The ACR, in concert with the Vasculitis Foundation, released three new vasculitis guidelines online first in July, with a fourth slated for publication by the end of the year. These are the first ever to be produced and endorsed by the ACR and the Vasculitis Foundation. Although most of the recommendations are conditional, due to…
Independence Day. I can’t wait. Generally, it’s not a holiday that carries a lot of meaning for me. Having grown up in New York and Boston, the smaller firework displays that take place in Baltimore fail to impress. Also, as a program director, the holiday falls in the middle of the new fellows’ first week…
It is well known that hip fractures are associated with significant morbidity and mortality: Mortality increases 15–25% in the year following a hip fracture.1–5 We know that treating osteoporosis prevents fractures and improves patient survival. But is there a relationship beyond this? Several studies have found that bisphosphonate therapy is associated with a reduction in…
In a randomized, controlled trial, the risk difference between groups is interpreted as a causal effect of the treatment, according to Seoyoung C. Kim, MD, ScD, MSCE, an associate professor of medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital and Harvard Medical…
A new Medscape survey found that rheumatology has the second-highest burnout level among the 29 specialties included, with 50% of the rheumatology respondents saying they’re experiencing “burnout.” To which some rheumatologists are responding: Really? “I was quite surprised by this,” says Beth Jonas, MD, chief of the Rheumatology, Allergy and Immunology Division at the University…
A phase 3 trial described in The New England Journal of Medicine (NEJM) highlights the potential of a C5a receptor inhibitor, avacopan, for anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis.1 Avacopan may potentially offer a steroid-sparing option for the treatment of this serious disease. Current Treatment of ANCA-Associated Vasculitis Morbidity and mortality from ANCA-associated vasculitis have…
We know a large percentage of the U.S. population falls into a vaccine-hesitant group. In fact, only 60% of Americans plan to be vaccinated against COVID-19, according to an article in The Atlantic.1 Given that rheumatology patients are among the vulnerable, we asked a handful of ACR/ARP members whether they have been vaccinated themselves and…
Women remain underrepresented in research and may receive less funding than men, according to a recent study that describes differences in sex representation among U.S. National Institutes of Health study sections.
The ACR has sent a letter to Cigna expressing opposition to the initiative, which jeopardizes patients’ health, interferes with medical decision making, undermines the doctor-patient relationship and may disproportionately affect patients of lower socioeconomic status.
Have you ever asked a patient, “How’s your sex life?” If your answer is “No,” you’re not alone. The Centers for Disease Control and Prevention (CDC) finds healthcare providers don’t talk about sex with their patients for a variety of reasons: They feel uncomfortable discussing sex and sexuality with patients; They believe discussing sex will…
Dermatomyositis is an uncommon autoimmune condition involving skeletal muscle characterized by subacute onset of progressive weakness, intramuscular inflammatory infiltrates and the presence of myositis-specific autoantibodies.1 Immune-mediated myopathies may exert some pathogenic effects on the muscle tissue by targeting the microvasculature.1 Capillary inflammation, fragility and loss may contribute to heightened bleeding events in these patients. Here,…
Calciphylaxis, or calcific uremic arteriolopathy, is a rare disease characterized by calcification of the arterioles and capillaries in the dermis and subcutaneous tissue, resulting in thrombus formation and subsequent skin ischemia and necrosis.1 This serious condition most commonly occurs in patients with end-stage renal disease (ESRD) requiring dialysis or in kidney transplant recipients. In rare…
The Budget Control Act of 2011 cut Medicare physician payments by 2% across the board. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law in 2020, suspended this sequester (i.e., a cut in government spending) between May 1 and Dec. 31, 2020. In the Consolidated Appropriations Act, signed into law in December…
More than 7 million doses of the Johnson & Johnson single-dose vaccine have been administered in the U.S.1 On Apr. 23, the Centers for Disease Control & Prevention (CDC) and the U.S. Food & Drug Administration (FDA) recommended lifting the recommended pause on Johnson & Johnson COVID-19 vaccine use following a thorough safety review. 2…
A 26-year-old Peruvian woman presented to the emergency department of a large teaching hospital in Lima, Peru, with epistaxis and hematomas that had occurred over the preceding few days; she was found to have severe thrombocytopenia and a normocytic, normochromic anemia. She was treated with pulse doses of methylprednisolone; however, within two days, she presented…
RA shortens life expectancy, even with advances in treatment—and more so for women than for men, according to new research by Chiu et al.
Common variable immunodeficiency (CVID) is a common primary immunodeficiency disease, with an estimated incidence of one per 25,000–50,000 individuals.1 The classic presentation includes frequent bacterial infections, secondary to dysfunctional B cell differentiation, impaired immunoglobulin production and diminished antibody response. The clinical presentation may be heterogenous and may include granulomatous disease as an uncommon manifestation. Granulomatous…
A 61-year-old white woman presented to our rheumatology clinic in New England to establish care in early June 2018, following a move from Texas. She reported a medical history of inflammatory bowel disease, uveitis and seronegative inflammatory arthritis, which was difficult to control and required the use of multiple medications. At her initial visit, she…
At the 2021 ACR State-of-the-Art Clinical Symposium, Saira Sheikh, MD, associate professor of Medicine and director of the Rheumatology Lupus Clinic, University of North Carolina, Chapel Hill, provided an update on the past, present and future of the management of systemic lupus erythematosus (SLE). This year, hydroxychloroquine received a great deal of attention, given early…
In 1888, Dr. Jan Mikulicz-Radecki reported a case of chronic, bilateral, painless enlargement of the salivary and lacrimal glands that appeared to be idiopathic.1 In subsequent years, other patients with these findings were reported, and the term Mikulicz syndrome was used to describe these cases. Although Mikulicz syndrome is now known to be associated with…
Many a rheumatology consult has centered on a perplexing question: Does this patient have central nervous system (CNS) vasculitis? At the 2021 ACR State-of-the-Art Clinical Symposium, Rula Hajj-Ali, MD, FACP, professor of medicine and associate director of vasculitis care and research, Cleveland Clinic Lerner College of Medicine, discussed this topic in detail, providing a series…
In spring 2020, as it became obvious that COVID-19 wasn’t going anywhere anytime soon, the leaders of the Rheumatology Research Foundation implemented an expedited process to distribute research funding beyond its typical awards program. This resulted in the Foundation awarding $1.65 million to fund five research studies that will look at the relationships between rheumatic…
Some artists paint with oils or watercolors, others with acrylics. Shivani Garg, MD, MS, prefers Nescafé or Maxwell House coffee. A faculty member in the Division of Rheumatology in the Department of Medicine at the University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Dr. Garg learned this technique—painting with instant coffee mixed…
On Feb. 1, the Royal Swedish Academy of Sciences announced that Daniel L. Kastner, MD, PhD, scientific director of the Division of Intramural Research of the National Human Genome Research Institute, where he is a National Institutes of Health (NIH) Distinguished Investigator, was awarded the 2021 Crafoord Prize in Polyarthritis “for having established the concept…
A recent study of data from the FDA’s Adverse Event Reporting System reveals that 14 drugs commonly prescribed by rheumatologists are on the list of the top 50 drugs that can cause anaphylaxis.