Rheumatologists the world over are joining forces to create a COVID-19 rheumatology registry designed to help both patients and providers learn from each other regarding management of rheumatologic diseases and risk of infection among patients who are commonly on chronic immunosuppressive medications.

The COVID-19 Global Rheumatology Alliance, a consortium supported by more than 50 major clinical societies and foundations, quickly grew from messages on social media platforms to a multinational group focused on the common goal of helping to “guide rheumatology clinicians in assessing and treating patients with rheumatologic disease and in evaluating the risk of infection in patients on immunosuppression.”

As of this writing, the rheumatology registry is still being assembled, and organizers are currently seeking approvals from various authorities. As of March 17, 2020, the Institutional Review Board (IRB) at the University of California, San Francisco, has determined that the registry is exempt from IRB approval requirements, a finding that should apply elsewhere in the United States, according to the registry website.

When it is fully up and running, clinicians will be able to report to the secure website on any and all cases of patients with rheumatologic disorders who present with COVID-19 of any severity, including patients with mild disease or asymptomatic patients who test positive.

“We are aiming for 5 to 10 minutes to input the data. We don’t want to drag them away from their clinical duties too much, but if clinicians are able to spare a few minutes to put in details about a patient, then that’s going to help build our knowledge and it’s going to help them with other patients,” said Philip Robinson, MBChB, associate professor of medicine at the University of Queensland in Brisbane, Australia, and the chief architect of the registry.

The data will be deindentified, with no protected health care information required or included, and made available to the global rheumatology community, but the registry will not offer clinical advice, Dr. Robinson said in an interview.

“This is observational data, it’s not randomized, but our approach is that some data is better than no data,” he said.

He also cautioned that the data will need careful interpretation, because information about patients with mild symptoms may offer false reassurances about the severity or extent of infection.

“For example, the patients with severe cases may be in the ICU, and can’t tell their doctors that they’re on methotrexate, so you can see how we need to be really careful about the messages from that data and not misinterpret it,” he said.

The COVID-19 rheumatology registry was inspired by a similar effort in the gastroenterology community, the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) registry. Patients with inflammatory bowel disease are often treated with immunosuppressive biologic agents familiar to the rheumatology community, such as infliximab (Remicade and biosimilars) and adalimumab (Humira and biosimilars), and methotrexate.

Rheumatologists the world over are joining forces to create a COVID-19 rheumatology registry designed to help both patients and providers learn from each other regarding management of rheumatologic diseases and risk of infection among patients who are commonly on chronic immunosuppressive medications.

The COVID-19 Global Rheumatology Alliance, a consortium supported by more than 50 major clinical societies and foundations, quickly grew from messages on social media platforms to a multinational group focused on the common goal of helping to “guide rheumatology clinicians in assessing and treating patients with rheumatologic disease and in evaluating the risk of infection in patients on immunosuppression.”

As of this writing, the rheumatology registry is still being assembled, and organizers are currently seeking approvals from various authorities. As of March 17, 2020, the Institutional Review Board (IRB) at the University of California, San Francisco, has determined that the registry is exempt from IRB approval requirements, a finding that should apply elsewhere in the United States, according to the registry website.

When it is fully up and running, clinicians will be able to report to the secure website on any and all cases of patients with rheumatologic disorders who present with COVID-19 of any severity, including patients with mild disease or asymptomatic patients who test positive.

“We are aiming for 5 to 10 minutes to input the data. We don’t want to drag them away from their clinical duties too much, but if clinicians are able to spare a few minutes to put in details about a patient, then that’s going to help build our knowledge and it’s going to help them with other patients,” said Philip Robinson, MBChB, associate professor of medicine at the University of Queensland in Brisbane, Australia, and the chief architect of the registry.

The data will be deindentified, with no protected health care information required or included, and made available to the global rheumatology community, but the registry will not offer clinical advice, Dr. Robinson said in an interview.

“This is observational data, it’s not randomized, but our approach is that some data is better than no data,” he said.

He also cautioned that the data will need careful interpretation, because information about patients with mild symptoms may offer false reassurances about the severity or extent of infection.

“For example, the patients with severe cases may be in the ICU, and can’t tell their doctors that they’re on methotrexate, so you can see how we need to be really careful about the messages from that data and not misinterpret it,” he said.

