Across the Table: Cush & Erkan on Antiphospholipid Syndrome (Best of 2017)

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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.

Creaky Joints Nails New Patient Pregnancy and Family Planning Guidelines

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Patients and physicians are riddled with misconceptions when pregnancy is concerned. As construed by Dr. Jack Cush, most rheumatologists treat pregnancy like a cancer and avoid the gravid patient, deferring to obstetricians who do not have training in rheumatology to manage the rheumatic condition as well as the pregnancy. 

Across the Table: Cush & Erkan on Antiphospholipid Syndrome

Save

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.

Ten Things to Do At Every Visit

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Busy days, overbooked patients and EMR overloads will certainly derail your day, especially if you don’t have a system to optimize efficiency.  However, in your harried efforts you may overlook several simple, smart, if not crucial, tasks while seeing your next patient.

Forced, Rational or Glitch-Ridden Prescribing Practices

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A recent analysis of 3 groups of treatment-naïve, early rheumatoid arthritis (ERA) patients looked at the factors that influenced the choice of therapy.

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.

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 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.

My Take on New Ocular Screening Guidelines for Plaquenil

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A recent article published by the American Academy of Ophthalmology presented new recommendations for screening of patients being managed with hydroxychloroquine that changed the previous monitoring paradigm. More importantly, it has repositioned hydroxychloroquine from one of the safest medications that rheumatologists use to a drug that can have potentially significant ocular morbidity (if used in doses greater than 5 mg per kilogram and or for prolonged periods of time).

TIPS for Arthritis Travelers

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Travel can be challenging for arthritis patients. Here are some useful tips to travel smoothly and pain free.

It's the engine that kills ya’, not the caboose

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This past weekend I was fortunate to lecture at the Harvard Advances in Rheumatology Course, where I reviewed the safety issues surrounding the use of biologic therapies. In discussing infections, cancer, cardiovascular events, etc., it became very clear to me that these problems, while worrisome, are often escalated in their importance – all at the expense of what is most dangerous: RA itself.

Go Ahead, Jump!

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You write the prescription, hand it to the patient and explain why it’s needed, how to take it and what the most common or most dangerous side effects might be. Comprehensive, reasonable, and professional. Certainly the patient should fill the prescription and start the drug.

My Nurse Practitioner

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My NP is not only a great nurse, counselor, rheumatologist, complex disease manager, joint injector, diabetes expert, clinic leader, mother, wife, and friend – she’s the go to person if you’re a patient, coworker, colleague, cousin or neighbor. She is one of few great partnerships in my entire career. To go to battle with a NP at my side gives me a tremendous daily advantage.

The Purse Exam: a Forgotten Part of the Physical

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Should you assess your patients' “purse-onality? The purse exam is an important part of the physical that can help make the diagnosis and improve patient outcomes. I often wonder if downsizing the purse should be part of the T2T (treat to target) initiative.

MONEYBALL

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The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.