The Exchange

Commentary and Observations from
the Medical Front Lines

Latest Rheumatology Articles on PCE's The Exchange

Hyperuricemia and Renal Disease

Hyperuricemia and Renal Disease

Gout and renal disease exist with a bidirectional relationship: gout can cause renal disease and renal disease can cause gout. Numerous studies have found these 2 conditions to be linked; the symptomatic uric acid crystallization seen in gout likely increases the risk of renal disease. However, connecting asymptomatic hyperuricemia with an increased risk of renal disease is more controversial and studies evaluating this potential association have been limited and fraught with methodological i... Continue Reading

Filed under: Curbside Consultations, Rheumatology

Pre-Exposure COVID-19 Prophylaxis in Rheumatology Patients

Pre-Exposure COVID-19 Prophylaxis in Rheumatology Patients

On December 8, 2021, the US Food and Drug Administration issued an emergency use authorization (EUA) for tixagevimab/cilgavimab as pre-exposure prophylaxis o... Continue Reading

Filed under: Infectious Diseases, Preventive Medicine, Rheumatology

Which Drugs Are Linked to Arthritis Development? Part 2

Which Drugs Are Linked to Arthritis Development? Part 2

As mentioned in my previous posting, there are a number of drugs that may be associated with rheumatologic symptoms and disease. Here I will continue discus... Continue Reading

Filed under: Orthopedics, Rheumatology

Which Drugs Are Linked to Arthritis Development? Part 1

Which Drugs Are Linked to Arthritis Development? Part 1

Since the art and science of diagnosing arthritis is not often straightforward, it is always helpful to get additional insights in this area. Here, I'd like... Continue Reading

Filed under: Orthopedics, Rheumatology

Rheumatoid Arthritis and Air Pollution

Rheumatoid Arthritis and Air Pollution

The risk of developing rheumatoid arthritis (RA) has previously been linked to certain genetic and environmental factors. For example, smoking has been assoc... Continue Reading

Filed under: Public Health, Rheumatology

Rheumatology and Telemedicine: Here to Stay or Passing Pandemic Fad?

Rheumatology and Telemedicine: Here to Stay or Passing Pandemic Fad?

In March 2020, the world changed for many of us. For those of us in healthcare, we found ourselves with new lives and new ways of trying to treat our patient... Continue Reading

Filed under: Practice Management/Career, Rheumatology

Scary Words in Rheumatology

Scary Words in Rheumatology

There are many rheumatology words that are difficult to pronounce, poorly understood, and that can generate fear in both practitioners and patients. As such,... Continue Reading

Filed under: Rheumatology

Non-radiographic Axial Spondyloarthropathy—Often Not Recognized and Commonly Misdiagnosed

Non-radiographic Axial Spondyloarthropathy—Often Not Recognized and Commonly Misdiagnosed

Non-radiographic axial spondyloarthropathy (nr-axSpA) is an autoimmune, inflammatory disease affecting the spine, sacroiliac joints, and hips. Unlike its mor... Continue Reading

Filed under: Rheumatology

IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic

IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic

The COVID-19 pandemic has brought many challenges to our daily rheumatology practices: From the initial switch to mostly telemedicine appointments in early 2... Continue Reading

Filed under: Miscellaneous, Rheumatology

Periprosthetic Fractures: The New Osteoporotic Fragility Epidemic

Periprosthetic Fractures: The New Osteoporotic Fragility Epidemic

Periprosthetic fracture, defined as a post-operative fracture around or near a prosthesis, has become increasingly common. This was shown in a study publishe... Continue Reading

Filed under: Orthopedics, Rheumatology

Prime Time for Osteoanabolic Therapy

Prime Time for Osteoanabolic Therapy

We now have fracture risk reduction evidence from 2 separate trials comparing oral bisphosphonates with osteoanabolic medications. These well controlled phas... Continue Reading

