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Coin toss

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? 
pregnant, pregnancy, mother, fertility

Pregnancy and Psoriatic Arthritis

Patient TS was a 30 year old woman who had been living with psoriatic arthritis for about 18 months. Her symptoms had started about 6 months after the birth of her first child with mild psoriasis in her scalp but increasing joint pain in her hands, wrists, elbows, knees, and ankles.

lumbar,spine,lbp,pain

Axial Disease in Psoriatic Arthritis

Inflammatory involvement of the axial skeleton and sacroiliac joints occurs, on average, in 40-50% of patients with psoriatic arthritis (PsA). When present, axial involvement is a “biomarker” of more severe PsA disease: more severe peripheral joint disease, enthesitis, skin disease, pain, impaired function and quality of life, and work productivity. Thus, it is important to recognize and include in a comprehensive PsA treatment approach.
Methotrexate

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.
syringe, pill, DMARD, Treatment, therapy

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.
poker.jpg

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.
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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.

poker.jpg

ICYMI: 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.
ape%20silver-back-707324__180.jpg

ICYMI: 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.

twitter bird social

Three Healthcare Hashtags You Should Follow 

I've sent more than 2,000 tweets since joining Twitter in July 2010. Even better, I've read (and sometimes shared) thousands of other educational, informative and sometimes humorous tweets from fellow rheumatologists, physicians, healthcare providers and others around the world. While following individuals and organizations relevant to you is important, so is following hashtags. Here are three I recommend.
covid vaccine

Best of 2020: My Experience as a COVID19 Vaccine Trial Participant

I have been an investigator for many clinical rheumatology studies over the past two decades but have never been a study subject until now. On October 31, 2020, I enrolled in the phase 3 trial of the Pfizer/BioNTech mRNA vaccine against SARS-CoV2 (protocol C4591001). Here's my experience.
poker.jpg

Best of 2020: 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.
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