Rheumatologists are accustomed to educating patients about medications—but biologic medications require some additional time and discussion. “Biologics are inherently more complex [than other medications], and there are multiple issues to consider before initiating treatment,” says K. “Kwas” Huston, MD, The Center for Rheumatic Disease, Kansas City, Mo. “This includes the patient’s disease activity, prior medications…
In 1982, my wife (also a rheumatologist) and I attended our first American Rheumatism Association (now the ACR) national meeting. After the meeting we stayed with a friend in a suburb of Boston, where we also had the opportunity to meet our hostess’ in-laws, a retired general practitioner and his wife. When her father-in-law shook…
Although gout is one of the most effectively treated of all rheumatic diseases, it is among the worst-managed diseases long term, as shown by many studies. “Treatments are excellent, yet are dramatically under-utilized,” says Theodore Fields, MD, FACP, rheumatologist, Hospital for Special Surgery (HSS), New York. “This is because some gout patients feel better between…
In May, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published its recommendations for the treatment of psoriatic arthritis (PsA).1 The updated recommendations represent advances in drug development and availability since previous recommendations published in 2009, as well changes in treatment paradigms and the importance of associated aspects of the disease.2…
Depending on stage, severity and rate of progression of disease, systemic corticosteroids are commonly used to treat pulmonary sarcoidosis. However, a review of the literature suggests they have limited usefulness in advanced stage IV pulmonary sarcoidosis. Once sarcoidosis has advanced to this degree, steroid use may unnecessarily expose a patient to life-threatening complications, as demonstrated…
Both due to its efficacy and favorable side effect profile when compared with alternative drugs for rheumatologic conditions, hydroxychloroquine is an important agent in rheumatologists’ armamentarium. However, one barrier to hydroxychloroquine use can be its effects on the eye (also see “Revised Retinopathy Screening Guidelines,”). Ocular side effects of hydroxychloroquine can include impact on the…
A 73-year-old white male presented with a one-day history of a cold, painful, right foot. The foot had a blue discoloration to it, particularly the toes. The emergency physician suspected an atheroembolic cause, given this patient’s age and history of coronary artery disease. However, the patient also reported a one-year history of painful pallor in…
Oral health is not frequently considered within the sphere of a rheumatologist’s practice. However, recent results published by the Canadian Scleroderma Research Group (CSRG) point out the importance of assessing oral health in patients with systemic sclerosis (SSc). Result of 3-Year Grant Between 2008 and 2011, 163 patients with SSc and 231 controls were entered…
We read the case report by Dr. Diana Girnita and colleagues (“Severe Refractory Gout: What options are left when pegloticase fails?” The Rheumatologist, August 2016) with interest. A case is reported of a subject with 20 years of chronic refractory gout who failed to respond to pegloticase therapy, and the potential roles of anti-drug antibodies or…
Scleroderma, or systemic sclerosis (SSc), is an autoimmune disease characterized by vasculopathy and fibrosis. Although relatively rare, with a prevalence in North America of approximately 300 per 1 million people, SSc is associated with significant morbidity and high rates of mortality.1 Patients with scleroderma have four times greater mortality than age- and sex-matched controls, with…