Sally Koch Kubetin

SAN FRANCISCO – The atypical presentation of cardiovascular disease in patients with rheumatoid arthritis often masks its presence until the patient dies suddenly, according to Dr. Vibeke Strand.

The mortality in patients with RA is twice that of the normal population, with the average life span being reduced by 15-18 years in RA, which is comparable to the early mortality seen in patients with diabetes. Cardiovascular disease (CVD) explains almost all of the excess mortality seen in patients with RA, said Dr. Strand of the division of immunology and rheumatology at Stanford (Calif.) University.

CVD risk factors are atypical in RA patients. They are less likely to be obese or to have hypertension, hyperlipidemia, or diabetes (J. Rheumatol. 2011;38:29-35). Heart failure is more common in the RA population, especially in rheumatoid factor (RF)-positive patients. However despite their heart failure, their ejection fraction often remains normal.

Patients’ body mass index tends to be low, suggesting that their heart failure may result from reduced myocardial mass rather than from hypertrophy. Those with a BMI less than 20 kg/m² have a significantly decreased survival, she said at the Perspectives in Rheumatic Diseases 2011 meeting.

Because their CVD presentation is atypical, RA patients tend to get recognized later in the course of their heart disease and to be treated less aggressively. RA patients are less likely than those without the disease to undergo revascularization or receive cardiovascular medications after an MI.

Until recently, rheumatologists have been unable to lessen early mortality among RA patients. However, data from a study of 3,862 RA patients diagnosed with RA either before 1970, between 1970 and 1980, or after 1990 showed a drop in excess mortality among the 1,240 patients diagnosed after 1995. The researchers attributed the prolonged survival to the use of methotrexate (Lancet 2002;359:1173-7; Circulation 2004;110:1774-9).

With the advent of the biologics era, particularly the widespread use of tumor necrosis factor (TNF) inhibitors, rheumatologists have been wondering whether the anti-inflammatory properties of these agents would lower CVD mortality among RA patients.

Data presented at the 2005 Congress of the European League Against Rheumatism (EULAR) (abstract OP0095) showed that use of TNF inhibitors lowers the hazard ratio of all-cause mortality to 0.72 among RA patients. These findings were based on 63,811 patient-years of follow-up of 19,580 RA patients, among whom there were 1,129 deaths. Use of methotrexate was associated with an HR of 0.82. Prednisone increased the risk to an HR of 1.60, which is consistent with the well-documented risk of CVD associated with the use of even small doses of this agent, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Standard risk scores such as the Framingham score underestimate the risk for heart disease in an RA population. The underestimation is clear in the results of a study that compared mortality risk as calculated by the Framingham score with actual events in 341 women with RA aged 30-74 years and 150 men with RA aged 30-74 years. According to the Framingham score, the 10-year CVD risk for the women was 4.6%. In fact, it was 11.1%. For the men, the Framingham risk was 12%. The actual cardiovascular risk was 25.8% (Arthritis Rheum. 2009;60:S264).

The excess CVD risk persists even after traditional risk factors seen in normal populations are controlled for. The biggest remaining risk is the burden of inflammation. There are increased levels of TNF-alpha and interleukin-6 in the serum, myocardium, and synovitis of RA, according to Dr. Strand.

Recommendations on limiting the increased risk for CVD issued by EULAR (Ann. Rheum. Dis. 2010;69:325-31) suggest modifying the risk score by multiplying it by 1.5 when the patient has two of the three following signs of severe disease: RA duration of more than 10 years; rheumatoid factor and anti-CCP antibody positivity; and/or extra-articular disease manifestations.

The following steps should be taken in such patients:

• Monitor total cholesterol/high-density lipoprotein levels.

• Manage appropriate treatment with statins, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers.

• Prescribe steroids at the lowest possible dose, if at all.

• Urge caution regarding the use of nonsteroidal anti-inflammatory drugs and COX-2 inhibitors.

• Urge patients to stop smoking.

Dr. Strand disclosed that she has financial relationships with many companies that make treatments for RA.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – The atypical presentation of cardiovascular disease in patients with rheumatoid arthritis often masks its presence until the patient dies suddenly, according to Dr. Vibeke Strand.

The mortality in patients with RA is twice that of the normal population, with the average life span being reduced by 15-18 years in RA, which is comparable to the early mortality seen in patients with diabetes. Cardiovascular disease (CVD) explains almost all of the excess mortality seen in patients with RA, said Dr. Strand of the division of immunology and rheumatology at Stanford (Calif.) University.

CVD risk factors are atypical in RA patients. They are less likely to be obese or to have hypertension, hyperlipidemia, or diabetes (J. Rheumatol. 2011;38:29-35). Heart failure is more common in the RA population, especially in rheumatoid factor (RF)-positive patients. However despite their heart failure, their ejection fraction often remains normal.

Patients’ body mass index tends to be low, suggesting that their heart failure may result from reduced myocardial mass rather than from hypertrophy. Those with a BMI less than 20 kg/m² have a significantly decreased survival, she said at the Perspectives in Rheumatic Diseases 2011 meeting.

Because their CVD presentation is atypical, RA patients tend to get recognized later in the course of their heart disease and to be treated less aggressively. RA patients are less likely than those without the disease to undergo revascularization or receive cardiovascular medications after an MI.

Until recently, rheumatologists have been unable to lessen early mortality among RA patients. However, data from a study of 3,862 RA patients diagnosed with RA either before 1970, between 1970 and 1980, or after 1990 showed a drop in excess mortality among the 1,240 patients diagnosed after 1995. The researchers attributed the prolonged survival to the use of methotrexate (Lancet 2002;359:1173-7; Circulation 2004;110:1774-9).

With the advent of the biologics era, particularly the widespread use of tumor necrosis factor (TNF) inhibitors, rheumatologists have been wondering whether the anti-inflammatory properties of these agents would lower CVD mortality among RA patients.

Data presented at the 2005 Congress of the European League Against Rheumatism (EULAR) (abstract OP0095) showed that use of TNF inhibitors lowers the hazard ratio of all-cause mortality to 0.72 among RA patients. These findings were based on 63,811 patient-years of follow-up of 19,580 RA patients, among whom there were 1,129 deaths. Use of methotrexate was associated with an HR of 0.82. Prednisone increased the risk to an HR of 1.60, which is consistent with the well-documented risk of CVD associated with the use of even small doses of this agent, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Standard risk scores such as the Framingham score underestimate the risk for heart disease in an RA population. The underestimation is clear in the results of a study that compared mortality risk as calculated by the Framingham score with actual events in 341 women with RA aged 30-74 years and 150 men with RA aged 30-74 years. According to the Framingham score, the 10-year CVD risk for the women was 4.6%. In fact, it was 11.1%. For the men, the Framingham risk was 12%. The actual cardiovascular risk was 25.8% (Arthritis Rheum. 2009;60:S264).

The excess CVD risk persists even after traditional risk factors seen in normal populations are controlled for. The biggest remaining risk is the burden of inflammation. There are increased levels of TNF-alpha and interleukin-6 in the serum, myocardium, and synovitis of RA, according to Dr. Strand.

Recommendations on limiting the increased risk for CVD issued by EULAR (Ann. Rheum. Dis. 2010;69:325-31) suggest modifying the risk score by multiplying it by 1.5 when the patient has two of the three following signs of severe disease: RA duration of more than 10 years; rheumatoid factor and anti-CCP antibody positivity; and/or extra-articular disease manifestations.

The following steps should be taken in such patients:

• Monitor total cholesterol/high-density lipoprotein levels.

• Manage appropriate treatment with statins, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers.

• Prescribe steroids at the lowest possible dose, if at all.

• Urge caution regarding the use of nonsteroidal anti-inflammatory drugs and COX-2 inhibitors.

• Urge patients to stop smoking.

Dr. Strand disclosed that she has financial relationships with many companies that make treatments for RA.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – The atypical presentation of cardiovascular disease in patients with rheumatoid arthritis often masks its presence until the patient dies suddenly, according to Dr. Vibeke Strand.

The mortality in patients with RA is twice that of the normal population, with the average life span being reduced by 15-18 years in RA, which is comparable to the early mortality seen in patients with diabetes. Cardiovascular disease (CVD) explains almost all of the excess mortality seen in patients with RA, said Dr. Strand of the division of immunology and rheumatology at Stanford (Calif.) University.

CVD risk factors are atypical in RA patients. They are less likely to be obese or to have hypertension, hyperlipidemia, or diabetes (J. Rheumatol. 2011;38:29-35). Heart failure is more common in the RA population, especially in rheumatoid factor (RF)-positive patients. However despite their heart failure, their ejection fraction often remains normal.

Patients’ body mass index tends to be low, suggesting that their heart failure may result from reduced myocardial mass rather than from hypertrophy. Those with a BMI less than 20 kg/m² have a significantly decreased survival, she said at the Perspectives in Rheumatic Diseases 2011 meeting.

Because their CVD presentation is atypical, RA patients tend to get recognized later in the course of their heart disease and to be treated less aggressively. RA patients are less likely than those without the disease to undergo revascularization or receive cardiovascular medications after an MI.

Until recently, rheumatologists have been unable to lessen early mortality among RA patients. However, data from a study of 3,862 RA patients diagnosed with RA either before 1970, between 1970 and 1980, or after 1990 showed a drop in excess mortality among the 1,240 patients diagnosed after 1995. The researchers attributed the prolonged survival to the use of methotrexate (Lancet 2002;359:1173-7; Circulation 2004;110:1774-9).

