The introduction of the 2015 rheumatoid arthritis treatment guidelines has prompted discussion and critique from many.  Here's my perspective on where monotherapy and methotrexate combination therapy fits in our armamentarium.

Patients should act as if they are the CEO of a new business. Their business is the disease they must manage. The analogies of managing a business and a disease are numerous and instructive for patients and physicians alike.

We review the available literature, with a particular focus on the recent findings in the Hopkins Lupus Cohort, regarding the clinical utility of hydroxychloroquine blood levels in helping to clarify some of the issues regarding retinopathy, how best to dose this medication, and medication adherence. 

Highlights of Rheumatology news for the week ending 20 Feb 2016.

Video highlights from last week's reports, news and tweets on RheumNow.com

My colleagues indulged me in a small experiment. I set before them $100 in cash and offered each of them a choice: take the $100, or flip a coin for a 50% chance to win a certain amount of money that they could specify. They would tell me the minimum amount of money I needed to offer in order to prefer the coin flip over taking the $100. What does this have to do with treat-to-target?

It’s somewhat bizarre that a designer drug from over 65 years ago would become the cornerstone of treatment for rheumatoid arthritis in the 21st century. When Sidney Farber designed a molecule that would interfere with folate metabolism in the middle of the 20th century, he was looking for a ubiquitous antimetabolite to treat cancer. Farber was actually quite concerned with the potential side effects of a drug that competitively inhibits folate metabolism. That is part of the reason he combined the “met” for metabolism with an “x”. The x was found on poison bottles and he thought it wise to include it in the name of this agent.

Dr. Cush reviews highlights from last week's news and research in rheumatology.

Four men and 4 women, 5 joint replacements, 4 knee arthroscopies, 2 cancers and 6 bad attitudes were not enough to deter the inspiration and perspiration required of us last weekend. So how did we do? And yes, there are pictures. 

With so much controversy surrounding the American Board of Medical Specialties' Maintenance of Certification program in 2015, especially as it pertained to the ABIM, Dr. Westby Fisher recaps some of the earlier announcements about the ABMS MOC program, then summarizes the year's most pertinent developments to serve as a springboard for 2016. 

A patient recently asked me, “What do you think it’s like to have RA” and “How would you describe it to someone you just met?”   Could I walk a mile in her shoes?  Here's my version and theirs.

Was 2015 a good year for psoriasis, IL-17, biosimilars, narcotics, the ACR and gout? Our year end review discusses the most impactful news and research from the last 12 months.

pspan id="docs-internal-guid-e781d644-1329-b82e-568a-073291db4b14"spanImagine being in practice in the early 1940s, when the best you could do was salicylates and bed rest. Enter t/span/spanspan id="docs-internal-guid-e781d644-1329-efe6-be35-2eac264a3c59"spanhe clinical team of Philip Hench, Howard Polley and Charles Slocumb./span/span/p

Here are five things every rheumatologist should know about antimalarial medications for lupus. 

Wine and the rheumatologist in theory could be about a lot of things. Naturally, as rheumatologists, we are interested in how wine may affect rheumatic diseases. I am more inclined to write about how our community interacts around and enjoys wine.

Notalgia, Lyme disease in Texas and still wearing your hospital ID bracelet? You may have been misdiagnosed and instead have fibromyalgia!

As I think of the many meetings I attend as a speaker or attendee, the experience ranges from grueling to exhilarating. Yes, each venue has its own merit, including furthering my education, presenting my research, and, certainly, seeing old friends and interesting places. This particular trip had all of this but so much more.

Let me share a great wine and ACR 2105 story with all of you. It epitomizes everything I think of when I wish to blend my work and my life, and I owe this experience to Mike Schweitz, a noted rheumatologist from Palm Beach.

Here are five things every rheumatologist should know about antimalarial medications for lupus. 

While there are currently 9 biologic agents approved and marketed for the treatment of RA, and although each has a valued place in our arsenal, I would propose none has been as influential or dramatic as TNF inhibitors. The “born again” rheumatoid feeling is not well captured by any of the usual metrics or measures. It’s not found in the HAQ, DAS28, SF36 (either mental or physical), fatigue score, or any lab parameter. I believe it’s best described by my patient RH who wrote me a letter soon after starting etanercept.

While decades of drug development have improved treatment options, some of our older drugs are harder to improve upon. The same can be said for old movies and new movies, or classic literature and current best sellers. Which do you prefer or rely on?

Are you efficient, productive and accurate in what you do?  Could you be better? Or do the job differently?

I have a 21 yr. old lupus nephritis patient on mycophenolate, hydroxychloroquine and prednisone 40 mg per day. She says both her current nephrologist and her prior pediatric rheumatologist told her NOT to get pneumococcal and flu vaccines. I thought she is supposed to get them - any comment?

I think this will be my 35th ACR meeting. Meetings such as ACR are family events as much as they are scientific events, meant to be celebrated with food and your favorite legal beverage, which in my case is wine.

A reprise of a prior blog on the "best kinds of arthritis" to have.  This time with more commentary and good news.

Hospital consults – “nobody goes there anymore”, and not because it’s too crowded (a quote from the late great Yogi Berra), but rather because it’s a poor investment of time and resources.

The American College of Physicians issued a position statement about medical clinics popping up inside of retail establishments and pharmacies. For years now I’ve schemed of starting a national chain of “Jiffy Joints”. Is it time?

Today marks the one year anniversary of hydrocodone becoming a schedule II drug with more restrictive access. Has life been better under these new rules?

I had a wonderful time in Rome, due in small part to the wonderful wines I drank with family and friends. When I got home, enjoying those same wines again made me wonder about the placebo effect. 

Rheums do not live by wits and cytokine blockers alone. We need tools, equipment and material goods to be the diagnostician, communicator, and technical wizards that triple-threat rheumatologists propound to be. Not long ago I ranked my top and bottom 5 joints. Now we tackle the most and least important tools of the trade in rheumatology.