Choice Overload (and the Way Out)

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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”.

What Goes Wrong with the Immune System in PMR?

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Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease. The exact trigger for PMR onset remains unknown. However, immunology studies and clinical trials with biological DMARDs now shed light on the immune pathways involved in PMR.

Infections Rheums Should Worry About

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With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”.

Respiratory Burden of RA

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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.

Cardiovascular comorbidity in rheumatoid arthritis

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Friday afternoon page: please call to discuss stress test- moderate ischemia. The page was regarding a patient in a study I was conducting on RA and cardiovascular disease. Determining how to better identify and manage RA patients at elevated CV risk was one of the driving reasons that led my colleagues and I to establish an interdisciplinary clinic between cardiology and rheumatology over a decade ago.

New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

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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. 

B Cell Depletion in RA: The future is bright

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The incredible potential of B cell depletion in rheumatic diseases was heralded by its activity in the treatment of rheumatoid arthritis (RA) over 20 years ago. Rituximab (RTX) was cemented into the armamentarium of RA by its efficacy in TNF-inhibitor inadequate responders (REFLEX).

ICYMI: The Biosimilar "Buy In"

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The landscape of biosimilars is vast. This year alone we are expecting 17 biosimilars in rheumatology. While some pharmaceutical company and payer contracts are still under negotiation, we need to start preparing ourselves and our patients.  Drs. Jack Cush and Arthur Kavanuagh shared insights into these key discussions during RheumNow Live 2023.

The Biosimilar "Buy In"

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The landscape of biosimilars is vast. This year alone we are expecting 17 biosimilars in rheumatology. While some pharmaceutical company and payer contracts are still under negotiation, we need to start preparing ourselves and our patients.  Drs. Jack Cush and Arthur Kavanuagh shared insights into these key discussions during RheumNow Live 2023.

Best of 2022: The Enthesitis Challenge in Psoriatic Arthritis

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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! 

Best of 2022: Five Mistakes When Diagnosing Still’s Disease

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Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.

Best of 2022: Methotrexate in PsA

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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.