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The Rheumatologist: February 2023

Polymyalgia Rheumatica: New Tricks for an Old Disease

Desh Nepal, MD, Sebastian E. Sattui, MD, MS, & Michael Putman, MD, MS  |  January 29, 2024

Originally posted Feb. 13, 2023; reposted in conjunction with publication of the PMR supplement to the February 2024 issue of The Rheumatologist. PHILADELPHIA—Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that almost exclusively affects individuals older than 50.1 First described in 1888, PMR has been a recognized rheumatic disease since at least 1957. Diagnosing the…

Revisiting Our Assumptions & Preconceptions

Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS  |  February 14, 2023

Admittedly, there’s not much to see on a country road 100 miles southwest of Iowa City, Iowa. It’s especially true in winter, when a blanket of white snow obscures any and all features of the seemingly endless fields of corn and soy. In the radiance of fresh snow on a bright winter day, even the…

In Memoriam: A Tribute to Dr. Philip Robinson

The COVID-19 Global Rheumatology Alliance Steering Committee: Jinoos Yazdany, MD, MPH; Zachary S. Wallace, MD, MSc; Paul Sufka, MD; Emily Sirotich, PhD; Pedro Machado, MD, PhD, FRCP; Jean Liew, MD, MS; Jonathan Hausmann, MD; Rebecca Grainger, MB ChB, PhD; Monique Gore-Massy; & Suleman Bhana, MD, FACR  |  January 11, 2023

We write to celebrate the life of Philip C. Robinson, MB ChB, PhD, FRACP, a beloved colleague and leader in rheumatology. Phil died in early January after an unexpected and short illness. He is survived by his wife, Helen, and his two young sons. We have witnessed an incredible outpouring of respect and affection for…

2023 Medicare Physician Fee Schedule Final Rule for Quality Payment Program Published

From the College  |  January 6, 2023

The ACR highlights essential policy and reporting changes to the Quality Payment Program for performance year 2023 and beyond. Key changes include policies regarding the development of new MIPS Value Pathways and refinement of subgroup participation.

RheumMadness 2023: the All-Star Season

David L. Leverenz, MD, MEd  |  February 13, 2023

RheumMadness is back for its third season, and everyone who is crazy about rheumatology is welcome to play. That includes practicing rheumatologists, fellows, residents, medical students, advanced practice providers, other healthcare professionals and patients. Basically, if you are reading this article, you can play RheumMadness. RheumMadness is an online tournament in which a bracket of…

Case Report: Adult-Onset Still’s Disease with Complications

Cristina Romaniello, DO, & Caitlin Kesari, MD  |  February 14, 2023

The following report outlines a case of newly diagnosed adult-onset Still’s disease (AOSD) complicated by macrophage activation syndrome (MAS) in a previously healthy and active 32-year-old man who had emigrated from Africa to the U.S. Case A man with no prior medical history presented with acute-onset polyarthritis, fevers and fatigue that began one month previously….

Case Report: A Long, Arduous Evaluation Capped by Genetic Testing

Saud Abaalkhail, MD, Muhammad Umair Javaid, DO, & Amarie Negron Rodriguez, MD  |  February 14, 2023

Systemic autoinflammatory diseases (SAIDs) are rare syndromes characterized by alterations in innate immunity that result in a variety of clinical manifestations that are usually associated with recurrent fevers.1 Thanks to advances in genetic sequencing over the past few years, monogenic causes for some of these autoinflammatory diseases, such as Yao syndrome, have been discovered.2 Previously…

Case Report: World Trade Center Dust Stokes a Foreign Body Reaction

Branden Ireifej, MD, Lea Meir, MD, Emily Gutowski, MD, Hansen Lam, MD, & Wei Wei Chi, MD  |  February 14, 2023

The terrorist attacks on the Twin Towers at the World Trade Center (WTC) that led to their destruction on Sept. 11, 2001, as well as the subsequent year-long cleanup of the site (i.e., Ground Zero) in 2001 and 2002, not only had immediate implications for the lives and health of thousands of individuals at the…

3 AC&R Study Summaries: Treat to Target in Gout, Response to Biologics in Patients with JIA, & Rehabilitation Dose in Adults with RA

Arthritis Care & Research  |  February 14, 2023

Treat to Target in Gout Monitoring & achievement of target serum urate levels By Jing Li & Gabriela Schmajuk, MD, MS Why was this study done? The ACR’s 2020 guideline for the management of gout recommends using a treat-to-target (T2T) approach to lower serum urate (SU). Using the ACR’s RISE registry, we examined the use…

ACR Image Competition 2022 Results, Part 3

Masaki Itagane, MD  |  February 15, 2023

Localized Scleroderma in Anti-NXP2-Antibody Positive Dermatomyositis A 67-year-old woman presented with erythematous, indurated skin on her left flanks. She had been diagnosed with dermatomyositis one year earlier when proximal muscle weakness, dysphagia and skin rash developed (see Figure A). Tests at the time showed the presence of anti-NXP2 and anti-Ro52 antibodies, as well as pathological…