With the advent of the biologics era, particularly the widespread use of tumor necrosis factor (TNF) inhibitors, rheumatologists have been wondering whether the anti-inflammatory properties of these agents would lower CVD mortality among RA patients.

Data presented at the 2005 Congress of the European League Against Rheumatism (EULAR) (abstract OP0095) showed that use of TNF inhibitors lowers the hazard ratio of all-cause mortality to 0.72 among RA patients. These findings were based on 63,811 patient-years of follow-up of 19,580 RA patients, among whom there were 1,129 deaths. Use of methotrexate was associated with an HR of 0.82. Prednisone increased the risk to an HR of 1.60, which is consistent with the well-documented risk of CVD associated with the use of even small doses of this agent, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Standard risk scores such as the Framingham score underestimate the risk for heart disease in an RA population. The underestimation is clear in the results of a study that compared mortality risk as calculated by the Framingham score with actual events in 341 women with RA aged 30-74 years and 150 men with RA aged 30-74 years. According to the Framingham score, the 10-year CVD risk for the women was 4.6%. In fact, it was 11.1%. For the men, the Framingham risk was 12%. The actual cardiovascular risk was 25.8% (Arthritis Rheum. 2009;60:S264).

The excess CVD risk persists even after traditional risk factors seen in normal populations are controlled for. The biggest remaining risk is the burden of inflammation. There are increased levels of TNF-alpha and interleukin-6 in the serum, myocardium, and synovitis of RA, according to Dr. Strand.

Recommendations on limiting the increased risk for CVD issued by EULAR (Ann. Rheum. Dis. 2010;69:325-31) suggest modifying the risk score by multiplying it by 1.5 when the patient has two of the three following signs of severe disease: RA duration of more than 10 years; rheumatoid factor and anti-CCP antibody positivity; and/or extra-articular disease manifestations.

The following steps should be taken in such patients:

• Monitor total cholesterol/high-density lipoprotein levels.

• Manage appropriate treatment with statins, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers.

• Prescribe steroids at the lowest possible dose, if at all.

• Urge caution regarding the use of nonsteroidal anti-inflammatory drugs and COX-2 inhibitors.

• Urge patients to stop smoking.

Dr. Strand disclosed that she has financial relationships with many companies that make treatments for RA.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Rheumatologists can prescribe drugs that can not only drive rheumatoid arthritis into remission but can also achieve some repair to the joints damaged by inflammation, according to Dr. Marc D. Cohen.

"In rheumatology, remission can never mean no disease. It just means not very much disease," said Dr. Cohen, emeritus professor of medicine at the Mayo Clinic, Rochester, Minn., and acting chief and professor of medicine at National Jewish Medical and Research Center in Denver.

"Rheumatologists need to be better sellers of what we can do. If you are not interested in changing the face of this disease, what are you doing?" he asked at the Perspectives in Rheumatic Diseases 2011 meeting.

In a review of the data on the efficacy of various biologic drugs in rheumatoid arthritis (RA), Dr. Cohen pointed out that, until the advent of biologics, there were no good trial data on the efficacy of methotrexate in RA. "The biologics are the best thing that ever happened to methotrexate, believe me," he said.

The study that put methotrexate on the map was the SWEFOT, in which investigators put all patients with RA on a trial of methotrexate before randomizing them to either triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine or to methotrexate plus a tumor necrosis factor inhibitor (TNFi). The findings from the methotrexate-monotherapy portion of the trial showed that 30% of the patients improved on methotrexate alone (Lancet 2009;374:459-66).

Because of these findings, all patients get a trial of methotrexate first, as quickly as possible, ramping up the dose over 1-2 months, to see what happens. What may get overlooked is the investigators’ note that, while a subset of patients experience clinical benefit from methotrexate monotherapy, radiographic disease progression continues despite methotrexate making the patients feel better.

There is no way to predict which 30% may respond clinically to methotrexate. That is one reason why one may want to rush through ramping up the dose.

Commonly, the next step in treating RA is to apply triple therapy. Further findings from the SWEFOT trial of 487 patients with RA symptoms of less than 1 year’s duration showed that clinically at 2 years the two treatment groups were the same in terms of Disease Activity Score (DAS). However, patients given triple therapy had more radiographic progression than did those given a TNFi plus methotrexate.

"Is that important to your patient? I am not sure. The problem is that we have no way to measure that. We need a point system. If you have RA in your right big toe and you are a piano player that is probably not as bad as having wrist disease. Maybe we should weight them."

The bottom line is that the addition of a TNFi to the treatment regimen of someone who did not respond completely to methotrexate will improve the clinical and radiologic response in two to three times the number of patients (Lancet 2007;370:1861-74).

This combination approach does not capture everyone.

This is part of the motivation behind the push for primary care physicians to recognize RA early and get the patients to the rheumatologists for biologic therapy early. When the biologics are given aggressively within the first 6 months of the disease, "we may be able to reset the disease, turn it off," he said.

In some cases, x-rays show repair of the joint damage when biologics are given early enough, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Dr. Paul Emery, professor of rheumatology and head of the academic unit of musculoskeletal medicine at the University of Leeds (England), presented data at the 2011 EULAR Congress showing that after patients achieved remission with methotrexate and a biologic, they could be maintained on methotrexate. This approach has the advantage of maintaining remission with a less-costly drug that also poses fewer potentially adverse effects than a biologic agent. "We do not know the right combination initially, but it is being examined," said Dr. Cohen.

SDEF and this news organization are owned by Elsevier.

Dr. Cohen reported having no relevant conflicts of interest to disclose.

SAN FRANCISCO – Rheumatologists can prescribe drugs that can not only drive rheumatoid arthritis into remission but can also achieve some repair to the joints damaged by inflammation, according to Dr. Marc D. Cohen.

"In rheumatology, remission can never mean no disease. It just means not very much disease," said Dr. Cohen, emeritus professor of medicine at the Mayo Clinic, Rochester, Minn., and acting chief and professor of medicine at National Jewish Medical and Research Center in Denver.

"Rheumatologists need to be better sellers of what we can do. If you are not interested in changing the face of this disease, what are you doing?" he asked at the Perspectives in Rheumatic Diseases 2011 meeting.

In a review of the data on the efficacy of various biologic drugs in rheumatoid arthritis (RA), Dr. Cohen pointed out that, until the advent of biologics, there were no good trial data on the efficacy of methotrexate in RA. "The biologics are the best thing that ever happened to methotrexate, believe me," he said.

The study that put methotrexate on the map was the SWEFOT, in which investigators put all patients with RA on a trial of methotrexate before randomizing them to either triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine or to methotrexate plus a tumor necrosis factor inhibitor (TNFi). The findings from the methotrexate-monotherapy portion of the trial showed that 30% of the patients improved on methotrexate alone (Lancet 2009;374:459-66).

Because of these findings, all patients get a trial of methotrexate first, as quickly as possible, ramping up the dose over 1-2 months, to see what happens. What may get overlooked is the investigators’ note that, while a subset of patients experience clinical benefit from methotrexate monotherapy, radiographic disease progression continues despite methotrexate making the patients feel better.

There is no way to predict which 30% may respond clinically to methotrexate. That is one reason why one may want to rush through ramping up the dose.

Commonly, the next step in treating RA is to apply triple therapy. Further findings from the SWEFOT trial of 487 patients with RA symptoms of less than 1 year’s duration showed that clinically at 2 years the two treatment groups were the same in terms of Disease Activity Score (DAS). However, patients given triple therapy had more radiographic progression than did those given a TNFi plus methotrexate.

"Is that important to your patient? I am not sure. The problem is that we have no way to measure that. We need a point system. If you have RA in your right big toe and you are a piano player that is probably not as bad as having wrist disease. Maybe we should weight them."

The bottom line is that the addition of a TNFi to the treatment regimen of someone who did not respond completely to methotrexate will improve the clinical and radiologic response in two to three times the number of patients (Lancet 2007;370:1861-74).

This combination approach does not capture everyone.

This is part of the motivation behind the push for primary care physicians to recognize RA early and get the patients to the rheumatologists for biologic therapy early. When the biologics are given aggressively within the first 6 months of the disease, "we may be able to reset the disease, turn it off," he said.

In some cases, x-rays show repair of the joint damage when biologics are given early enough, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Dr. Paul Emery, professor of rheumatology and head of the academic unit of musculoskeletal medicine at the University of Leeds (England), presented data at the 2011 EULAR Congress showing that after patients achieved remission with methotrexate and a biologic, they could be maintained on methotrexate. This approach has the advantage of maintaining remission with a less-costly drug that also poses fewer potentially adverse effects than a biologic agent. "We do not know the right combination initially, but it is being examined," said Dr. Cohen.

SDEF and this news organization are owned by Elsevier.

Dr. Cohen reported having no relevant conflicts of interest to disclose.

SAN FRANCISCO – Rheumatologists can prescribe drugs that can not only drive rheumatoid arthritis into remission but can also achieve some repair to the joints damaged by inflammation, according to Dr. Marc D. Cohen.

