Friday, 23 Mar 2018


Methotrexate: Where it All Began

It’s somewhat bizarre that a designer drug from over 65 years ago would become the cornerstone of treatment for rheumatoid arthritis in the 21st century. When Sidney Farber designed a molecule that would interfere with folate metabolism in the middle of the 20th century, he was looking for a ubiquitous antimetabolite to treat cancer. Farber was actually quite concerned with the potential side effects of a drug that competitively inhibits folate metabolism. That is part of the reason he combined the “met” for metabolism with an “x”. The x was found on poison bottles and he thought it wise to include it in the name of this agent.


The Week in Review: 5 February 2016

Dr. Cush reviews highlights from last week's news and research in rheumatology.

It Took Me 30 Years to Learn This About Rheumatoid Arthritis

I’m alot better at RA in the last 10 years than I was when I started to practice 30 years ago. RA has not changed, but tools, knowledge and treatments have progressed admirably. Decades have taught me that many aspects of RA were wrongly taught, misunderstood or not apparent when I first started in rheumatology in 1984. Here are 10 things I've learned.

70 & Up

Four men and 4 women, 5 joint replacements, 4 knee arthroscopies, 2 cancers and 6 bad attitudes were not enough to deter the inspiration and perspiration required of us last weekend. So how did we do? And yes, there are pictures. 

Pushy Patients

Do your patients challenge you? Do you live up to their expectations? How many steps do you have to climb to be better?

Patients Believe Lab Tests More Than Doctors

Patients believe that a lab result is a numeric true representation their biology and a pivotal arbiter of wellness, yet physicians often dismiss such results as hanging chads in a meaningless election. Why do patients believe their labs moreso than their doctor? 

How to Handle Latex Allergies and Biologics

What to do when a patient has a latex allergy and you prescribe an injectable biologic (many having latex allergy as a contraintication)?

The Maintenance of Certification Controversy 2015: The Year in Review

With so much controversy surrounding the American Board of Medical Specialties' Maintenance of Certification program in 2015, especially as it pertained to the ABIM, Dr. Westby Fisher recaps some of the earlier announcements about the ABMS MOC program, then summarizes the year's most pertinent developments to serve as a springboard for 2016. 

What's it like to have RA - from those who do and don't

A patient recently asked me, “What do you think it’s like to have RA” and “How would you describe it to someone you just met?”   Could I walk a mile in her shoes?  Here's my version and theirs.

2015 Rheumatology Year in Review

Was 2015 a good year for psoriasis, IL-17, biosimilars, narcotics, the ACR and gout? Our year end review discusses the most impactful news and research from the last 12 months.

Book Review: The Quest for Cortisone by Thom Rooke, MD

Imagine being in practice in the early 1940s, when the best you could do was salicylates and bed rest. Enter the clinical team of Philip Hench, Howard Polley and Charles Slocumb.

Leading With Questions

I find it interesting that when the Q&A part of the lecture begins, everyone acts as if they just got on the elevator. Who is willing to go out on a limb and ask the first question? Is Q&A the best or worst part of lectures that you attend?  What can you do change the impact of your next Q&A experience?