The COVID-19 rheumatology registry was inspired by a similar effort in the gastroenterology community, the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) registry. Patients with inflammatory bowel disease are often treated with immunosuppressive biologic agents familiar to the rheumatology community, such as infliximab (Remicade and biosimilars) and adalimumab (Humira and biosimilars), and methotrexate.

Rheumatologists the world over are joining forces to create a COVID-19 rheumatology registry designed to help both patients and providers learn from each other regarding management of rheumatologic diseases and risk of infection among patients who are commonly on chronic immunosuppressive medications.

The COVID-19 Global Rheumatology Alliance, a consortium supported by more than 50 major clinical societies and foundations, quickly grew from messages on social media platforms to a multinational group focused on the common goal of helping to “guide rheumatology clinicians in assessing and treating patients with rheumatologic disease and in evaluating the risk of infection in patients on immunosuppression.”

As of this writing, the rheumatology registry is still being assembled, and organizers are currently seeking approvals from various authorities. As of March 17, 2020, the Institutional Review Board (IRB) at the University of California, San Francisco, has determined that the registry is exempt from IRB approval requirements, a finding that should apply elsewhere in the United States, according to the registry website.

When it is fully up and running, clinicians will be able to report to the secure website on any and all cases of patients with rheumatologic disorders who present with COVID-19 of any severity, including patients with mild disease or asymptomatic patients who test positive.

“We are aiming for 5 to 10 minutes to input the data. We don’t want to drag them away from their clinical duties too much, but if clinicians are able to spare a few minutes to put in details about a patient, then that’s going to help build our knowledge and it’s going to help them with other patients,” said Philip Robinson, MBChB, associate professor of medicine at the University of Queensland in Brisbane, Australia, and the chief architect of the registry.

The data will be deindentified, with no protected health care information required or included, and made available to the global rheumatology community, but the registry will not offer clinical advice, Dr. Robinson said in an interview.

“This is observational data, it’s not randomized, but our approach is that some data is better than no data,” he said.

He also cautioned that the data will need careful interpretation, because information about patients with mild symptoms may offer false reassurances about the severity or extent of infection.

“For example, the patients with severe cases may be in the ICU, and can’t tell their doctors that they’re on methotrexate, so you can see how we need to be really careful about the messages from that data and not misinterpret it,” he said.

The COVID-19 rheumatology registry was inspired by a similar effort in the gastroenterology community, the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) registry. Patients with inflammatory bowel disease are often treated with immunosuppressive biologic agents familiar to the rheumatology community, such as infliximab (Remicade and biosimilars) and adalimumab (Humira and biosimilars), and methotrexate.

Key clinical point: Serum 25(OH)D levels are associated with a modest decrease in relapse rate and radiological inflammatory activities in patients with early relapsing multiple sclerosis (MS).

Major finding: Each 25 nmol/L increase in serum 25(OH)D levels is associated with a decrease in clinical relapse rate (risk ratio [RR], 0.90), gadolinium-enhancing lesions (RR, 0.69), new/enlarging T2 lesions (RR, 0.86), and new active lesions (RR, 0.81) in the magnetic resonance imaging. 

Study details: Meta-analysis of 13 studies including 3,498 patients.

Disclosures: No study sponsor was identified.

Citation: Martínez-Lapiscina EH et al. J Neurol Sci. 2020 Jan 25. doi: 10.1016/j.jns.2020.116668.

Key clinical point: Serum 25(OH)D levels are associated with a modest decrease in relapse rate and radiological inflammatory activities in patients with early relapsing multiple sclerosis (MS).

Major finding: Each 25 nmol/L increase in serum 25(OH)D levels is associated with a decrease in clinical relapse rate (risk ratio [RR], 0.90), gadolinium-enhancing lesions (RR, 0.69), new/enlarging T2 lesions (RR, 0.86), and new active lesions (RR, 0.81) in the magnetic resonance imaging. 

Study details: Meta-analysis of 13 studies including 3,498 patients.

Disclosures: No study sponsor was identified.

Citation: Martínez-Lapiscina EH et al. J Neurol Sci. 2020 Jan 25. doi: 10.1016/j.jns.2020.116668.

Key clinical point: Serum 25(OH)D levels are associated with a modest decrease in relapse rate and radiological inflammatory activities in patients with early relapsing multiple sclerosis (MS).

