Throw Me Rope

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A gal with rheumatoid arthritis moved to my town and has transferred her care to me. Despite having RA for 3 years and swollen joints at the last three visits, she has taken surprisingly few effective drugs thus far.

On this visit I declared my concerns for her future health, especially if we didn’t make significant changes in therapy. So I recommended she start a new drug. She asked several good questions, then stated she wanted to go home and think about this further and she would get back to me with her decision.

But wait, that’s what she said at her last visit 2 months ago!  

The Delayed Diagnosis of Spondyloarthritis

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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.

What You Don't Know (Best of 2017)

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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.

What I know and learned is often the subject of blogs on RheumNow. Yet, I’ve always been challenged and irked by what I don’t know.

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

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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.

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).