Virtual Rheumatology Practicum - Adult

The ACR Committee on Training and Workforce is pleased to present the Virtual Rheumatology Practicum for Adult Rheumatology Fellows (ViP - Adult). This lecture series began on July 8, 2021 and ran through August 12. ViP - Adult is designed for first-year fellows in training enrolled in adult fellowship programs. See the program for the schedule of topics, learning objectives, and accompanying reading materials.

ViP - Adult Program Schedule and Learning Objectives 
Times and speakers are subject to change.

Watch ViP - Adult Playlist

This program is designed for educational purposes only. The material presented is not intended to represent the only or the best methods appropriate for the medical situations discussed, but rather is intended to present the opinions of the authors or presenters, which may be helpful to other practitioners. Attendees participating in this education activity sponsored by the ACR do so with full knowledge that they waive any claim they may have against the ACR for reliance on any information presented during this educational activity.

 

2021 ViP - Adult Lecture Recordings

Lecture 11 Recording (August 12)  

Sjögren's Disease
Alan Baer, MD
In this talk, Dr. Baer provides an overview of Sjögren's disease, including its underlying pathology, clinical and laboratory features, diagnostic approach, and management. It is intended for rheumatology fellows who will diagnose and manage this common systemic autoimmune rheumatic disease during their careers.

Antiphospholipid Syndrome (APS)
Jason Knight, MD, PhD
Dr. Knight’s APS lecture will provide a brief historical perspective that gives important context to the diagnostic tests we order today. The underappreciated diversity of APS clinical presentations will be covered, as will various approaches to their treatment. Finally, the intersection of antiphospholipid antibodies and COVID-19 will be discussed.


Lecture 10 Recording (August 9)  

Rheumatoid Arthritis I: Epidemiology and Diagnosis
Jon Giles, MD, MPH
In this lecture, Jon Giles, MD, MPH, reviews the features of rheumatoid arthritis. These include the epidemiology of the disease, genetic and environmental risk factors for incident disease, and the phenotypic features of the disease, including important extra-articular features and comorbidities. Classification criteria and methods for assessing disease activity will be reviewed.

Rheumatoid Arthritis II: Treatment
Joan Bathon, MD
This lecture by Joan Bathon, MD, will focus on therapeutic strategies and goals, as well as on specific classes of disease modifying agents and their mechanisms, efficacies, and toxicities.


Lecture 9 Recording (August 5)  

Immunology Overview for Rheumatologists
Konstantinos Loupasakis, MD
This talk serves as a refresher of basic immunology for rheumatology fellows and as a step forward towards correlation with clinical concepts. Current insights into the pathogenesis of some common rheumatic diseases and mechanisms of action of targeted therapies are also reviewed.

Fibromyalgia and Chronic MSK Pain
Leslie Crofford, MD
This presentation will review pain transmission pathways and allow the learner to understand the central mechanisms of chronic pain. We will also provide information to assist the learner in recognizing the symptoms of fibromyalgia and review treatment options.


Lecture 8 Recording (August 2)  

Spondyloarthritis
Ethan Craig, MD, MHS
Alexis Ogdie, MD
The spondyloarthritides include an interrelated set of diagnoses, including axial spondyloarthritis and psoriatic arthritis, with common clinical manifestations and underlying pathophysiology. This talk will focus on the recognition of the features of spondyloarthritis, and approaches to diagnosis and treatment of this spectrum of diseases.

Osteoporosis
Ken Saag, MD, MSc
In this presentation, Ken Saag, MD, MSc, covers diagnostic approaches to osteoporosis and reviews data supporting the use of calcium and vitamin D supplements. In addition to the potential benefits and risks of bisphosphonates and denosumab, newer anabolic approaches to osteoporosis and data on glucocorticoid-induced osteoporosis are reviewed.


Lecture 7 Recording (July 29)  

Crystalline Arthritis: Focus on Gout
Tuhina Neogi, MD, PhD
Gout is the most common inflammatory arthritis worldwide, often complicated by comorbidities such as cardiovascular and renal disease that can make management more challenging. Effective management options are available, yet gout management remains suboptimal. This talk will review evidence-based management of gout by providing an overview of the 2020 ACR Gout Treatment Guideline.