Major finding: Each 25 nmol/L increase in serum 25(OH)D levels is associated with a decrease in clinical relapse rate (risk ratio [RR], 0.90), gadolinium-enhancing lesions (RR, 0.69), new/enlarging T2 lesions (RR, 0.86), and new active lesions (RR, 0.81) in the magnetic resonance imaging. 

Study details: Meta-analysis of 13 studies including 3,498 patients.

Disclosures: No study sponsor was identified.

Citation: Martínez-Lapiscina EH et al. J Neurol Sci. 2020 Jan 25. doi: 10.1016/j.jns.2020.116668.

Key clinical point: A significant proportion of patients with multiple sclerosis (MS) and spasticity from Oregon, US reported cannabis use and found it beneficial for their pain and spasticity.

Major finding: Among the patients assessed, 54% reported using cannabis in the past and 36% reported current use of cannabis. For the treatment of spasticity, 26% of patients used both prescribed medications and cannabis. Among current users, 85% and 79% of patients reported cannabis being somewhat to very helpful for pain and spasticity, respectively.

Study details: A cross-sectional study evaluated the cannabis use and its perceived benefits among patients with MS and self-reported spasticity (n = 91) who were enrolled in a randomized controlled trial for MS-related spasticity in Oregon, US.

Disclosures: The study was supported by the VA Office of Research and Development via Rehabilitation Research and Development. Dr. Rice reported consulting for Greenwich Biosciences. Dr. Cameron reported consulting for Adamas Pharmaceuticals Inc. and Greenwich Biosciences. Ms. Hugos and Ms. Hildebrand declared no conflict of interest.

Citation: Rice J et al. Mult Scler Relat Disord. 2020 Feb 11. doi: 10.1016/j.msard.2020.102009.

Key clinical point: A significant proportion of patients with multiple sclerosis (MS) and spasticity from Oregon, US reported cannabis use and found it beneficial for their pain and spasticity.

Major finding: Among the patients assessed, 54% reported using cannabis in the past and 36% reported current use of cannabis. For the treatment of spasticity, 26% of patients used both prescribed medications and cannabis. Among current users, 85% and 79% of patients reported cannabis being somewhat to very helpful for pain and spasticity, respectively.

Study details: A cross-sectional study evaluated the cannabis use and its perceived benefits among patients with MS and self-reported spasticity (n = 91) who were enrolled in a randomized controlled trial for MS-related spasticity in Oregon, US.

Disclosures: The study was supported by the VA Office of Research and Development via Rehabilitation Research and Development. Dr. Rice reported consulting for Greenwich Biosciences. Dr. Cameron reported consulting for Adamas Pharmaceuticals Inc. and Greenwich Biosciences. Ms. Hugos and Ms. Hildebrand declared no conflict of interest.

Citation: Rice J et al. Mult Scler Relat Disord. 2020 Feb 11. doi: 10.1016/j.msard.2020.102009.

Key clinical point: A significant proportion of patients with multiple sclerosis (MS) and spasticity from Oregon, US reported cannabis use and found it beneficial for their pain and spasticity.

Major finding: Among the patients assessed, 54% reported using cannabis in the past and 36% reported current use of cannabis. For the treatment of spasticity, 26% of patients used both prescribed medications and cannabis. Among current users, 85% and 79% of patients reported cannabis being somewhat to very helpful for pain and spasticity, respectively.

Study details: A cross-sectional study evaluated the cannabis use and its perceived benefits among patients with MS and self-reported spasticity (n = 91) who were enrolled in a randomized controlled trial for MS-related spasticity in Oregon, US.

Disclosures: The study was supported by the VA Office of Research and Development via Rehabilitation Research and Development. Dr. Rice reported consulting for Greenwich Biosciences. Dr. Cameron reported consulting for Adamas Pharmaceuticals Inc. and Greenwich Biosciences. Ms. Hugos and Ms. Hildebrand declared no conflict of interest.

Citation: Rice J et al. Mult Scler Relat Disord. 2020 Feb 11. doi: 10.1016/j.msard.2020.102009.

Key clinical point: The personalized multidisciplinary rehabilitation (PMDR) approach can improve highly impacting symptoms in patients with relapse-onset multiple sclerosis (MS) and have a positive influence on their quality of life.

