee of Imperial College London,pooled data from three randomized controlled trials encompassing 180 patients,alongside 13 single-arm studies involving 668 individuals. The procedure itself appears safe, boasting a 98.3% success rate. However, a key finding reveals a stark contrast between the results of rigorously controlled trials and earlier, less controlled studies.
Patients did report improvements in angina symptoms in both types of studies. however,the magnitude of improvement was considerably smaller in the randomized controlled trials. Specifically, approximately 26% of patients in the controlled trials experienced at least a one-class improvement in angina severity (according to the Canadian Cardiovascular Society classification), while 17% saw at least a two-class improvement. These figures represent roughly a third of the gains observed in the single-arm studies.
Crucially, the controlled trials failed to demonstrate any objective benefits. Continuous measurements like the Seattle Angina questionnaire showed no significant change, and there was no evidence of improved blood flow to the heart muscle following the procedure.
Dr. Deepak Bhatt, a cardiologist at Mount Sinai in New York City, who penned an accompanying editorial, emphasized the need for more effective treatments for refractory angina patients, who have often fatigued all other options. While CSR holds potential, he cautioned that larger, more definitive trials are essential before widespread adoption. “We need robust,objectively measured evidence to justify the cost of this procedure,” he stated. He pointed to past examples, like percutaneous laser therapy, which initially appeared promising but ultimately proved ineffective in rigorous trials.
Currently approved for use in the UK and Europe, where its adoption is growing, the CSR device is not yet available in the United States. The ongoing COSIRA-II trial, enrolling approximately 380 patients, is expected to provide the conclusive data needed for potential US approval.
Dr. Al-Lamee believes that if COSIRA-II demonstrates clear benefits, the device coudl become a preferred treatment option before more invasive procedures like repeat coronary artery bypass surgery. “Why resort to a high-risk revascularization if a safe and effective option exists?” she proposed.
Dr. Al-Lamee disclosed financial ties to Shockwave Medical, the manufacturer of the CSR device. Dr. Bhatt reported no relevant financial conflicts.
Acromegaly Patients Face Significantly Higher Cancer Risk, Early Screening Urged
Patients diagnosed wiht acromegaly, a condition characterized by the overproduction of growth hormone, exhibit a substantially elevated risk of developing various cancers, including leukemia, lymphoma, ovarian, breast, and lung cancers.Alarmingly, many of these cancers manifest at younger ages compared to the general population, underscoring a critical need for integrated cancer screening protocols in routine acromegaly care.
The underlying mechanism is believed to involve elevated levels of insulin-like growth factor (IGF-1) in acromegaly patients, a known contributor to cancer growth. A extensive retrospective cohort analysis, drawing data from a multinational research network, compared cancer prevalence in 10,207 individuals with acromegaly against a control group of 102,070 individuals without the condition. The acromegaly cohort had a mean age of 43.2 years at disease onset, with 52.9% being women.
The findings revealed a stark increase in cancer odds for acromegaly patients. They faced a 3.3-fold higher likelihood of developing leukemia or lymphoma, a 1.9-fold increased risk for ovarian cancer, and a 1.8-fold increased risk for breast cancer. Lung cancer risk was also elevated by 1.9-fold, and prostate cancer risk by 1.5-fold. Furthermore, the study highlighted that certain cancers, specifically ovarian, lung, liver, and neuroendocrine tumors, appeared significantly earlier in acromegaly patients, with onset occurring 3.2 to 7.2 years sooner than in the general population.
“Our findings suggest that acromegaly may play a bigger role in cancer risk than previously thought, highlighting the need for increased awareness and early cancer screening in this population,” stated the lead researcher. This research, presented at ENDO 2025: The Endocrine Society Annual Meeting, emphasizes the proactive approach required to manage the health of individuals with acromegaly.