Approach to hyperCKemia in Rheumatology
Chet Oddis, MD
An elevated CK is a common problem encountered by both rheumatologists and primary care physicians. The differential diagnosis is broad including serious problems and benign conditions. This case-driven lecture will summarize some common conditions associated with an elevated CK as well as those relevant to the clinical practice of a rheumatologist.


Lecture 6 Recording (July 26)  

Rheumatologic Emergencies
Joseph McCune, MD
This talk focuses on approaches to clinical rheumatic disease syndromes that might present to the emergency room or clinic requiring urgent intervention. Included are patients, particularly with lupus or Sjögren’s syndrome presenting with transverse myelitis and the identification of the subset of these patients who have neuromyelitis optica requiring special approaches; current strategies for managing patients presenting with suspected of giant cell arteritis, and the evaluation of thrombotic microangiopathies is complicated rheumatic disease including TTP, atypical hemolytic uremic syndrome, and CAPS.

Systemic Sclerosis
Chase Correia, MD
This lecture covers what you need to know to classify scleroderma patients, identify the clinical manifestations of systemic sclerosis, and apply the 2013 ACR systemic sclerosis classification criteria to your patients.


Lecture 5 Recording (July 22)  

Large Vessel Vasculitis
Tanaz Kermani, MD, MS
In this presentation, Tanaz Kermani, MD, MS, reviews the classification, clinical manifestations, and treatment of giant cell arteritis and Takayasu arteritis. The role of large-vessel imaging for these diseases is also discussed.

Small Vessel Vasculitis
Kevin Byram, MD
During this talk, Kevin Byram, MD, explores small vessel vasculitis through the lens of IgA vasculitis (HSP) and ANCA-associated vasculitis. He discusses a framework of conceptualizing small vessel vasculitis that will help the first-year fellow deal with complex cases. The talk is mainly focused on clinical presentation and diagnostics, with some brief comments on therapy.


Lecture 4 Recording (July 19)  

Lupus Nephritis
Brad Rovin, MD
Brad Rovin, MD, discusses the diagnosis and management of lupus nephritis from the nephrologist’s perspective. He reviews diagnostic testing including the importance of the kidney biopsy, the current state of therapy, and focus on newly approved drugs for the treatment of lupus nephritis.

Lupus
Richard Furie, MD
In this presentation, Richard Furie, MD, discusses the clinical heterogeneity and pathogenesis of SLE. He reviews classification criteria and disease activity measures as well options for the treatment of SLE.


Lecture 3 Recording (July 15)  

Osteoarthritis
Najia Shakoor, MD
This lecture will provide an overview of clinical aspects of the most common arthritis, osteoarthritis, including diagnosis, risk factors, and management.

Approach to Joint Aspiration and Injections: Indications, Techniques, and Billing
Karina Torralba, MD, MAMC
This presentation will discuss the indications and approaches to common joint injections. It will also briefly go over indications for performance of ultrasound-guided injections when palpation or blind injections are not possible and will go over basic procedures for informed consent and billing for such procedures.


Lecture 2 Recording (July 12)  

MSK Radiology
Beth Jonas, MD
In this presentation, Beth Jonas, MD, outlines a systematic approach to the interpretation of plain radiographs in the evaluation of arthritis and describes the plain radiographic features of the most common arthropathies.

Approach to Lab Testing - Positive ANA, ENA, RF, CCP, ESR, CRP
Lisa Zickuhr, MD
Knowledge of laboratory studies commonly used to evaluate patients with musculoskeletal and rheumatic diseases is requisite for the practice of rheumatology. This session introduces the techniques used to perform these analyses, lists the prototypical diseases associated with positive tests, and highlights caveats that should be considered when interpreting results. Audience members participated in an interactive case during the talk, and knowledge transfer questions for independent review after the session will be listed in the online schedule under Reading Materials.


Lecture 1 Recording (July 8)  

Approach to Patients with Rheumatic Conditions
Jason Kolfenbach, MD
Jason Kolfenbach, MD, provides an overview of the evaluation of patients presenting with arthritic complaints, with a focus on developing a systematic approach to the differential diagnosis of inflammatory arthritis. Key elements from the history and physical exam that drive the subsequent selection of laboratory and imaging studies are reviewed.