Major finding: Patients receiving PMDR had a reduction in perceived fatigue and improvement of walking abilities and health-related quality of life compared with control individuals. Improved performance on a motor sequence learning task in terms of accuracy was observed after rehabilitation. All improvements persisted at the 4-week follow-up. 

Study details: A longitudinal parallel group study included 24 patients with relapse-onset MS, who received a 4-week PMDR, and 24 control individuals. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Athina Papadopoulou, Laura Gaetano, Katrin Parmar, Thierry Ettlin, Corina Schuster-Amft, Jens Wuerfel, Ludwig Kappos, Till Sprenger, and Stefano Magon reported receiving research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Zuber P et al. J Neurol. 2020 Mar 2. doi: 10.1007/s00415-020-09768-6.

Key clinical point: The personalized multidisciplinary rehabilitation (PMDR) approach can improve highly impacting symptoms in patients with relapse-onset multiple sclerosis (MS) and have a positive influence on their quality of life.

Major finding: Patients receiving PMDR had a reduction in perceived fatigue and improvement of walking abilities and health-related quality of life compared with control individuals. Improved performance on a motor sequence learning task in terms of accuracy was observed after rehabilitation. All improvements persisted at the 4-week follow-up. 

Study details: A longitudinal parallel group study included 24 patients with relapse-onset MS, who received a 4-week PMDR, and 24 control individuals. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Athina Papadopoulou, Laura Gaetano, Katrin Parmar, Thierry Ettlin, Corina Schuster-Amft, Jens Wuerfel, Ludwig Kappos, Till Sprenger, and Stefano Magon reported receiving research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Zuber P et al. J Neurol. 2020 Mar 2. doi: 10.1007/s00415-020-09768-6.

Key clinical point: The personalized multidisciplinary rehabilitation (PMDR) approach can improve highly impacting symptoms in patients with relapse-onset multiple sclerosis (MS) and have a positive influence on their quality of life.

Major finding: Patients receiving PMDR had a reduction in perceived fatigue and improvement of walking abilities and health-related quality of life compared with control individuals. Improved performance on a motor sequence learning task in terms of accuracy was observed after rehabilitation. All improvements persisted at the 4-week follow-up. 

Study details: A longitudinal parallel group study included 24 patients with relapse-onset MS, who received a 4-week PMDR, and 24 control individuals. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Athina Papadopoulou, Laura Gaetano, Katrin Parmar, Thierry Ettlin, Corina Schuster-Amft, Jens Wuerfel, Ludwig Kappos, Till Sprenger, and Stefano Magon reported receiving research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Zuber P et al. J Neurol. 2020 Mar 2. doi: 10.1007/s00415-020-09768-6.

Key clinical point: Patients with moderate-to-severe multiple sclerosis (MS) contribute substantially to the disease-related morbidity burden.

Major finding: Patients in asymptomatic and mild stages of MS represent 68.4% of the population and contribute to 39.8% of the MS-specific morbidity. The remaining 60.2% of the MS-specific morbidity comes from the 31.6% of patients in the moderate or severe disease stages. 

Study details: The data come from an analysis of 1,412 patients with MS identified from the Swiss Multiple Sclerosis Registry. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Anke Salmen, Claudio Gobbi, Caroline Pot, Christian P. Kamm, Jens Kuhle, Pasquale Calabrese, Stefanie Müller, and Sven Schippling reported research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Kaufmann M et al. Front Neurol. 2020 Mar 6. doi: 10.3389/fneur.2020.00156.

Key clinical point: Patients with moderate-to-severe multiple sclerosis (MS) contribute substantially to the disease-related morbidity burden.

Major finding: Patients in asymptomatic and mild stages of MS represent 68.4% of the population and contribute to 39.8% of the MS-specific morbidity. The remaining 60.2% of the MS-specific morbidity comes from the 31.6% of patients in the moderate or severe disease stages. 

Study details: The data come from an analysis of 1,412 patients with MS identified from the Swiss Multiple Sclerosis Registry. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Anke Salmen, Claudio Gobbi, Caroline Pot, Christian P. Kamm, Jens Kuhle, Pasquale Calabrese, Stefanie Müller, and Sven Schippling reported research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Kaufmann M et al. Front Neurol. 2020 Mar 6. doi: 10.3389/fneur.2020.00156.

