What Characterizes SARDs or Connective Tissue Diseases?

Transcript:

W. Hayes Wilson, MD: Welcome to this HCPLive® Peers and Perspectives presentation titled, “Treatment of Rare Systemic Autoimmune Rheumatic Diseases, Systemic Lupus Erythematosus and Idiopathic Inflammatory Myopathies.” I am Dr W. Hayes Wilson, a practicing rheumatologist at Piedmont Rheumatology Consultants in Atlanta, Georgia. Joining me today is Dr Kostas N. Botsoglou, a practicing rheumatologist and medical director of the Rheumatology Center of WNY in Cheektowaga, New York, to discuss the management of rare systemic autoimmune rheumatic diseases [SARDs]. Welcome. Let’s begin. Dr B, what characterizes systemic autoimmune rheumatic diseases or connective tissue diseases?

Kostas N. Botsoglou, MD:Dr Wilson, in our practice, we see an array of patients who have what we call autoimmune or mixed connective tissue diseases. To simply it for our patients, I tell them their immune system is overreacting, and it can affect a variety of organ systems whether it’s their joints, their skin, their muscles, their organs, including their heart and lungs. These are diseases where your body is under attack, and it involves sophisticated treatment, and it’s what we do every day.

W. Hayes Wilson, MD: I say your immune system is supposed to protect you, and sometimes it turns against you; instead of fighting off outside invaders it starts attacking you, and that’s kind of a bummer. Most of the stuff that we do as you know is rather esoteric, at least when we order things at the hospital, they put our investigations under esoteric laboratory testing. Along that line, how do you define a rare disease?

Kostas N. Botsoglou, MD: For me, a rare disease is something I don’t see often in the practice. By definition, it affects under 200,000 individuals, but for us rare diseases, we might only have a handful in our practice, and we have 4 providers here. Again, it’s something that we don’t typically treat or see daily.

W. Hayes Wilson, MD: As you know, I had a resident in here earlier today, and she was talking to me about how on board [examination] questions, rheumatology questions seem to come up a lot. And I think it is because some of what we do is out of the norm, and I guess everything we do is a little on the rare side. When we look at our diseases, how do you define quality of living, QOLS [Quality of Life Scale]?

Kostas N. Botsoglou, MD: That is one of our goals as rheumatologist, to preserve quality of life functionality of our patients. Many times, we don’t see that in lab work for example. I am always asking my patients how are they able to perform their activities of daily living? They will fill out a questionnaire while they are in the waiting room. I gauge their morning stiffness; I measure it in time, are they working full time, are they on disability, are they able to take care of their grandchildren, are they able to dress and groom themselves? I measure more than just a physical exam and lab work, it’s also how they perform their daily acts.

W. Hayes Wilson, MD: We do the same thing. We check out how they dress and how they get around and the sort of things that they can do, and try to score it, assuming quantitatively. I guess one of the cool things about rheumatology, at one time they said rheumatologists were the most common to be the chairman of medicine because we really take care of the whole body. When we look at things, we also look at comorbidities. Do you want to comment on other associated comorbidities with autoimmune disease?

Kostas N. Botsoglou, MD: Absolutely. A lot of our colleagues consider us the detectives of internal medicine because many patients have seen other subspecialties, and they can’t quite tie in a unifying diagnosis. Then between our great history taking and some esoteric labs, we are able to determine and make a unifying disease diagnosis. Like I said earlier, our diseases can affect any organ. For example, lupus can attack anything, it’s very heterogeneous. We are constantly looking for other comorbidities that may have an influence in our decisions.

W. Hayes Wilson, MD: I want to thank all those out there who are watching this HCPLive® Peers and Perspectives. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox.

Transcript edited for clarity.