Articles By David Liew, FRACP
Will the Robots Save Ultrasound?
Despite all its benefits, ultrasound’s daily clinical use remains the domain of only a subset of interested rheumatologists. If the benefits are so clear, then why is it not universal? In the late-breaking oral abstracts at ACR Convergence, the final abstract presentation was from the Danish rheumatologists behind ARTHUR and DIANA: the robot which holds the MSK ultrasound probe, and the artificial intelligence brains which empowers it. Perhaps the robots will save us?
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Ozempic will change rheumatology
Many of our diseases are made worse by obesity, notably rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Much of the refractory pain and suffering from these conditions might be attributable to obesity, so active questions will be raised about how GLP-1 agonists can influence the diseases we treat.
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JAK inhibitors in GCA?
The SELECT-GCA study, looking at upadacitinib in GCA, anchored the ACR 2024 opening plenary for a reason - it is highly notable and badly needed.
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The path to new technologies in rheumatology must be beset with caution
As we have incorporated technology into our workflows, and consequently saved lives and suffering, we have balanced our excitement about progress with proof that incremental advances can truly deliver benefit. it is easy to let promise carry our caution away - and while most of the time such advances come in a vetted package, which we can consume without concern, conference abstracts come raw. This is the necessary ingredient to a platform which allows for bold ideas and innovation, but for that reason it is not such a curated space. At EULAR 2024, we saw the usual mix of bright, raw ideas on the poster floor emblematic of this paradigm.
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Choices in GCA
There are a number of diseases where new biologic and targeted synthetic therapeutic options are coming online, and the temptation will be to consider them all equally. GCA is one of those diseases.
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The art of talking about risks with our patients
On the first day of EULAR 2024, I am debating Janet Pope.
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ICYMI: How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard.
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When should we be starting therapy in GCA and PMR?
The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it. GCA and PMR are at the stage in the growth of their therapeutic development where this problem is moving to the front of mind, and it made for a fitting topic in the ACR Great Debate. Drs. Rob Spiera and Phil Seo - two luminaries in the vasculitis and PMR worlds - were pitted head to head to discuss.
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Why are older RA patients getting mistreated?
Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. So I am genuinely shocked that, in a large United States Medicare 20% sample dataset between 2008-17, less than 30% of new RA patients aged 66 years or older have a DMARD initiated.
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How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard.
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