"In rheumatology, remission can never mean no disease. It just means not very much disease," said Dr. Cohen, emeritus professor of medicine at the Mayo Clinic, Rochester, Minn., and acting chief and professor of medicine at National Jewish Medical and Research Center in Denver.

"Rheumatologists need to be better sellers of what we can do. If you are not interested in changing the face of this disease, what are you doing?" he asked at the Perspectives in Rheumatic Diseases 2011 meeting.

In a review of the data on the efficacy of various biologic drugs in rheumatoid arthritis (RA), Dr. Cohen pointed out that, until the advent of biologics, there were no good trial data on the efficacy of methotrexate in RA. "The biologics are the best thing that ever happened to methotrexate, believe me," he said.

The study that put methotrexate on the map was the SWEFOT, in which investigators put all patients with RA on a trial of methotrexate before randomizing them to either triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine or to methotrexate plus a tumor necrosis factor inhibitor (TNFi). The findings from the methotrexate-monotherapy portion of the trial showed that 30% of the patients improved on methotrexate alone (Lancet 2009;374:459-66).

Because of these findings, all patients get a trial of methotrexate first, as quickly as possible, ramping up the dose over 1-2 months, to see what happens. What may get overlooked is the investigators’ note that, while a subset of patients experience clinical benefit from methotrexate monotherapy, radiographic disease progression continues despite methotrexate making the patients feel better.

There is no way to predict which 30% may respond clinically to methotrexate. That is one reason why one may want to rush through ramping up the dose.

Commonly, the next step in treating RA is to apply triple therapy. Further findings from the SWEFOT trial of 487 patients with RA symptoms of less than 1 year’s duration showed that clinically at 2 years the two treatment groups were the same in terms of Disease Activity Score (DAS). However, patients given triple therapy had more radiographic progression than did those given a TNFi plus methotrexate.

"Is that important to your patient? I am not sure. The problem is that we have no way to measure that. We need a point system. If you have RA in your right big toe and you are a piano player that is probably not as bad as having wrist disease. Maybe we should weight them."

The bottom line is that the addition of a TNFi to the treatment regimen of someone who did not respond completely to methotrexate will improve the clinical and radiologic response in two to three times the number of patients (Lancet 2007;370:1861-74).

This combination approach does not capture everyone.

This is part of the motivation behind the push for primary care physicians to recognize RA early and get the patients to the rheumatologists for biologic therapy early. When the biologics are given aggressively within the first 6 months of the disease, "we may be able to reset the disease, turn it off," he said.

In some cases, x-rays show repair of the joint damage when biologics are given early enough, he said at the meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

Dr. Paul Emery, professor of rheumatology and head of the academic unit of musculoskeletal medicine at the University of Leeds (England), presented data at the 2011 EULAR Congress showing that after patients achieved remission with methotrexate and a biologic, they could be maintained on methotrexate. This approach has the advantage of maintaining remission with a less-costly drug that also poses fewer potentially adverse effects than a biologic agent. "We do not know the right combination initially, but it is being examined," said Dr. Cohen.

SDEF and this news organization are owned by Elsevier.

Dr. Cohen reported having no relevant conflicts of interest to disclose.

SAN FRANCISCO – Patients believe that setting specific goals at the beginning of a new therapy will help them achieve optimal treatment outcomes, in a slight variation of the treat-to-target mantra heard so widely in rheumatology these days.

Findings from an unpublished survey of 1,242 women and 587 men with moderate rheumatoid arthritis (RA) disease severity showed that at the start of treatment, 81% set personal or social goals (ability to garden or stand at a cocktail party), with 80% saying that the setting of such goals would be a good way to assess whether the new treatment was working; 91% set treatment goals (an MRI will show less inflammation in the joint), according to Dr. Vibeke Strand.

Most patients (87%) agreed that establishing such targets and achieving them would have a positive impact on their disease management.

Patients’ perceptions of goal setting included:

• I think setting personal and social goals would be of benefit as I can then assess whether my treatment is working or not in a simple to understand way (80% agreed).

• A treatment that works gets me to my personal and social goals quickly (84% agreed).

• If I set myself personal and social goals and achieve them, I would feel positive (87% agreed).

But they expected rapid results. About 81% wanted a new treatment to make them feel better within 3 months, and 56% said they would talk with their physician within less than a month of starting a new treatment if they felt no improvement, said Dr. Strand, adjunct clinical professor in the division of immunology at Stanford (Calif.) University.

A few were willing to give a new treatment longer to produce a benefit, with 20% saying they expected improved signs and symptoms within 3-6 months; only 5% were willing to wait more than 6 months.

Patients are just as impatient with their physicians as with their treatments. A total of 11% cited their physician as the biggest obstacle in controlling RA. Another 54% said that the leading challenge was finding the right treatment, and 16% named lack of education and understanding of RA. The remainder was made up of 11% who said lack of personal resolve was their biggest obstacle, and another 8% listed assorted other issues.

Over half of those surveyed (60%) had not heard of the treat-to-target approach to RA therapy. According to 61%, their physician did not manage their RA with strict goals and timeframes in place. But 62% said that they shared decisions with their physician on how best to treat their RA, Dr. Strand said at the Pespectives in Rheumatic Diseases 2011 meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

This survey was a follow-up to an earlier one of 1,958 women with RA from seven countries, including the United States, which was the first to characterize in detail the impact RA has on the daily lives of women and on their relationships. The survey was conducted on the Internet; all the women had been vetted as having RA of at least 6 months duration and all were 25-65 years of age.

The bottom line from that survey is that well into the era of biologics, women with rheumatoid arthritis report that pain remains a frequent and disabling symptom of their disease. Daily pain was reported by 63% of the women surveyed; 75% said they took pain medication daily, and 87% said they found it important to be able to describe the type and frequency of their RA-associated pain. Overall, 67% of the women reported that they constantly look for new ways to cope with their pain. When asked to describe a "good day with RA," 57% said it was a day free from pain, 58% said it was a day without fatigue, and 29% said it was a day when they were able to do everything easily.

Of the surveyed women, 68% reported that they felt it was necessary to conceal pain from their family and/or coworkers.

Regarding the effects of RA on their activities of daily living, 49% said it was difficult to keep fit, 45% found it difficult to garden, and 67% reported feeling less self-confident at work. Of the women who had been employed full time at diagnosis, 23% of the women had stopped working because of their disease and 27% reported they had cut back their work hours to part time.

The impact of RA extended beyond the workplace: 32% of the women said RA affected their closest relationships, with 55% reporting that they felt less confident in their sexuality; 31% reporting that they found it difficult to explain their sexual needs; of the 611 women who were single, 40% said RA played a role in it being difficult to find a partner.

The overarching weakness of both Internet surveys is the possibility that women with the worst disease were the ones who elected to complete the questionnaire, which may have introduced some bias, Dr. Strand noted.

The survey was funded by UCB, which manufactures Cimzia (certolizumab pegol). Dr. Strand disclosed that she has financial relationships with many companies that make treatments for rheumatoid arthritis, among other things.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Patients believe that setting specific goals at the beginning of a new therapy will help them achieve optimal treatment outcomes, in a slight variation of the treat-to-target mantra heard so widely in rheumatology these days.

Findings from an unpublished survey of 1,242 women and 587 men with moderate rheumatoid arthritis (RA) disease severity showed that at the start of treatment, 81% set personal or social goals (ability to garden or stand at a cocktail party), with 80% saying that the setting of such goals would be a good way to assess whether the new treatment was working; 91% set treatment goals (an MRI will show less inflammation in the joint), according to Dr. Vibeke Strand.

Most patients (87%) agreed that establishing such targets and achieving them would have a positive impact on their disease management.

Patients’ perceptions of goal setting included:

• I think setting personal and social goals would be of benefit as I can then assess whether my treatment is working or not in a simple to understand way (80% agreed).

• A treatment that works gets me to my personal and social goals quickly (84% agreed).

• If I set myself personal and social goals and achieve them, I would feel positive (87% agreed).

But they expected rapid results. About 81% wanted a new treatment to make them feel better within 3 months, and 56% said they would talk with their physician within less than a month of starting a new treatment if they felt no improvement, said Dr. Strand, adjunct clinical professor in the division of immunology at Stanford (Calif.) University.

A few were willing to give a new treatment longer to produce a benefit, with 20% saying they expected improved signs and symptoms within 3-6 months; only 5% were willing to wait more than 6 months.

Patients are just as impatient with their physicians as with their treatments. A total of 11% cited their physician as the biggest obstacle in controlling RA. Another 54% said that the leading challenge was finding the right treatment, and 16% named lack of education and understanding of RA. The remainder was made up of 11% who said lack of personal resolve was their biggest obstacle, and another 8% listed assorted other issues.

Over half of those surveyed (60%) had not heard of the treat-to-target approach to RA therapy. According to 61%, their physician did not manage their RA with strict goals and timeframes in place. But 62% said that they shared decisions with their physician on how best to treat their RA, Dr. Strand said at the Pespectives in Rheumatic Diseases 2011 meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

This survey was a follow-up to an earlier one of 1,958 women with RA from seven countries, including the United States, which was the first to characterize in detail the impact RA has on the daily lives of women and on their relationships. The survey was conducted on the Internet; all the women had been vetted as having RA of at least 6 months duration and all were 25-65 years of age.