Key clinical point: Patients with moderate-to-severe multiple sclerosis (MS) contribute substantially to the disease-related morbidity burden.

Major finding: Patients in asymptomatic and mild stages of MS represent 68.4% of the population and contribute to 39.8% of the MS-specific morbidity. The remaining 60.2% of the MS-specific morbidity comes from the 31.6% of patients in the moderate or severe disease stages. 

Study details: The data come from an analysis of 1,412 patients with MS identified from the Swiss Multiple Sclerosis Registry. 

Disclosures: The study was supported by the Swiss Multiple Sclerosis Society. Anke Salmen, Claudio Gobbi, Caroline Pot, Christian P. Kamm, Jens Kuhle, Pasquale Calabrese, Stefanie Müller, and Sven Schippling reported research support/speaker fees/speaker honoraria/travel support/consultancy fees/advisory fees from one or more pharmaceutical companies and/or organizations. The remaining authors declared no conflict of interest.

Citation: Kaufmann M et al. Front Neurol. 2020 Mar 6. doi: 10.3389/fneur.2020.00156.

Key clinical point: Alemtuzumab infusion in patients with multiple sclerosis (MS) is associated with the elevation of D-dimer level and the prolongation of prothrombin time (PT).

Major finding: Alemtuzumab infusion resulted in a significant elevation in D-dimer levels within the patient group (before vs after infusion, P = .00001) and also compared with control individuals (P = .00001). PT was also prolonged in patients receiving alemtuzumab post-infusion compared with the pre-infusion values (P = .00001).

Study details: In this study, coagulation parameters were analyzed in 13 patients with MS treated with alemtuzumab and 13 control individuals.

Disclosures: The study was supported by the MH CZ-DRO, Motol University Hospital, Prague, Czech Republic. Jana Libertinova, Eva Meluzinova, Eva Nema, Petra Rockova, Martin Elisak, Marko Petrzalka, and Hana Mojzisova reported receiving compensation for travel and/or speaker honoraria and consultant fees from multiple pharmaceutical companies. The remaining authors declared no conflict of interest. 

Citation: Libertinova J et al. Mult Scler. 2020 Feb 20. doi: 10.1177/1352458520904277. 

Key clinical point: Alemtuzumab infusion in patients with multiple sclerosis (MS) is associated with the elevation of D-dimer level and the prolongation of prothrombin time (PT).

Major finding: Alemtuzumab infusion resulted in a significant elevation in D-dimer levels within the patient group (before vs after infusion, P = .00001) and also compared with control individuals (P = .00001). PT was also prolonged in patients receiving alemtuzumab post-infusion compared with the pre-infusion values (P = .00001).

Study details: In this study, coagulation parameters were analyzed in 13 patients with MS treated with alemtuzumab and 13 control individuals.

Disclosures: The study was supported by the MH CZ-DRO, Motol University Hospital, Prague, Czech Republic. Jana Libertinova, Eva Meluzinova, Eva Nema, Petra Rockova, Martin Elisak, Marko Petrzalka, and Hana Mojzisova reported receiving compensation for travel and/or speaker honoraria and consultant fees from multiple pharmaceutical companies. The remaining authors declared no conflict of interest. 

Citation: Libertinova J et al. Mult Scler. 2020 Feb 20. doi: 10.1177/1352458520904277. 

Key clinical point: Alemtuzumab infusion in patients with multiple sclerosis (MS) is associated with the elevation of D-dimer level and the prolongation of prothrombin time (PT).

Major finding: Alemtuzumab infusion resulted in a significant elevation in D-dimer levels within the patient group (before vs after infusion, P = .00001) and also compared with control individuals (P = .00001). PT was also prolonged in patients receiving alemtuzumab post-infusion compared with the pre-infusion values (P = .00001).

Study details: In this study, coagulation parameters were analyzed in 13 patients with MS treated with alemtuzumab and 13 control individuals.

Disclosures: The study was supported by the MH CZ-DRO, Motol University Hospital, Prague, Czech Republic. Jana Libertinova, Eva Meluzinova, Eva Nema, Petra Rockova, Martin Elisak, Marko Petrzalka, and Hana Mojzisova reported receiving compensation for travel and/or speaker honoraria and consultant fees from multiple pharmaceutical companies. The remaining authors declared no conflict of interest. 

