Aim: To evaluate the efficacy and tolerability of febuxostat (FBX) and benzbromarone (BNZ) combination therapy in patients with difficult-to-treat (D2T) gout. Methods: This observational study was performed at two centers and included patients fulfilling the 2015 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) gout classification criteria, with clinical tophi and suboptimal response to standard urate-lowering therapy. A two-step treatment regimen was implemented: a 6-month dose escalation of the FBX dose followed by add-on BNZ. Demographic, clinical, and laboratory data—including cardiovascular risk factors (CVRFs), history of nephrolithiasis, liver enzymes, and estimated glomerular filtration rate (eGFR)—were recorded. Changes in serum urate (SUA) and eGFR were analyzed using paired t-tests. Results: The study population comprised 15 patients (87% male, median age 59 years) with longstanding gout [median 15 years, range 3–31; interquartile range (IQR) 8–25]. Baseline SUA was 10.3 ± 1.7 mg/dL; mean eGFR was 63.7 ± 23.6 mL/min. CVRFs were common (hypertension, 93%; dyslipidemia, 73%: major adverse cardiovascular events, 13%; diabetes, 7%). At 12 months, SUA had decreased significantly to 2.9 ± 1.1 mg/dL (Δ = 7.4 mg/dL; p < 0.01), with FBX alone contributing to a Δ of 5.4 mg/dL and BNZ an additional Δ of 2.1 mg/dL (both p < 0.01). Tophi resolved in 60% of patients. No serious adverse events or significant changes in liver or renal function were observed. One unrelated death was recorded. Conclusions: FBX + BNZ was effective and well-tolerated in patients with severe D2T gout, achieving a substantial reduction in SUA and clinically significant dissolution of tophi.

Soft tissue sarcoma (STS) is a rare malignancy with a high incidence. Early diagnosis can reduce the rate of amputations and increase survival, however, this is typically delayed. The diagnosis and treatment of smaller lesions have a better prognosis; nonetheless, patients present to physicians when the soft tissue mass is large with obvious signs of red flags. In addition, the symptoms of this disease are highly non-specific and overlap greatly with benign conditions, resulting in a lack of clinical suspicion and low awareness among practitioners and the general public. Thusly, it is entitled as “the loneliest cancer”. This can make an accurate diagnosis difficult, with a great proportion of misdiagnoses leading subsequent inadvertent to incomplete STS excision, affecting the overall prognosis of the disease and devastating consequences in the disease process. A timely and precise diagnosis is essential because half of people with STS progress toward quietly aggressive illness. The purpose of this review is to raise awareness of STSs so that early recognition, accurate work-up, overview of conventional treatment plans, and appropriate referral to a tumor center can be achieved, avoiding whoop situations, and improving patient outcomes. In addition, insight into the advances in immunotherapy, nanotechnology, and artificial intelligence (AI) can lead to STS diagnosis and treatment prognosis.

Rheumatoid arthritis (RA) is the most common rheumatologic disease characterized by inflammation with a definite relationship with heart disease. Impaired immunity, chronic inflammation, genetic susceptibility, autonomic nervous system (ANS) dysfunction, altered metabolic profile have been blamed for ischemic and non-ischemic heart diseases in RA patients. Medications used in RA treatment can also modify the risk of heart diseases by different mechanisms. Understanding the pathogenesis is essential to prevent early cardiac dysfunction in RA patients. Fundamental cellular and molecular mechanisms of pathogenesis await further elucidation. Disease management is of great importance since the cardiovascular (CV) events are known to be reduced with low disease activity. Discovery of new mechanisms will pave the way for the development of novel treatment modalities. This review highlights the epidemiology, pathogenesis, risk factors, diagnosis and screening methods and management of CV comorbidities in RA patients. Besides impact of RA medications and exercise on CV risk are summarized.