Michael Putman
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Articles by Michael Putman
To Pulse or Not to Pulse in ANCA Associated Vasculitis? Save
Randomized trials typically get top billing at ACR Convergence, but the past three years have seen “target trial emulations” land coveted plenary sessions and oral abstracts. These are not actually trials; instead, they are a new-ish approach to generating causal inferences from observational datasets. One particularly interesting oral presentation from the meeting used this idea to investigate a critical question in ANCA associated vasculitis: should we be giving pulse dose steroids?
Efgartigimod: A New Mechanism for Myositis? Save
Abstracts come and go, but new trials and new mechanisms stay with us for the long haul. One of the more interesting new mechanisms is the FcRn drugs, and at ACR Convergence 2026 we got to see positive results from the Phase 3 ALKIVIA trial for efgartigimod. Efgartigimod is a human IgG1 antibody Fc fragment that binds FcRn. The idea is that this reduces IgG antibodies by impairing recycling and increasing lysosomal degradation.
RITAZAREM: Three Things I Learned about AAV Maintenance Save
One of the most common questions I receive in my vasculitis clinic is one of the most difficult to answer: “When can we stop rituximab?” While we know everyone needs therapy for at least one year and have reasonably good data for 18 months, whether folks should continue after that remains an open question. That is why I was especially excited to see a post hoc analysis of RITAZAREM, which followed patients for up to 48 months from enrollment (Abstract 2149). Quick reminder about RITAZAREM.
EBR Journal Club: Secukinumab in Polymyalgia Rheumatica (REPLENISH) Save
The EBR Journal Club Companion applies my adapted version of the JAMA approach to critical appraisal to an important RCT in rheumatology. Each review covers four domains: Does this apply to my patients? What is the risk of bias? How great are the benefits and harms? And what didn’t they show me? Feel free to use this in your own journal clubs! This edition: REPLENISH (secukinumab in polymyalgia rheumatica).
EBR Journal Club: Brepocitinib in Dermatomyositis (VALOR) Save
The EBR Journal Club Companion applies my adapted version of the JAMA approach to critical appraisal. Each review covers four domains: Does this apply to my patients? What is the risk of bias? How great are the benefits and harms? And what didn’t they show me? Feel free to use this in your own journal clubs! This edition: VALOR (brepocitinib in dermatomyositis).
EBR Journal Club: Obexelimab in IgG4-Related Disease (INDIGO) Save
The EBR Journal Club Companion applies my adapted version of the JAMA approach to critical appraisal to an important RCT in rheumatology. Each review covers four domains: Does this apply to my patients? What is the risk of bias? How great are the benefits and harms? And what didn’t they show me? This edition: INDIGO (obexelimab in IgG4-related disease).
EBR Journal Club: Dapirolizumab Pegol in SLE (PHOENYCS GO) Save
The EBR Journal Club Companion applies my adapted version of the JAMA approach to critical appraisal to an important RCT in rheumatology. Each review covers four domains: Does this apply to my patients? What is the risk of bias? How great are the benefits and harms? And what didn’t they show me? Feel free to use this in your own journal clubs! This edition: PHOENYCS GO (dapirolizumab pegol in SLE).
Sul087 COMPARISON OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE BIOPSY FOR SOLID LESIONS OF THE UPPER GASTROINTESTINAL TRACT, WITH AND WITHOUT ROSE: A SINGLE CENTER RETROSPECTIVE REVIEW
Also available on ScienceDirect
Sjögren's disease RCTs: Has the Long Drought Ended?
Sjögren's disease has been a difficult space for new FDA approvals. TNF inhibitors, rituximab, tocilizumab, and our favorite connective-tissue-drug hydroxychloroquine have all been studied in RCTs, all of which failed to meet their primary endpoints.
Sjögren's disease RCTS: Has the Long Drought Ended?
Sjögren's disease has been a difficult space for new FDA approvals. TNF inhibitors, rituximab, tocilizumab, and our favorite connective-tissue-drug hydroxychloroquine have all been studied in RCTs, all of which failed to meet their primary endpoints.
