Rheumatologists should be more actively engaged in the management of 

, Jeffrey Curtis, MD, MS, MPH, Professor of Medicine at the University of Alabama at Birmingham, talked about the current gaps in rheumatological care of patients with cardiovascular risk.

The big question in this domain of care is on whom, or which specialist, does cardiovascular risk management fall.

“There’s often this tension with rheumatologists who say, ‘I don’t really want to mess with managing blood pressure, or hyperlipidemia. I’ve got a limited amount of time to do smoking cessation and lifestyle counseling.”

Curtis considered this hesitation or pushback to be a current shortcoming in the field. In fact, he noted that rheumatologists may tend to see patients with high cardiovascular risk more frequently than other specialists or the primary care physician.

However, he acknowledged that there is an ever-so-slight shift in the medical landscape that is just beginning to take place, and which can go even further.

“I think there is a growing recognition that rheumatologists are probably on the frontlines, and they need to increasingly recognize that,” he said. “At a minimum, they can coordinate care with respect to cardiovascular risk factor stratification as well as mitigation in order to get these risk factors under control.”

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An expert discusses the role of the rheumatologist in managing cardiovascular risk factors as well as current gaps in the field.

Jeffrey Curtis, MD, MS, MPH: The Responsibility of Cardiovascular Risk Management in Rheumatology

Due to inflammation in the joints and the body attacking joints and muscles, many 

It is important to keep abreast of the evolution of pain treatment and techniques like interventional pain management can be used.

In every community now, there are American Society of Interventional Pain-affiliated specialists, and rheumatologists, regardless of location, can go on the website and find 1 of the 5000 members to connect with, Alan Kaye, MD, PhD, of the LSU Health School of Medicine, said in a recent interview with 

There are various rheumatologic diseases and for many of them, there are a lot who have pain.

“We don’t want to be practicing in the 1970s, 1980s, and 1990s,” Kaye said.

While Kaye’s approach is interventional medicine, other therapies exist rather than opioids, and there are ways to connect to experts who can help guide rheumatologists to the best possible care for a patient experiencing pain.

“These people should be your partners for pain management of these very complicated rheumatologic patients,” Kaye concluded.

An expert explains resources for pain related to rheumatic conditions.

Alan Kaye, MD, PhD: The Intersection of Pain and Rheumatology

 pandemic has exposed new pathologies and conditions that were once unheard of or considered unlikely in the 

. Cases of multisystem Inflammatory Syndrome in Children (MIS-C) is a new condition that has recently emerged in pediatric 

“This is a new entity that seems to be a post-infectious process in COVID-19 that children seem to be at higher risk for than adults,” said Randall Cron, MD, PhD, Professor of Pediatrics and Medicine, University of Alabama at Birmingham, in an interview with 

In many patients, MIS-C presents features similar to Kawasacki disease, with coronary artery changes in a small subpopulation. Furthermore, shock and gastrointestinal illnesses can be a result of the syndrome if the child is sick enough. Features of a cytokine storm may also occur.

Cron explained that, in addition to treating the shock, it would be typical to manage the hyperinflammation. Because of the syndrome’s shared features with Kawasacki disease, the patient then might receive intravenous immunoglobulin to prevent other complications, such as coronary aneurysms.

“I don’t know who would have predicted MIS-C, or PMIS, or PIMS, or whatever you want to call it. I certainly didn’t predict it,” he concluded. “It’s a fascinating new entity, unfortunately, for pediatric rheumatologists and others.”

MIS-C is a condition recently recognized in children with COVID-19.


Randall Cron, MD, PhD: Multisystem Inflammatory Syndrome in Children

When considering pregnancy, patients with 

 must consult with their healthcare providers. Additionally, there must be an open line of communication between their rheumatologist and obstetrician-gynecologist (OB-GYN).

“Rheumatology patients have special concerns and risk with regard to pregnancy, and therefore it is very, very important that this be planned,” said Lisa Sammaritano, MD, of Weill Cornell Medicine and Hospital for Special Surgery in an interview with 

Systemic lupus and antiphospholipid antibodies syndrome historically have posed the greatest risk for both the mother’s health and the outcome of the pregnancy. Both disorders may coincide, thus increasing risk. In fact, about 1/3 of patients with lupus also present with antiphospholipid antibodies.