Citation: Libertinova J et al. Mult Scler. 2020 Feb 20. doi: 10.1177/1352458520904277. 

Key clinical point: Sexual dysfunction is highly prevalent in women with multiple sclerosis (MS), and it significantly affects their quality of life.

Major finding: The overall prevalence of sexual dysfunction in women with MS was 70.3%. Sexual dysfunction in women with MS had a significant correlation with age (P = .004), duration of marriage, (P = .004), fatigue (P less than or equal to .001), Expanded Disability Status Scale (P = .004), and the combined physical and mental health aspects of quality of life (P less than .05).                   

Study details: The data come from a cross-sectional study that was conducted in Iran, which included 300 married women with MS aged 22-50 years. 

Disclosures: The study was funded by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflict of interest.

Citation: Nazari F et al. BMC Urol. 2020 Feb 21. doi: 10.1186/s12894-020-0581-2.

Key clinical point: Sexual dysfunction is highly prevalent in women with multiple sclerosis (MS), and it significantly affects their quality of life.

Major finding: The overall prevalence of sexual dysfunction in women with MS was 70.3%. Sexual dysfunction in women with MS had a significant correlation with age (P = .004), duration of marriage, (P = .004), fatigue (P less than or equal to .001), Expanded Disability Status Scale (P = .004), and the combined physical and mental health aspects of quality of life (P less than .05).                   

Study details: The data come from a cross-sectional study that was conducted in Iran, which included 300 married women with MS aged 22-50 years. 

Disclosures: The study was funded by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflict of interest.

Citation: Nazari F et al. BMC Urol. 2020 Feb 21. doi: 10.1186/s12894-020-0581-2.

Key clinical point: Sexual dysfunction is highly prevalent in women with multiple sclerosis (MS), and it significantly affects their quality of life.

Major finding: The overall prevalence of sexual dysfunction in women with MS was 70.3%. Sexual dysfunction in women with MS had a significant correlation with age (P = .004), duration of marriage, (P = .004), fatigue (P less than or equal to .001), Expanded Disability Status Scale (P = .004), and the combined physical and mental health aspects of quality of life (P less than .05).                   

Study details: The data come from a cross-sectional study that was conducted in Iran, which included 300 married women with MS aged 22-50 years. 

Disclosures: The study was funded by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflict of interest.

Citation: Nazari F et al. BMC Urol. 2020 Feb 21. doi: 10.1186/s12894-020-0581-2.

As of this morning, March 19, 2020, I’m still working.

Granted, there aren’t a lot of people who want to come in. My schedule has dropped to 3-5 follow-ups per day and no new patients.

I can understand people not wanting to expose themselves unnecessarily right now.

But, I’m still a doctor. What drove me to study for the MCAT, apply to med school 2 years in a row, and then survive medical school, internship, residency, and fellowship ... is still there.

Like I said in my 1987 personal statement, I still want to help people. I’d feel remiss if (provided I don’t have COVID-19) I didn’t show up for work each day, ready to care for any who need me. It’s part of who I am, what I do, and what I believe in.

I’m sure my colleagues in family practice, internal medicine, and pulmonology are swamped right now, but neurologists with primarily outpatient practices are taking a back seat except for a handful of patients.

My small office has been set up for my staff to work remotely in a pinch since 2016, so that was easy to enact. The three of us cover the phones the way we always have, and I see patients here.

With the relaxing of telehealth requirements for Medicare that were announced on March 17, I’m setting up to “see” patients remotely.

The whole situation seems bizarre and surreal.

It’s easy for anyone to read too much into anything. A brief tickle in my throat when I wake up, or a sneeze, or a few coughs, suddenly trigger a flurry of “could I have it?” thoughts. Fortunately, they fade when things quickly return to normal, but a few weeks ago I wouldn’t have thought anything of them at all.

Inevitably, I and pretty much everyone else will be exposed to or catch the virus. It’s what virions do. Unless you absolutely isolate yourself on a desert island, it will happen. When it does, you can only hope for the best.

I’m here for my patients today and will be as long as they need me. Unless I have to go into quarantine, of course. And even then, if able, I’ll do the best I can to treat them remotely.

That’s all I could ever want.
 

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

As of this morning, March 19, 2020, I’m still working.