MSK Exam
Kenneth O'Rourke, MD
In this presentation, Kenneth O'Rourke, MD, explains the physical exam maneuvers to differentiate intra- from extra-articular sources of regional musculoskeletal pain and describes the pattern of joint distribution of common inflammatory and noninflammatory arthritides.

 

2020 ViP - Adult Lecture Recordings

Lecture 16 Recording (August 28)  

MSK Ultrasound
Eugene Kissin, MD

In this presentation, Eugene Kissin, MD, discusses the basics of ultrasound imaging and equipment settings, scanning techniques for the shoulder and hip, and ultrasound use for diagnosis of gout and PMR.

Fibromyalgia & Chronic MSK Pain
Leslie Crofford, MD

In this presentation, Leslie Crofford, MD, discusses basic mechanisms of pain from peripheral nociceptors to pain transmission pathways and central nervous system involvement. Concepts of acute, persistent, and nociplastic pain will be introduced. The recognition and management of fibromyalgia, a prototypical nociplastic, or centralized pain syndrome, will be reviewed.


Lecture 15 Recording (August 24)  

Antiphospholipid Syndrome
Medha Barbhaiya, MD, MPH

In this presentation, Medha Barbhaiya, MD, MPH, discusses the epidemiology, etiology/pathogenesis, clinical manifestations, diagnosis, and treatment of antiphospholipid syndrome.

Management of Pregnancy in Rheumatic Diseases Patients
Bonnie L. Bermas, MD

In this presentation, Bonnie L. Bermas, MD, discusses her approach to the management of rheumatic diseases during pregnancy using SLE and RA as prototypes. Dr. Bermas emphasizes medication compatibility in pregnancy and lactation, as well as for paternal exposure.


Lecture 14 Recording (August 20)  

Innate Immunity
Michael Pillinger, MD

In this presentation, Michael Pillinger, MD, reviews the mechanisms of innate immunity, the processes through which never-before-seen foreign threats are neutralized or resisted until the adaptive immune system can become activated, how innate immunity can result in disease—typically rheumatic disease—is considered, as well as how innate immunity and inflammation are regulated.

Acquired Immunity in Rheumatic Disease
R. John Looney, MD

In this presentation, R. John Looney, MD, reviews the adaptive immune system and the key roles played by adaptive immunity in rheumatic diseases.


Lecture 13 Recording (August 17)  

Viral Arthritis
Cassandra Calabrese, DO

In this presentation, Cassandra Calabrese, DO, discusses rheumatic manifestations of key viral infections including epidemiology, pathophysiology, clinical presentation, and pertinent diagnostics and management principles.

Biologics and Targeted Small Molecules in Rheumatoid Arthritis
Eric M. Ruderman, MD

In this presentation, Eric M. Ruderman, MD, reviews the biologic and targeted small molecule therapies used in the treatment of rheumatoid arthritis, including mechanism of action, selection of agents, safety, and use in special circumstances, including pregnancy and peri-operatively.


Lecture 12 Recording (August 13)  

Osteoporosis
Marcy Bolster, MD

In this case-based presentation on osteoporosis, Marcy Bolster, MD, discusses therapeutic options for the management of osteoporosis, distinguishing optimal therapy duration. Potential risks and adverse effects of medications used in the treatment of osteoporosis are also discussed, as well as the evidence behind recommendations for duration of therapy, introduction of a drug holiday, and guidance for the resumption of therapy after a drug holiday.

Osteoarthritis
Marc Hochberg, MD

In this presentation, Marc Hochberg, MD, provides a brief overview of the conceptual definition, epidemiology, pathophysiology, clinical features, and management of patients with osteoarthritis (OA). OA is the most common form of arthritis and is a disease of the whole joint characterized by alteration in the homeostasis of chondrocyte metabolism with the degradation of articular cartilage, changes in subchondral bone and synovitis with activation of the innate immune system. Current management is focused on control of joint pain, reduction of activity limitation, and remediation of physical disability. Future management goals are the development of disease-modifying OA drugs that will alter the underlying pathophysiology and lead to improved and clinically relevant outcomes for patients.


