My first-ever medical mission trip, after 37 years of medical practice, was to Teleman, Alta Verapaz, Guatemala. Prior to the trip, my excitement as an adult-trained rheumatologist was balanced against my apprehension about witnessing new diseases, caring for children and practicing in an austere environment with limited medical resources. As directed by the travel clinic,…
In May, the ACR released a new treatment guideline for the management of gout for simultaneous publication in Arthritis & Rheumatology and Arthritis Care & Research.1 Based on evidence from more than 130 published studies, the guideline makes a total of 42 recommendations—of which 16 are strong: It has 27 recommendations for urate-lowering therapy (ULT)…
ATLANTA—The authors of the new draft ACR treatment guideline for the management of gout presented the draft guideline on Nov. 13 at the 2019 ACR/ARP Annual Meeting. Based on evidence from more than 130 published studies, there are 42 recommendations, of which 16 were strong, including 27 for urate-lowering therapy (ULT) management, 13 of which…
Patients with chronic kidney disease (CKD) often experience joint pain due to various etiologies, including crystalline arthropathies, renal osteodystrophy, amyloid arthropathy, erosive osteoarthritis, avascular necrosis and even erosive spondylarthrosis.1 Below, we present a case of crystalline arthropathy in a patient with chronic kidney disease, mistaken for gout. The Case A 29-year-old man was admitted to…
CHICAGO—The path to the discovery of cortisone—a top-selling, important drug, with dozens of indications—was complicated by failure, false moves, desperation and obsession. The tale, recounted in the Philip Hench, MD, Memorial Lecture: Crossroads of History & Hope: Discovery & First Use of Cortisone for RA at the 2018 ACR/ARHP Annual Meeting in October, is an…
Presentation A 26-year-old man with a history of acne vulgaris and hidradenitis suppurativa presented to our rheumatology clinic with persistent back pain and stiffness of three years’ duration. He described bilateral low back pain that was worse when he arose in the morning and at night when he was trying to sleep. In a similar…
A 43-year-old man with a past medical history of type 2 diabetes mellitus, bilateral inguinal hernia repair as a child and prior cholecystectomy woke from sleep with sudden-onset periumbilical abdominal pain. He was admitted to another hospital, but required transfer to our surgical intensive care unit after a recurrent episode of severe abdominal pain, during…
“Wait. I can explain.” One could imagine this phrase coming up under many conditions in daily life. When I first became a physician, however, I would never have expected to use this phrase in my clinic. In medical school, I was taught the importance of dialogue in establishing a relationship with a patient. Statistics indicate…
(Reuters Health)—Some adults in the U.S. who use supplements to get their daily requirement of calcium are taking higher doses than necessary, a recent study suggests. Researchers examined nationally representative survey data on dietary habits and vitamin and supplement use collected between 1999 and 2014 from 42,038 adults. About one in 20 adults got a…
Innate lymphoid cells (ILCs) in the joints of patients may drive the pathology of spondyloarthritis through the production of granulocyte colony-stimulating factor (GM-CSF). A recent study found that both GM-CSF-producing CD4 T cells and the GM-CSF+ Th17 cells expressed high levels of GPR65—indicating that both GM-CSF and GPR65 may be therapeutic targets for spondyloarthritis…