The bottom line from that survey is that well into the era of biologics, women with rheumatoid arthritis report that pain remains a frequent and disabling symptom of their disease. Daily pain was reported by 63% of the women surveyed; 75% said they took pain medication daily, and 87% said they found it important to be able to describe the type and frequency of their RA-associated pain. Overall, 67% of the women reported that they constantly look for new ways to cope with their pain. When asked to describe a "good day with RA," 57% said it was a day free from pain, 58% said it was a day without fatigue, and 29% said it was a day when they were able to do everything easily.

Of the surveyed women, 68% reported that they felt it was necessary to conceal pain from their family and/or coworkers.

Regarding the effects of RA on their activities of daily living, 49% said it was difficult to keep fit, 45% found it difficult to garden, and 67% reported feeling less self-confident at work. Of the women who had been employed full time at diagnosis, 23% of the women had stopped working because of their disease and 27% reported they had cut back their work hours to part time.

The impact of RA extended beyond the workplace: 32% of the women said RA affected their closest relationships, with 55% reporting that they felt less confident in their sexuality; 31% reporting that they found it difficult to explain their sexual needs; of the 611 women who were single, 40% said RA played a role in it being difficult to find a partner.

The overarching weakness of both Internet surveys is the possibility that women with the worst disease were the ones who elected to complete the questionnaire, which may have introduced some bias, Dr. Strand noted.

The survey was funded by UCB, which manufactures Cimzia (certolizumab pegol). Dr. Strand disclosed that she has financial relationships with many companies that make treatments for rheumatoid arthritis, among other things.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Patients believe that setting specific goals at the beginning of a new therapy will help them achieve optimal treatment outcomes, in a slight variation of the treat-to-target mantra heard so widely in rheumatology these days.

Findings from an unpublished survey of 1,242 women and 587 men with moderate rheumatoid arthritis (RA) disease severity showed that at the start of treatment, 81% set personal or social goals (ability to garden or stand at a cocktail party), with 80% saying that the setting of such goals would be a good way to assess whether the new treatment was working; 91% set treatment goals (an MRI will show less inflammation in the joint), according to Dr. Vibeke Strand.

Most patients (87%) agreed that establishing such targets and achieving them would have a positive impact on their disease management.

Patients’ perceptions of goal setting included:

• I think setting personal and social goals would be of benefit as I can then assess whether my treatment is working or not in a simple to understand way (80% agreed).

• A treatment that works gets me to my personal and social goals quickly (84% agreed).

• If I set myself personal and social goals and achieve them, I would feel positive (87% agreed).

But they expected rapid results. About 81% wanted a new treatment to make them feel better within 3 months, and 56% said they would talk with their physician within less than a month of starting a new treatment if they felt no improvement, said Dr. Strand, adjunct clinical professor in the division of immunology at Stanford (Calif.) University.

A few were willing to give a new treatment longer to produce a benefit, with 20% saying they expected improved signs and symptoms within 3-6 months; only 5% were willing to wait more than 6 months.

Patients are just as impatient with their physicians as with their treatments. A total of 11% cited their physician as the biggest obstacle in controlling RA. Another 54% said that the leading challenge was finding the right treatment, and 16% named lack of education and understanding of RA. The remainder was made up of 11% who said lack of personal resolve was their biggest obstacle, and another 8% listed assorted other issues.

Over half of those surveyed (60%) had not heard of the treat-to-target approach to RA therapy. According to 61%, their physician did not manage their RA with strict goals and timeframes in place. But 62% said that they shared decisions with their physician on how best to treat their RA, Dr. Strand said at the Pespectives in Rheumatic Diseases 2011 meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).

This survey was a follow-up to an earlier one of 1,958 women with RA from seven countries, including the United States, which was the first to characterize in detail the impact RA has on the daily lives of women and on their relationships. The survey was conducted on the Internet; all the women had been vetted as having RA of at least 6 months duration and all were 25-65 years of age.

The bottom line from that survey is that well into the era of biologics, women with rheumatoid arthritis report that pain remains a frequent and disabling symptom of their disease. Daily pain was reported by 63% of the women surveyed; 75% said they took pain medication daily, and 87% said they found it important to be able to describe the type and frequency of their RA-associated pain. Overall, 67% of the women reported that they constantly look for new ways to cope with their pain. When asked to describe a "good day with RA," 57% said it was a day free from pain, 58% said it was a day without fatigue, and 29% said it was a day when they were able to do everything easily.

Of the surveyed women, 68% reported that they felt it was necessary to conceal pain from their family and/or coworkers.

Regarding the effects of RA on their activities of daily living, 49% said it was difficult to keep fit, 45% found it difficult to garden, and 67% reported feeling less self-confident at work. Of the women who had been employed full time at diagnosis, 23% of the women had stopped working because of their disease and 27% reported they had cut back their work hours to part time.

The impact of RA extended beyond the workplace: 32% of the women said RA affected their closest relationships, with 55% reporting that they felt less confident in their sexuality; 31% reporting that they found it difficult to explain their sexual needs; of the 611 women who were single, 40% said RA played a role in it being difficult to find a partner.

The overarching weakness of both Internet surveys is the possibility that women with the worst disease were the ones who elected to complete the questionnaire, which may have introduced some bias, Dr. Strand noted.

The survey was funded by UCB, which manufactures Cimzia (certolizumab pegol). Dr. Strand disclosed that she has financial relationships with many companies that make treatments for rheumatoid arthritis, among other things.

SDEF and this news organization are owned by Elsevier.

Do you love being a rheumatologist enough to still be seeing patients, teaching, and conducting research when you are 100 years old? May you live long enough to find out the answer to that question.

Rheumatologist Dr. Ephraim P. Engleman, who turned 100 years old in March, loves his specialty enough to still be very active in it. He is the longest tenured professor in any medical specialty at the University of California, San Francisco, where he is director of the Rosalind Russell Medical Research Center for Arthritis, and he continues to see patients 3 days a week.

When asked in an interview with this news organization what he considers to be the most important advances in rheumatology since he began his career in the 1940s, Dr. Engleman listed without reservation, "the discovery and proper use of cortisone, an invaluable drug in all medical specialties including rheumatology and joint replacements." Dr. Engleman also included the development of biologic therapy, noting "its long-term undesirable effects [having] not yet been determined." Anticytokine therapy also made the list of important advances in rheumatology.

As for the greatest challenges facing the specialty, Dr. Engelman listed "lack of national recognition of the rheumatologist’s critical role in the optimal management of patients with musculoskeletal diseases, the commonest of the chronic disorders. Furthermore, the kinds of services provided by rheumatologists are not adequately reimbursed in contemporary health insurance; thus, it is difficult for many rheumatologists to sustain viable practices."

He is touching the future by endowing the ACR REF/Ephraim P. Engleman Resident Research Preceptorship with the American College of Rheumatology Research and Education Foundation. The grant is $15,000. The deadline for online applications is Feb. 1, 2012. The purpose of the grants is to attract promising physician scientists to the field of rheumatology.

Dr. Engleman was born in San Jose, Calif. While an undergrad at Stanford University, he had a brief musical career as a violinist. He continues to play to this day.

He graduated with his M.D. from Columbia University, New York, in 1937. Following medical residencies at University of California, San Francisco, and Tufts University, Boston, he was a fellow at the Massachusetts General Hospital where he received his training in rheumatology with Dr. Walter Bauer, professor of medicine at Harvard. Dr. Engelman recalls with affection his mentor Dr. Bauer, a pioneer in arthritis research. Anyone who completed a fellowship under him was guaranteed a successful career in rheumatology.

During World War II, Dr. Engelman saw military service as a major, serving as chief of the Army’s Rheumatic Fever Center.

Any impulse he may have had to retire has been blocked by recognition of his career achievements by his peers in academia and elsewhere. He served as president of a number of organizations including the American Rheumatism Association, now the American College of Rheumatology, from 1962-1963; the National Society of Clinical Rheumatology (1967-1969); and the International League Against Rheumatism (1981-1985).

From 1975-1976, Dr. Engelman chaired the congressionally mandated National Commission on Arthritis, a task force charged with recommending remedies for the inadequate status of arthritis research, teaching, and patient care in the United States. Among its recommendations were the creation of what is now the Institute of Arthritis, Musculoskeletal, and Skin Diseases and tripling of the ongoing federal budget for arthritis research. The task force’s report also called attention to the surprising number of medical schools with no curriculum in rheumatology.

Do you love being a rheumatologist enough to still be seeing patients, teaching, and conducting research when you are 100 years old? May you live long enough to find out the answer to that question.

Rheumatologist Dr. Ephraim P. Engleman, who turned 100 years old in March, loves his specialty enough to still be very active in it. He is the longest tenured professor in any medical specialty at the University of California, San Francisco, where he is director of the Rosalind Russell Medical Research Center for Arthritis, and he continues to see patients 3 days a week.

When asked in an interview with this news organization what he considers to be the most important advances in rheumatology since he began his career in the 1940s, Dr. Engleman listed without reservation, "the discovery and proper use of cortisone, an invaluable drug in all medical specialties including rheumatology and joint replacements." Dr. Engleman also included the development of biologic therapy, noting "its long-term undesirable effects [having] not yet been determined." Anticytokine therapy also made the list of important advances in rheumatology.