Ben Askren Heads Home After Life-Threatening Pneumonia and Double Lung Transplant
Retired UFC Fighter Shares His Journey to Recovery
Former UFC fighter **Ben Askren** has been released from the hospital and is heading home, marking a significant milestone after a harrowing battle with severe pneumonia that necessitated a double lung transplant.
A Near-Fatal Ordeal
The retired mixed martial artist was recently in a critical, comatose state as doctors fought to save his life due to a severe pneumonia diagnosis. The situation escalated to the point where **Askren** required a double lung transplant, a procedure he has now recovered from sufficiently to be discharged.
Day 59, I’m out! With my beautiful wife supportive. That was a long journey and it’s not over because I still can’t really walk. I have to re-teach myself to do that among many other things. I guess I can make light of it because it was me and I don’t really remember it. pic.twitter.com/bW48R7x9xS
— Ben Askren (@BenAskren) June 4, 2024
**Askren** shared his progress on social media, stating, Day 59, I’m out! With my beautiful wife supportive. That was a long journey and it’s not over because I still can’t really walk. I have to re-teach myself to do that among many other things.
He also reflected on the severity of his condition, with his wife, **Amy**, confirming that he had “a few times” come very close to death during his hospital stay.
Gratitude for Global Support
The path to recovery included weeks of crucial post-operative monitoring to ensure the transplanted lungs functioned correctly and to prevent infection or rejection. Upon his release, **Askren** expressed deep emotion regarding the outpouring of support he received from friends, family, and fans worldwide.
“I’ve said this already in one of the videos but the support you guys gave me, whether it was setting up a GoFundMe, whether it was helping my kids and wife get through it, I had friends come from all over the country just to hang out for a couple of days. It meant so much. It was so great to have all the support and all the love.”
—Ben Askren
The former athlete acknowledged the significant impact of this support, stating, Hopefully I’m not in this situation again for a really, really, really long time. I plan on living a while. So thank you guys again.
Organ transplant recipients often face lengthy rehabilitation periods; for example, lung transplant patients in the U.S. typically require months of physical therapy to regain strength and mobility, according to the U.S. Department of Health & Human Services (HHS Transplant Statistics).
Looking Ahead
**Askren**, a two-time NCAA Division I wrestling champion before transitioning to professional fighting, now faces the challenge of rebuilding his physical strength and mobility. His journey highlights the critical importance of organ donation and the resilience of the human spirit in overcoming immense health challenges.
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Rheumatoid Nodules: Modern Treatments Reduce Incidence,Present Diagnostic Challenges
Table of Contents
- Rheumatoid Nodules: Modern Treatments Reduce Incidence,Present Diagnostic Challenges
While modern treat-to-target therapies have decreased the occurrence of extra-articular manifestations of rheumatoid arthritis (RA), including rheumatoid nodules, these nodules continue to present clinical challenges. These challenges include the need to rule out other serious conditions and address potential complications, especially those affecting the lungs.Rheumatoid nodules, recurrent inflammatory granulomas, can impact daily life both cosmetically and functionally.
understanding Rheumatoid Nodules
Dr. Christopher Edwards, a rheumatology professor at University Hospital Southampton, addressed the clinical significance and treatment of rheumatoid nodules at the 2025 Annual Meeting of the European Alliance of Associations for Rheumatology. rheumatoid nodules,once a key diagnostic criterion for RA,are granulomatous inflammatory lesions that can appear in various locations throughout the body. While often found subcutaneously, they can also occur on the sclera, larynx, heart valves, and lungs.
Did You Know? Rheumatoid nodules are more common in individuals who are seropositive for rheumatoid factor or anti-cyclic citrullinated peptide antibodies.
Pulmonary Nodules: Diagnostic Difficulties
Pulmonary nodules can be particularly challenging to diagnose. According to Dr. Edwards, some patients are initially misdiagnosed with lung metastases, causing significant distress. Conditions like granulomatosis with polyangiitis can also mimic rheumatoid nodules, further complicating the diagnostic process. It is crucial to differentiate these nodules from infections such as tuberculosis, as RA patients are at a higher risk of infection due to their disease and immunosuppressive treatments.
