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Infections Rheums Should Worry About

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”.

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.

Assessing Cardiovascular Risks: The Responsibility of the Rheumatologist

In 2016, EULAR posted recommendations for the management of cardiovascular risks in patients with rheumatoid arthritis and other inflammatory joint diseases. Three overarching principles emerged, but one caught my attention: “the rheumatologist is responsible for CV disease risk management.” It leaves no room for interpretation.

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?

Cardiovascular comorbidity in rheumatoid arthritis

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.

Multimorbidity in RA

Multimorbidity is a little bit different than comorbidity, which may be a term that you're more familiar with. In comorbidity, we put rheumatoid arthritis as our focus, whereas in multimorbidity, we put the patient at the center of our focus.

A Brief History of Rheumatoid Arthritis Mimics

Imagine that 100 years from now, your great granddaughter, an eminent rheumatologist, reviews the history of rheumatoid arthritis mimics.

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. 

B Cell Depletion in RA: The future is bright

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).

Comorbidities in Rheumatoid Arthritis: A Precarious Stack of Blocks

Comorbidities can pile up like a stack of blocks for people with rheumatoid arthritis (RA).  At the time when RA is diagnosed, they already have more comorbidities than their peers, and after RA diagnosis they accumulate comorbidities faster than their peers.