Lecture 11 Recording (August 10)  

Conventional Synthetic DMARDs: Old Dogs and New Tricks
Amy C. Cannella, MD, MS, RhMSUS

In this presentation, Amy C. Cannella, MD, MS, RhMSUS, reviews commonly used DMARDs (MTX, LEF, SSZ, HCQ, AZA, MMF), including mechanism of action, pharmacology, dosing, toxicity, monitoring strategies and use in pregnancy and lactation.

Lyme Arthritis
Robert Kalish, MD

Lyme arthritis remains a clinical entity rheumatologists should be comfortable diagnosing and managing. In this presentation, Robert Kalish, MD, reviews the diagnosis, clinical features, and management of Lyme arthritis including post-infectious and treatment-refractory arthritis, and touches upon the entity of “chronic Lyme disease” and tick-borne co-infections.


Lecture 10 Recording (August 6)  

Crystalline Arthritis
Brian Mandell, MD

In this presentation, Brian Mandell, MD, will discuss an overview of the pathophysiologic basis for gout, focusing on areas that can be directly addressed by effective therapy. This provides attendees with a rational and evidence-based approach to managing patients with different stages of gout. A brief discussion of calcium pyrophosphate arthritis will be presented.

Spondyloarthritis
Lianne Gensler, MD

In this presentation, Lianne Gensler, MD, uses a case-based approach to review the clinical presentation and manifestations, including extra musculoskeletal manifestations, imaging findings, and initial approach to treatment across the spectrum of disease.


Lecture 9 Recording (August 3)  

Rheumatoid Arthritis – Clinical Presentation, Pathogenesis and Diagnosis
Uzma Jalal Haque, MD

In this presentation, Uzma Jalal Haque, MD, provides a broad overview of rheumatoid arthritis. This includes a discussion of pathogenesis, clinical manifestations, and diagnosis of rheumatoid arthritis.

Rheumatoid Arthritis - Pharmacologic and Other Therapeutics
James O'Dell, MD

In this presentation, James O'Dell, MD, will focus on initial foundational principles in treating rheumatoid arthritis, including early diagnosis, treating to a target, and the use of DMARDs, especially methotrexate.


Lecture 8 Recording (July 30)  

Vasculitis - Non-ANCA
Jason Springer, MD, MS

In this presentation, Jason Springer, MD, MS, provides an overview of forms of non-ANCA associated vasculitis, including Takayasu’s arteritis, polyarteritis nodosa, IgA vasculitis, cryoglobulinemic vasculitis, and Behçet’s disease. This includes discussions of clinical manifestations, differential diagnosis, diagnostic approaches, and therapeutic management of these forms of vasculitis.

Scleroderma
Richard Silver, MD, MACR

Systemic sclerosis has the highest case-specific mortality among the systemic autoimmune diseases. In this presentation, Richard Silver, MD, MACR, will review the clinical aspects of scleroderma, including racial and gender disparities, and will outline the three facets of scleroderma pathophysiology: autoimmunity, vasculopathy, and fibrosis.


Lecture 7 Recording (July 27)  

Vasculitis
Anisha Dua, MD, MPH; Phillip Seo, MD, MHS

In this presentation, Anisha Dua, MD, MPH, and Philip Seo, MD, MHS, provide a broad overview of the ANCA-associated vasculitides. This includes a discussion of clinical manifestations, diagnostic issues, and treatment considerations.

Myositis
Rohit Aggarwal, MD

In this presentation, Rohit Aggarwal, MD, will cover basics in myositis diagnosis, classification, clinical phenotypes, autoantibodies, as well as associated conditions like interstitial lung disease and cancer-associated myositis. Management strategies for myositis and myositis associated interstitial lung disease will be briefly discussed.


Lecture 6 Recording (July 23)  

Recognition and Treatment of Macrophage Activation Syndromes
W. Winn Chatham, MD

In this presentation, W. Winn Chatham, MD, will review clinical and laboratory features of macrophage activation syndrome (MAS). The known triggers for MAS and what is known about the underlying immunopathogenesis and genetic susceptibility will also be discussed. In this context, reported effective treatment strategies will also be reviewed.

Sjögren's Syndrome for the Clinician
Chadwick, Johr, MD

Sjögren's syndrome is one of the more common systemic autoimmune diseases. It is easily misdiagnosed and often poorly understood. In this presentation, Chadwick, Johr, MD, will focus on practical clinical aspects of the disease using a question and answer approach.