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The Great Debate – Who Really Won? | RheumNow
My favorite session at ACR Convergence is often the “Great Debate.” The debate this year also evaluated one of my favorite topics – ultrasound in giant cell arteritis (GCA). More specifically, it asked the question of whether biopsy or ultrasound should be the preferred modality for diagnosing GCA. Ultrasound should replace biopsy and is the bestest-thing-ever-OMG-it’s-great: On one side, Dr. Wolfgang Schmidt argued in favor of using ultrasound as the initial approach to diagnosing GCA.
The Great Debate – Who Really Won? | RheumNow
My favorite session at ACR Convergence is often the “Great Debate.” The debate this year also evaluated one of my favorite topics – ultrasound in giant cell arteritis (GCA). More specifically, it asked the question of whether biopsy or ultrasound should be the preferred modality for diagnosing GCA. Ultrasound should replace biopsy and is the bestest-thing-ever-OMG-it’s-great: On one side, Dr. Wolfgang Schmidt argued in favor of using ultrasound as the initial approach to diagnosing GCA.
Sooner May Still Be Too Late: Kidney Biopsies in SLE
ACR Convergence 2025 will be kicking off with a Plenary Session by Michelle Petri (Abstract 0772: Redefining When to Biopsy the Kidney in Patients with SLE), which is a great place to kick off our coverage of the meeting. As part of a collaboration with the Accelerating Medicines Partnership, Petri and colleagues have given data to what many of us have long suspected: a biopsy threshold of 0.5g/d of proteinuria may be too high.
Choice of biologic immunotherapy for psoriasis or psoriatic arthritis not associated with risk of major adverse cardiac events
Choice of biologic immunotherapy for psoriasis or psoriatic arthritis not associated with risk of major adverse cardiac events Jack Geiger, Bonit Gill, Jean Liew, Michael Putman, Shikha Singla The Journal of Rheumatology Oct 2025, jrheum.2025-0446; DOI: 10.3899/jrheum.2025-0446
Steroids in SLE Lupus Nephritis: No Free Lunch
Hello, I'm Mike Putman, I'm Assistant Professor of Medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin. Today I'm here to talk with you about steroids in lupus nephritis. The impetus for this is the 2024 ACR Guidelines for the Management of Lupus Nephritis.
Steroids in Lupus Nephritis: No Free Lunch
Hello, I'm Mike Putman, I'm Assistant Professor of Medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin. Today I'm here to talk with you about steroids in lupus nephritis. The impetus for this is the 2024 ACR guideline for the management of lupus nephritis.
Prophylaxis Against PJP in SLE: I'll Pass
Hi everybody. It’s Mike Putman. I'm an assistant professor of medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin, and I am here talking to you with RheumNow about my favorite, least favorite topic, which is PJP prophylaxis. So I think we're all somewhat familiar with PJP prophylaxis. This is the thing we do to stop the scary infection. The scary infection in particular: PJP is pneumocystic JCI pneumonia.
Moving From the Periphery to Practitioner: Investigating the Development of a Community of Practice Within a Year-Long Clinical Experience
Get full access to this article View all access and purchase options for this article. References Allen J. M., Wright S. E. (2014). Integrating theory and practice in the pre-service teacher education practicum. Teachers and Teaching: Theory and Practice, 20(2), 136–151. https://doi.org/10.1080/13540602.2013.848568 American Association of Colleges for Teacher Education. (2018).
The National Academies’ 2024 Diagnostic Criteria for Long COVID: Concerns that Could Affect the Rheumatology Community
Corresponding Author Leonard H Calabrese DO Cleveland Clinic, Cleveland Clinic Lerner College of Medicine Corresponding author: Leonard H. Calabrese, D.O., Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Vice Chairman, Department of Rheumatic and Immunologic Diseases, 9500 Euclid Avenue, Desk A50, Cleveland, Ohio 44195, Phone: (216) 444-5258, Fax: (216) 445-7569.
Comment on: 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases
Filename Description art43106-sup-0001-Disclosureform.pdfPDF document, 185.6 KB Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus
Key Indexing Terms: antibiotic prophylaxis pneumocystis pneumonia systemic lupus erythematosus Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that predominantly affects patients with compromised immune systems, including those with systemic lupus erythematosus (SLE).
Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus
Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus Yiran Jiang, Alí A. Duarte-García, Michael S. Putman, David J. Gazeley The Journal of Rheumatology Nov 2024, jrheum.2023-1038; DOI: 10.3899/jrheum.2023-1038
Is Your Practice Up to Date? New Guidelines for SLE Nephritis
Randomized controlled trials (RCTs) drive guidelines; guidelines drive clinical practice. Because updated guidelines lag trials by many years and dissemination of guidelines takes additional time, rheumatologists often practice “behind the data.” The 2024 ACR Guidelines for the Management of SLE Nephritis reaffirmed many of our typical practice patterns, including hydroxychloroquine for all, renin/angiotensin blockade, and favoring mycophenolate mofetil over cyclophosphamide.
ACR 2024: What Exactly do JAKs and TYKs Do?
Let me start by confessing something embarrassing: the immune system is just too complex for me to understand. I suspect the onslaught of new drugs with new mechanisms at ACR 2024 may have left many of you feeling similarly. This may be particularly true for the TYK/JAK/STAT signaling pathway, where each agent has a slightly-different combination of binding affinity to various JAK and TYK signaling dimers.
Taking CAR-T for a Test Drive
When the ACR Convergence 2024 abstract site went live, the first query I typed into the search bar was, “CAR-T.” I consider myself a CAR-T skeptic and would be surprised if the magical results from this NEJM case series replicate at scale, but it seems likely that CAR-T will revolutionize the care for (some) patients with rheumatic diseases. What is CAR-T? How can you get a healthy dose of it at ACR? And what does it mean for the future?
Fragility of randomised controlled trials for systemic lupus erythematosus and lupus nephritis therapies
Discussion In this study of pivotal phase III, randomised, placebo-controlled trials of new treatments for SLE and LN, many trials had an important degree of fragility, even among RCTs of medications that obtained approval.
ICYMI: Effective Treatments for Rheumatoid Arthritis ILD
The American College of Rheumatology (ACR) guidelines for the diagnosis and management of interstitial lung disease, which includes rheumatoid arthritis interstitial lung disease (RA-ILD), has been one of the most controversial topics in the runup to ACR Convergence. The guidelines expanded screening recommendations, which will likely result in overdiagnosis and overtreatment.
ICYMI: Bimekizumab is Coming…in Third Place
Of the many exciting advancements for patients with psoriatic arthritis at ACR Convergence, one upcoming therapy stood out: the dual IL-17A/F inhibitor bimekizumab. Nearly two dozen bimekizumab abstracts will be featured at this year’s meeting and it recently received authorization in Europe and the United States for psoriasis. That makes this the year I plan to figure out where this drug will be useful for my patients with psoriatic arthritis (PsA).
ICYMI: Here at Last: Treatment Options for VEXAS
We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but prior to ACR Convergence 2023 there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients).
Here at Last: Treatment Options for VEXAS
We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but prior to ACR Convergence 2023 there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients).
Effective Treatments for Rheumatoid Arthritis ILD
The American College of Rheumatology (ACR) guidelines for the diagnosis and management of interstitial lung disease, which includes rheumatoid arthritis interstitial lung disease (RA-ILD), has been one of the most controversial topics in the runup to ACR Convergence. The guidelines expanded screening recommendations, which will likely result in overdiagnosis and overtreatment.
Bimekizumab is Coming… in Third Place
Of the many exciting advancements for patients with psoriatic arthritis at ACR Convergence, one upcoming therapy stood out: the dual IL-17A/F inhibitor bimekizumab. Nearly two dozen bimekizumab abstracts will be featured at this year’s meeting and it recently received authorization in Europe and the United States for psoriasis. That makes this the year I plan to figure out where this drug will be useful for my patients with psoriatic arthritis (PsA).
Universal Imaging for GCA in PMR? Not So Fast
Hi again. It's Mike Putman from the Medical College of Wisconsin. Happy to be back on RheumNow as part of the polymyalgia rheumatica or PMR campaign. Now, I last appeared here to discuss, and I guess somewhat wound up calling it more of a rant than a discussion, but whatever, rheumatoid arthritis ILD. If you haven't checked out that coverage on RheumNow, I highly recommend it.
Hard Conversations: DMARDs and Malignancy
Cancer is the most difficult disease modifying antirheumatic drug (DMARD) risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control. Today I would like to discuss a few relevant pathways as a means to describe my overall approach to counseling about this risk.