As for the greatest challenges facing the specialty, Dr. Engelman listed "lack of national recognition of the rheumatologist’s critical role in the optimal management of patients with musculoskeletal diseases, the commonest of the chronic disorders. Furthermore, the kinds of services provided by rheumatologists are not adequately reimbursed in contemporary health insurance; thus, it is difficult for many rheumatologists to sustain viable practices."

He is touching the future by endowing the ACR REF/Ephraim P. Engleman Resident Research Preceptorship with the American College of Rheumatology Research and Education Foundation. The grant is $15,000. The deadline for online applications is Feb. 1, 2012. The purpose of the grants is to attract promising physician scientists to the field of rheumatology.

Dr. Engleman was born in San Jose, Calif. While an undergrad at Stanford University, he had a brief musical career as a violinist. He continues to play to this day.

He graduated with his M.D. from Columbia University, New York, in 1937. Following medical residencies at University of California, San Francisco, and Tufts University, Boston, he was a fellow at the Massachusetts General Hospital where he received his training in rheumatology with Dr. Walter Bauer, professor of medicine at Harvard. Dr. Engelman recalls with affection his mentor Dr. Bauer, a pioneer in arthritis research. Anyone who completed a fellowship under him was guaranteed a successful career in rheumatology.

During World War II, Dr. Engelman saw military service as a major, serving as chief of the Army’s Rheumatic Fever Center.

Any impulse he may have had to retire has been blocked by recognition of his career achievements by his peers in academia and elsewhere. He served as president of a number of organizations including the American Rheumatism Association, now the American College of Rheumatology, from 1962-1963; the National Society of Clinical Rheumatology (1967-1969); and the International League Against Rheumatism (1981-1985).

From 1975-1976, Dr. Engelman chaired the congressionally mandated National Commission on Arthritis, a task force charged with recommending remedies for the inadequate status of arthritis research, teaching, and patient care in the United States. Among its recommendations were the creation of what is now the Institute of Arthritis, Musculoskeletal, and Skin Diseases and tripling of the ongoing federal budget for arthritis research. The task force’s report also called attention to the surprising number of medical schools with no curriculum in rheumatology.

Do you love being a rheumatologist enough to still be seeing patients, teaching, and conducting research when you are 100 years old? May you live long enough to find out the answer to that question.

Rheumatologist Dr. Ephraim P. Engleman, who turned 100 years old in March, loves his specialty enough to still be very active in it. He is the longest tenured professor in any medical specialty at the University of California, San Francisco, where he is director of the Rosalind Russell Medical Research Center for Arthritis, and he continues to see patients 3 days a week.

When asked in an interview with this news organization what he considers to be the most important advances in rheumatology since he began his career in the 1940s, Dr. Engleman listed without reservation, "the discovery and proper use of cortisone, an invaluable drug in all medical specialties including rheumatology and joint replacements." Dr. Engleman also included the development of biologic therapy, noting "its long-term undesirable effects [having] not yet been determined." Anticytokine therapy also made the list of important advances in rheumatology.

As for the greatest challenges facing the specialty, Dr. Engelman listed "lack of national recognition of the rheumatologist’s critical role in the optimal management of patients with musculoskeletal diseases, the commonest of the chronic disorders. Furthermore, the kinds of services provided by rheumatologists are not adequately reimbursed in contemporary health insurance; thus, it is difficult for many rheumatologists to sustain viable practices."

He is touching the future by endowing the ACR REF/Ephraim P. Engleman Resident Research Preceptorship with the American College of Rheumatology Research and Education Foundation. The grant is $15,000. The deadline for online applications is Feb. 1, 2012. The purpose of the grants is to attract promising physician scientists to the field of rheumatology.

Dr. Engleman was born in San Jose, Calif. While an undergrad at Stanford University, he had a brief musical career as a violinist. He continues to play to this day.

He graduated with his M.D. from Columbia University, New York, in 1937. Following medical residencies at University of California, San Francisco, and Tufts University, Boston, he was a fellow at the Massachusetts General Hospital where he received his training in rheumatology with Dr. Walter Bauer, professor of medicine at Harvard. Dr. Engelman recalls with affection his mentor Dr. Bauer, a pioneer in arthritis research. Anyone who completed a fellowship under him was guaranteed a successful career in rheumatology.

During World War II, Dr. Engelman saw military service as a major, serving as chief of the Army’s Rheumatic Fever Center.

Any impulse he may have had to retire has been blocked by recognition of his career achievements by his peers in academia and elsewhere. He served as president of a number of organizations including the American Rheumatism Association, now the American College of Rheumatology, from 1962-1963; the National Society of Clinical Rheumatology (1967-1969); and the International League Against Rheumatism (1981-1985).

From 1975-1976, Dr. Engelman chaired the congressionally mandated National Commission on Arthritis, a task force charged with recommending remedies for the inadequate status of arthritis research, teaching, and patient care in the United States. Among its recommendations were the creation of what is now the Institute of Arthritis, Musculoskeletal, and Skin Diseases and tripling of the ongoing federal budget for arthritis research. The task force’s report also called attention to the surprising number of medical schools with no curriculum in rheumatology.

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000(11 pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in southwest England

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre.

Anyone who attended the 2011 European Congress of Rheumatology in London's Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak's hatches. “I don't have a spare kayak, so I can't smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee's own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date, his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team (http://www.britishmedicalfootballteam.co.uk/index.php/the-news/62-dr-martin-lees-100-day-round-the-isles-challenge

For more information about the challenge and to sponsor Dr. Lee, please go to http://www.martinkayaking.co.uk/

Dr. Martin Lee is attempting to raise funds for the National Royal Arthritis Society in a 100-day circumnavigation of Great Britain by kayak.

Source Courtesy Dr. Martin Lee

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000(11 pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in southwest England

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre.

Anyone who attended the 2011 European Congress of Rheumatology in London's Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak's hatches. “I don't have a spare kayak, so I can't smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee's own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date, his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team (http://www.britishmedicalfootballteam.co.uk/index.php/the-news/62-dr-martin-lees-100-day-round-the-isles-challenge

For more information about the challenge and to sponsor Dr. Lee, please go to http://www.martinkayaking.co.uk/

Dr. Martin Lee is attempting to raise funds for the National Royal Arthritis Society in a 100-day circumnavigation of Great Britain by kayak.

Source Courtesy Dr. Martin Lee

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000(11 pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in southwest England

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre.

Anyone who attended the 2011 European Congress of Rheumatology in London's Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak's hatches. “I don't have a spare kayak, so I can't smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee's own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date, his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team (http://www.britishmedicalfootballteam.co.uk/index.php/the-news/62-dr-martin-lees-100-day-round-the-isles-challenge

For more information about the challenge and to sponsor Dr. Lee, please go to http://www.martinkayaking.co.uk/

Dr. Martin Lee is attempting to raise funds for the National Royal Arthritis Society in a 100-day circumnavigation of Great Britain by kayak.

Source Courtesy Dr. Martin Lee

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000 (114,400 euros, U.S.$163,200)  in pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in South-West England

Courtesy of Dr. Martin Lee

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre. Anyone who attended the 2011 European Congress of Rheumatology in London’s Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak’s hatches. “I don't have a spare kayak, so I can’t smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee’s own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team.

Find out more about the challenge and how to sponsor Dr. Lee.

* This story was updated on August 2, 2011.

<[

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000 (114,400 euros, U.S.$163,200)  in pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in South-West England

Courtesy of Dr. Martin Lee

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre. Anyone who attended the 2011 European Congress of Rheumatology in London’s Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak’s hatches. “I don't have a spare kayak, so I can’t smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee’s own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team.

Find out more about the challenge and how to sponsor Dr. Lee.

* This story was updated on August 2, 2011.

<[

The circumference of Great Britain is 2,600 miles, according to Dr. Martin Lee. The newly qualified consultant rheumatologist should know, given that he intends to kayak every inch of it to raise £100,000 (114,400 euros, U.S.$163,200)  in pledges for the National Rheumatoid Arthritis Society.

With a launch date of April 1, 2012, Dr. Lee, who has been granted a sabbatical by the Royal National Hospital of Rheumatic Diseases in Bath, has been inspired to undertake this endeavor by his beloved aunt, who has rheumatoid arthritis. Also on his mind are the many other people with RA whom he has met during his training, first at the University of Wales College of Medicine and then during his rheumatology training in South-West England

Courtesy of Dr. Martin Lee

Planning to structure the trip as 100 marathons in 100 days, 32-year-old Dr. Lee said in an interview that he will launch from the a public boating club in Greenwich called the Ahoy Centre. Anyone who attended the 2011 European Congress of Rheumatology in London’s Docklands neighborhood was close to being across the Thames from the Ahoy Centre.

The conditions of his voyage will be spartan. Dr. Lee plans to sleep in a sleeping bag on the ground and survive on food stored in the kayak’s hatches. “I don't have a spare kayak, so I can’t smash my one on rocks!” Friends and relatives will deliver supplies of fresh food at prearranged meeting places along the route.

All the funds Dr. Lee plans to raise are to go to the National Rheumatoid Arthritis Society, a charity that provides support and advice for people with rheumatoid arthritis. Dr. Lee’s own clinical area of interest is early inflammatory arthritis and rheumatoid arthritis, he said.

Dr. Lee has been kayaking since he was a teenager. To date his greatest kayak adventure was when he was 17 years old and spent the summer exploring North Vancouver Island in Canada. An all-around fierce athlete, Dr. Lee is also a member of the British Medical Football Team.

