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Bad Stress

“Bad is stronger than good.” 

Wait, bad is bad, right?


A Shortage of Trust

I wanted to complain about patients who complain, but guilt and common sense took over. I intended to declare the problem to primarily belong to the doctor, rather than the patient. To me, the solution to the patient’s consternation should begin and end with the source: me (you). My introspection, reasonings, and commandments were fine, but I kept running into the enigma of “Trust” – which can either be a speed-bump or chasm in our physician-patient relationships.

Best of 2022: I Need a Nemesis

A nemesis is so much more than the "enemy". Your nemesis defines what matters most to you and how you will overcome. Seth Godin once said, “Pick your enemies, pick your future”.
heel enthesitis spur calcaneal

Best of 2022: The Enthesitis Challenge in Psoriatic Arthritis

A colleague of mine once told me an interesting story of how her father, who was a doctor, misdiagnosed his wife with fibromyalgia when she actually had psoriatic arthritis with enthesitis all along. I would venture out and say that the average physician would have trouble evaluating enthesitis because even we, as rheumatologists do! 

Best of 2022: Freeze Tag

A beloved childhood game I enjoyed was Freeze Tag. Players would run to avoid being tagged by the person who was “It”.  If you were tagged, you had to “freeze” in your spot until someone was brave enough to come un-tag you.  The game ends when everyone is frozen or if people quit. For over 2 years, I have been living in a real-life “Freeze Tag” game and able to dodge COVID19, until now. Sitting in my room symptomatic and frozen in isolation, I ruminated about my patients who had COVID19 and their experiences. I wanted to share with you three stories of three variants.
Coin toss

Best of 2022: Toss of a Coin - How do You Choose PsA Medication?

When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they? 

Best of 2022: Five Mistakes When Diagnosing Still’s Disease

Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.
Myth vs reality

Best of 2022: Myths & Misconceptions with Febrile Disorders

Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations.

Best of 2022: The Contribution of the Gut Microbiome and Diet to Joint Inflammation in PsA

Interactions of the gut microbiota in humans promote the release of a variety of metabolites with profound effects on human health and immune regulation.
Hands caring bond

Best of 2022: The Sacred Bond

Patients and their family for years have been inviting me to their dinners, picnics, baptisms, anniversaries, and funerals. I always felt somewhat awkward when asked to participate in a patient’s life outside of my office or the hospital setting and usually will decline politely. I tell myself I should not blur the lines between patient care and friendship. I broke this rule recently.

Best of 2022: Methotrexate in PsA

Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic.

Best of 2022: Rheumatology Valentine

My uncle is going through medical hell.  As a committed iatrophobic (fear of doctors), any mention of phlebotomy, tests, needles or a clinic visit evokes flop-sweat.  Since being slapped with a cancer diagnosis, he has overcome a lot, and much to my surprise has bravely done so. When I asked how he has adapted so well to the medical onslaught he now leans into, his answer was quick and poignant.