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RHODE ISLAND M EDICAL J OURNAL Body Worlds Vital visits Rhode Island, page 66 R SPECIAL SECTION ADVANCES IN AUTOIMMUNE DISEASES GUEST EDITOR: EDWARD V. LALLY, MD DECember 2016 VOLUME 99 • NUMBER 12 ISSN 2327-2228 Your records are secure. Until they’re not. Data theft can happen to anyone, anytime. A misplaced mobile device can compromise your personal or patient records. RIMS IBC can get you the cyber liability insurance you need to protect yourself and your patients. Call us. 401-272-1050 IN COOPERATION WITH RIMS IBC RIMS INSURANCE BROKERAGE CORPORATION 405 PROMENADE STREET, SUITE B, PROVIDENCE RI 02908-4811 MEDICAL PROFESSIONAL/ CYBER LIABILITY PROPERTY/ CASUALTY LIFE/HEALTH/ DISABILITY RHODE ISLAND M EDICAL J OURNAL 18 Newer Treatment Strategies for Autoimmune Diseases EDWARD V. LALLY, MD GUEST EDITOR E. Lally, MD 19 Targeted Immunomodulatory Therapy: An Overview ASHLEY L. LEFEBVRE, PharmD, CDOE LAURA MCAULIFFE, PharmD: PGY2 23 Systemic Lupus Erythematosus: A. Lefebvre, PharmD A Review of the Clinical Approach to Diagnosis and Update on Current Targeted Therapies JOANNE SZCZYGIEL CUNHA, MD KATARZYNA GILEK-SEIBERT, MD J. Cunha, MD 28 Pemphigus: Pathogenesis to Treatment K. Gilek-Siebert, MD CHRISTOPHER DIMARCO, MD 32 Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP): C. DiMarco, MD Clinical Features, Diagnosis, and Current Treatment Strategies JACQUES REYNOLDS, DO GEORGE SACHS, MD, PhD G. Sachs, MD, PhD KARA STavROS, MD 36 Autoimmune Cytopenias: Diagnosis & Management CHRISTIAN P. NIXON, MD, PhD JOSEPH D. SWEENEY, MD C. Nixon, MD, PhD RHODE ISLAND M EDICAL J OURNAL 8 COMMENTARY Medical Tourism JOSEPH H. FRIEDMAN, MD Dickensian Diagnostics: The Diseases of Christmas Past What ailed Scrooge and Tiny Tim? HERBERT RAKATANSKY, MD Reconnecting with my Purpose in the Kingdom of Bhutan ERIC COHEN, MD 17 RIMJ AROUND THE WORLD New York, New York 58 RIMS NEWS Are you reading RIMS Notes? Working for You Weight + Wellness Summit Why You Should Join RIMS 66 SPOTLIGHT Body Worlds Exhibit: Anatomy Up Close & Personal MARY KORR 78 HeritaGE Dec. 7, 1941: 75 years ago, Japan attacks Pearl Harbor RIMJ launches special features: Doctors at War & Calling All Battle Stations MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS ALPERT FOUNDATION 68 72 WOMEN & INFANTS awards Brown medical school $27M files letter of intent for renovation of labor and delivery suite AMA ADOPTS NEW POLICIES 68 to support student wellness and mental health 72 STOICO/FIRSTFED FOUNDATION TEXTBOOK 70 donates $1.1M for maternity care trains physicians on ‘third science’ at St. Luke’s Hospital BRADLEY HASBRO CHILDREN’S RESEARCH CENTER 70 73 DRS. GRUPPUSO, ADASHI awarded $3.3M NIH grant to study effects of trauma question ‘residency placement fever’ on teens and value of social media in recovery PEOPLE/PLACES PHYLLIS A. DENNERY, MD 75 76 ROGER WILLIAMS CANCER CENTER named president-elect recognized at American Cancer of Society for Redox Society’s RI research breakfast Biology and Medicine 78 GAURAV GUPTA, MD, DEMETRA C. OUELLETTE 75 graduates from AAO leadership named president of Roger development program Williams Medical Center 78 MEMORIAL HOSPITAL LAWRENCE T. SAULNIER, RN, BSN 75 School of Nurse Anesthesia joins Visiting Nurse of HopeHealth graduates 9 as director of nursing 80 ROBERT J. WESTLAKE, MD, EDEN CARDOZO, MD 76 honored by Butler Hospital joins W&I to oversee fertility preservation 80 KENT’S WOMEN’S CARE CENTER program receives Baby-Friendly designation DECEMBER 2016 VOLUME 99 • NUMBER 12 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL J OURNAL 99 PUBLISHER RHODE ISLAND MEDICAL SOCIETY 12 PRESIDENT 2016 RUSSELL A. SETTIpane, MD December PRESIDENT-ELECT 1 SARAH J. FESSLER, MD VICE PRESIDENT BRADLEY J. COLLINS, MD CONTRIBUTION secretary CHRISTINE BROUSSEEAU, MD 41 Fibromyalgia Syndrome, A Geriatric Challenge TREASURER JULIO C. DEFILLO-DRAIBY, MD JOSE R. POLANCO, MD JOHN S. PAGE IMMEDiate PAST PRESIDENT PETER KARCZMAR, MD EXECUTIVE DIRECTOR CASE REPORTS NEWELL E. WARDE, PhD 45 Fournier’s gangrene of the penis in a EDITOR-IN-CHIEF 12-year-old patient secondary to phimosis JOSEPH H. FRIEDMAN, MD LUTHER WaRD, MD, MPH, FACS associate EDITOR DANIEL EISENSON, BA SUN HO AHN, MD JEAN-LOUIS FILS, MD PUBLication StaFF MANAGING EDITOR 47 Right in Front of Our Eyes: MARY KORR Evolution of Streptococcal Toxic Shock Syndrome [email protected] with Ischemic Optic Neuropathy GRAPHIC DESIGNER SALAHELDIN M. ELHAMAMSY, MD MARIANNE MIGLIORI MAZEN O. AL-QADI, MD ADVertisinG STEVEN DETOY TaRO MINAMI, MD SARAH STEVENS MARGUERITE NEILL, MD [email protected] EDITORIAL BOARD PUBLIC HEALTH JOHN J. CRONAN, MD JAMES P. CROWLEY, MD 50 PUBLIC HEALTH BRIEFING EDWARD R. FELLER, MD Ten Years and Growing: JOHN P. FULTON, PhD PETER A. HOLLMANN, MD Medical Marijuana in Rhode Island – Where Are We Now? KENNETH S. KORR, MD JAMES V. MCDONALD, MD, MPH MARGUERITE A. NEILL, MD MIKE SIMOLI FRANK J. SCHABERG, JR., MD LAWRENCE W. VERNAGLIA, JD, MPH 