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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. 

Screening and Overdiagnosis of ILD in RA

Dr. Michael Putman (Milwaukee, WI) reviews his approach to screening for ILD and RA, the potential for overdiagnosis and how this impacts treatment choices. Does this differ from your approach?

Focus on the Fasting Lipid Profile

How best do we communicate CV risk associated with RA to other members of the treating team, most particularly the primary care physicians? After some experimentation, I have come up with an approach that seems to work and which does not take up much time.

Comorbidities in RA: Focus on Difficult-to-Treat Disease

The presence of comorbidities naturally complicates treatment choice, patient adherence to medication and patient outcomes, increasing also the risk of making RA ‘difficult-to-treat’.

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.