Is the Biologic Failing—or Has the Readout Changed?

A 48-year-old woman, years stable on the same biologic, drifts out of remission. Her tender joint count and global assessment rise and push the composite score past the flare line, while swollen joints stay low and CRP is unchanged. Part I of a series on female hormonal physiology as an unmeasured modifier of advanced-therapy response — and whether a rising disease activity score reports renewed synovitis or a changed readout.

When Remission Stops Feeling Like Remission

At 47, a woman years into biologic-controlled RA begins to deteriorate again — tender joints and patient global assessment climb, morning stiffness returns beside night sweats and broken sleep — while swollen joints stay quiet and CRP barely moves. Part II of the series moves inside that gap to ask what is actually changing under the number: recurrent synovitis, or sleep, mood, mechanical pain, and a body composition shifting beneath a scale that has not moved.

Imaging-First Phenotype Anchoring in Early Seronegative Arthritis: Microerosions, Enthesitis-Adjacent Changes, and Progression Prevention

When serology is silent and radiographs read “no erosions,” early seronegative arthritis stalls during the window that matters most. A narrative review proposing an XR-first, question-driven pathway — reading microerosions and enthesitis-adjacent changes as patterns rather than isolated findings — to anchor phenotype and support progression prevention.

The Axial Set: Why Spine, Pelvis, and Hips Are One Study

The spine, pelvis, and hips form one anatomical chain, yet they are ordered separately, read on different days, and the diagnosis often lives in the relationship between them. Eight clinical scenarios mapping the minimum imaging that answers nothing against the optimal coverage that answers the question — and what the gap costs the patient.

Radiation Is Not the Opposite of Safety

Plain radiographs sit on the “risk” side of the ledger while deferring imaging is treated as “safe” — but in suspected axial spondyloarthritis that comparison is wrong. The real choice is rarely radiation versus zero: it is a small, protocol-dependent exposure weighed against years of diagnostic delay in a systemic inflammatory disease, where imaging used in the right sequence becomes risk reduction rather than risk.

Distinguishing Ankylosing Spondylitis from DISH on Plain Radiography

Two patients, near-identical lumbar films — one has DISH, the other a decade of ankylosing spondylitis. The features that separate them are visible on plain radiography, but only when the study is designed to capture them: level count, ossification morphology, disc height, and sacroiliac joint status.

From Diagnostic Ambiguity to Pattern Clarity: Deterministic Radiographic Pattern Analytics in DISH vs Axial SpA Differentiation

A deliberately difficult axial case — overlapping DISH, degenerative, and sacroiliac signatures, plus an “AS?” label that entered from history rather than from imaging. A worked demonstration of blind, XR-first phenotype anchoring, with MRI brought in afterward to confirm the pattern rather than to decide it.

Op-Med · Doximity

Fibromyalgia Does Not Belong in Rheumatology Long-Term

A woman in her 40s, a referral reading “rule out lupus,” a shopping bag of records, and seventy minutes spent confirming what the workup had already answered — while three patients with active inflammatory disease waited. An essay separating diagnostic workup from long-term ownership, with the workforce math on what every misplaced slot costs a lupus or vasculitis referral.

Op-Med · Doximity

MOC, the Subscription We Can’t Opt Out Of

Five board certifications, three of them on active maintenance cycles across different portals and deadlines. An essay on why board-run quality improvement — down to Part 4 modules that earn credit on simulated data — ends up measuring completion rather than outcomes, and what a certification process built around clinical reality would auto-credit instead.