Find out more about the challenge and how to sponsor Dr. Lee.

* This story was updated on August 2, 2011.

<[

ATLANTA – Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger, J.D., told newly minted rheumatology fellows during a special session an the annual meeting of the American College of Rheumatology.

Ms. Roediger’s "three basic rules of employment contracts" are:

• It should never cost money to take a job.

• It should never cost you anything to work in a job.

• It should never cost you anything to leave a job.

Ms. Roediger, a partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said "the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong." But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2-3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is "not legally binding."

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. "The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement."

Ms. Roediger also offered the following general recommendations about contract negotiation.

Get moving expenses covered. "I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate." Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

Ask for a signing bonus. "If you don’t ask for one, you are not going to be given one. At this point in your career, you can expect anything from between $5,000 and $25,000." The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require things like continuing medical education allowance, hospital dues or used vacation time be paid back on a pro-rated basis if the physician leaves before the end of the contract.

Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, Ms. Roediger said. Under such terms, known as "eat what you kill," one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

ATLANTA – Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger, J.D., told newly minted rheumatology fellows during a special session an the annual meeting of the American College of Rheumatology.

Ms. Roediger’s "three basic rules of employment contracts" are:

• It should never cost money to take a job.

• It should never cost you anything to work in a job.

• It should never cost you anything to leave a job.

Ms. Roediger, a partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said "the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong." But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2-3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is "not legally binding."

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. "The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement."

Ms. Roediger also offered the following general recommendations about contract negotiation.

Get moving expenses covered. "I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate." Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

Ask for a signing bonus. "If you don’t ask for one, you are not going to be given one. At this point in your career, you can expect anything from between $5,000 and $25,000." The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require things like continuing medical education allowance, hospital dues or used vacation time be paid back on a pro-rated basis if the physician leaves before the end of the contract.

Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, Ms. Roediger said. Under such terms, known as "eat what you kill," one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

ATLANTA – Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger, J.D., told newly minted rheumatology fellows during a special session an the annual meeting of the American College of Rheumatology.

Ms. Roediger’s "three basic rules of employment contracts" are:

• It should never cost money to take a job.

• It should never cost you anything to work in a job.

• It should never cost you anything to leave a job.

Ms. Roediger, a partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said "the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong." But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2-3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is "not legally binding."

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. "The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement."

Ms. Roediger also offered the following general recommendations about contract negotiation.

Get moving expenses covered. "I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate." Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

Ask for a signing bonus. "If you don’t ask for one, you are not going to be given one. At this point in your career, you can expect anything from between $5,000 and $25,000." The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require things like continuing medical education allowance, hospital dues or used vacation time be paid back on a pro-rated basis if the physician leaves before the end of the contract.

Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, Ms. Roediger said. Under such terms, known as "eat what you kill," one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

SANTA MONICA, CALIF. — Social media provide a way for physicians to engage with their patients and the community, whether the physician practices in an HMO or privately, according to Dr. Jeffrey Benabio, a dermatologist at Kaiser Permanente in San Diego.

Moreover, physicians in private practice could find social media useful in building their practices, Dr. Benabio said at a meeting sponsored by Skin Disease Education Foundation and the University of Louisville.

No matter what the specialty, the principles of using social media such as blogs, Facebook, and Twitter and Web sites as tools for improving patient care will apply. “Online patient communities are an ascendant means for patients to learn about their disease, and seek advice and comfort from [other] patients like them. Physicians can be part of this conversation and contribute to it. Who better to [advise] patients [on] how to live with pain, live with deformity, deal with insurance companies, than physicians?” noted Dr. Benabio in an interview.

It takes no money but lots of time to build online networks. So why bother to do it? Dr. Benabio offered several reasons.

“Patients are going online to interact with their physicians, and we are not there,” he said.

“Physicians are losing [their] status as the sole source of medical knowledge. Whereas patients always had to come to us to learn about disease and health, now they get most of their information online. Our absence online perpetuates a trend of diminishing importance of our profession. Patients are online; physicians need to be where they are,” he said.

As with much in life, the secret to being effective online comes down to showing up.

“A physician becomes a trusted member of the community by being present. Over time, regular blog posts, Facebook updates, and Tweets allow the audience to become familiar with the physician, to know that he or she is there, is listening, is part of the community.

“Physicians should blog and have Facebook pages. They should post things that are helpful and informative for their audience. They can report news, but it must be within the law. Physicians can talk about drugs and about non-FDA–approved uses of drugs as long as they are not giving actual medical advice, and are clear about any disclosures and disclaimers,” Dr. Benabio said.

They should Google themselves and see what they find – though they might not like it. The only content you can control is the content you create, he asserted. Google has 400 million queries daily and 75%-80% of adults have sought medical information online. The nature of information on the Internet is that it is collaborative, and physicians need to be part of that. Otherwise, the public might be offered information that is inaccurate and biased, he said.

“It is as important to be a trusted member of the online community as it is to be a trusted member of your actual community,” Dr. Benabio said. Starting a blog and making it part of your practice's Web site will have the additional benefit of marketing the practice at the same time you are offering the public a reliable perspective on medical developments within your specialty.

Getting your name out online, making sure it is associated with reliable information, and being available as a caring, informed physician are all effective marketing strategies that are literally at your fingertips in the form of social media tools. Some would say this is becoming the first choice in marketing, and that traditional marketing is dying. Dr. Benabio warned that others

Dr. Benabio warned that others will usurp physicians' role as providers of health information unless they get online to counter that trend. Certainly alternative health providers are on social media, building relationships with patients and boosting their status among patients. Just as a patient who has no access to a dermatologist will see a nurse or naturopath, patients online seek information from nonphysicians, he noted.

Physicians are on a slippery slope in this age of the Internet information highway. “This is a critical time when we are trying to demonstrate our value as practitioners,” he said. “The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice.”

SDEF and this news organization are owned by Elsevier. Dr. Benabio disclosed that he is a consultant for Live-strong.com

To watch an interview on social media with Dr. Jeffrey Benabio, please go to

Source Sally Kubetin/Elsevier Global Medical Newswww.rheumatologynews.com

SANTA MONICA, CALIF. — Social media provide a way for physicians to engage with their patients and the community, whether the physician practices in an HMO or privately, according to Dr. Jeffrey Benabio, a dermatologist at Kaiser Permanente in San Diego.

Moreover, physicians in private practice could find social media useful in building their practices, Dr. Benabio said at a meeting sponsored by Skin Disease Education Foundation and the University of Louisville.

No matter what the specialty, the principles of using social media such as blogs, Facebook, and Twitter and Web sites as tools for improving patient care will apply. “Online patient communities are an ascendant means for patients to learn about their disease, and seek advice and comfort from [other] patients like them. Physicians can be part of this conversation and contribute to it. Who better to [advise] patients [on] how to live with pain, live with deformity, deal with insurance companies, than physicians?” noted Dr. Benabio in an interview.

It takes no money but lots of time to build online networks. So why bother to do it? Dr. Benabio offered several reasons.

“Patients are going online to interact with their physicians, and we are not there,” he said.

“Physicians are losing [their] status as the sole source of medical knowledge. Whereas patients always had to come to us to learn about disease and health, now they get most of their information online. Our absence online perpetuates a trend of diminishing importance of our profession. Patients are online; physicians need to be where they are,” he said.

As with much in life, the secret to being effective online comes down to showing up.

“A physician becomes a trusted member of the community by being present. Over time, regular blog posts, Facebook updates, and Tweets allow the audience to become familiar with the physician, to know that he or she is there, is listening, is part of the community.

“Physicians should blog and have Facebook pages. They should post things that are helpful and informative for their audience. They can report news, but it must be within the law. Physicians can talk about drugs and about non-FDA–approved uses of drugs as long as they are not giving actual medical advice, and are clear about any disclosures and disclaimers,” Dr. Benabio said.

They should Google themselves and see what they find – though they might not like it. The only content you can control is the content you create, he asserted. Google has 400 million queries daily and 75%-80% of adults have sought medical information online. The nature of information on the Internet is that it is collaborative, and physicians need to be part of that. Otherwise, the public might be offered information that is inaccurate and biased, he said.

“It is as important to be a trusted member of the online community as it is to be a trusted member of your actual community,” Dr. Benabio said. Starting a blog and making it part of your practice's Web site will have the additional benefit of marketing the practice at the same time you are offering the public a reliable perspective on medical developments within your specialty.

Getting your name out online, making sure it is associated with reliable information, and being available as a caring, informed physician are all effective marketing strategies that are literally at your fingertips in the form of social media tools. Some would say this is becoming the first choice in marketing, and that traditional marketing is dying. Dr. Benabio warned that others

Dr. Benabio warned that others will usurp physicians' role as providers of health information unless they get online to counter that trend. Certainly alternative health providers are on social media, building relationships with patients and boosting their status among patients. Just as a patient who has no access to a dermatologist will see a nurse or naturopath, patients online seek information from nonphysicians, he noted.

Physicians are on a slippery slope in this age of the Internet information highway. “This is a critical time when we are trying to demonstrate our value as practitioners,” he said. “The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice.”

