The immune system is an ocean, wide, vast and unfathomably deep, over which we rheumatologists traverse. Beyond the ripples, waves and eddies on the surface, we can only imagine what lies under the surface. With new information from basic laboratory studies and the incorporation of immunomodulators into clinical practice, we have some new insight into…
As if the fatigue, joint pain, etc., were not enough, new research has found many lupus patients must contend with clinical depression as well—something that can have a devastating cascade effect on other areas of their lives. Are adults with childhood-onset lupus at greater risk of depression than lupus patients with onset of disease during…
Understanding rheumatic and musculoskeletal diseases (RMDs) is an understandably tall order for the lay public, what with the huge number of conditions and the complex—and often little understood—processes involved. Now, a working group of the European League Against Rheumatism (EULAR) and the ACR has set out to try to correct this problem with a definition…
When Jeanne Scott first entered nursing school, she planned to become a women’s health nurse practitioner. She was not expecting her final clinical placement in rheumatology to change the entire course of her career. “Truthfully, I did not understand what rheumatology practitioners did until this introduction to the field,” says Ms. Scott, who describes being…
Audit activity among Medicare and most third-party payers has increased in response to pressure to reduce healthcare costs. The return of billions of dollars to Medicare, Medicaid and third-party programs through these medical audit reviews has also increased. For example, the Government Accountability Office (GAO) 2014 Annual Report estimated that the Centers for Medicare &…
How do you ask a new patient about sex and gender—or know which pronoun to use? Keep the conversation straightforward and respectful to put everyone at ease, says Morgan Orndorff, a transgender man who works as an administrator at a major academic medical center. “Everyone is a little different in terms of their sensitivity level”…
In the U.S. today, approximately 45% of pregnancies are unintended or unplanned.1 Although this rate is considerably lower than in the past, women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or inflammatory myopathies tend to have better pregnancy outcomes if their disease is well controlled when they conceive. In addition, women taking certain medications…
Think back to your time as a trainee. Do you remember an interaction with a consultant in which you learned something, felt your opinion was heard, were empowered to collaborate with the consulting team and knew you were providing outstanding care? We suspect a number of examples come to mind, regardless of the amount of…
Bad things happen to good rheumatologists—and to their patients—and can have profound personal and professional consequences for the doctor. Sometimes recommended treatments can have predictable, but devastating, side effects. Even if the rheumatologist does everything right according to evidence-based best practice, patients can still have bad outcomes, even die—with resulting feelings of sadness, anger, guilt…
You see a patient for the first time to establish care for Sjögren’s disease. She complains of dry eyes, dry mouth and diffuse arthralgias. You do not appreciate any synovitis on physical exam. Of note, you are the fourth rheumatologist she has seen during the past year. Toward the end of the clinic visit, she…