My Approach to Difficult RA
Patients are labeled as having “difficult RA" when: 1) we are frustrated, 2) it's too late, 3) we've run out of options or 4) the relationship is failing. We see them, but don’t quite know what to do with them.
Blogs
What You Don't Know
“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle
The Negotiator
This is going to be my third visit with this patient and I’m not looking forward to it.
In the first two, I discovered how sick she was and how, despite my handouts, efforts, insights and words, my educated medical expertise was totally wasted.
The IL-6 Wars
In the years to come, the availability of numerous new IL-6 inhibitors it will either complicate treatment decisions, alter existing treatment paradigms, or result in an all-out war against TNF inhibitor dominance. Data, differences and time will tell.
The Paradox and Value of Choice
I’m sitting with a patient discussing moving to an advanced therapeutic (i.e., medication that costs a lot of money). I started thinking about what I would choose and given my busy lifestyle a quick injection or tablet would seem preferable to an intravenous infusion. I assume that my patients are probably like me and would make similar choices. I am a little taken aback when this patient chooses an IV medication. She tells me her rationale in terms of her feelings, ideas, fears, and expectations and it makes complete sense. I may have misjudged her and without asking may have suggested a treatment that would not have been the best for her in terms of her lifestyle or beliefs.
Food and Wine and the Rheumatologist: The Microbiome and Natural Wine
Is the microbiome influenced by wines "terroir" (“the complete natural environment in which a particular wine is produced, including factors such as the soil, topography, and climate”)? Len Calabrese believes so.What I'm Looking Forward to at #ACR16
The ACR Annual Meeting (#ACR16) is such a huge event that it’s worth your time to spend an hour or two planning your time at the meeting. Here's my tentative #ACR16 session schedule.
Prescribing Hope
Everything will be alright in the end; and if it’s not alright, then it’s not yet the end. – Suni Kapoor (from the Best Exotic Marigold Hotel)
