Treat-to-Target in Rheumatic Diseases: Rationale and Results
This issue of the Rheumatic Disease Clinics of North America has broken ground in the area of process management of our diseases. The remarkable success of the treat-to-target approach in rheumatoid arthritis has led to increased speculation: can it be applied to our other rheumatic diseases, which may be more heterogeneous (in some cases) or where the targets are less obvious or more multidimensional? The assumption that control of inflammation, by its very nature, can lead to the optimum result of damage prevention makes intuitive sense, but at what level is the inflammation judged to be important? Should we use highly s...
Source: Rheumatic Disease Clinics of North America - August 31, 2019 Category: Rheumatology Authors: Michael H. Weisman Tags: Foreword Source Type: research

Treat to Target in Systemic Lupus Erythematosus
The treat-to-target principle of controlling inflammatory disease activity by means of disease-modifying antirheumatic drugs or immunosuppressive drugs also pertains to systemic lupus erythematosus (SLE). However, in SLE, intensifying immunosuppression with higher-dose glucocorticoids may worsen outcomes. Therefore, all current recommendations favor better disease control while limiting daily glucocorticoid doses to a maximum of 5 or 7.5 mg of prednisolone daily. Hydroxychloroquine and other prophylactic measures are added, and antiphospholipid syndrome is treated with anticoagulation and not with immunosuppression, which ...
Source: Rheumatic Disease Clinics of North America - August 22, 2019 Category: Rheumatology Authors: Martin Aringer, Nicolai Leuchten, Matthias Schneider Source Type: research

Treating Rheumatic Diseases to Target: A Story of Success
Define a target and treat your patient toward it! Quite trivial, isn ’t it? But sometimes the beauty of a concept lies exactly in the obvious and the intuitive that no one has clearly articulated before. Treat-to-Target (aka “T2T”) is one of these concepts: it could be regarded as overly simplistic to just recommend reaching remission in as many patients as pos sible. The current issue clearly shows that this is not quite the case. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - August 22, 2019 Category: Rheumatology Authors: Daniel Aletaha Tags: Preface Source Type: research

Treat-to-Target in Axial Spondyloarthritis
This article discusses treat-to-target strategies in axial spondyloarthritis and current status. Treatment ranging from nonsteroidal anti-inflammatory drugs to biologic and other disease-modifying drugs is discussed in the context of treat-to-target. The article explores evidence from landmark randomized, controlled trials and observational studies focusing on both radiographic and nonradiographic axial spondyloarthritis. The feasibility of treat-to-target, as well as predictors of remission are addressed in line with existing evidence. Finally, issues around management principles and challenges, as well as unmet need in t...
Source: Rheumatic Disease Clinics of North America - August 17, 2019 Category: Rheumatology Authors: Elena Nikiphorou, Xenofon Baraliakos Source Type: research

Treat to Target in Rheumatology
Chronic immune-mediated rheumatic diseases are characterized by inflammatory signs and symptoms, damage to joints, or spine and physical disability. In all these diseases the adverse outcomes are related to the degree of the inflammatory response and the duration of the high inflammatory situation. A state in which inflammation is minimized or eliminated is the therapeutic goal, but the time to reach such a state is also essential. Repeated treatment adaptations in the course of regular clinical assessments of disease activity are essential until the desired, predefined state is achieved. This approach constitutes the trea...
Source: Rheumatic Disease Clinics of North America - August 16, 2019 Category: Rheumatology Authors: Josef S. Smolen Source Type: research

Treat-to-Target in Psoriatic Arthritis
A treat-to-target approach to psoriatic arthritis has emerged as a topic of interest following successful application of this treatment paradigm to rheumatoid arthritis. In psoriatic arthritis, this has been examined in one randomized trial to date showing benefits of a tight control treatment strategy over standard care. Nonetheless, international treatment recommendations have called for clinicians to aim for a target of remission or low disease activity, although little or no consensus exists on how to measure these targets. An ideal measure to define a treatment target should be able to address all the disease domains ...
Source: Rheumatic Disease Clinics of North America - August 16, 2019 Category: Rheumatology Authors: Amy D. Zhang, Arthur Kavanaugh Source Type: research

