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The Rheumatologist: March 2023

Rheumatology & the Shifting Patient Landscape

Marissa Blum, MD, MSHPR, Rachel Dayno, MD, & Anna Wexler, PhD  |  March 9, 2023

Rheumatologists are often called upon to see patients with unexplained symptoms and mysterious illnesses and to manage disease, sometimes with a dearth of evidence. Patients in rheumatology practices also tend to explore treatment modalities outside of the established medical model, sometimes referred to as fringe medicine. Complementary and alternative medicine practices that comprise fringe medicine…

How a Trip to the Vet Made Me a Better Doc

Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS  |  March 10, 2023

A plain X-ray film appeared on the computer screen—a humerus, a radius and an ulna were all visible. My pupils zoomed around the screen, and on initial inspection, everything looked fine. However, this X-ray was unlike any film I had ever reviewed. You see, it was for my then 4-year-old puppy, Lexi. My sweet little…

Speak Out Rheum: Musings on Our Past & Rheumatology

David R. Mandel, MD, FACR  |  March 10, 2023

I have been reading Yuval Harari’s thought-provoking and engaging book, Sapiens: A Brief History of Humankind, about our species’ struggles and the path that led to our emergence as the predominant species. I was captivated by the drawing of the hand of one of our ancestors and mused about what that forebear was thinking as…

Case Report: Is It Cardiac Sarcoidosis or COVID-19 Myocarditis?

Simranjit Kaur, MBBS, Sirajum Munira, MD, Farooq H. Sheikh, MD, FACC, & Anjani Pillarisetty, MD, RhMSUS  |  March 12, 2023

COVID-19 causes myriad cardiac dysfunctions, ranging from mild to fulminant disease, including myocarditis, acute congestive heart failure, cardiogenic shock and sudden cardiac death.1,2 COVID-19 myocarditis can mimic cardiac sarcoidosis clinically and on cardiac imaging, which can lead to diagnostic challenges and treatment delays. We present a case of cardiac sarcoidosis with interval development of metabolic…

Rheumatology Research Foundation Supports High-Risk, High-Reward Ideas

Leslie Mertz, PhD  |  February 21, 2023

Now in the second year of his 2021–2023 term as the Rheumatology Research Foundation president, V. Michael Holers, MD, a professor of medicine and immunology and the Smyth Professor of Rheumatology at the University of Colorado, Denver, is looking forward to fortifying and expanding the Foundation’s missions in the framework of its new strategic plan.

ACR Releases New Vaccination Guideline

Ruth Jessen Hickman, MD  |  March 6, 2023

The ACR recently released its first guideline focused on vaccination in adult and pediatric patients with rheumatic and musculoskeletal diseases.1 The guideline recommends modifications to certain vaccine and medication schedules to increase immunogenicity and ensure patient safety, while encouraging providers not to miss vaccination opportunities. The Need Patients with rheumatic conditions who are on immunosuppressive…

Rheumatology Association of Iowa Supports Members & Advocates for Patients

Linda Childers  |  January 20, 2023

One of the newer state rheumatology organizations, the Rheumatology Association of Iowa, brings together rheumatology professionals, offering connections to fill rural care needs and advocate for policies that support patient care. The organization’s 9th annual meeting will be Feb. 24–25.

The Gender Gap in Rheumatology Awards

Katie Robinson  |  March 12, 2023

Women are substantially under-represented among the recipients of major awards in rheumatology, according to a 2022 study by Halling et al., which looked at the gender award gap in North America and Europe over the past two decades.1 This trend is also seen in other fields, with only one woman winning the Fields Medal in…

Clinical Rheumatology Year in Review—2022

Samantha C. Shapiro, MD  |  December 4, 2022

In this overview of clinical updates in rheumatology in the last year, high-impact studies were discussed, including the GLORIA, ORAL Surveillance and MIRROR trials.

