In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

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? 

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.

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.