The “Treat-to-Target” Approach to Rheumatoid Arthritis
This article reviews the latest information regarding T2T in rheumatoid arthritis, including a synopsis of the different disease activity scores available, new definitions of remission used in clinical trials and in routi ne clinical care, studies supporting a T2T approach, the role of imaging to guide treatment, and areas in which uncertainty remains. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - August 9, 2019 Category: Rheumatology Authors: Karen Salomon-Escoto, Jonathan Kay Source Type: research

Treatment of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis
This article reviews existing data for treatment and the current role of CYC in the management of AAV. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Sebastian E. Sattui, Robert F. Spiera Source Type: research

Should Platelet-Rich Plasma or Stem Cell Therapy Be Used to Treat Osteoarthritis?
Osteoarthritis is the most common form of arthritis and unfortunately lacks disease-modifying treatments. This has led to a growing demand for more effective nonoperative treatment options. Platelet-rich plasma and mesenchymal stem cell therapy offer the potential to modify the natural course of knee osteoarthritis using cell-based technology. Because of the lack of high-quality evidence and the large degree of heterogeneity, in terms of study designs and measured outcomes, the use of platelet-rich plasma or mesenchymal stem cell therapy to treat knee osteoarthritis cannot be recommended at this time. (Source: Rheumatic Di...
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Hani Rashid, C. Kent Kwoh Source Type: research

Intra-articular Hyaluronan Therapy for Symptomatic Knee Osteoarthritis
Intra-articular hyaluronan therapy (IAHA) is a common but controversial nonsurgical treatment of symptomatic knee osteoarthritis. The overall treatment effect of IAHA for osteoarthritis pain is substantial, but the majority of this benefit is mediated by the placebo effect. Despite the large overall benefit of IAHA when the effect of the hyaluronan is combined with the placebo effect, there is only a small benefit of questionable clinical significance of IAHA compared with intra-articular placebo. Compared with intra-articular corticosteroids, however, IAHA most likely is comparable for long-term pain relief and possibly s...
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Carrie Richardson, Anna Plaas, Joel A. Block Source Type: research

Controversies in Rheumatology
Kay and Schwartzman have submitted to the reader a very thoughtful assessment of some of the most important controversies facing the rheumatologist clinician today, especially regarding therapeutic choices in commonly encountered situations. Their choices of topics and experts are timely, as follows. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Michael H. Weisman Tags: Foreword Source Type: research

Controversies in Rheumatology
Rheumatology is a relatively young subspecialty, first recognized in 1925 when the International Committee on Rheumatism was founded by Jan van Breeman at the first meeting of the International Society of Medical Hydrology in Paris.1 As such, research into the pathophysiology, clinical presentation, and treatment of the rheumatic diseases and the development of classification criteria for individual conditions continues to advance, as our subspecialty is poised to enter its second century. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Jonathan Kay, Sergio Schwartzman Tags: Preface Source Type: research

Controversies in Rheumatology
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Authors: Jonathan Kay, Sergio Schwartzman Source Type: research

Copyright
ELSEVIER (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Source Type: research

Contributors
MICHAEL H. WEISMAN, MD (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Source Type: research

Contents
Michael H. Weisman (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Source Type: research

Forthcoming Issues
Treat to Target in Rheumatic Diseases: Rationale and Results (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - July 3, 2019 Category: Rheumatology Source Type: research

Does Triple Conventional Synthetic Disease-Modifying Antirheumatic Drug Therapy Improve upon Methotrexate as the Initial Treatment of Choice for a Rheumatoid Arthritis Patient?
Although many treatment options exist for the initial management of rheumatoid arthritis, there has long been discussion about whether initial treatment should be with methotrexate (MTX) as monotherapy or in combination with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Although studies initially showed additional benefit from combining MTX with other csDMARDs, this benefit disappears when glucocorticoids are added to MTX, a strategy recommended in current guidelines as a short-term bridging approach until MTX therapy exhibits its full efficacy. Also concomitant use of glucocorticoids, with...
Source: Rheumatic Disease Clinics of North America - June 5, 2019 Category: Rheumatology Authors: Daniel Aletaha, Josef S. Smolen Source Type: research

