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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Apr 8, 2019

Join(t) us in learning about rheumatoid arthritis care for the internist with Robert McLean MD, rheumatologist, Associate Clinical Professor at Yale, and President Elect of the ACP! We discuss the complexity of rheumatoid arthritis, how to differentiate from other arthritic conditions, and how to have a patient-centered framework for the evaluation and treatment of affected patients. ACP members can claim CME-MOC credit at on ACP's site..

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Writer (Interview & CME questions): Cyrus Askin MD

Show Notes and Infographic by: Elena Gibson MS4

Hosts: Matthew Watto MD, Stuart Brigham MD

Editors: Matthew Watto MD, Emi Okamoto MD

Guest: Robert McLean MD

Time Stamps

  • 00:35 Disclaimer, intro and guest bio
  • 03:38 Guest onliner; Nudge (book) on behavioral economics
  • 08:30 Favorite failure; Stuart’s pick of the week
  • 12:24 Key historical features of RA
  • 15:30 Differential diagnosis
  • 19:20 Physical findings in RA
  • 20:58 Initial labs orders for suspected inflammatory arthritis; CRP vs high sensitivity (cardio) CRP assays
  • 27:45 Epidemiology of RA; Is there a utility for scoring systems?; A bit more on inflammatory markers
  • 32:30 Recap and test interpretation
  • 36:22 High yield physical exam in RA
  • 40:56 Initial counseling after RA diagnosis
  • 46:00 Therapeutic trial with NSAIDS or steroids for inflammatory arthritis
  • 50:29 When to reach for the DMARDS
  • 52:40 Are steroids considered DMARDS?
  • 54:50 Primary care considerations for patients starting steroids or DMARDS (TB, vaccinations)
  • 60:34 When and how long to hold DMARDS for surgery or acute illness
  • 62:10 Drug-drug interactions and monitoring with methotrexate, hydroxychloroquine, sulfasalazine
  • 70:10 Anti-inflammatory diets
  • 73:30 Take home points
  • 76:00 Outro