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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.

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.

Hydrocodone: Then and Now

Today marks the one year anniversary of hydrocodone becoming a schedule II drug with more restrictive access. Has life been better under these new rules?

Highlights from the 4th World Psoriasis and Psoriatic Arthritis Conference; Stockholm, Sweden July 9-11, 2015

The 4th annual IFPA meeting was held in Stockholm, Sweden on July 9-11, 2015. Leading experts discussed advances in research, therapy and patient care for psoriasis and psoriatic arthritis.

Focus on Fatigue?

Fatigue is not far behind pain as the complaint that affects the quality of life in numerous rheumatic and autoimmune disorders. But do we need to focus on fatigue in our disease management?

Letter to the Expert: Is there life after ONJ?

Patient on bisphosphonates for several years, later placed on denosumab. After her 2nd dose, she developed ONJ. Patient then placed on daily teriparatide with resolution of ONJ and now has a normal BMD. She is about to complete her 2nd year of PTH therapy. What should she be treated with after PTH?

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