Blogs
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.
Best of 2022: Toss of a Coin - How do You Choose PsA Medication?
When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they?
Best of 2022: Methotrexate in PsA
Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic.
The Best Prescription
The craziest question that you can ask any doctor is “what is your best therapy for __?”. Crazy, because there are exponential answers, with factored layers that make each decision unique to that doctor. Each doctor has her own cha-cha-cha algorithm to a particular problem. The problem is, we each dance to a different cha-cha-cha tune in the practice of medicine.