Granted, there aren’t a lot of people who want to come in. My schedule has dropped to 3-5 follow-ups per day and no new patients.

I can understand people not wanting to expose themselves unnecessarily right now.

But, I’m still a doctor. What drove me to study for the MCAT, apply to med school 2 years in a row, and then survive medical school, internship, residency, and fellowship ... is still there.

Like I said in my 1987 personal statement, I still want to help people. I’d feel remiss if (provided I don’t have COVID-19) I didn’t show up for work each day, ready to care for any who need me. It’s part of who I am, what I do, and what I believe in.

I’m sure my colleagues in family practice, internal medicine, and pulmonology are swamped right now, but neurologists with primarily outpatient practices are taking a back seat except for a handful of patients.

My small office has been set up for my staff to work remotely in a pinch since 2016, so that was easy to enact. The three of us cover the phones the way we always have, and I see patients here.

With the relaxing of telehealth requirements for Medicare that were announced on March 17, I’m setting up to “see” patients remotely.

The whole situation seems bizarre and surreal.

It’s easy for anyone to read too much into anything. A brief tickle in my throat when I wake up, or a sneeze, or a few coughs, suddenly trigger a flurry of “could I have it?” thoughts. Fortunately, they fade when things quickly return to normal, but a few weeks ago I wouldn’t have thought anything of them at all.

Inevitably, I and pretty much everyone else will be exposed to or catch the virus. It’s what virions do. Unless you absolutely isolate yourself on a desert island, it will happen. When it does, you can only hope for the best.

I’m here for my patients today and will be as long as they need me. Unless I have to go into quarantine, of course. And even then, if able, I’ll do the best I can to treat them remotely.

That’s all I could ever want.
 

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

As of this morning, March 19, 2020, I’m still working.

Granted, there aren’t a lot of people who want to come in. My schedule has dropped to 3-5 follow-ups per day and no new patients.

I can understand people not wanting to expose themselves unnecessarily right now.

But, I’m still a doctor. What drove me to study for the MCAT, apply to med school 2 years in a row, and then survive medical school, internship, residency, and fellowship ... is still there.

Like I said in my 1987 personal statement, I still want to help people. I’d feel remiss if (provided I don’t have COVID-19) I didn’t show up for work each day, ready to care for any who need me. It’s part of who I am, what I do, and what I believe in.

I’m sure my colleagues in family practice, internal medicine, and pulmonology are swamped right now, but neurologists with primarily outpatient practices are taking a back seat except for a handful of patients.

My small office has been set up for my staff to work remotely in a pinch since 2016, so that was easy to enact. The three of us cover the phones the way we always have, and I see patients here.

With the relaxing of telehealth requirements for Medicare that were announced on March 17, I’m setting up to “see” patients remotely.

The whole situation seems bizarre and surreal.

It’s easy for anyone to read too much into anything. A brief tickle in my throat when I wake up, or a sneeze, or a few coughs, suddenly trigger a flurry of “could I have it?” thoughts. Fortunately, they fade when things quickly return to normal, but a few weeks ago I wouldn’t have thought anything of them at all.

Inevitably, I and pretty much everyone else will be exposed to or catch the virus. It’s what virions do. Unless you absolutely isolate yourself on a desert island, it will happen. When it does, you can only hope for the best.

I’m here for my patients today and will be as long as they need me. Unless I have to go into quarantine, of course. And even then, if able, I’ll do the best I can to treat them remotely.

That’s all I could ever want.
 

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Newly updated guidance on treating patients with the novel coronavirus (COVID-19) has been published by the World Health Organization.

While it can’t replace clinical judgment or specialist consultation, the new guidance may help strengthen the clinical management of patients when COVID-19 is suspected, according to its authors.

The guidance, adapted from an earlier edition focused on the management of suspected Middle East respiratory syndrome coronavirus (MERS-CoV), covers best practices for triage, infection prevention and control, and optimized supportive care for mild, severe, or critical coronavirus disease 2019 (COVID-19).

“This guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival,” the authors wrote in the guidance.

Newly updated guidance on treating patients with the novel coronavirus (COVID-19) has been published by the World Health Organization.

While it can’t replace clinical judgment or specialist consultation, the new guidance may help strengthen the clinical management of patients when COVID-19 is suspected, according to its authors.

