Best rheumatology Q&As of 2023 covered Alzheimer’s, lupus in a catatonic patient
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In 2023, Healio had questions, the experts had answers.
Healio leveraged its robust roster of professionals to get to the heart of some of the most important issues facing rheumatology care today. Experts weighed in on the possibility that Alzheimer’s disease may have roots in autoimmunity, the ongoing battle against institutional racism in academic medicine, the challenges faced by community practitioners, and the diagnostic delays that continue to plague patients with Sjogren’s disease. Read on for in-depth information.
What if Alzheimer’s disease, a neurological disorder that has confounded researchers since its identification in 1907, were not a brain disorder at all? What if it were instead an autoimmune disease that attacks the brain?
That is the idea proposed in a paper published in Alzheimer’s & Dementia by Donald F. Weaver, MD, PhD, senior scientist with the Krembil Brain Institute and professor of chemistry, medicine and pharmaceutical science at the University of Toronto. In that paper, Weaver suggested a new mechanistic model of Alzheimer’s disease, the most common form of dementia worldwide, as a disease of the immune system within the brain.
An “undercurrent of racism” runs throughout academic medicine, resulting in not only “disillusionment and attrition,” but also internalized racism among underrepresented groups, according to a letter published in The Lancet.
In the letter, Puja Mehta, MD, of the Center for Inflammation and Tissue Repair, in the division of medicine at University College London, and Christopher D. Buckley, MD, of the Kennedy Institute for Rheumatology at the University of Oxford, covered topics ranging from intersectionality to stereotyping. Importantly, they offered suggestions for having the kind of difficult conversations required to overcome racial bias.
Patients with rheumatoid arthritis and periodontal disease may experience flares due to bacteria from “leaky gums” moving into their bloodstream and causing inflammation, according to findings published in Science and Translational Medicine.
In the paper, Dana Orange, MD, associate professor of clinical investigation at Rockefeller University, and assistant attending in rheumatology at the Hospital for Special Surgery, and William H. Robinson, MD, PhD, professor of medicine at Stanford University, addressed the potential for bidirectional causality between rheumatoid arthritis and periodontal disease, the implications for the practicing rheumatologist, and directions for future research into this association.
Although rheumatology is plagued by diagnostic delays, no patient population faces greater challenges in that regard than those with Sjögren’s disease, according to Pulukool Sandhya, MD, a rheumatologist at St. Stephen’s Hospital, in Delhi, India.
In her conversation with Healio, Sandhya discussed the importance of keeping Sjogren’s on the radar for patients with dry mouth and eyes, as well as the conditions that may mimic Sjogren’s symptomatology and strategies rheumatologists can employ to assure that these patients are diagnosed and treated in a timely fashion.
Adapting to shifting boundaries and responsibilities is critical for rheumatology nurses to provide care for their patients, according to Carrie Beach, BSN, RN-BC, past president of the Rheumatology Nurses Society.
The workforce shortage among rheumatology practitioners has created an increasing demand on the time and energy of nurses in the specialty. Although organizations like the RNS can offer support and information, individual nurses are also encouraged to set their own boundaries and engage in self-care behaviors to avoid burnout and maintain enthusiasm.
The American College of Rheumatology in January announced the creation of its Community Practice Council. According to the ACR, this new body aims to assist and educate private practice rheumatologists in a health care system increasingly filled with large corporate entities and academic medical centers.
Healio sat down with Tien-I Karleen Su, MD, the newly announced chair of the ACR Community Practice Council, to discuss ways to hold firm against the corporatization of medicine, the advantages of working in a small practice, and hard-boiled financial advice for physicians working in rural, semi-urban and urban environments.
In perhaps the most compelling Q&A of 2023, Healio spoke with Anca D. Askanase, MD, MPH, director of the Columbia University Lupus Center, about a patient who had been catatonic for nearly 2 decades. After treatment with pulse steroids and cyclophosphamide, the patient “woke up.”
It turned out she had lupus.
Askanase discussed the laboratory panel that first clued physicians that perhaps her condition was rooted in autoimmunity, along with the coincidental set of circumstances that led to the diagnosis.