SDEF and this news organization are owned by Elsevier. Dr. Benabio disclosed that he is a consultant for Live-strong.com

To watch an interview on social media with Dr. Jeffrey Benabio, please go to

Source Sally Kubetin/Elsevier Global Medical Newswww.rheumatologynews.com

SANTA MONICA, CALIF. — Social media provide a way for physicians to engage with their patients and the community, whether the physician practices in an HMO or privately, according to Dr. Jeffrey Benabio, a dermatologist at Kaiser Permanente in San Diego.

Moreover, physicians in private practice could find social media useful in building their practices, Dr. Benabio said at a meeting sponsored by Skin Disease Education Foundation and the University of Louisville.

No matter what the specialty, the principles of using social media such as blogs, Facebook, and Twitter and Web sites as tools for improving patient care will apply. “Online patient communities are an ascendant means for patients to learn about their disease, and seek advice and comfort from [other] patients like them. Physicians can be part of this conversation and contribute to it. Who better to [advise] patients [on] how to live with pain, live with deformity, deal with insurance companies, than physicians?” noted Dr. Benabio in an interview.

It takes no money but lots of time to build online networks. So why bother to do it? Dr. Benabio offered several reasons.

“Patients are going online to interact with their physicians, and we are not there,” he said.

“Physicians are losing [their] status as the sole source of medical knowledge. Whereas patients always had to come to us to learn about disease and health, now they get most of their information online. Our absence online perpetuates a trend of diminishing importance of our profession. Patients are online; physicians need to be where they are,” he said.

As with much in life, the secret to being effective online comes down to showing up.

“A physician becomes a trusted member of the community by being present. Over time, regular blog posts, Facebook updates, and Tweets allow the audience to become familiar with the physician, to know that he or she is there, is listening, is part of the community.

“Physicians should blog and have Facebook pages. They should post things that are helpful and informative for their audience. They can report news, but it must be within the law. Physicians can talk about drugs and about non-FDA–approved uses of drugs as long as they are not giving actual medical advice, and are clear about any disclosures and disclaimers,” Dr. Benabio said.

They should Google themselves and see what they find – though they might not like it. The only content you can control is the content you create, he asserted. Google has 400 million queries daily and 75%-80% of adults have sought medical information online. The nature of information on the Internet is that it is collaborative, and physicians need to be part of that. Otherwise, the public might be offered information that is inaccurate and biased, he said.

“It is as important to be a trusted member of the online community as it is to be a trusted member of your actual community,” Dr. Benabio said. Starting a blog and making it part of your practice's Web site will have the additional benefit of marketing the practice at the same time you are offering the public a reliable perspective on medical developments within your specialty.

Getting your name out online, making sure it is associated with reliable information, and being available as a caring, informed physician are all effective marketing strategies that are literally at your fingertips in the form of social media tools. Some would say this is becoming the first choice in marketing, and that traditional marketing is dying. Dr. Benabio warned that others

Dr. Benabio warned that others will usurp physicians' role as providers of health information unless they get online to counter that trend. Certainly alternative health providers are on social media, building relationships with patients and boosting their status among patients. Just as a patient who has no access to a dermatologist will see a nurse or naturopath, patients online seek information from nonphysicians, he noted.

Physicians are on a slippery slope in this age of the Internet information highway. “This is a critical time when we are trying to demonstrate our value as practitioners,” he said. “The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice.”

SDEF and this news organization are owned by Elsevier. Dr. Benabio disclosed that he is a consultant for Live-strong.com

To watch an interview on social media with Dr. Jeffrey Benabio, please go to

Source Sally Kubetin/Elsevier Global Medical Newswww.rheumatologynews.com

ATLANTA — Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger told newly minted rheumatology fellows during a special session at the annual meeting of the American College of Rheumatology.

Ms. Roediger's “three basic rules of employment contracts” are:

▸ It should never cost money to take a job.

▸ It should never cost you anything to work in a job.

▸ It should never cost you anything to leave a job.

Ms. Roediger, an attorney and partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said “the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong.”

But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2–3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is “not legally binding.”

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time, and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. “The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement.”

Ms. Roediger also offered the following general recommendations about contract negotiation:

▸ Get moving expenses covered. “I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate.” Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

▸ Ask for a signing bonus. “If you don't ask for one, you are not going to be given one. At this point in your career, you can expect anything from between &dollar;5,000 and &dollar;25,000.” The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

▸ Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require that things like continuing medical education allowance, hospital dues, or used vacation time be paid back on a prorated basis if the physician leaves before the end of the contract.

▸ Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, said Ms. Roediger.

Under such terms, known as “eat what you kill,” one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

ATLANTA — Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger told newly minted rheumatology fellows during a special session at the annual meeting of the American College of Rheumatology.

Ms. Roediger's “three basic rules of employment contracts” are:

▸ It should never cost money to take a job.

▸ It should never cost you anything to work in a job.

▸ It should never cost you anything to leave a job.

Ms. Roediger, an attorney and partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said “the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong.”

But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2–3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is “not legally binding.”

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time, and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. “The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement.”

Ms. Roediger also offered the following general recommendations about contract negotiation:

▸ Get moving expenses covered. “I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate.” Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

▸ Ask for a signing bonus. “If you don't ask for one, you are not going to be given one. At this point in your career, you can expect anything from between &dollar;5,000 and &dollar;25,000.” The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

▸ Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require that things like continuing medical education allowance, hospital dues, or used vacation time be paid back on a prorated basis if the physician leaves before the end of the contract.

▸ Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, said Ms. Roediger.

Under such terms, known as “eat what you kill,” one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

ATLANTA — Following three basic rules can help you to avoid taking misleading employment offers that can hound you – and cost you – for years to come, Joan M. Roediger told newly minted rheumatology fellows during a special session at the annual meeting of the American College of Rheumatology.

Ms. Roediger's “three basic rules of employment contracts” are:

▸ It should never cost money to take a job.

▸ It should never cost you anything to work in a job.

▸ It should never cost you anything to leave a job.

Ms. Roediger, an attorney and partner at the firm of Obermayer, Rebmann, Maxwell & Hippel LLP in Philadelphia, said “the best contract you sign is one you put in a drawer and never look at again. The contract is for when something goes wrong.”

But often something does go wrong, she said. More than 60% of young physicians change jobs within the first 2–3 years of employment.

Further, she acknowledged that the shortcomings of some contracts are not readily apparent. Often, what is not mentioned in the contract is problematic.

The first document signed in the process of getting hired is the letter of intent. Do not sign and return it without reading it carefully, she said. First, one should look out for terms that seem unfair: a too-low salary, too much on-call time, not enough leave. Also, make sure the letter of intent contains the wording that it is “not legally binding.”

Hospital assistance agreements – which may be known as income guarantee, recruitment, or loan agreements – are part of the private practice hiring process in underserved areas. The community hospital assists the private practice in bringing the hired physician into the community. Salary is guaranteed for a period of time, and other incentives are paid by the hospital. These agreements are filled with pitfalls, she said. “The one time I would insist you hire a lawyer is when you are faced with both a hospital income agreement and an employment agreement.”

Ms. Roediger also offered the following general recommendations about contract negotiation:

▸ Get moving expenses covered. “I feel very firmly that moving expenses should be paid, whether I am representing the employer or employee. And they should not be paltry. Your days of hiring a rental truck and hauling your own sofas are over. Call a mover for an estimate.” Expenses should be paid at the time of the move, or better yet, have the mover bill the employer directly.

▸ Ask for a signing bonus. “If you don't ask for one, you are not going to be given one. At this point in your career, you can expect anything from between &dollar;5,000 and &dollar;25,000.” The signing bonus should be paid at signing. There is a disturbing trend for it to be paid in thirds starting 90 days after the signing, she said.

▸ Avoid payback stipulations. If you leave the job, you should not have to pay back moving expenses. In an ideal world, signing bonuses should not have to be repaid. But Ms. Roediger said that she will accept that a physician who quits within the first year can be asked to pay back a prorated amount.

Under poorly negotiated hospital income agreements, if the physician does not stay in the community for the contracted period of time, he/she may have to pay back all the money. In fact, the practice rather than the physician is the entity that benefited from the agreement, she said.

Beware of contracts that require that things like continuing medical education allowance, hospital dues, or used vacation time be paid back on a prorated basis if the physician leaves before the end of the contract.

▸ Get a guarantee of income. Employment agreements without a guarantee of income are unusual, but she has seen a few, mostly in the Atlanta and the Washington metro regions, said Ms. Roediger.

Under such terms, known as “eat what you kill,” one might as well be a solo practitioner, she said.

Ms. Roediger disclosed no conflicts of interest.

ATLANTA — The number of women serving as professors and division directors of rheumatology has not changed for the past 30 years, a circumstance that should prompt a policy directive from the American College of Rheumatology, according to some of its leaders.

During an annual meeting session sponsored by the Committee on Rheumatology Training and Workforce Issues and the ACR Young Investigator Subcommittee of the Research Committee, Dr. Abby Goulder Abelson noted that women accounted for 60% of graduates of rheumatology fellowships in 2009. Yet women hold just 30% of all academic appointments and comprise 15% of full professors and 7% of division heads. Those figures have been virtually unchanged for the past 30 years, according to Dr. Abelson, who chairs the committee.

Findings from a 2009 benchmarking survey by the American Association of Medical Colleges showed that women accounted for 18% of full professors, 13% of department chairs, and 12% of medical school deans.

