Low Dose IL-2 Effective in Lupus
Sep-18-2019
A double-blind, placebo-controlled clinical trial of low-dose IL-2 in patients with systemic lupus erythematosus (SLE) has shown that low-dose IL-2 induced was clinically effective while expandng regulatory T cells and NK cells, which may benefit immune homeostasis in SLE patients.
The 16th Annual La Paulee
Oct-21-2018
La Paulee is traditionally the party/feast after harvest and a time when hard work is rewarded with food, fun, and wine. And so it was that evening; after better understanding genes, cytokines, and pathology it was time to have a good time with friends, old and new.
Update on Myositis
Sep-20-2018
The ACR/ARHP 2018 national meeting in Chicago presented us with opportunities to learn more about inflammatory myositis. A particularly interesting lecture was HOT topics in myositis. There were a few abstracts on MDA-5 related disease and a few on new or repurposed medications for dermatomyositis which will be covered here.
Negotiation Skills for Rheumatologists
Sep-18-2018
Physicians as a group are trained to have excellent clinical skills, but the difference between an average and extremely successful physician often comes down to factors outside of their ability to provide clinical care.
FEAR: A Perception of Fact In Spite of the Fiction
Sep-19-2019
Pregnancy for patients with lupus has long been considered high risk and associated with both medical and obstetric complications, but outcomes have improved over the last 2 decades and continue to improve. The large decline in in-hospital maternal mortality was greater for lupus pregnancies than for non-lupus pregnancies. Findings from a retrospective cohort study are published in Annals of Internal Medicine.
Methotrexate and the Risk of Lung Disease
Feb-25-2020
Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.
Clinical criteria for the diagnosis of MTX pneumonitis (acute, reversible) and RA-ILD (chronic, progressive) are quite different and are reviewed in this article.
Best of EULAR 2018
Jul-24-2019
A video matrix of the best moments and findings from our coverage of EULAR 2018 in Amsterdam
Do Autoantibodies Drive Disease in Seropositive RA?
Jul-17-2018
RA is an autoimmune disease driven by self-perpetuating central pathways, involving B-cell–derived autoantibodies and proinflammatory cytokines. Disease progression is driven by a range of immune cells that include T cells, B cells, and macrophages.
GoutOUT Surging in the Polls
Jun-07-2018
6 Rheumatologists talk about the recent FDA Approval for over-the-counter GoutOut
Biosimilars in Rheumatology
May-31-2019
A first-of-its kind educational video series focusing on the “hot topics” in biosimilars from the perspective of leading Rheumatology experts. This educational series is presented by Sandoz, Inc.
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Apr-06-2020
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Need for Pre-operative Hyperglycemia Testing Prior to Total Joint Replacement
Apr-28-2020
JAMA reports on a large Medicare cohort study showing that amongst patients undergoing total joint replacement (TJR), preoperative HbA1c testing was performed in 26% to 43% of patients with diabetes and in only 5% of those without diabetes. Importantly research has shown that an elevated HbA1c level is associated with postoperative complications.
Our Privilege
May-11-2020
Another lonely locked-down day. Seems like months. Rent is due, phone and EMR fees next week. Loan is pending. Seems impossible to treat complex diseases without touch and only computer screen rapport. And yet, it is a good day.
Shutdown and the New Normal
Apr-16-2020
COVID-19 is not going to suddenly end on June 1st. This is a long haul change and you need to be prepared for the aftershocks and fallout. It’s time to be be a Marine and ”Improvise, Adapt, and Overcome”.
Urgent or Not
Apr-09-2020
Our practice standards have been flipped. The physician’s best clinical tool has become the webcam or telephone. The nagging question is: “who needs to be seen in clinic or in the hospital with a F2F evaluation?” It basically boils down to urgency.
Goodwill Wednesday
Mar-11-2020
Business as usual, Wednesday morning, as I quickly stop at 7-Eleven for my morning coffee and it all begins.
A nice stranger holds the door open for me; I reach for a carton of milk for someone unable to; the cashier skips the 2 cents on a $2.02 bill (with a smile).
What transpired in a quick five minutes was a series of random, unrelated, unprovoked acts of kindness. Blatant politeness, sincere smiles, compliments between strangers and lots of open doors.
This made me think.
Steroid Poker
Jan-14-2020
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.
Best of 2019 - The House of God After 40 Years: A Rheumatologist's Reflection
Jan-01-2020
The House of God is probably more known of than read, with over 3 million copies sold since its release when I was a Chief Medical Resident in the era of its writing. The book itself, according to the author Samuel Schem (aka Steven Bergman, MD, DPhil), a psychiatrist and currently Professor of Humanities at NYU, is a true account of his internship, albeit laden with some liberties of fiction - and it's been quoted for generations. The House of God is cruelly funny and portrays many uncomfortable and dehumanizing aspects of medicine, including substance abuse, bawdy sex (and lots of it), sleeplessness, depression, and suicide to name a few. Taken at face value, it would seem countercultural to our current aspirations of putting patients first, #MeToo and burnout concerns. Is this book merely a humorous anachronistic rant, or a serious work of reflection meritorious of being read and pondered upon?
Millennial Doctors: Digital natives and the death of medicine as we know it
Dec-23-2019
Millennial physicians comprise a wider, diverse population compared to prior generations, including an ever-increasing female physician community. It is estimated that by 2025, 75% of the work force will be millennials.1 This generation grew up in an era of participation trophies and structured childhood schedules, all while watching their predecessors sacrifice work/life balance due to persistent slashing of reimbursement. All of this sets the tone for change.
Tips from a HomeRheum Mom
Dec-18-2019
At the recent ACR 2019 meeting, I met some incredible women who shared with me their struggles, sacrifices and success when it comes to balancing a career and family while still retaining their sense of self. Many of you know I am a mother to 3 children ages 15, 12 and 9. Life can be challenging, especially since my husband has a busy practice, too. So how do you advance your career and still raise a family? Here are five lessons I've learned.
Pearls Part 2: Common Sense Rheumatology
Dec-03-2019
We live in an era where you need evidence in order to believe, but life’s experiences should not be discounted even if we do not have the statistics to support them…yet. In Part 2 of my annual meeting Pearls Trilogy, I present ten tips and observations shared by Dr. Sterling West from his session, "Rheumatology Top Secrets & Pearls".
2021 E/M Coding Update
Nov-29-2019
I had the pleasure of attending the CSRO legislative update while at #ACR19 and wanted to shed some light on one hot topic, the E/M coding from CMS and the 2021 update.
Improving the ACR – Big Meeting Experience
Nov-29-2019
Our experts say you should: Plan the night before, use the ACR meeting App, work in groups, be involved in social media and, have fun! What's your advice on how to best attend the ACR meeting?
Rheum For Interpretation: Three Tips To Apply RCTs To Your Clinical Practice
Nov-28-2019
At the 2019 meeting, almost 500 presentations discussed new randomized controlled trials. We are lucky to have so much research activity in our field, but applying an RCT to your daily practice can be challenging. Here are three tips to supercharge your critical appraisal!
A Review of the Review Course + How to Make the Information Stick
Nov-25-2019
I have been attending the ACR Review Course for more than a decade, and it seems every year it gets better and better. Contrary to what most people think, this is not a board review course; it is more of a review of the latest research delivered by experts condensing rheumatology in eight hours.
When Classification And Diagnosis Diverge
Nov-21-2019
Few rheumatologic diseases have diagnostic criteria, so clinicians often rely on classification criteria to diagnose patients in clinic. Because classification criteria were not designed to be used for these purposes, they have important limitations.