Vascular Consequences of Hyperuricemia and Hypouricemia
There are more than 10,000 articles in the literature published since 1999 that appear in a search of hyperuricemia and hypouricemia for vascular events. Systematic reviews were reviewed for this time frame, numbering approximately 300 articles in addition to more than 400 reports of randomized clinical trials published since 2017. In summary, the epidemiologic associations of hyperuricemia and hypouricemia with vascular disease are confounded by comorbid conditions. The interventional data are suggestive of a relationship of gout and vascular disease and to a lesser extent hyperuricemia and hypertension; however, more int...
Source: Rheumatic Disease Clinics of North America - June 5, 2019 Category: Rheumatology Authors: Daniel Albert, Paige N. Scudder, Pamela Bagley, Kenneth G. Saag Source Type: research

Is There a Role for MRI to Establish Treatment Indications and Effectively Monitor Response in Patients with Axial Spondyloarthritis?
MRI has an important role in the assessment of axial spondyloarthritis (axSpA), particularly early in the disease course, before radiographic damage is apparent. For this reason, MRI was incorporated into the 2009 ASAS/OMERACT classification criteria for spondyloarthritis. However, there are current controversies regarding its use. Important questions include whether the spine should be used in the routine diagnosis and classification of axSpA, whether MRI should replace radiographs as the imaging modality of choice in axSpA, and whether MRI findings in axSpA have prognostic significance. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - June 5, 2019 Category: Rheumatology Authors: Monica Schwartzman, Walter P. Maksymowych Source Type: research

Should Methotrexate Have Any Place in the Treatment of Psoriatic Arthritis?
Methotrexate (MTX) is widely used in the treatment of psoriatic arthritis (PsA), despite the evidence base for this being limited. This narrative review summarizes the evidence to date of using MTX within different domains of psoriatic disease, including peripheral arthritis, axial disease, dactylitis, enthesitis, psoriasis, and nail disease. We also explore the role of MTX in combination therapy with tumor necrosis factor inhibitors, in addition to its safety and tolerability, to answer the question: should methotrexate have any place in the treatment of psoriatic arthritis? (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - May 30, 2019 Category: Rheumatology Authors: Weiyu Ye, Laura C. Coates Source Type: research

Are the Current Recommendations for Chloroquine and Hydroxychloroquine Screening Appropriate?
Hydroxychloroquine and quinacrine are frequently used to treat rheumatic diseases. Ocular toxicity, although infrequent, is one of the potential side effects of antimalarial therapies. Current recommendations are unifocal in being developed by only ophthalmologists who do not treat patients for their rheumatic diseases. The data used to create the recommendations are meager and retrospective. Comanagement of patients with rheumatic disease who are exposed to antimalarial therapies requires a greater interaction between ophthalmologists and rheumatologists. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - May 30, 2019 Category: Rheumatology Authors: Sergio Schwartzman, C. Michael Samson Source Type: research

Is There a Place for Hematopoietic Stem Cell Transplantation in Rheumatology?
In a time where new immunomodulatory therapies are widely available, it seems remarkable that the number of hematopoietic stem cell transplantations (HSCT) performed in rheumatic diseases is still increasing. However, in progressive systemic sclerosis, autologous HSCT is the only treatment with proven survival benefits. In refractory cases of inflammatory arthritis, systemic lupus erythematosus, and several other rare rheumatic conditions, HSCT contributed to better disease control as well. Nevertheless, HSCT is still associated with considerable risks, and a careful balancing of benefits and risks remains paramount. (Sour...
Source: Rheumatic Disease Clinics of North America - May 27, 2019 Category: Rheumatology Authors: Julia Spierings, Jacob M. van Laar Source Type: research

