Lipstick Rheumatology

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A 25 year-old female recently diagnosed with seronegative rheumatoid arthritis was started on a TNF inhibitor. She came in for a follow-up visit and noted that her toenails were brittle and discolored when she removed her nail polish recently.

My Approach to Difficult RA

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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.

The Great Masquerader

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Review: A Book Trilogy About an Irish Country Doctor

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My original agreement with Jack was to review a serious scientific book.  However, half way through one, I was bored, so I went to the library. I'm so glad I did, because I came upon two books, written by Ireland-born physician Patrick Taylor, that continued the tale I'd started years ago about Fingal Flahertie O'Reilly.

 

Wine and the Rheumatologist: A Perfect Meal

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I had dinner about a month ago in Phoenix with Peter Lipsky, an icon in rheumatology and who requires no introduction to my readers, where we discussed a rambling number of topics both rheumatologic (hence, the experience does qualify for a blog!) and non-rheumatologic.

What You Don't Know

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“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle

The Negotiator

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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

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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 Pain of Funerals and Suicides

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It's All in the Name

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I got onto flight #610 from Atlanta to Dallas the other day and was greeted by a flight attendant in first class. After introducing himself, he said, “That’s my name and you can imagine how it’s gone for the past 25 years.”

The Paradox and Value of Choice

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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.

The Rheumatologist’s Rubaiyat: A Mug of Coffee, a Loaf of Bread and Thou Beside Me (Part 2)

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In my last article, I said that coffee, not wine, would be the libation of choice for rheumatologists. Why coffee? you may ask. After all, the language of coffee is not dissimilar to that of wine and writers of coffee (as well as the label descriptions) use the same vocabulary and analogies as does the writing about wine. Often, from the description-with words like spice, cocoa or nuts-it is not clear whether the beverage is a Cotes-de-Rhone or an Americano. Certainly coffee is better hot than cold and appropriate for all meals although some argue that champagne can be quaffed all day long.