The identification of specific transcription factors linked to the Epstein-Barr virus (EBV) provides new information on the molecular mechanisms underlying the link between EBV and autoimmune disease. A recently published study, “Transcription Factors Operate Across Disease Loci, with EBNA2 Implicated in Autoimmunity,” co-led by John B. Harley, MD, PhD; Leah C. Kottyan, PhD; and Matthew…
More than 72,000 Americans died from opioid overdoses in 2017, according to the National Institutes of Health.1 The impact of the opioid epidemic has affected many levels of patient care and, as a result, healthcare systems are responding to escalating death rates, new legislation and the possibility of compromised patient safety in a multitude of…
Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis. SRC occurs in 2–15% of patients with diffuse sclerosis and usually within the first five years from the time of diagnosis. Risk factors for SRC include, but are not limited to, early diagnosis, corticosteroid or cyclosporine use, and the presence of anti-RNA polymerase III…
The traditional model for subspecialist consultations on hospitalized patients by outpatient-based rheumatologists may seem straightforward. Hospitalists (the inpatient specialists who now manage most in-hospital medical care in the majority of U.S. hospitals) typically call upon the rheumatologist’s expertise for joint swelling and a rash or fever of unknown origin, says Lianne Gensler, MD, of the…
When I first met Ms. Miller (name changed), quite frankly, I couldn’t wait to get out of the room. I’m sure she couldn’t either. A woman in her 40s with systemic lupus erythematosus, poorly controlled asthma and fibromyalgia, she seemed to have every conceivable symptom. And, worse than that, due to a long history of…
Rheumatologists want to be the best clinicians possible, provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In the Lessons from a Master Clinician series, we offer insights from clinicians who have achieved a level of distinction in the field of rheumatology. Michael H. Weisman, MD, is a professor…
Apremilast was first marketed in March 2014 for the treatment of adults with psoriatic arthritis (PsA). An immunomodulating drug, which is a small molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP), apremilast is administered orally. By inhibiting PDE4, intracellular cAMP levels are increased. Although the exact mechanism of action is not…
In 2004, the British Medical Journal published an article titled, “Resisting Cookbook Medicine,” which looked askance at the “routine use of predetermined directives” in clinical practice because it reduced doctors to practicing so-called cookbook medicine and eroded the art of medicine.1 Fast forward 15 years, and we find our appetite for “predetermined directives”—what we now…
The cards sat, untouched, in a corner of my desk. In the 1800s, it was common for American saloons to provide patrons with a free meal. Of course, the meal came with a catch: The meals were predictably salt laden and designed to encourage patrons to drink more beer. Hence was born the expression, “There…
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease. Although RA develops its central pathology within the synovium of diarthrodial joints, many non-articular organs can be involved, particularly in patients with severe joint disease.1 Although most patients are asymptomatic, cardiac involvement is relatively common and includes rheumatic heart nodules, pericarditis (30–50%), pericardial effusion and…