Pulmonary rheumatoid nodules, similar to tuberculomas, can undergo central necrosis when exposed to tumor necrosis factor-alpha inhibitors, perhaps leading to cavitation or pneumothorax. Any cavity in the lung can become infected, emphasizing the need for careful monitoring.
Diagnosing Peripheral Nodules
Diagnosing peripheral rheumatoid nodules is generally more straightforward. These nodules typically feel rubbery and are movable relative to the underlying tissue. Differential diagnoses include gouty tophi, lipomas, epidermoid cysts, infectious granulomas, sarcoidosis, and neoplastic lesions. Imaging tools like ultrasound or fine-needle aspiration can aid in diagnosis, especially when gout is suspected. Biopsy is typically reserved for cases where there is concern about a neoplastic or malignant process.
The Decline in Rheumatoid Nodule Incidence
Dr. Edwards noted a decline in the frequency of rheumatoid nodules in his practice.epidemiological data supports this observation. The 10-year cumulative incidence of subcutaneous nodules in RA patients decreased from 30.9% between 1985 and 1999 to 15.8% between 2000 and 2014 [[1]].
This decline is likely due to earlier initiation of more effective therapies and a reduction in smoking rates. Smoking remains a significant risk factor for nodule development,along with long-standing,severe RA,male sex,and seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide antibodies.
Pro Tip: Maintaining tight control of disease activity is crucial for preventing rheumatoid nodules.
Treatment and Management Strategies
The presence of nodules alone shoudl not prompt discontinuation of methotrexate (MTX), according to Dr. Edwards. While there were past concerns about MTX causing nodules, current data suggests otherwise. Other medications, such as tumor necrosis factor inhibitors like etanercept, have also been linked to nodule development, even though this might potentially be due to reporting bias.
Often, treatment is not necessary, and observation is sufficient. painful or functionally limiting nodules can be managed with local glucocorticoid injections to reduce discomfort and soften the nodules. However, injections over the elbow should be avoided due to the increased risk of infection.
Surgery might potentially be considered for nodules that ulcerate, become infected, or impair function. Pulmonary rheumatoid nodules often respond well to rituximab or abatacept,leading to shrinkage or stabilization.case reports have also documented advancement with janus kinase inhibitors.
| Treatment | Application | Considerations |
|---|---|---|
| Observation | Asymptomatic nodules | Monitor for changes in size or symptoms |
| Glucocorticoid Injections | Painful or functionally limiting nodules | Avoid injections over the elbow |
| Surgery | Ulcerated, infected, or functionally impairing nodules | Potential for recurrence |
| Rituximab/Abatacept | Pulmonary rheumatoid nodules | Effective in shrinking or stabilizing nodules |
Key Factors Influencing Rheumatoid Nodule Development
- Smoking
- Long-standing, severe RA
- Male sex
- Seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide antibodies
These factors highlight the importance of addressing modifiable risk factors and managing RA effectively to minimize the risk of developing rheumatoid nodules.
What strategies have you found most effective in managing rheumatoid arthritis symptoms? Share your experiences in the comments below!
Are there any specific concerns you have about rheumatoid nodules or their treatment?
Evergreen Insights: Rheumatoid Nodules and RA
Rheumatoid nodules are a common extra-articular manifestation of rheumatoid arthritis, a chronic autoimmune disease primarily affecting the joints. While advancements in RA treatment have reduced their incidence, understanding their formation, diagnosis, and management remains crucial for rheumatologists and patients alike. Historically, the presence of rheumatoid nodules was a key diagnostic criterion for RA, reflecting the severity and progression of the disease. Today,with earlier and more effective treatments,the focus has shifted towards preventing their development through tight disease control and addressing modifiable risk factors such as smoking.
Frequently Asked Questions About Rheumatoid Nodules