“If [the ACR's Research and Education Foundation (REF)] had a policy that it would not support fellowship programs that did not have more women in leadership,” the problem would fix itself, said Dr. David Wofsy, past president of the ACR. “A decade ago we were tremendously short of rheumatology fellows. So REF and ACR set a goal and achieved it. … Let's articulate the goals and decide what practices we need to achieve these goals.”

Dr. Wofsy suggested increasing by 25% the number of women division chiefs. Dr. Wofsy is professor of medicine and microbiology/immunology and chief of rheumatology at the San Francisco VA Medical Center and associate dean for admissions at the University of California at San Francisco.

“We need to communicate the message that having more women in leadership in academic programs is good for training and good for society,” said Dr. Christy I. Sandborg, a pediatric rheumatologist who is associate chair of the department of pediatrics at Stanford (Calif.) University.

The lack of women in academic leadership positions in rheumatology training programs is not a woman's issue. It is a rheumatology issue and an ACR issue, said Dr. Sandborg, who cautioned against tainting any effort to promote more women with even the hint that women are in some way damaged and need help.

Data gathered in 2008 showed that 9.1% of women left their academic posts early in their careers compared with 7.7% of men. Women cited as their reasons for leaving their observation that their gender affected their salary, their rate of promotion, and the amount of their protected time for research and teaching. As pronounced as these problems were for women in general, they were more so for minority women, said Dr. Abelson, who is interim chair of the department of rheumatologic and immunologic disease at the Cleveland Clinic.

At the same time, there is a sea change in how both men and women approach their professional lives and look for work-life integration. “This is the first time that I have attended a session on gender where 50% of the audience is male,” she said.

Most rheumatology divisions around the country are actively recruiting new faculty. But to many young rheumatologists, private practice feels like the better choice.

Dr. David Karp, chief of the division of rheumatology at the University of Texas Southwestern Medical Center at Dallas, acknowledged that “my young fellows feel that an academic career lacks control.”

Dr. Abelson noted that young male rheumatologists want more control and a less stressful lifestyle, which is also changing academic medicine. “They start early, work through lunch, and leave early to pick up their kids from day care.”

In Dr. Sandborg's experience, young men who ask for flexible work arrangements are stigmatized because older faculty consider them to be less than serious about their careers.

Another presenter, Anne C. Talley, told the audience: “You can't wait for the culture to change.

“People must feel free to ask for flexible arrangements such as job sharing, even at the director level. We must push through the stigma,” said Ms. Talley of Merck & Co., who spoke as a representative of the HealthCare Businesswomen's Association, Pittsgrove, N.J.

None of the presenters reported any relevant conflicts of interest.

ATLANTA — The number of women serving as professors and division directors of rheumatology has not changed for the past 30 years, a circumstance that should prompt a policy directive from the American College of Rheumatology, according to some of its leaders.

During an annual meeting session sponsored by the Committee on Rheumatology Training and Workforce Issues and the ACR Young Investigator Subcommittee of the Research Committee, Dr. Abby Goulder Abelson noted that women accounted for 60% of graduates of rheumatology fellowships in 2009. Yet women hold just 30% of all academic appointments and comprise 15% of full professors and 7% of division heads. Those figures have been virtually unchanged for the past 30 years, according to Dr. Abelson, who chairs the committee.

Findings from a 2009 benchmarking survey by the American Association of Medical Colleges showed that women accounted for 18% of full professors, 13% of department chairs, and 12% of medical school deans.

“If [the ACR's Research and Education Foundation (REF)] had a policy that it would not support fellowship programs that did not have more women in leadership,” the problem would fix itself, said Dr. David Wofsy, past president of the ACR. “A decade ago we were tremendously short of rheumatology fellows. So REF and ACR set a goal and achieved it. … Let's articulate the goals and decide what practices we need to achieve these goals.”

Dr. Wofsy suggested increasing by 25% the number of women division chiefs. Dr. Wofsy is professor of medicine and microbiology/immunology and chief of rheumatology at the San Francisco VA Medical Center and associate dean for admissions at the University of California at San Francisco.

“We need to communicate the message that having more women in leadership in academic programs is good for training and good for society,” said Dr. Christy I. Sandborg, a pediatric rheumatologist who is associate chair of the department of pediatrics at Stanford (Calif.) University.

The lack of women in academic leadership positions in rheumatology training programs is not a woman's issue. It is a rheumatology issue and an ACR issue, said Dr. Sandborg, who cautioned against tainting any effort to promote more women with even the hint that women are in some way damaged and need help.

Data gathered in 2008 showed that 9.1% of women left their academic posts early in their careers compared with 7.7% of men. Women cited as their reasons for leaving their observation that their gender affected their salary, their rate of promotion, and the amount of their protected time for research and teaching. As pronounced as these problems were for women in general, they were more so for minority women, said Dr. Abelson, who is interim chair of the department of rheumatologic and immunologic disease at the Cleveland Clinic.

At the same time, there is a sea change in how both men and women approach their professional lives and look for work-life integration. “This is the first time that I have attended a session on gender where 50% of the audience is male,” she said.

Most rheumatology divisions around the country are actively recruiting new faculty. But to many young rheumatologists, private practice feels like the better choice.

Dr. David Karp, chief of the division of rheumatology at the University of Texas Southwestern Medical Center at Dallas, acknowledged that “my young fellows feel that an academic career lacks control.”

Dr. Abelson noted that young male rheumatologists want more control and a less stressful lifestyle, which is also changing academic medicine. “They start early, work through lunch, and leave early to pick up their kids from day care.”

In Dr. Sandborg's experience, young men who ask for flexible work arrangements are stigmatized because older faculty consider them to be less than serious about their careers.

Another presenter, Anne C. Talley, told the audience: “You can't wait for the culture to change.

“People must feel free to ask for flexible arrangements such as job sharing, even at the director level. We must push through the stigma,” said Ms. Talley of Merck & Co., who spoke as a representative of the HealthCare Businesswomen's Association, Pittsgrove, N.J.

None of the presenters reported any relevant conflicts of interest.

ATLANTA — The number of women serving as professors and division directors of rheumatology has not changed for the past 30 years, a circumstance that should prompt a policy directive from the American College of Rheumatology, according to some of its leaders.

During an annual meeting session sponsored by the Committee on Rheumatology Training and Workforce Issues and the ACR Young Investigator Subcommittee of the Research Committee, Dr. Abby Goulder Abelson noted that women accounted for 60% of graduates of rheumatology fellowships in 2009. Yet women hold just 30% of all academic appointments and comprise 15% of full professors and 7% of division heads. Those figures have been virtually unchanged for the past 30 years, according to Dr. Abelson, who chairs the committee.

Findings from a 2009 benchmarking survey by the American Association of Medical Colleges showed that women accounted for 18% of full professors, 13% of department chairs, and 12% of medical school deans.

“If [the ACR's Research and Education Foundation (REF)] had a policy that it would not support fellowship programs that did not have more women in leadership,” the problem would fix itself, said Dr. David Wofsy, past president of the ACR. “A decade ago we were tremendously short of rheumatology fellows. So REF and ACR set a goal and achieved it. … Let's articulate the goals and decide what practices we need to achieve these goals.”

Dr. Wofsy suggested increasing by 25% the number of women division chiefs. Dr. Wofsy is professor of medicine and microbiology/immunology and chief of rheumatology at the San Francisco VA Medical Center and associate dean for admissions at the University of California at San Francisco.

“We need to communicate the message that having more women in leadership in academic programs is good for training and good for society,” said Dr. Christy I. Sandborg, a pediatric rheumatologist who is associate chair of the department of pediatrics at Stanford (Calif.) University.

The lack of women in academic leadership positions in rheumatology training programs is not a woman's issue. It is a rheumatology issue and an ACR issue, said Dr. Sandborg, who cautioned against tainting any effort to promote more women with even the hint that women are in some way damaged and need help.

Data gathered in 2008 showed that 9.1% of women left their academic posts early in their careers compared with 7.7% of men. Women cited as their reasons for leaving their observation that their gender affected their salary, their rate of promotion, and the amount of their protected time for research and teaching. As pronounced as these problems were for women in general, they were more so for minority women, said Dr. Abelson, who is interim chair of the department of rheumatologic and immunologic disease at the Cleveland Clinic.

At the same time, there is a sea change in how both men and women approach their professional lives and look for work-life integration. “This is the first time that I have attended a session on gender where 50% of the audience is male,” she said.

Most rheumatology divisions around the country are actively recruiting new faculty. But to many young rheumatologists, private practice feels like the better choice.

Dr. David Karp, chief of the division of rheumatology at the University of Texas Southwestern Medical Center at Dallas, acknowledged that “my young fellows feel that an academic career lacks control.”

Dr. Abelson noted that young male rheumatologists want more control and a less stressful lifestyle, which is also changing academic medicine. “They start early, work through lunch, and leave early to pick up their kids from day care.”

In Dr. Sandborg's experience, young men who ask for flexible work arrangements are stigmatized because older faculty consider them to be less than serious about their careers.

Another presenter, Anne C. Talley, told the audience: “You can't wait for the culture to change.

“People must feel free to ask for flexible arrangements such as job sharing, even at the director level. We must push through the stigma,” said Ms. Talley of Merck & Co., who spoke as a representative of the HealthCare Businesswomen's Association, Pittsgrove, N.J.

None of the presenters reported any relevant conflicts of interest.