Should Generalized Immunosuppression or Targeted Organ Treatment be the Best Principle for Overall Management of Systemic Lupus Erythematosus?
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, and standard therapy algorithms include the use of agents with generalized immunosuppressive effects. The outcomes for SLE patients have been markedly improved by this approach. However, the concept that involved organs might be targeted for treatment in an individual patient has potential to provide further benefits, offering enhanced efficacy and fewer off-target effects. This review considers how two of the most commonly involved organ systems in SLE, skin and kidney, might be targets for new therapeutic approaches based on knowledge of underlying mech...
Source: Rheumatic Disease Clinics of North America - May 27, 2019 Category: Rheumatology Authors: Nancy Olsen Source Type: research

Are There Benefits and Risks to Biosimilars from a Patient Perspective?
Biosimilars are copies of biologic medications, which no longer are protected by patent, that are intended to be marketed at lower prices than their reference products to increase patient access to treatment. Because a biosimilar must have equivalent pharmacokinetic parameters and efficacy and comparable safety and immunogenicity with its reference product, the only significant difference between the two should be cost. Lower-priced biosimilars are intended to introduce market competition. The availability of biosimilars should yield savings for the health care system and improve treatment outcomes by expanding patient acc...
Source: Rheumatic Disease Clinics of North America - May 24, 2019 Category: Rheumatology Authors: Jonathan Kay Source Type: research

Motivational Counseling and Text Message Reminders
Most patients with rheumatoid arthritis tend to be physically inactive and spend more time in sedentary behaviors compared with the general population. This inactive lifestyle can lead to serious health consequences, for example, increased risk of cardiovascular disease. For this reason, there is an interest in increasing participation in physical activity in patients with rheumatoid arthritis. The relatively new approach of reducing sedentary behavior and replacing it with light-intensity physical activity has been shown to be feasible and effective in promoting physical activity in patients with rheumatoid arthritis. How...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Tanja Thomsen, Bente Appel Esbensen, Merete Lund Hetland, Mette Aadahl Source Type: research

Patient-Reported Outcomes Measurement Information System Versus Legacy Instruments
“Legacy” patient-reported outcome measures (PROs) have been used for decades; however, they have many limitations. The National Institutes of Health–funded PRO Measurement Information System (PROMIS) was developed to be a generic, flexible, precise, and reliable tool to measure core and additi onal domains of physical and emotional health and social well-being. Unlike Legacy PROs, PROMIS measures can be implemented across diseases, and use a common T-score metric-based scoring system derived using item response theory. PROMIS measure scores have potential to predict scores of Legacy PROs and could be the ...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Vivian P. Bykerk Source Type: research

Using Health Information Technology to Support Use of Patient-Reported Outcomes in Rheumatology
Technology can help health care providers understand their patients ’ experience of illness in a way that was previously impossible. Experience in using health information technology (IT) to capture this information through PROs within rheumatology suggests that careful attention to human centered design, including detailed workflow planning, consideration of pati ent and physician burden, integration into the health IT ecosystem, and delivering information to the right person at the right time are all important. Technology applications must be tested in diverse health systems and populations to ensure they are simpl...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Julie Gandrup, Jinoos Yazdany Source Type: research

Patient Self-Management and Tracking
The shift from a paternalistic model of health care to a doctor-patient relationship in which the doctor and patient make shared decisions, requires an actively involved patient who takes responsibilities. This is why self-management by the patient with a chronic disease plays more of an important role in patient care nowadays; however, the degree of self-management varies per patient. To help stimulate patients in their self-management behavior, it is necessary to use an adequate tool, and to educate patients and health professionals. In this article, we share experiences using a digital tool for this from the Netherlands...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Piet L.C.M. van Riel, Rixt M. Zuidema, Carine Vogel, Sanne A.A. Rongen-van Dartel Source Type: research

