Blogs
Hydroxychloroquine for Everyone
Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, if not overly aggressive, in treating all RA patients. And my view was that HCQ was representative of under-treatment. I have reconsidered the use of HCQ in RA substantially in the last few years, based on its merit.
Overlap Syndrome with ILD
How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?
Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.
Choice Overload (and the Way Out)
I recently overheard a very good practicing rheumatologist complain, “why do I need yet another drug for psoriatic arthritis? I have more treatment choices than I have actual PsA patients who need a new or better drug”.
Using Methotrexate in PMR
Treatment of PMR is still largely based on glucocorticoids. Where in other inflammatory rheumatic disorders, such as RA and PsA, early initiation of methotrexate is common practice, this is not the case in PMR.
Hard Conversations: DMARDs and Malignancy
Cancer is the most difficult DMARD risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control.
Should You De-escalate DMARDs in RA?
I'm here to talk about de-escalation of DMARDs in patients who are in remission. Should you do it? Here's what I think.
Respiratory Burden of RA
Lung complications in RA remain a major issue, termed the “respiratory burden of RA.” Respiratory mortality is one of the leading causes of death for people with RA, particularly those with seropositive RA.
Why aren’t we preventing RA yet?
Ever since the seminal studies demonstrating a prolonged preclinical period for seropositive RA, which have been replicated in multiple cohorts around the world using both retrospective and prospective study designs, the rheumatology community has been tantalized by the prospect of preventing the onset of inflammatory joint disease in seropositive individuals exhibiting no clinically detectable synovitis. So why can’t we prevent RA yet?
New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.