Lecture 5 Recording (July 20)  

Lupus
Rosalind Ramsey-Goldman, MD

The goal of this presentation is to provide a basis to build your clinical knowledge base about lupus while seeing patients in the outpatient or hospital setting. In this presentation, Rosalind Ramsey-Goldman, MD, will cover the epidemiology of lupus, including health disparities, making the diagnosis of lupus including interpretation of a positive anti-nuclear antibody (ANA), review the protean manifestations of lupus, and review management to minimize damage from the disease and treatment.

Lupus Nephritis
Joan Mitchell, MD

In this presentation, Joan Mitchell, MD, will review the current understanding of nephritis pathophysiology and the clinical evidence supporting current treatment options. Progress in the application of emerging knowledge about immune processes to treatment selection and dosing will be critiqued.


Lecture 4 Recording (July 16)  

Musculoskeletal Exam of the Shoulder and Knee
Michael J. Battistone, MD

In this presentation, Michael J. Battistone, MD, introduces a systematic approach to the physical examination of the shoulder and knee, and discusses how the findings can be used to help distinguish among common causes for shoulder and knee pain. Following a review of basic anatomy, videos will be shown to demonstrate the sequence of the exams, with details of maneuvers discussed afterward. The integration of exam findings into clinical decision making regarding the use of X-ray and MRI will also be discussed.

Giant Cell Arteritis
Rebecca Manno, MD, MHS

In this presentation, Rebecca Manno, MD, MHS, will review the clinical and radiographic features of giant cell arteritis, including the role of temporal artery biopsy and large vessel imaging. Treatment strategies for GCA will be discussed, including the use of biologic agents.


Lecture 3 Recording (July 13)  

Laboratory Tests in the Rheumatic Diseases
Sterling G. West, MD, MACP, MACR

This presentation, based on an actual case, will examine the use and interpretation of the most common laboratory tests that are ordered during the evaluation of a patient presenting with a possible inflammatory rheumatic disease. The laboratory tests that will be discussed include ESR, CRP, RF, anti-CCP, ANA, complement, ANCA, as well as others. See if you can diagnose the patient’s disease before the final laboratory test is ordered.

Approach to Arthrocentesis and Injections
Kenneth S. O'Rourke, MD

In this presentation, Kenneth O’Rourke, MD, provides an overview of the technical aspects of arthrocentesis and soft tissue injections. Following a review of synovial fluid analysis, a detailed description of the sequential steps of these procedures is provided. Key elements that differentiate corticosteroid preparations, skin antiseptic options, local anesthetics, and the selection of needles and other hardware are reviewed.


Lecture 2 Recording (July 9)  

Enhancing Patient Care and Teaching During Inpatient Consultation
Eli Miloslavsky, MD

Subspecialty consultation is an increasingly utilized hospital resource and is a critical component of patient care, resident and student education, as well as a recruitment tool for subspecialties. In this session, we will review best practices for being a consultant in the inpatient setting with a particular focus on teaching during consultation.

Primer on Plain Radiography for Rheumatology Fellows
Beth Jonas, MD, FACR

In this presentation, we will outline the plain radiographic features of arthritis, with a focus primarily on the hands. We will discuss findings in the soft tissues, boney alignment, bone mineral density, evaluation of the joint spaces, and the appearance of erosions in the common forms of arthritis. We will review the common patterns of joint involvement in arthritis.


Lecture 1 Recording (July 6)

Approach to the Patient with Arthritis
Jason Kolfenbach, MD, University of Colorado

In this presentation, Jason Kolfenbach, MD, provides an overview to the evaluation of patients presenting with arthritic complaints, with a focus on developing a systematic approach to the differential diagnosis of inflammatory arthritis. Key elements from the history and physical exam that drive the subsequent selection of laboratory and imaging studies will be reviewed.

Rheumatology Emergencies
Lisa Criscione-Schreiber, MD, MEd, Duke University

This presentation covers general principles for approaching urgent situations that a rheumatologist may encounter in clinical practice. Through a review of four representative cases, attendees will learn about the appropriate history, physical examination and laboratory evaluation in patients with acute rheumatic presentations. Additionally, differential diagnoses and the initial treatment of these conditions are reviewed.

 

Questions

If you have questions about ViP - Adult, contact Connie Herndon.

 

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