Digital Interventions to Build a Patient Registry for Rheumatology Research
This article aims to describe key issues, processes, and outcomes related to development of a patient registry for rheumatology research using a digital platform where patients track useful data about their condition for their own use while contributing to research. Digital interventions are effective to build a patient research registry for people with rheumatoid arthritis and other rheumatic and musculoskeletal diseases. ArthritisPower provides evidence of the value of digital interventions to build community support for research and to transform patient engagement and patient-generated data capture. (Source: Rheumatic D...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: William Benjamin Nowell, David Curtis, Michelle Thai, Carole Wiedmeyer, Kelly Gavigan, Shilpa Venkatachalam, Seth Ginsberg, Jeffrey R. Curtis Source Type: research

Tools and Methods for Real-World Evidence Generation
This article reviews these topics in the context of describing several exemplar use cases specific to rheumatology and provides perspective regarding both the promise and potential pitfalls in using these tools and approaches. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Jeffrey R. Curtis, P. Jeff Foster, Kenneth G. Saag Source Type: research

The Interface Between Digital Health and Rheumatology
Technology is effecting a sea of change in both health care research and the practice of clinical medicine. In this technology-focused issue of Rheumatic Disease Clinics of North America, we have assembled a cadre of reports that illustrate the wide breadth of examples by which technology is transforming both research methods and clinical practice in rheumatology. Many of these articles were borne out of presentations given at the 2018 American College of Rheumatology (ACR) premeeting clinical research conference (CRC), “Application of Mobile Health Technologies.” The ACR and its membership continue to maintain...
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Jeffrey R. Curtis, Kaleb Michaud, Kevin Winthrop Tags: Preface Source Type: research

Technology and Big Data in Rheumatology
This issue was intended to examine the impact of new technology and “big data” on the field of Rheumatology, and it certainly met its goals. Drs Winthrop, Curtis, and Michaud have assembled very thoughtful and incisive pieces to address how, if, or why these “new tools” will have an impact on our research, education, and practice effort in Rheumatology. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Michael H. Weisman Tags: Foreword Source Type: research

Technology and Big Data in Rheumatology
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Authors: Jeffrey R. Curtis, Kaleb Michaud, Kevin Winthrop Source Type: research

Copyright
ELSEVIER (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Source Type: research

Contributors
MICHAEL H. WEISMAN, MD (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Source Type: research

Contents
Michael H. Weisman (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Source Type: research

Forthcoming Issues
Controversies in Rheumatology (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - April 3, 2019 Category: Rheumatology Source Type: research

Digital Patient Education and Decision Aids
New technologies can do more than just digitize health information; they can support multimedia platforms for patient education and health decision support. Technology can simplify the way health decisions are made by offering quick access to a vast amount of information that can be tailored to specific populations. Digital tools can increase knowledge and assist consumers in comparing health care alternatives. They are well received by patients because of the myriad features that render them visually appealing and entertaining, including audiovisual and interactive elements. To be effective, however, digital tools must be...
Source: Rheumatic Disease Clinics of North America - March 8, 2019 Category: Rheumatology Authors: Maria A. Lopez-Olivo, Maria E. Suarez-Almazor Source Type: research

Imaging in the Mobile Domain
This article outlines the current state of imaging software with an emphasis on mobile sharing of images and mobile sharing of imaged data. The second portion focuses on the mobility of imaging design devices, highlighting the accessibility and the wider application of mobile devices. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - March 8, 2019 Category: Rheumatology Authors: Paul Bird Source Type: research

Project ECHO
(Extension for Community Healthcare Outcomes) was developed at the University of New Mexico Health Sciences Center to educate health care professionals in underserved communities to treat chronic complex diseases, allowing patients to receive better care, closer to home, with greater convenience, and at lower cost than referral to a specialty center. Videoconferencing technology is used to create learning networks, with case-based discussions as the primary method of education. The 3-year experience of Bone Health TeleECHO, a strategy to improve the care of osteoporosis and reduce the large treatment gap, is discussed. (S...
Source: Rheumatic Disease Clinics of North America - March 8, 2019 Category: Rheumatology Authors: E. Michael Lewiecki, Rachelle Rochelle Source Type: research

