In my experience, rheumatologists are very fine people. Since they are cognitive specialists, they are scholarly, thoughtful and prudent. Furthermore, they are sensitive to the vicissitudes of human existence. Rheumatology is probably the first subspecialty to consider the impact of a chronic painful illness on the spirit and soul and emphasize quality of life as an outcome. Seeking wisdom and knowledge from great minds, rheumatologists are also interested in culture, mindful that masters like Renoir and Klee were among their patients.

Following the November elections, there are now 29 states and the District of Columbia that have legalized marijuana (aka cannabis) for medical use. Of these, eight states and the District of Columbia have also approved laws legalizing marijuana for recreational use. Regardless of the stated benefits associated with marijuana use, there are potential health risks. One of these which rheumatologists may see more of in the future is cannabis arteritis. The following is a recent case we saw at the University of Colorado.

Many readers of RheumNow know of my interest in the history of our discipline, and some of the writings and discoveries which have resulted from them. In the past three years, I have had the opportunity to explore the contributions of Max Hirsch, MD to our field.

The ACR Annual Meeting (#ACR16) is such a huge event that it’s worth your time to spend an hour or two planning your time at the meeting. Here's my tentative #ACR16 session schedule.

Everything will be alright in the end; and if it’s not alright, then it’s not yet the end. – Suni Kapoor (from the Best Exotic Marigold Hotel)

This is written as a check-up to your digital self and a wake-up call to those of you who are disconnected lazily or willfully. This is written for the journal-subscribing, big textbook toting physicians whose primary education is acquired at the medical library, weekly medical conferences or grandiose annual conventions. Before you bail out on this blog, you should recognize the consequences of not being digital.

Rheumatologists in Georgia and across the country are under extreme pressure to care for our patients. The Georgia Society of Rheumatology exists to stimulate interest and increase knowledge of arthritis and rheumatic diseases among physicians, allied health professionals, and lay advocates. Following are highlights of GRS issues and activities.

This past weekend I was fortunate to lecture at the Harvard Advances in Rheumatology Course, where I reviewed the safety issues surrounding the use of biologic therapies. In discussing infections, cancer, cardiovascular events, etc., it became very clear to me that these problems, while worrisome, are often escalated in their importance – all at the expense of what is most dangerous: RA itself.

Through educational, administrative and legislative efforts, FSR works for the betterment of rheumatology practices and patients in Florida. Here's how.

Like the EULAR Congress of 2010, the 2016 version was in the giant ExCel center out in the Docklands area. The meeting rooms are cavernous, big as some basketball stadiums. The ExCel is so big that it is served by two stations of the DLR railroad and it is probably long enough to function as a runway with planes that fly overhead on the way to London City Airport. Ed Sullivan would have called the ExCel “really, really big.” Donald Trump would say it is “yuge.”

When I was just a lad in the 1950s, I used to enjoy a television quiz show called “Name that Tune.” This popular show, which was hosted by an amiable singer and comedian named George DeWitt, had a premise that was simple but appealing. The studio orchestra would start playing the notes of a song and the two contestants would compete to see who could identify the song first, running across the stage “to ring a bell and name that tune.”

You write the prescription, hand it to the patient and explain why it’s needed, how to take it and what the most common or most dangerous side effects might be. Comprehensive, reasonable, and professional. Certainly the patient should fill the prescription and start the drug.

Should you assess your patients' “purse-onality? The purse exam is an important part of the physical that can help make the diagnosis and improve patient outcomes. I often wonder if downsizing the purse should be part of the T2T (treat to target) initiative.

You are in good company if you find the alphabet soup of rules and regulations impacting your practice a bit overwhelming. MU, ICD10, MOC, VBM, MIPS, APM, PQRS, ACO, SGR...it’s enough to trigger fantasies of early retirement among even young rheumatologists. But don’t despair!

The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.

Experience is a great teacher. My experience with knee replacement surgery taught me the pivotal importance of the physical therapist in individual outcomes.

Rheumatologists distinguish themselves from their medical colleagues in several ways: exceptional joint exam and joint injection skills, interpretation of complex immunologic findings and cost-efficient ways of managing common musculoskeletal disorders. But what’s the one trait, skill or question that defines the acumen of the rheumatologist? Please don’t say morning stiffness. 

pSpending almost half of the year traveling, I am privileged to get to read lots of books. I rarely read a book twice. This book was an exception. nbsp;/p

Upon reading the title of a recent news item - 'Medical error is the third leading cause of death in the US' - a feeling of apprehension and dread arose. Very quickly, my worst fears were realized.

Dr. Jack Cush provides a perspective on the first year anniversary of RheumNow.com - a site dedicated to delivering the wisdom, art and science of Rheumatology. 

A new subspecialty may emerge. New drugs will be approved (but it will be difficult for patients to get coverage for them). And an American team will win the World Series. All these and more: here are predictions for 2017 and beyond from rheumatologists across the country and around the world.

"Making the complex simple, the simple useful, and the opaque crystal clear." Rheumatologists (plus one non-rheumatologist) from around the world weigh in on RheumNow's impact over the past year. 

Where do your patients sit? Have you noticed they don't usually sit where you expect them to? What's up with that, and is there a psychology behind one's choice of seating? This curious observation may portend the nature of the physician-patient relationship or, at the very least, impact the layout of your next clinic.

Google Images is a treasure trove of photos and drawings about medicine. The pictures of RA, though, look as if nothing happened in the last 90 years: the field stagnant, gold the gold standard, biologicals never invented, ulnar deviation rampant and joint destruction inevitable. If early recognition of inflammatory disease is at the crux of modern treatment, why show end-stage disease except as a warning?

Despite regular attendance at medical meetings and despite fulfilling regulatory requirements for our specialty, I’m not sure how much I learn that changes the way I practice medicine. So I recently persuaded a colleague to come and coach me, inviting him to observe me for a morning in clinic. This was the first time I had been observed in this way since I was a medical student. A little daunting, but after a while I largely forgot he was there. Then he gave me some feedback.