53 HEALTH BY NUMBERS NEWELL E. WaRDE, PhD Surveillance of Suicide and Suicide Attempts Among Rhode Island Youth Using Multiple Data Sources RHODE ISLAND MEDICAL JOURNAL YONGWEN JIANG, PhD (USPS 464-820), a monthly publication, is DEBORAH N. PEARLMAN, PhD owned and published by the Rhode Island JEFFREY HILL, MS Medical Society, 405 Promenade Street, Suite A, Providence RI 02908, 401-331-3207. All SAMARA VINER-BROWN, MS rights reserved. ISSN 2327-2228. Published articles represent opinions of the authors and 57 Vital Statistics do not necessarily reflect the official policy of the Rhode Island Medical Society, unless ROSEANN GIORGIANNI, DEPUTY STATE REGISTRAR clearly specified. Advertisements do not im- ply sponsorship or endorsement by the Rhode Island Medical Society. Advertisers contact: Sarah Stevens, RI Medical Society, 401-331-3207, fax 401-751-8050, [email protected]. © COPYRIGHT JANUARY 2013, RHODE ISLAND MEDICAL SOCIETY, ALL RIGHTS RESERVED. Increase your Risk IQ Outsmarting risk requires a high degree of intelligence – yours and ours. Changing care delivery models, new technology, and shifting responsibilities create new exposures for physicians and hospitals daily. But with the right risk intelligence, you can predict and prevent those vulnerabilities. Coverys combines proven Medical Professional Liability Insurance with proactive risk analytics, resources, and education to outsmart risk and improve outcomes. Visit Coverys.com or call 800-225-6168 ProSelect Insurance Company commentary Medical Tourism JOSEPH H. FRIEDMAN, MD [email protected] 8 9 EN THIS COLUMN IS ABOUT A I am monolingual, which might be wise advice for any different sort of medi- a major drawback, I teacher, especially one from New York. cal tourism. The term believe, in life. I find There are two questions to consider “medical tourism” gen- the experiences always about this type of medical tourism. erally refers to patients enriching. Now that I am What are the benefits for the tourist and who travel outside their an experienced, old-hand what are the benefits for the recipient? country to seek medical at this, or, simply, just The hosts always act grateful, although, care, usually because of old, and a professor at to be honest, cultural insensitivity expense. There are places Brown, I have taken on from both ends, may undercut this. that may be tourist des- the title of the visiting My colleagues at home rarely appear to tinations, with nice cli- professor. Since I have comprehend, however, how much the mates, beautiful beaches, visited places that are tourist receives in exchange. cheap hotels and good food, where the greatly deficient in neurology, I think Each medical trip I’ve made has staff may be first rate, often Ameri- I can make a difference, albeit a small always increased my gratefulness for can- or European-trained, who practice one, in helping general internists under- being born when and where I was, for medicine at a high level, with excellent stand and evaluate neurological prob- not being poor, for not having limited nursing care, air-conditioned, hotel-like lems better. There is, of course, a limit possibilities. But I’ve always been premises, and solicitous VIP treatment. on how much one can accomplish in any impressed with the resourcefulness of The cost may be less than the co-pay period of time, and shorter, obviously, the local doctors, and for the patients’ for some insurance plans, or the treat- means less. However, some government tolerance of their limited medical pos- ment may not be covered by insurance ministries are loath to consider an ex- sibilities. It is a harsh and awful fact in the U.S. or may be performed much patriot for a stay of less than 2 or 3 that a family in most of Africa will sooner than can be provided by national months, assuming, correctly, I think, in accept as an unfortunate fate that they insurers, as in Canada or England. most cases, that it takes several weeks for lack the money to pay for the tests or I have been a different kind of med- a newcomer to get his “sea legs.” It often treatment for a loved one. It contrasts ical tourist. I spent time in Tanzania takes some weeks to both understand with the railing against the unfairness of (3 months as a graduating medical English with a novel accent, especially fate I sometimes see from the children student), working in or teaching in when spoken softly, as is the norm in of the 88-year-old person with one of hospitals in Zambia (4 weeks), Kenya some places, and, perhaps more impor- the dread neurological disorders of the (2 weeks), Rwanda (10 weeks), Malawi tantly for a teacher, to be understood. elderly. Seeing medicine in different (4 weeks) and Ghana (2 weeks). I cannot When I was a Peace Corps teacher cultures teaches us about life, how each account for my focus on African coun- in Ghana, several decades ago, I some- of us lives our lives as constrained by tries, other than, perhaps, the fact that times would translate from English our cultures.