General Rheumatology

Raynaud’s Syndrome

June 23, 2021 ·

(Pause while everyone looks down at their own nails)

I learned to include this little pause during my medical student lectures on Raynaud’s Syndrome and Scleroderma. As opposed to many of the other conditions I treat and teach, there is actually a very high likelihood that a handful in the audience will have Raynaud’s. This isn’t surprising given how common it is, especially amongst women between the ages of 15 and 30. It is when discussing the connection between Raynaud’s and Lupus or Scleroderma, that the wave of concern washes over some faces in the audience. What the audience members are looking for are changes in the nail bed capillaries. These changes, can be a sign that their Raynaud’s Syndrome is part of a larger autoimmune condition. Thankfully, most, if not all, will have perfectly normal nail bed capillaries and be able to sit through the rest of the lecture panic-free. But it is always a reminder that even when speaking to trainees and students, I am speaking to patients.

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Know the facts about your dsDNA antibody

June 15, 2021 ·

Most lupus patients are familiar with the dsDNA antibody blood test. Like the ANA result, it is a blood test most closely related to lupus. Occasionally a positive dsDNA result can be seen in other conditions. But, the presence of a dsDNA antibody is considered specific for a diagnosis of lupus. As there are multiple ways a lab may detect a dsDNA, there still remains the possibility of a false positive, but a positive dsDNA result warrants a trip to the rheumatologist. (Reminder = “false positive” simply means the test is positive, yet the patient doesn’t have the condition associated with that result) Patients often are referred to a rheumatologist with a notebook full of labs, mostly of all varieties of antibodies and it is overwhelming.

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What is Scleroderma?

June 8, 2021 ·

“Please don’t google this until we have more information.”

That’s not something I often say to my patients. I usually write out diagnoses and treatments, specifically so patients CAN google and research them. The internet is a wild place but I still stand on the side of more information is better than less. Yet, when it comes to scleroderma, I take a different approach. I want to make sure my patients have 1) the right diagnosis and 2) an appropriate perspective on their diagnosis before engaging with, what can be, the scary world of scleroderma online. Because I also know that a scleroderma diagnosis doesn’t have to be that scary.

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Transitioning from the pediatrician’s office

June 1, 2021 ·

Being diagnosed with a chronic medical condition during childhood or adolescence shapes the lives of the patient and their family. In Rheumatology, the pediatric rheumatologist can become an additional parent and a partner. Pediatric hospitals and clinics become homes away from home. They are often painted bright colors, have comfy furniture and entertainment throughout the halls as everyone tries to make the heartbreaking reality of disease in children more palatable. Thankfully, treatment success in rheumatology is the norm and there will come a day in most patient’s lives when they need to say goodbye to their pediatric rheumatologist and find a new adult-focused rheumatologist. Transitioning from the pediatrician’s office is a day most patients and parents dread. This process, known as “transition,” is an integral part to any young person’s care.

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Race & Lupus: Understand the Connection

May 25, 2021 ·

Lupus can affect anyone. And although this is true, we do not want to ignore the fact that lupus disproportionately affects certain people. We have discussed how it affects young women, but we haven’t discussed how it affects young Black women. Lupus affects 1 in every 250 Black women and when compared to the white community, the prevalence of lupus in the Black community is 3-4x higher. It is well established that Black lupus patients tend to be sicker, need more aggressive medications and have worse outcomes. And despite the amazing advancements in testing and treatment, Black patients don’t benefit from those advances to the same extent as their white counterparts.

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