Sammaritano urged rheumatologists to inquire into their patients’ intentions, and to caution against inadvertent pregnancies. Furthermore, the ideal treatment and management scenario would be a level of synergy between both the rheumatologist and OB-GYN; both specialists must be attuned to patient conditions and pregnancy plans.

“We may think of this as the domain of the OB-GYN. Of course, they know everything about pregnancy and contraception. But we know everything about lupus and other related diseases,” she said. “And really, it takes both of those knowledge bases to come up with the right solution for any given patient.” 

Rheumatologists and OB-GYNs must communicate openly with each other and to patients with rheumatic diseases who are considering pregnancy.

Lisa Sammaritano, MD: Rheumatic Diseases, Pregnancy, and the Importance of Communication

The more healthcare workers can collaborate with each other, the better care they can give to patients. That’s because every patient has distinct features and do not fit into individual boxes.

“With my rheumatology colleagues I find communication is the biggest thing,” Ashley Crew, MD, of Keck Medicine of USC, said in a recent interview with 

Rheumatologists and dermatologists often work together to make the best treatment decision. Crew has a multidisciplinary clinic where she and a rheumatologist see a patient synchronously. They work together and there is the benefit of having the same history and assessment and the providers can talk in and out of the room to come up with a treatment decision.

Other times, however, practice does not look like that, she said. Most of the time she shares patients with providers who are either in the same facility or a completely different setting in a different part of her city.

“I think no matter what, as long as we’re communicating with each other, then we can really be beneficial to each other and again help for diagnostic purposes and also for therapeutic interventions and how we can better maximize them,” Crew concluded.

How providers of multiple specialists can come together to help 1 patient.


Ashley Crew, MD: The Relationship Between Healthcare Specialists

If something is out of a provider’s wheelhouse, they may inaccurately prescribe something to a patient. That means the provider could be unsure about the side effects to a prescription or exactly how it can benefit a patient or be used.

, Ashley Crew, MD, of Keck Medicine of USC, said that comes into play a lot in rheumatology—and other specialties—with topical steroids.

One of the biggest issues Crews, a dermatologist, sees, is a failure of the provider to pick the appropriate strength topical steroid, whether it be low, moderate, or strong potency.

“We basically decide which class we want to use depending on the location we’re treating and the disease-process we are treating,” Crew said. “So, the strength is 1 important component, and oftentimes non-dermatologists undershoot with strength because they are anxious and don’t want to treat with something too strong because they are worried they might do damage, which I think is a good caution to have if you haven’t been coached on how to do it appropriately.”

It is also necessary to think about the actual steroid being used—a solution, a cream, or an ointment. That’s important because it affects the potency of the topical steroid and if the patient hates what is prescribed to them, they aren’t likely to use it.

For example, if someone presents to the rheumatologist with scalp psoriasis and is prescribed an ointment, they likely will not use it, Crew said. Instead, if an alcohol-based solution is prescribed, it might better be suited to address the needs of the patient while actually being used and benefitted from.

Ashley Crew, MD: Barriers to Topical Steroid Use

, Randall Cron, MD, PhD, Professor of Pediatrics and Medicine, University of Alabama at Birmingham, discussed his presentation on 

Clinical Congress of Rheumatology (CCR) East meeting.

Cytokine storm syndrome is a generic term that envelops various hyperinflammatory conditions—such as macrophage activation syndrome (MAS) and hemophagocytic lymphohistiocytosis (HLH)—yet it would be inaccurate to consider them all identical. Cron stressed the importance of their distinctions, which influences identification within patient populations and treatment decisions.

He also briefly touched on genetic predispositions to these conditions, hinting at a potential novel gene that physicians and rheumatologists should be aware of.

Additionally, he talked about the intersection between cytokine storm syndrome and 

“Many of us think that COVID-19 has a cytokine storm. It falls under that umbrella as well,” he said. “It’s unique from other cytokine storms, but it has enough features that treating the cytokine storm is really important to prolonged survival.”

