History A 25-year-old female patient is seen in the office after her primary care physician requested a consultation for a possible diagnosis of systemic lupus erythematosus (SLE). The patient presents today with muscle pain in both legs, she rates the pain at an 8 on a scale of 10. She states she experiences throbbing, usually…
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Hyperuricemia Doesn’t Always Indicate Gout in Rheumatic Disease
A 57-year-old Ghanaian woman was referred to our rheumatology practice with acute, left elbow swelling and pain. The referring oncologist suspected gout, because the patient had hyperuricemia. Six months before, the patient was diagnosed with stage IV human T-lymphotropic virus type 1 (HTLV-1)-associated adult T cell lymphoma (ATLL). Her initial oncologic manifestations included multiple thoracic,…

Rheumatic Disease Does Not Preclude Pregnancy
Preconception planning is essential to help women with autoimmune disease have optimal pregnancy outcomes. Unplanned pregnancy can also negatively impact disease course in some patients. Yet many rheumatologic patients of childbearing age do not receive adequate contraception or prepregnancy education and counseling. Rheumatologists must work collaboratively with other healthcare providers to make sure rheumatic patients…

Physical Activity, Exercise Can Benefit Patients with RA
While medical advances in rheumatoid arthritis (RA) have led to improvements in disease control and quality of life for patients worldwide, the rate for stable remission remains low.1 Management of RA symptoms is traditionally accomplished through a combination of medications and nonpharmacological interventions.2 This approach can prevent the development of secondary adverse health outcomes. Two…

Rheumatology Health Professionals’ Awards, Appointments and Announcements November 2017
Dr. Sherine Gabriel Joins Board of Trustees In July, ACR Past President Sherine E. Gabriel, MD, MSc, joined the New York Academy of Medicine Board of Trustees. Dr. Gabriel is a distinguished professor and dean of Rutgers Robert Wood Johnson Medical School. As dean emerita of Mayo Medical School, Dr. Gabriel developed successful clinical research training and career development…
Kentucky Accuses Endo of Contributing to Opioid Epidemic
(Reuters)—Kentucky accused units of Endo International Plc. on Monday of contributing to drug overdoses by deceptively marketing its painkiller Opana ER, in the latest lawsuit by state or local governments against the drugmaker amid an opioid epidemic. Kentucky Attorney General Steve Beshear said the lawsuit would seek to hold Endo responsible for illegally building a…

Systemic Sclerosis Mortality Rate May Be Underestimated
Systemic sclerosis (SSc) is a disease characterized by immunologic abnormalities, microvascular involvement and tissue fibrosis. In previous studies, 10-year survival rates ranged from 50–84%. However, there are concerns that these studies, using prevalent cohorts, are underestimating mortality. “While the prognosis of many rheumatic diseases has improved with the availability of more effective and targeted therapies,…
Researchers Examine Lifetime Risk of Total Hip Replacements
Total hip replacement (THR) surgery is an effective way to reduce pain and improve function in people with advanced hip osteoarthritis (OA). In light of aging populations, there’s a need to use contemporary, population-level data to plan for future service provision. In a study designed to compare THR data across countries, researchers demonstrated a significant increase in the overall use of and lifetime risk for THR from 2003 to 2013. Women consistently had a higher lifetime risk of surgery than men in all five countries studied, whereas men in all five countries demonstrated a significant increase in lifetime risk for THR over time…

Unwise Choices: EHRs, PBMs, Drug Costs Are Leading to Physician Burnout
My dear electronic health records How do I dislike thee? Let me count the ways Adaptation of Sonnet 43 By Elizabeth Barrett Browning, 1806–1861 As my tenure as physician editor winds down, it’s worth reviewing some of the more nettlesome issues confronting clinicians that have been previously discussed in these pages and gauge their current…
Trump Panel Urges More Treatment Options to Fight Opioid Crisis
(Reuters)—A panel convened by U.S. President Donald Trump to tackle the opioid crisis called on Wednesday for more treatment programs, tighter prescribing guidelines and additional drug courts to help reduce overdose deaths. The commission, led by New Jersey Governor Chris Christie, said the recommendations would require funding by Congress but did not recommend an amount….
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