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Dr. Bevra Hahn at RWCS 2018 on Rheumatologist Burnout

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Hello i am bev rahan and i’m a rheumatologist at ucla today i am talking about lupus and i did a little bit of history going from the time before we had cyclophosphamide or mycophenolate or a sathya preen or biologics to treat lupus and bringing it up to date so one of the important things that happened in the past was the ban against kidney transplants in lupus

Patients was lifted in the mid 70s before that time the nephrologists and surgeons weren’t allowed to transplant somebody that had lupus because experts knew that the lupus would recur in the transplant kidney and in fact that only happens three percent of the time and now they’re transplanted as you know like everybody else another thing that happened that improved

Our care was a lot of government legislative advances that included the introduction of medicare and medicaid and surgery insurance for emergencies and the chip program for children and the affordable care act or obamacare and altogether about one in three americans are covered by a federal program for their health care and that’s allowed us to really expand the

Number of people we can treat and of course there’s been improvement in how we treat patients there’s been the introduction of cyclophosphamide and mycophenolate for people with serious lupus and people with lupus nephritis although they are not approved by the fda yet and neither is asa therapy but we all use them when we know how to use them and mycophenolate

Is coming up to the top as the first choice of many people for patients who have serious life-threatening lupus and that’s because it is as effective as cyclophosphamide but easier to tolerate and it’s effective in all races and the same thing can’t be said for cyclophosphamide and there’s recent data it might be a little more then a cythera preen so it’s in wide

Use and then of course belinda map has come in and we know that people with arthritis and skin disease particularly improve on at about 60 percent of people improve we now have the subcutaneous form which is going to make it so much easier for patients to use and looking toward tomorrow there are a lot of exciting things coming along that look very good in lupus

In phase two trials and one of them is an antibody against the interfere and type 1 receptors it’s called an a’ frollo map and it look very good in a phase 2 trial another one is vocal sporran which is a new calcineurin inhibitor that’s supposed to be safer for the kidney and by the way tacrolimus plus mycophenolate together looked really good in the chinese study

In terms of increasing the percent of people who get a response to lupus nephritis up to around 80% or better very very good response rates and another a new thing we’re looking at is you stick in a map which in recent abstract was shown to be effective in lupus patients who don’t have nephritis and better than standard of care so we should keep our eyes open for

All of these new things coming along and there many more i don’t have time to discuss but the cap on what i want to talk about is are we going to have a crisis in physicians who know how to use this because there is a big problem with physician burnout there are two articles in the new england journal of medicine about two weeks ago that show that 53 percent of

Today’s practicing physicians have symptoms of burnout and half of those will drop out of seeing patients sometime over the next decade that means we’re going to lose one out of every four physicians practicing today because of this burnout the institute of medicine has defined it as a crisis there are many groups who fund health care who realize it’s a crisis and

Many groups are being formed to try to address the solution to this crisis if anybody asks you to participate please help

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Dr. Bevra Hahn at RWCS 2018 on Rheumatologist Burnout By RheumNow