He went on to explain that if patients become hospitalized due to the virus, and present with inflammation or show evidence of a cytokine storm, then an intervention becomes all the more necessary.

Although proper interventions are uncertain at the moment, there is some emerging evidence that moderate doses of glucocorticoids may increase chance of survival.

“Maybe even some of the targeted approaches that we use in rheumatology to go after individual cytokines or groups of cytokines may also be beneficial,” Cron concluded.

COVID-19 is associated with its own cytokine storm syndrome.

Randall Cron, MD, PhD: Cytokine Storm Syndrome and COVID-19

Clinical manifestations may lead to a rheumatology patient needing to seek additional care from a dermatologist.

Conditions like psoriatic arthritis and psoriasis are seen all the time by dermatologists, Ashley Crew, MD, from Keck Medicine of USC, said in a recent interview with 

. Crew, who is a dermatologist, said a lot of patients go to her with suspected inflammatory arthritis and there is a question about whether it is psoriatic arthritis.

“I think it comes as a surprise to a lot of dermatologists that psoriatic arthritis is not a slam dunk always diagnosis and that there can be some grey area,” Crew said.

When rheumatologists debate about whether a patient has psoriatic arthritis, dermatologists are often asked to assist with rashes and other possible manifestations.

There are also tons of overlap with lupus. Such patients might have systemic lupus who also have cutaneous manifestations of the condition that can be acute, chronic, or sub-acute. Further, there are manifestations of dermatomyositis that dermatology clinics see a lot of that are rheumatology patients who they help to assess, make a diagnosis, and help to fine-tune therapeutics.

When a rheum patient might need to consult with a dermatologist.

Ashley Crew, MD: Clinical Manifestations in Rheum Care Requiring Derm Consult

 can work together to improve patient care.

When a joint decision-making model is instilled, or if a rheumatologist and dermatologist are working closely together, they are able to synthesize the same clinical information and can make a decision on which therapy is best suited for a patient.

Still, the relationship can be bi-directional, with rheumatologists and dermatologists either working hand-in-hand from the jump of a patient’s care, or a rheumatologist deciding during the treatment journey of a patient to consult with a dermatologist about what the best decision might be.

“I think diagnostically we help each other a lot,” Ashley Crew, MD, of Keck Medicine of USC, said in a recent interview with 

. Crew, a dermatologist, said such specialists have easy access to tissue, so if there are diagnostic troubles, they can take a biopsy to solidify or overturn a diagnosis. Dermatologists are trained to identify certain patterns in the skin to help diagnose.

On the other hand, dermatologists rely on their rheumatology colleagues to complete the clinical picture as far as other systemic manifestations.

“Diagnostically we can help each other quite a bit, but I also think therapeutically and in medical decision-making, we can be a really good team too,” Crew said.

How the 2 specialties play a role in each other.

Ashley Crew, MD: The Intersection of Dermatology and Rheumatology

 are likelier to have complications during pregnancies than the general population. Rheumatologists, therefore, must be aware of the risks these diseases pose for this specific patient population.

 Lisa Sammaritano, MD, Rheumatologist at Weill Cornell Medicine and Hospital for Special Surgery, discussed how rheumatology disorders may influence patients and physician decisions before, during, and after pregnancies.

Rheumatologists have a critical responsibility to evaluate these diseases and determine the best treatment or monitoring approach for such patients. Some courses of action may be encouraging the use of contraception, especially for individuals not planning for a pregnancy, or delaying pregnancy until any active diseases have been treated or managed. 

“It’s almost a universal finding in this area that having any active rheumatic disease prior to or at the moment of conception does increase risk, both maternal and pregnancy related.” Sammaritano said.

Another important consideration is the medication that is prescribed to treat the rheumatic disease. While some medicines are considered safe during pregnancies, other common therapies are potentially teratogenic.

It is thus important for the patient to be aware of their medication use before and during pregnancies, and healthcare providers must halt any potentially concerning treatments in a timely manner.

An expert discusses the risks that rheumatic diseases pose for pregnancies as well as the conversations rheumatologists need to have with their patients.