Filed under: Orthopedics, Rheumatology

Advanced Practice Clinicians in Rheumatology, Part 1

Advanced Practice Clinicians in Rheumatology, Part 1

I have been practicing as an NP in rheumatology for 7 years and I love it. I got lucky, really: A recruiter reached out to a fellow student who was not inter... Continue Reading

Filed under: NPs & PAs, Practice Management/Career, Rheumatology

Two Low-tech, High-value Methods for Reducing Knee Pain in Your Patients With Arthritis

Two Low-tech, High-value Methods for Reducing Knee Pain in Your Patients With Arthritis

Osteoarthritis (OA) of the knee is one of the most common musculoskeletal conditions treated in this country. According to NIH statistics, in 2005 there were... Continue Reading

Filed under: Orthopedics, Rheumatology

Understanding Raynaud’s Phenomenon

Understanding Raynaud’s Phenomenon

Color changes in patients' fingertips during cold weather can be confusing. It is important to distinguish Raynaud's phenomenon, as it can be associated with... Continue Reading

Filed under: Cardiometabolic, Rheumatology

Not so FAST! Febuxostat vs Allopurinol Showing Equal Safety –  Results of the FAST Trial in Europe

Not so FAST! Febuxostat vs Allopurinol Showing Equal Safety – Results of the FAST Trial in Europe

Optimal management of gout requires urate-lowering therapy; two commonly prescribed therapies for this are febuxostat and allopurinol. However, since 2018, t... Continue Reading

Filed under: Cardiometabolic, Rheumatology

Can Leading a Healthy Lifestyle Change the Likelihood of Developing Systemic Lupus Erythematosus?

Can Leading a Healthy Lifestyle Change the Likelihood of Developing Systemic Lupus Erythematosus?

An abstract presented at this year's American College of Rheumatology (ACR) conference asked whether the likelihood of being diagnosed with systemic lupus er... Continue Reading

Filed under: Preventive Medicine, Rheumatology

Gastric Bypass or Joint Replacement: Which Is the Better Option for Osteoarthritis of the Knee?

Gastric Bypass or Joint Replacement: Which Is the Better Option for Osteoarthritis of the Knee?

In November 2020, the American College of Rheumatology (ACR) hosted a virtual poster presentation. Abstract 1651, "Knee OA outcomes in patients with severe o... Continue Reading

Filed under: Orthopedics, Rheumatology

ACR Recommendations for Adult Patients With Rheumatoid Arthritis in the Context of COVID-19

ACR Recommendations for Adult Patients With Rheumatoid Arthritis in the Context of COVID-19

Since COVID-19 will continue to be with us for some time, patients on disease modifying antirheumatic drugs (DMARDs) may discontinue therapy on their own due... Continue Reading

Filed under: Infectious Diseases, Rheumatology

Synovial Biopsy in Rheumatoid Arthritis: The Next Big Thing?

Synovial Biopsy in Rheumatoid Arthritis: The Next Big Thing?

Synovial fluid aspirates, biomarkers in blood, serologic testing, radiography, and ultrasonography have all been used to assist in the diagnosis and manageme... Continue Reading

Filed under: Rheumatology

Uses of Anti-CCP in Early Rheumatoid Arthritis

Uses of Anti-CCP in Early Rheumatoid Arthritis

A young woman presents for evaluation of joint pain in both wrists and hands and swelling of one knee. Her history and physical exam suggest rheumatoid arthr... Continue Reading

Filed under: Rheumatology

2020 ACR Gout Guidelines for Allopurinol Have Changed!

2020 ACR Gout Guidelines for Allopurinol Have Changed!

Gout is the most common type of inflammatory arthritis in both men and women in the United States. Allopurinol is commonly used to manage hyperuricemia in it... Continue Reading

Filed under: Rheumatology

Do Traumatic Fractures Relate to Osteoporosis?
Is a Paradigm Shift Coming?

