AdminMDL | Michael D. Lockshin, MD

Does ANA-negative lupus exist? What other labs are helpful when thinking of this diagnosis, and what if all of them are negative?

Published on February 9, 2004 by AdminMDL in For Physicians

Ask the Expert The answer to the question depends on what is meant by lupus, and what is meant by ANA. To start with the definition of lupus: systemic lupus erythematosus (SLE) is one of many similar illnesses that affect young women and that cause arthritis, rashes, low white blood cell counts, low platelet counts,

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Update on Antiphospholipid Antibody – In-Depth Overview for Physicians

Published on December 16, 2003 by AdminMDL in For Physicians

Grand Rounds Michael D. Lockshin I want to give you both an overview of the antiphospholipid antibody syndrome and update the audience on things that happened at the recent meeting in Tours, France, which gave some of the most current and up-to-date information on the syndrome. I am also going to give you some speculations

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When should patients with antiphospholipid antibody be treated with long-term anticoagulation, and how high should the INR be?

Published on December 15, 2003 by AdminMDL in For Physicians

Ask the Expert Michael D. Lockshin Currently, the recommendation for asymptomatic patients who have antiphospholipid antibody (regardless of titer) is that they not be treated. One retrospective study, conducted here at HSS, looked at women who had been identified because of fetal loss and were/were not treated with aspirin; the results suggested that aspirin protects

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Vaccinations and Rheumatic Disease

Published on October 21, 2003 by AdminMDL in For Physicians

Special Report Common questions about vaccinations for patients with rheumatic disease fall into four categories: 1. Does vaccination cause rheumatic disease? 2. Does vaccination worsen rheumatic disease? 3. Is vaccination effective in rheumatic disease? 4. Are vaccinations dangerous for someone with rheumatic disease? Because there are many types of vaccinations (see Table below), many different

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Might herbals or other dietary supplements affect antiphospholipid syndrome or clotting risk, especially in patients treated with Coumadin? What about progesterone in postmenopausal patients with APS?

Published on July 30, 2003 by AdminMDL in For Physicians

Ask the Expert Michael D. Lockshin The antiphospholipid syndrome (APS) causes excessive blood clotting, leading to strokes, heart attacks, and pulmonary emboli (clots in the lungs). It also causes pregnancies to fail, because of clots in the placenta. While much is known about the syndrome, what actually triggers a clot at a specific time in

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How should proliferative glomerulonephritis with crescent formation be treated in young women with SLE? Will low-dose pulse cyclophosphamide (Cytoxan) and/or mycophenolate mofetil (CellCept) do the job while preserving fertility?

Published on May 28, 2003 by AdminMDL in For Physicians

Ask the Expert Decision-making in such young women can be difficult and among the most agonizing – for both patient and physician. It usually requires a very prolonged conversation with the patient and her immediate family, whether parents or significant other. While such women clearly need treatment – and preservation of fertility is obviously desired

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How has the treatment of psoriatic arthritis changed over the last 5 years? Where do you see it going in the next 2 years?

Published on May 19, 2003 by AdminMDL in For Physicians

Ask the Expert Several aspects of psoriatic arthritis make it hard to answer questions about its treatment succinctly. First, there are at least three forms of psoriatic arthritis: in some patients it looks very much like rheumatoid arthritis, in others like ankylosing spondylitis, and in still others only the end joints of the fingers (and,

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Is there any difference in the prognosis of SLE patients who are diagnosed and treated early versus late in the disease?

Published on March 3, 2003 by AdminMDL in For Physicians

Ask the Expert The biggest problem in answering this is the definition of ‘early’ and ‘late’ lupus. Some patients have very minor symptoms that persist for years and need almost no treatment; others are very sick from the outset of their very first symptoms. Most people use the term ‘early’ to denote time, but in

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Update on Smallpox and Flu Vaccinations

Published on December 16, 2002 by AdminMDL in For Patients

At this time of year, patients with lupus, rheumatoid arthritis, and other autoimmune diseases always ask, “Should I get a flu vaccination?” At this time in our history, many patients are also asking, “Should I get a smallpox vaccination?” These questions are really about three more general questions: Are patients with autoimmune diseases unusually susceptible

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Gender and Rheumatoid Arthritis

Published on October 14, 2002 by AdminMDL in For Patients

Summary of a presentation at the Living with RA Workshop at HSS The traditional answer to the question “Why are autoimmune diseases women’s diseases?” has been “It has to do with estrogen.” But that’s not a satisfactory answer because a lot of facts that don’t fit this theory. So the question has been researched with

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