Blogs
Best of 2018: The Delayed Diagnosis of Spondyloarthritis
You see them from the corner of your eye, standing with a kyphosis in the waiting room. They are filling out their paperwork, standing up because sitting is just not pleasant. You are the rheumatologist with an interest in ankylosing spondylitis (AS) and spondyloarthritis, so more likely than not, the patient with the bent spine is going to be your next new patient. In the back of your mind you are hoping that they are not so far along so that the therapy you may prescribe can make a difference in their life.
Pain: Objectifying a Subjective Symptom
My typically pleasant 76 year old male was livid when I walked into the exam room. He was pacing back and forth with furrowed eyebrows. I gingerly inquired what was bothering him the most.
Best of 2017: Across the Table: Cush & Erkan on Antiphospholipid Syndrome
The antiphospholipid syndrome (APS) is a common disorder affecting patients with and without autoimmune disease. Despite wider recognition of APS among physicians as well as the expanding research collaborations, many clinical questions are still encountered in clinical practice, which require further evidence-based studies. In this “Across the Table” edition, Drs. Cush and Erkan discuss some of these APS-related questions. Our guest expert, Dr. Doruk Erkan offers up his approach to diagnosis and management of APS.
The Gender Gap in Rheumatology Leaders
Leadership positions in medicine are disproportionately filled by men. Although the enrollment of medical schools are equal male: female or even some have more women, 40% of American medical institutions lack programs for recruiting women, or for retention and promotion of female faculty.
This may also be true in rheumatology, which is now attracting more women than men as trainees. I recently wrote an article in the Lancet about mentoring women in medicine and suggested ideas for improving the gender gap in leadership.
A Rheumatologist’s “Quality of Life”
I tell my patient’s that I empathize with them. I understand that they do not want a rheumatologic condition, nor do they want to take our medications and are disheartened when I tell them that we have no cures. But, if we flip that proverbial coin over, my goal for their care is to improve their quality of life.In rheumatology, we have many ways to accomplish that goal for our patients; from medication management to advocacy and support groups for patients and loved ones. But what are you doing at work or home to improve YOUR quality of life and the lives of those around you?
The Delayed Diagnosis of Spondyloarthritis
You see them from the corner of your eye, standing with a kyphosis in the waiting room. They are filling out their paperwork, standing up because sitting is just not pleasant. You are the rheumatologist with an interest in ankylosing spondylitis (AS) and spondyloarthritis, so more likely than not, the patient with the bent spine is going to be your next new patient. In the back of your mind you are hoping that they are not so far along so that the therapy you may prescribe can make a difference in their life.
Across the Table: Cush & Erkan on Antiphospholipid Syndrome (Best of 2017)
The antiphospholipid syndrome (APS) is a common disorder affecting patients with and without autoimmune disease. Despite wider recognition of APS among physicians as well as the expanding research collaborations, many clinical questions are still encountered in clinical practice, which require further evidence-based studies. In this “Across the Table” edition, Drs. Cush and Erkan discuss some of these APS-related questions. Our guest expert, Dr. Doruk Erkan offers up his approach to diagnosis and management of APS.
Across the Table: Cush & Erkan on Antiphospholipid Syndrome
The antiphospholipid syndrome (APS) is a common disorder affecting patients with and without autoimmune disease. Despite wider recognition of APS among physicians as well as the expanding research collaborations, many clinical questions are still encountered in clinical practice, which require further evidence-based studies. In this “Across the Table” edition, Drs. Cush and Erkan discuss some of these APS-related questions. Our guest expert, Dr. Doruk Erkan offers up his approach to diagnosis and management of APS.
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.
The Brooklyn HAQ
The Health Assessment Questionnaire is a utilitarian outcome measure, often used in clinical trials and daily practice. Unless you’re still prescribing penacillamine, never attended an ACR meeting, and never read an RA clinical trial, you’re quite familiar with the HAQ and its use in practice. So, surely you’ve heard of the “Brooklyn HAQ”?
Why Not Just Kick the TNFi Habit?
Why do we use TNF inhibitors as our first biologic choice? Is it the evidence of efficacy, access, safety, and drug retention, or is it a prescriber habit that merits critique?
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.
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?
The Week in Review: 5 February 2016
Dr. Cush reviews highlights from last week's news and research in rheumatology.