ADVOCATE Health Related Quality of Life on Apple Podcasts
This week I dive into the health related quality of life measures that were reported in the ADVOCATE study. I found them overall somewhat convincing and they have affected my practice. Have a listen and be sure to follow along. Find my work at ebrheum.com
Incidence of Pneumocystis jiroveci pneumonia in patients with ANCA‐associated vasculitis initiating therapy with rituximab or cyclophosphamide
Supporting Information Filename Description acr25222-sup-0001-Disclosureform.pdfPDF document, 711.8 KB Disclosure Form acr25222-sup-0002-FigureS1.jpgJPEG image, 2.7 MB Supplemental Figure 1: Love plot depicting balance across variables before and after inverse probability weighting acr25222-sup-0003-FigureS2.jpgJPEG image, 2.5 MB Supplemental Figure 2: Proportion of patients who developed PJP or a treatment related adverse event, stratified by prophylaxis exposure...
‘Knowing what you don’t know’: Education, communication can curb ANA over-testing
Source/Disclosures Source: Healio interviews Disclosures: Putman, Pope, Medlin and Garg report no relevant financial disclosures. Source/Disclosures Source: Healio interviews Disclosures: Putman, Pope, Medlin and Garg report no relevant financial disclosures. We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.
Differentiating biologics to prevent psoriatic arthritis in patients with psoriasis – Authors' reply
Differentiating biologics to prevent psoriatic arthritis in patients with psoriasis – Authors' reply - The Lancet Rheumatology
Weighing the Risks and Benefits of Pneumocystis Jirovecii Pneumonia Prophylaxis in Rituximab Users
Editorial Weighing the Risks and Benefits of Pneumocystis Jirovecii Pneumonia Prophylaxis in Rituximab Users Zachary S. Wallace, Corresponding Author Zachary S. Wallace Division of Rheumatology, Allergy, and Immunology and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston and Harvard Medical School, Boston, Massachusetts Address correspondence via email to Zachary S.
Association between biological immunotherapy for psoriasis and time to incident inflammatory arthritis: a retrospective cohort study
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Giant cell arteritis can occur in people of colour
Giant cell arteritis is the most common form of systemic vasculitis in individuals aged 50 years or more and is considered a medical emergency. Urgent diagnosis and initiation of treatment are crucial to prevent the serious potential sequalae of permanent visual loss and vascular complications.
Polymyalgia Rheumatica: New Tricks for an Old Disease
Originally posted Feb. 13, 2023; reposted in conjunction with publication of the PMR supplement to the February 2024 issue of The Rheumatologist. PHILADELPHIA—Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that almost exclusively affects individuals older than 50.1 First described in 1888, PMR has been a recognized rheumatic disease since at least 1957.
The “evidence pyramid” should be dismantled, brick by ill-conceived brick
I wrote last week about a systematic review of physical measures to block viral transmission. In the post I referenced the famous (or perhaps infamous) evidence pyramid. My goal was to show the idealized version of evidence—wherein a systematic review of randomized trials strengthens one’s confidence in any one trial’s signal.
February 2023 Archives - The Rheumatologist
newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology. About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences
There Is No Diagnosis of Exclusion in Rheumatology
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Many rheumatic diseases, including PMR, seronegative RA, sarcoidosis, CNS vasculitis, FM, and Behçet's syndrome, have been described as 'diagnoses of exclusion'.
Dr. Putman et al reply
To the Editor: We thank the authors1 for their thoughtful discussion of the editorial process and for engaging with our lighthearted tone. We join their call to provide additional education about the editorial process and commend the many rheumatology editors and editorial staff who have already worked to improve transparency in publishing.
‘Can’t be in 10 places at once’: Social media now a key part of rheumatology meetings
Source/Disclosures Source: Healio Interviews Disclosures: Liew, McLain, Putman and Lewandowski report no relevant financial disclosures. We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.
Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines
In the wake of the 2016 American Academy of Ophthalmology Guidelines, rheumatologists have dutifully reduced the dose of hydroxychloroquine (HCQ) take by patients with systemic lupus erythematosus (SLE) to some number south of 5mg/kg per day.
Best of 2022: Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines
Editor's note: this article originally published on November 22, 2022, and is being shared again as a Best of 2022. Enjoy! In the wake of the 2016 American Academy of Ophthalmology Guidelines, rheumatologists have dutifully reduced the dose of hydroxychloroquine (HCQ) take by patients with systemic lupus erythematosus (SLE) to some number south of 5mg/kg per day.
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