Blogs
MDA: Aiming for Perfection in PsA
When it comes to psoriatic arthritis clinical trials such as TICOPA (tight control in PsA) have consistently shown that treating to target correlates with improved disease domain and patient reported outcomes. Minimal disease activity (MDA) has become an oft used target and outcome in PsA trials. While many of us measure and record a variety of measures in our patient charts, we may be on our way to demonstrating MDA in practice. Here is a quick review of MDA components and how to capture them for your patients.
The Enthesitis Challenge in Psoriatic Arthritis
A colleague of mine once told me an interesting story of how her father, who was a doctor, misdiagnosed his wife with fibromyalgia when she actually had psoriatic arthritis with enthesitis all along. I would venture out and say that the average physician would have trouble evaluating enthesitis because even we, as rheumatologists do!
Combination Biologic Therapy in PsA: The beginning of a new era?
Without question, basic immunology is at the foundation of rheumatology as a discipline. Indeed, for many rheumatologists, it was the intricacies of the immune system that attracted us into the field. With each passing year, extraordinary advances in scientific methods begat tremendous gains in our understanding of the immune system. Excitingly, we may be entering a new era, driven by results in psoriatic arthritis and other related diseases.
A Rare Disease Doctor
Yesterday was national “Rare Disease Day” in the USA, with many tributes to the patients, doctors and researchers dedicated to these disorders. Moreover, it was a great opportunity to shout about the many rare conditions that don’t often get enough press, praise or funding.
Rheumatology Valentine
My uncle is going through medical hell. As a committed iatrophobic (fear of doctors), any mention of phlebotomy, tests, needles or a clinic visit evokes flop-sweat. Since being slapped with a cancer diagnosis, he has overcome a lot, and much to my surprise has bravely done so. When I asked how he has adapted so well to the medical onslaught he now leans into, his answer was quick and poignant.
A Guide to Self Care of (Mild) COVID19
There is guidance published on how to manage moderate to severe cases, but very few blueprints detail what to do with “mild” infection. The first day, I developed congestion and cough, with a sore throat. As the day progressed, I started to have chills, low grade fevers, and myalgias. The postnasal drainage was overwhelming, and when I tried to swallow, it felt like swallowing broken glass. Isolating in my room, I was left to deal with my symptoms.
Freeze Tag
A beloved childhood game I enjoyed was Freeze Tag. Players would run to avoid being tagged by the person who was “It”. If you were tagged, you had to “freeze” in your spot until someone was brave enough to come un-tag you. The game ends when everyone is frozen or if people quit. For over 2 years, I have been living in a real-life “Freeze Tag” game and able to dodge COVID19, until now. Sitting in my room symptomatic and frozen in isolation, I ruminated about my patients who had COVID19 and their experiences. I wanted to share with you three stories of three variants.
Who is Your Glue?
I’ve often talked about the nurses in my clinic as being the glue, the clinic glue, my personal glue. Without them, the day and task would never go as well and just might crash and burn, if not for their steadying influence.
Best of 2021: Steroid Poker
It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.
Best of 2021: Drug Safety Risk Communication- The 800 lb Gorilla Approach
Discussions on drug safety can be as treacherous as quicksand for the patient and physician. What the physician knows and what the patient perceives may not be in sync.
Best of 2021: 20,21 Whatever it Takes
Amazingly, we made it through 2020, a most forgettable year.
Life was great in the first 3 months of 2020, and then COVID hit the fan and a pandemic steamroller derailed life as we knew it.