Blood Is Thicker Than Water: Updates on the ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Jason Liebowitz, MD, FACR  |  December 12, 2022

PHILADELPHIA—Ever since the seminal work of C. Lockard Conley, MD, in 1952 of the discovery of the lupus anticoagulant, antiphospholipid syndrome (APS) has been of great interest to rheumatologists, hematologists and many others. At ACR Convergence 2022, the session titled Draft ACR/EULAR Antiphospholipid Syndrome Classification Criteria sought to summarize the rigorous process that went into…

New Findings for Polymyalgia Rheumatica & Osteoarthritis

Ruth Jessen Hickman, MD  |  December 1, 2022

The Plenary III Session reviewed the results of the SAPHYR trial of sarilumab in PMR patients, as well as the WE-CAN study on the impact of a community-level diet & exercise program on knee pain in patients with knee osteoarthritis.

The Complexity of SLE Drug Research

Ruth Jessen Hickman, MD  |  December 6, 2022

PHILADELPHIA—On Saturday, Nov. 12, at ACR Convergence 2022, Joan T. Merrill, MD, director of clinical projects in the Arthritis & Clinical Immunology Program at the Oklahoma Medical Research Foundation in Oklahoma City, gave a presentation on the future of drug development and treatments for systemic lupus erythematosus (SLE). She described how an in-depth understanding of…

Are You Listening? Young Patient Advocates Call for Change

Glen Rodman  |  December 12, 2022

PHILADELPHIA—Representatives of the Young Patients’ Autoimmune Research and Empowerment Alliance (YP AREA) led a panel titled Young Patients with Big Ideas Will Revolutionize Healthcare and Research, in which they discussed their work as advocates for adolescent and young adult (AYA) patients. YP AREA’s mission is to make autoimmune research more accessible and inclusive by involving…

Overcoming Healthcare Disparity

Thomas R. Collins  |  December 14, 2022

PHILADELPHIA—Quality improvement (QI) tools in pediatric rheumatology can help overcome health outcome disparities that are based on race, gender identity, income and other factors, experts said in a session at ACR Convergence. With it well established that these disparities exist, it’s time to begin eliminating them, said Emily Smitherman, MD, MS, assistant professor of pediatric…

How to Welcome and Care for Gender-Diverse Patients

Thomas R. Collins  |  February 15, 2023

PHILADELPHIA—Acknowledging the complexities of medical care for transgender (trans) and nonbinary or gender-diverse patients and emphasizing the urgency of doing it right, two experts offered guideposts to clinicians in an ACR Convergence 2022 session titled Dignity and Respect: How to Welcome and Care for Gender Diverse Patients in Your Practice, with advice on providing clinical…

An Integrative Approach to the Treatment of Rheumatoid Arthritis

Jason Liebowitz, MD, FACR  |  December 12, 2022

PHILADELPHIA—It is often the case that a holistic approach to the management of autoimmune disease is what patients are looking for and may indeed provide optimal care for these patients. At ACR Convergence 2022, the session titled ACR Guideline for Physical, Psychosocial, Mind-Body and Nutritional Interventions for Rheumatoid Arthritis: An Integrative Approach to Treatment sought…

Top 10 Tricks for the Management of Dry Mouth

Samantha C. Shapiro, MD  |  February 15, 2023

PHILADELPHIA—Whether due to Sjögren’s disease or something else, dry mouth is a common chief complaint from patients with rheumatic illnesses. Dry mouth isn’t life-threatening, but it can have a serious impact on quality of life. Sialogogues like cevimeline and pilocarpine may benefit some, but not all, patients, but cholinergic side effects often limit their usefulness….

ACR Convergence 2022 Closing Session Discusses Research Highlights

Thomas R. Collins  |  February 15, 2023

PHILADELPHIA—Expert panelists gathered in the closing session at ACR Convergence 2022 to give their take on what they saw as some of the most notable research findings and other insights to come out of the meeting, touching on a number of topics on the leading edge of the field. COVID-19 Prophylaxis & Vaccinations Alfred Kim,…

Winter 2023’s Awards, Appointments & Announcements in Rheumatology

Gretchen Henkel  |  February 15, 2023

Akiko Iwasaki, PhD, Receives the 2022 Lupus Insight Prize   In June 2022, the Lupus Research Alliance (LRA) awarded its Lupus Insight Prize to Akiko Iwasaki, PhD, for her discovery of the link between endogenous retroviruses and systemic lupus erythematosus (SLE). Dr. Iwasaki, who is a Sterling Professor of Immunobiology and a professor of dermatology,…

Insights into Methotrexate Toxicity in Elderly Patients with Rheumatic Disease

Michele B. Kaufman, PharmD, BCGP  |  December 12, 2022

Data from a small study show that severe methotrexate toxicity in patients who are 70 years of age and older and have rheumatic disease may be associated with poor renal function and the use of diuretic treatments.

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