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Archive for the ‘reports from the field’ Category

Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon, should one give it a try?

Although some new treatments have become available for the treatment of Raynaoud’s Phenomenon (whether primary or secondary), it remains a condition that is quite frequently encountered by a rheumatologist in the outpatient-clinic. A condition from which patients suffer quite a lot, even (or should one say typically) also in seasons other then wintertime. Treatment with Ilomedin – a prostacyclin analog- infusions are known to be of benefit in a number of severe cases, although the exact optimal dosing regimen (how many (series of) consecutive infusion treatment days) is unknown. It is also an expensive treatment, and the same holds true for a somewhat newer kid-on-the-block bosentan (named Tracleer in the Netherlands) which essentially is put forward in severe cases in systemic sclerosis with formations of pitting scars resulting from digital ulcera.

However, even for this more advanced and expensive treatment options success rates of treatment differ quite a lot (e.g. “bosentan is not effective in systemic sclerosis-related Raynaud’s Phenomenon without pre-existing digital ulcers” is concluded in this 2009 study), in other words the one-fits-all of alternatively optimal flowchart of medications for the succesfull treatment of severe Raynaud’s Phenomenon in the end still comes down to classic trial and error (with rationale of course). Read more…

A report from the field: abatacept administered triweekly

Sometimes you have those tiny observations from daily clinical practice that are just too short as a message to post to a journal in the field, even in the format of a “letter-to-the-editor” but are also too important not to share with others. These are often the particular case observations rheumatologists share with each other on scientific meetings (i.e. in the meeting area or during dinner, not in the plenary sessions themselevs). These shared reports from the field often form a cnsiderable part of the take home messages when traveling home having attended a scientific meeting. It’s a pity that such practical advice or observations from colleagues although very worthwile are scarce to find upon scientific literature searches. The reason, I guess, is probably that others think the same of an example I will be giving in this blogpost as I do, i.e. the message is too “small” (in number of reported cases and length of content one would share) to send it in to a peer-reviewed scientific journal. As a result, these valuable personal observations of fellow rheumatologists are mainly shared amongst colleagues that are physically met in real lfie, and not shared to a broader audience by using the web. In my opinion blogging such reports from the field could be a very nice way to make also these valuable personal n=1 or n=2 observations from the field avaiiable on internet searching (e.g. Google will for sure pick up this one when someone might type in abatacept triweekly in the near fiture, especially when tags are attached to blog postings). So I would like to make a call to worldwide rheumatologists reading my blog not to hesitate blogging about their own observations from the field too tiny to publish but to relevant not to share (by blogging). Read more…

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