ACR Image Competition 2022, Part 4

Joana Martins Martinho, MD  |  March 12, 2023

Periungual Erythema & Its Translation on Nailfold Videocapillaroscopy in a Patient with Very Early Systemic Sclerosis A 66-year-old woman presented with Raynaud’s phenomenon and periungual erythema. HEp-2 immunofluorescence assay was positive for antinuclear antibodies, showing a centromere pattern. The presence of anti-centromere antibodies was confirmed by chemiluminescent immunoassay. The patient was diagnosed with very early…

Treat to Target in axSpA

Samantha C. Shapiro, MD  |  November 29, 2022

PHILADELPHIA—Treat to target (T2T) is a common phrase in rheumatology these days—and a welcome one.1 Many of us are familiar with what T2T means in rheumatoid arthritis (RA), but we may be less sure of its meaning in axial spondyloarthritis (axSpA). At ACR Convergence 2022, Alexis Ogdie, MD, associate professor of medicine and epidemiology, University of…

A World of Difference: Updates from the Global Rheumatology Summit

Jason Liebowitz, MD, FACR  |  January 20, 2023

The second annual Global Rheumatology Summit focused on climate change, conflict and migration, as well as other global issues in rheumatology.

A Shot of Wisdom: Vaccinations in Patients with Rheumatic Disease

Jason Liebowitz, MD, FACR  |  December 2, 2022

PHILADELPHIA—The treatment of rheumatic diseases is often a double-edged sword: immunosuppressive regimens can be very effective in reducing disease activity, but the cost of such treatments may be seen in the form of increased risk of infection. At ACR Convergence 2022, the session titled ACR Guidelines for Vaccination in Patients with Rheumatic and Musculoskeletal Diseases…

Rheumatology Online: The State of the Art on Social Media

Mithu Maheswaranathan, MD  |  February 9, 2023

PHILADELPHIA—A session on social media in rheumatology at ACR Convergence 2022 focused on how to use social media to promote one’s work and collaborate on international research projects, as well as the use of podcasts in educating rheumatologists. Engaging at Conferences Jean Liew, MD, MS, assistant professor of medicine in the Section of Rheumatology at…

Glucocorticoids May Decrease White Matter Integrity & Change Gray Matter Volume

Samantha C. Shapiro, MD  |  February 27, 2023

Van der Meulen et al. found the use of both systemic and inhaled glucocorticoids is associated with changes in several brain imaging parameters, including decreased white matter integrity and gray matter volume. Study patients also reported more depressive symptoms and tiredness than controls.

Conflicts of Interest in Guideline Development: What to Do When Everyone Has a Conflict

Anne R. Bass, MD  |  March 12, 2023

Avoiding real and apparent conflicts of interest is a fundamental principle of guideline development, but what should we do when every thought leader is conflicted? An example of this conundrum in rheumatology has been the ACR’s ongoing effort to establish guidelines for the management of lupus nephritis, which has been stymied by the fact that…

First Biosimilar to Adalimumab (Humira) Enters the U.S. Market After Years of Legal Battles

Michele B. Kaufman, PharmD, BCGP  |  January 31, 2023

After years of legal disputes between drug makers, adalimumab-atto (Amjevita) biosimilar to adalimumab (Humira) is now available in the U.S. to treat rheumatoid arthritis and other diseases. Adalimumab-atto is the first of several biosimilars to adalimumab expected to become available in the U.S. in 2023.

Patients on Dialysis Taking Denosumab May Be at Risk of Severe Hypocalcemia

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

The FDA is investigating the risk of severe hypocalcemia with serious outcomes, such as hospitalization and death, in patients on dialysis taking denosumab.

FDA Revokes Emergency Use Authorization for Evusheld

From the College  |  February 2, 2023

The Food & Drug Administration announced Jan. 26 that tixagevimab/cilgavimab (Evusheld) is no longer authorized for use in the U.S. The decision was based on new data suggesting that the treatment is unlikely to be active against the most common current SARS-CoV-2 variants.

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