Alvin Wells, MD, PhD: Testing and Monitoring Rheumatic Disease With the Ps Mnemonic

As a number of options for managing rheumatic disease, including conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), biologic DMARDs, and targeted synthetic DMARDs have become available, initial workup testing and monitoring of patients with rheumatic diseases, including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), may benefit from a more standardized and rigorous decision making and checklist system.

Alvin Wells, MD, PhD, director of rheumatology at Advocate Aurora Health, has been using a pneumonic P system to ensure meticulous testing of all relevant factors for patients with rheumatic disease. These include Purified protein derivative/IGRA/T spot assay; Posterior, anterior, and lateral chest X-ray; Panel for hepatitis B; Pneumococcal vaccine; Pox (varicella) titer; Panel for lipids; Pregnancy test; Procalcitonin (PCT) level; and “Phungal” (fungal) test/b-D-glucan test.

“I wanted to come up with a way that if I'm seeing a new patient for rheumatoid arthritis, a new patient for psoriatic arthritis, that everybody's going to be getting the same type of workup. I don't want to say, I forgot to do this, I forgot to do that. [So, I decided to] come up with a catchy way of teaching that. So, we did that, and developed this whole “Ps” concept, not only for the residents and fellows that we work with, but for students and APCs, and it stuck,” Wells told HCPLive®.

Wells discussed the importance and recommended frequency for several items in the Ps mnemonic, including lipid panels and chest X-rays. He also emphasized the importance of pregnancy testing for patients of child-bearing age and noted pneumococcal vaccines as an often overlooked factor in testing and monitoring.

“As an immunologist, I want to do everything I can to boost that patient’s immune system so when they walk out the door on one of my drugs, their body is able to fight off any offending infection, whether it's viral or bacterial, and that's [one thing] I think some of my colleagues overlook sometimes,” Wells said.

Before concluding the discussion, Wells discusses the transformation of his 9 Ps to 10 with the addition of the PrismRA test. The blood test is designed to predict which patients with rheumatoid arthritis are unlikely to respond to tumor necrosis factor inhibitor therapy. It is covered by Medicare for certain patients with rheumatoid arthritis as of October 15, 2023. Of note, this test and report have not been reviewed, cleared, or approved by the Food and Drug Administration.

Relevant disclosures for Wells include Abbvie, Bristol Myers Squibb, and others. Quotes have been edited for clarity.

REFERENCE

Wells AF, Haddad R. Remember Your Ps: Some Considerations for Initial Testing and Ongoing Monitoring for Patients on DMARDs. Rheumatol (Sunnyvale). 2020:(10):265. doi: 10.35248/2161-1149.20.10.265.