Maximizing Engagement in Mobile Health Studies
This article discusses lessons learned from attempting to maximize engagement in 2 successful UK mHealth studies —Cloudy with a Chance of Pain and Quality of Life, Sleep and Rheumatoid Arthritis. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - March 8, 2019 Category: Rheumatology Authors: Katie L. Druce, William G. Dixon, John McBeth Source Type: research

Mobile Apps for Rheumatoid Arthritis
This article presents an overview of the types of mobile apps that can be used for RA and discusses the opportunities and challenges associated with them. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - March 8, 2019 Category: Rheumatology Authors: Elizabeth Mollard, Kaleb Michaud Source Type: research

The Economics of Rheumatology Practice in the United States
The current environment shaping rheumatology practice economics, with a focus on revenues, is described. The policies and practices of private and public insurance companies, pharmaceutical manufacturers, and pharmacy benefit managers (PBMs) are summarized, identifying economic implications for rheumatologists. The role of rebates in shaping practice economics is discussed, along with the central role of payers in defining PBM policies. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Jon Glaudemans Source Type: research

Workforce Trends in Rheumatology
The United States is facing a rheumatology provider shortage over the next decade, which will negatively affect care for patients with rheumatic disease across the nation if this deficit is not thoughtfully addressed. The increasing numbers of retiring rheumatology specialists, women entering the workforce, and rheumatology graduates seeking part-time employment were identified as the most significant factors driving the projected decline in supply of providers. The major factors driving the projected increase in demand include an aging and growing population and improved treatment options, both of which increase disease p...
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Adam Kilian, Laura A. Upton, Daniel F. Battafarano, Seetha U. Monrad Source Type: research

Challenges to Practicing Rheumatology in an Academic Center
Rheumatologists working in academics participate in patient care, teaching, and research. There are several challenges associated with the pursuit of these academic missions, and these are the focus of this article. Additionally, how financial pressures faced by academic institutions have led to greater emphasis on the generation of revenue from clinical activities to the detriment of other academic pursuits is discussed. In an era of greater physical burnout and with the looming shortages of the rheumatology workforce, the importance of addressing these issues is stressed and potential solutions discussed. (Source: Rheuma...
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Sobia Hassan, Meghan M. Smith, Joel A. Block, Meenakshi Jolly Source Type: research

Challenges of Practicing Rheumatology in a Government Setting
This article highlights processes and services that are unique to practicing rheumatology in a government setting, specifically, resource allocation with clinic space and staffing; protocols for access to conventional and biologic disease modifying antirheumatic drugs; and research opportunities for rheumatologists working in a government setting. Our aim is to expand the reader ’s understanding of this practice setting. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Gopika D. Miller, Jasvinder A. Singh Source Type: research

The Focused Musculoskeletal Factory
Rheumatology has evolved rapidly over the past 20  years. The availability of numerous treatment interventions has dramatically altered patient outcomes and revitalized the specialty. At the same time, the economics of medical practice is challenging the practicing rheumatologist to seek more efficient and more attractive models of care delivery. These models of care must be attractive not only to rheumatologists and their patients but also to other interested parties as well, such as payers, government agencies, and accreditation bodies. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Gerald M. Eisenberg Source Type: research

Clinical Trials in Rheumatology
Clinical trials evaluate the benefits and harms of medical interventions with the ultimate goal of establishing an evidence-based regimen that contributes to clinical decision making. Physicians benefit greatly from clinical research because it provides a greater understanding of epidemiology and health outcomes, and patients are given opportunities to participate in such trials. In this review, we discuss the challenges of conducting clinical trials investigating rheumatic diseases, including that of recruitment, finding the right trial, designing a budget, and performing a study in a timely manner. If done right, clinica...
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Christine H. Lee, Daniel J. Wallace Source Type: research

Challenges in Implementing Treat-to-Target Strategies in Rheumatology
This article discusses the barriers (including access to care, patient and physician factors, and systems issues) to implementing TTT in the clinic, and proposes possible solutions and future research directions. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - November 15, 2018 Category: Rheumatology Authors: Julia A. Ford, Daniel H. Solomon Source Type: research