RESUMEN
OBJECTIVE: Rheumatology fellowship programs lack formal curricular content to educate trainees about legislative and regulatory health care policies that have a profound impact on academic and community practices. Advocacy 101 was created as a program to address this gap and engage fellows-in-training (FIT) in health advocacy efforts. METHODS: A web-based survey was sent via the American College of Rheumatology (ACR) FIT listserve in July 2015 and April 2016. The survey queried respondents about their knowledge of and participation in health policy and advocacy. Survey results guided the design of an educational program called Advocacy 101 for FIT and program directors in conjunction with the ACR Advocates for Arthritis fly-in meeting. RESULTS: The survey response rate increased from 19% in 2015 (95 of 500 FIT) to 39% in 2016 (231 of 595 FIT). In 2015, the top reason for nonparticipation in health policy and advocacy efforts (64% of respondents) was lack of knowledge on how to get involved. This reason decreased to 39% of respondents in 2016. Other barriers to participation included lack of time and familiarity with the issues. Over the 2 years, FIT identified patient access to medication and insurance, and physician reimbursement as important advocacy issues. All participants of Advocacy 101 reported an increase in knowledge of health policy and the intent to stay involved. CONCLUSION: FIT regard health policy issues as important, but many are uncertain of how to participate in advocacy. Advocacy 101 is the first program designed to educate and engage rheumatology FIT in health policy and advocacy endeavors.
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Conocimientos, Actitudes y Práctica en Salud , Política de Salud , Reumatología/educación , Becas , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Infection is a leading cause of morbidity and mortality among patients with systemic lupus erythematous (SLE). Dysfunction of the innate and adaptive immune systems increases the risk of infection in patients with SLE. Infectious agents have also been theorized to play a role in the pathogenesis of SLE. This article summarizes our current knowledge of the infectious risk SLE patients face as a result of their underlying disease including abnormal phagocytes and T cells as well as the increased risk of infection associated with immunosuppressive agents used to treat disease. Pathogens thought to play a role in the pathogenesis of disease including EBV, CMV, human endogenous retroviruses (HERVs), and tuberculosis will also be reviewed, as well as the pathologic potential of microbial amyloids and the microbiome.
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Lupus Eritematoso Sistémico/complicaciones , Infecciones Oportunistas/complicaciones , Inmunidad Adaptativa , Diagnóstico Diferencial , Humanos , Inmunidad Innata , Inmunosupresores/efectos adversos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/genética , Lupus Eritematoso Sistémico/inmunología , Microbiota , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunologíaRESUMEN
Large difficult to heal ulcers of various etiologies carry a high morbidity and mortality rate. Becaplermin is a recombinant platelet-derived growth factor approved for treatment of diabetic ulcers. In this two-case series, we report the use of becaplermin in the treatment of ulcers due to (i) calciphylaxis, an often fatal condition resulting from systemic calcification and thrombosis of vessels and (ii) pyoderma gangrenosum (PG), a neutrophilic dermatosis. We also report that topical collagenase worsened PG ulcers, consistent with pathergy. Becaplermin can be used to help treat ulcers resulting from calciphylaxis and PG. These encouraging results lend support for the utilization of becaplermin in the treatment of nondiabetic chronic ulcers of various etiologies.
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Inductores de la Angiogénesis/uso terapéutico , Calcifilaxia/tratamiento farmacológico , Proteínas Proto-Oncogénicas c-sis/uso terapéutico , Piodermia Gangrenosa/tratamiento farmacológico , Adulto , Anciano , Becaplermina , Calcifilaxia/patología , Humanos , Masculino , Piodermia Gangrenosa/patología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/patología , Resultado del TratamientoRESUMEN
Hyperuricemia has long been established as the major etiologic factor in gout. In recent years, a large body of evidence has accumulated that suggests that hyperuricemia may play a role in the development and pathogenesis of a number of metabolic, hemodynamic, and systemic pathologic diseases, including metabolic syndrome, hypertension, stroke, and atherosclerosis. A number of epidemiologic studies have linked hyperuricemia with each of these disorders. In some studies, therapies that lower uric acid may prevent or improve certain components of the metabolic syndrome. There is an association between uric acid and the development of systemic lupus erythematosus; the connection between other rheumatic diseases such as rheumatoid arthritis and osteoarthritis is less clear. The mechanism for the role of uric acid in disorders other than gout is not well established but recent investigations point towards systemic inflammation induced by urate, as the major pathophysiological event common to systemic diseases, including atherosclerosis.
RESUMEN
Thirty-year-old woman with history of AIDS and anxiety presented with palpitations. Although clinically euvolemic, she was aggressively fluid resuscitated in lieu of sinus tachycardia. She developed unilateral pulmonary edema on account of left decubitus positioning and volume resuscitation. Given her normal cardiac, renal, and liver status, she spontaneously cleared the extra fluid, and the pulmonary edema resolved. This case highlights the importance of recognizing transient unilateral pulmonary edema and need for early radiographs to document clearance and prevent unnecessary testing.