The guidance, adapted from an earlier edition focused on the management of suspected Middle East respiratory syndrome coronavirus (MERS-CoV), covers best practices for triage, infection prevention and control, and optimized supportive care for mild, severe, or critical coronavirus disease 2019 (COVID-19).

“This guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival,” the authors wrote in the guidance.

Newly updated guidance on treating patients with the novel coronavirus (COVID-19) has been published by the World Health Organization.

While it can’t replace clinical judgment or specialist consultation, the new guidance may help strengthen the clinical management of patients when COVID-19 is suspected, according to its authors.

The guidance, adapted from an earlier edition focused on the management of suspected Middle East respiratory syndrome coronavirus (MERS-CoV), covers best practices for triage, infection prevention and control, and optimized supportive care for mild, severe, or critical coronavirus disease 2019 (COVID-19).

“This guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival,” the authors wrote in the guidance.

Key clinical point: After 10 years, a high proportion of migraineurs improve. Reduction in headache frequency, medical follow-up, and nonsmoking are independent factors associated with improvement.

Major finding: After 10 years, 48.2% of patients did not receive a medical follow-up for their migraine. Moreover, 47.4% (180/380) of patients had a decrease of 50% or higher in frequency (defined as improvement), which increased the proportion of episodic migraine (73.7% vs. 87.4%). Factors independently associated with improvement included a baseline frequency of greater than 10 headache days/month (odds ratio [OR], 3.04), having a medical follow-up (OR, 2.45), and nonsmoking (OR, 2.13).

Study details: A 10-year longitudinal study included 1,109 patients with migraine who answered an initial survey (380 completed the survey) and compared initial (2008) and final (2018) data, focusing on baseline prognostic factors of improvement (50% or higher frequency reduction) and no improvement (less than 50% frequency reduction).

Disclosures: No study sponsor was identified. The presenting author had no disclosures. Two coauthors received honoraria from pharmaceutical companies. 

Citation: Caronna E et al. Headache. 2020 Feb 18. doi: 10.1111/head.13774. 

Key clinical point: After 10 years, a high proportion of migraineurs improve. Reduction in headache frequency, medical follow-up, and nonsmoking are independent factors associated with improvement.

Major finding: After 10 years, 48.2% of patients did not receive a medical follow-up for their migraine. Moreover, 47.4% (180/380) of patients had a decrease of 50% or higher in frequency (defined as improvement), which increased the proportion of episodic migraine (73.7% vs. 87.4%). Factors independently associated with improvement included a baseline frequency of greater than 10 headache days/month (odds ratio [OR], 3.04), having a medical follow-up (OR, 2.45), and nonsmoking (OR, 2.13).

Study details: A 10-year longitudinal study included 1,109 patients with migraine who answered an initial survey (380 completed the survey) and compared initial (2008) and final (2018) data, focusing on baseline prognostic factors of improvement (50% or higher frequency reduction) and no improvement (less than 50% frequency reduction).

Disclosures: No study sponsor was identified. The presenting author had no disclosures. Two coauthors received honoraria from pharmaceutical companies. 

Citation: Caronna E et al. Headache. 2020 Feb 18. doi: 10.1111/head.13774. 

Key clinical point: After 10 years, a high proportion of migraineurs improve. Reduction in headache frequency, medical follow-up, and nonsmoking are independent factors associated with improvement.

Major finding: After 10 years, 48.2% of patients did not receive a medical follow-up for their migraine. Moreover, 47.4% (180/380) of patients had a decrease of 50% or higher in frequency (defined as improvement), which increased the proportion of episodic migraine (73.7% vs. 87.4%). Factors independently associated with improvement included a baseline frequency of greater than 10 headache days/month (odds ratio [OR], 3.04), having a medical follow-up (OR, 2.45), and nonsmoking (OR, 2.13).

Study details: A 10-year longitudinal study included 1,109 patients with migraine who answered an initial survey (380 completed the survey) and compared initial (2008) and final (2018) data, focusing on baseline prognostic factors of improvement (50% or higher frequency reduction) and no improvement (less than 50% frequency reduction).

Disclosures: No study sponsor was identified. The presenting author had no disclosures. Two coauthors received honoraria from pharmaceutical companies. 

Citation: Caronna E et al. Headache. 2020 Feb 18. doi: 10.1111/head.13774.