Friday, 23 Mar 2018


Midlife Plateau

Despite regular attendance at medical meetings and despite fulfilling regulatory requirements for our specialty, I’m not sure how much I learn that changes the way I practice medicine. So I recently persuaded a colleague to come and coach me, inviting him to observe me for a morning in clinic. This was the first time I had been observed in this way since I was a medical student. A little daunting, but after a while I largely forgot he was there. Then he gave me some feedback. 

Smoking and Rheumatoid Arthritis

Why don't rheumatologists send their smoker patients to smoking cessation programs or use aids for cessation? Do we think it is not our problem?

Polymyalgia Rheumatica: An Interval Look at Management Questions


Despite an often fairly characteristic pattern of signs and symptoms, there are significant diagnostic challenges with polymyalgia rheumatica. The reason is that similar clinical features can be also observed in other diseases mimicking PMR, including infectious and malignancies, elderly-onset rheumatoid arthritis, giant cell arteritis, chondrocalcinosis or myositis, to mention some of the most important differential diagnoses.  

Time for a Paradigm Change in Rheumatoid Arthritis

How many clues are needed for a rheumatologist to know something is wrong with the therapeutic soup he/she is trying to concoct?  One patient's tale leads to rethinking the RA treatment paradigm.

RA Guidelines Shouldn't Ignore the Power of Methotrexate Combo Therapy

The introduction of the 2015 rheumatoid arthritis treatment guidelines has prompted discussion and critique from many.  Here's my perspective on where monotherapy and methotrexate combination therapy fits in our armamentarium.

Be the CEO of Your Health

Patients should act as if they are the CEO of a new business. Their business is the disease they must manage. The analogies of managing a business and a disease are numerous and instructive for patients and physicians alike.

The Role of Hydroxychloroquine Blood Levels in SLE

Laura Durcan

We review the available literature, with a particular focus on the recent findings in the Hopkins Lupus Cohort, regarding the clinical utility of hydroxychloroquine blood levels in helping to clarify some of the issues regarding retinopathy, how best to dose this medication, and medication adherence. 

How Do I Treat Symptomatic Interstitial Lung Disease in Scleroderma?

Will the results of two recent large scleroderma lung studies finally inform us on how to manage interstitial lung disease in systemic sclerosis?  

Diabolical Negativism

Our inner thoughts are usually negative, critical or pessimistic. Negative thinking is ubiquitous, and may be responsible for indecision or ill-choices.  How to identify it and deal with it in patient care is an unsavory challenge often left undone.

Week in Review - 20 Feb 2016

Highlights of Rheumatology news for the week ending 20 Feb 2016.

The Week in Review - 13 February 2016

Video highlights from last week's reports, news and tweets on

Why T2T is Too Risky for Some Patients

My colleagues indulged me in a small experiment. I set before them $100 in cash and offered each of them a choice: take the $100, or flip a coin for a 50% chance to win a certain amount of money that they could specify. They would tell me the minimum amount of money I needed to offer in order to prefer the coin flip over taking the $100. What does this have to do with treat-to-target?