Do Traumatic Fractures Relate to Osteoporosis? Is a Paradigm Shift Coming?

A new study by Leslie and colleagues evaluating high and low trauma fractures may change our thought process regarding how traumatic fractures pertain to ris... Continue Reading

Filed under: Orthopedics, Rheumatology

Raynaud’s Phenomenon: A Common Sense Approach to Diagnosis and Management

Raynaud’s Phenomenon: A Common Sense Approach to Diagnosis and Management

Raynaud's phenomenon (RP) is all too common in New England during the colder months of the year. In October, we often see patients return who ha... Continue Reading

Filed under: Miscellaneous, Rheumatology

Hydroxychloroquine Monitoring: A Common Drug Seen in Primary Care

Hydroxychloroquine Monitoring: A Common Drug Seen in Primary Care

Hydroxychloroquine (Plaquenil) has been a staple for treatment of rheumatoid arthritis, systemic lupus erythematosis (SLE), and discoid lupus for many decade... Continue Reading

Filed under: Rheumatology

Medical Marijuana, Fibromyalgia, and PTSD

Medical Marijuana, Fibromyalgia, and PTSD

Have you made up your mind about the use of medical marijuana in your practice? I haven't yet, but writing this posting has improved my knowledge of its use.... Continue Reading

Filed under: Rheumatology

Lyme Arthritis—From High Index of Suspicion to Diagnosis and Treatment

Lyme Arthritis—From High Index of Suspicion to Diagnosis and Treatment

An effusion of the knee(s) is the most common manifestation of Lyme arthritis, a late stage of infection with Borrelia burgdorferi, the tick involve... Continue Reading

Filed under: Infectious Diseases, Rheumatology

How Do Drug Pricing Systems Work? If There Is More Competition, Shouldn’t the List Price Go Down?

How Do Drug Pricing Systems Work? If There Is More Competition, Shouldn’t the List Price Go Down?

Have you ever noticed how much more expensive drug prices become every year? I think we have all noticed this increase, so this week I decided to look in to... Continue Reading

Filed under: Health Policy and Trends, Rheumatology

What is the Best Treatment for Painful Osteoporotic Compression Fractures of the Spine?

What is the Best Treatment for Painful Osteoporotic Compression Fractures of the Spine?

Pop quiz: What is the best method of treatment for osteoporotic compression fractures of the spine? Nonsurgical treatment (NST) Balloon kyphop... Continue Reading

Filed under: Rheumatology

A View of Rheumatology From 31 Years And 30,000 Feet

A View of Rheumatology From 31 Years And 30,000 Feet

The last 31 years of my PA career has been in the subspecialty of rheumatology. As I reflect on the changes in the field, I have become aware of the incredib... Continue Reading

Filed under: Rheumatology

Expanding JAK Inhibitor Market for RA on the Horizon in 2019: “Which One Is the Best?”

Expanding JAK Inhibitor Market for RA on the Horizon in 2019: “Which One Is the Best?”

Rheumatoid arthritis (RA) treatments continue to improve outcomes in the latest clinical trials. At the 2018 American College of Rheumatology (ACR) meeting t... Continue Reading

Filed under: Rheumatology

CARES Study Prompts FDA Boxed Warning on Febuxostat

CARES Study Prompts FDA Boxed Warning on Febuxostat

On February 21, 2019, the US Food and Drug Administration (FDA) issued a boxed warning on febuxostat. This was a result of the CARES study published in the Continue Reading

Filed under: Rheumatology

How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?

How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?

Primary care/urgent care/emergency rooms are all settings where acute monoarthritis is seen. The differential diagnosis includes acute crystal arthritis (gou... Continue Reading

Filed under: Rheumatology

Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?

Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?

In the January issue of Osteoporosis International, there was an article entitled, “Mortality Risk Reduction Differs According to Bisphosphonate C... Continue Reading

Filed under: Rheumatology

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