• Sarah Schafer, MD

Sjogren's neglect IV - CME

Updated: May 12

Did you ever wonder how doctors stay up-to-date? They participate in continuing medical education programs (CME) in order to learn about new developments and current standards of care. CME programs include live events such as conferences or professional meetings as well as online educational programs, audios, videos and written publications.


The lack of CME programs about Sjogren’s suggests to clinicians that the disease is not that important. Without educational updates, there is little incentive to learn about this extremely complex disease. This in turn perpetuates the suboptimal care that so many Sjogren’s patients experience. The following examples of recent CME offerings illustrate the extent of this problem.


Perspectives in Rheumatic Diseases Annual Conference

This September 2019 general rheumatology conference, geared toward both PCPs and rheumatologists, offered ZERO presentations dedicated to Sjogren’s. Every other common rheumatologic disease was featured, in addition to some that are not so common.

ACR Annual Meeting

Rheumatologists in the US tend to look to the ACR (American College of Rheumatology) as a primary source of guidance for clinical practice. The ACR hosts a large, well-attended, rheumatology meeting each November. A search of the sessions offered at the most recent ACR meeting (2018) shows only one dedicated to Sjogren’s. Hopefully this one was well attended, because the title Sjogren’s Syndrome: Beyond Dryness reflects the core message that many rheumatologists need to get on board with.


By comparison, a search revealed 21 sessions specifically dedicated to systemic lupus, 19 to rheumatoid arthritis, 11 to systemic sclerosis, and 7 to gout. Titles among the lupus presentations included, “Lupus and APS” and “When Lupus gets bad.” How about a “Sjogren’s and APS” presentation? While Antiphospholipid syndrome is far more common in lupus, it does occur in Sjogren’s. Or how about “When Sjogren’s gets bad?” Many Sjogren’s patients have serious systemic complications, and not just lymphoma. This needs to be highlighted!


The Rheumatologist Newsletter


The rheumatologist newsletter is a popular monthly publication of the ACR. Frustrated by the lack of attention to Sjogren’s, I wrote an editorial article that was published in the September 2013 newsletter. The administrator who worked with me commented that it was difficult to find writers for Sjogren’s topics.


The search function of The Rheumatologist illustrates once again how Sjogren’s remains “Under the radar.” Not accidentally, this is the title of my article! Here are the results of a search of The Rheumatologist using the following terms. Each full page links to approximately 10 articles:.

  • “Rheumatoid arthritis” - 189 pages (about 2000 articles)

  • “Systemic lupus” - 66 pages (about 600-700 articles)

  • “Gout” - 38 pages (about 400 articles)

  • “Dermatomyositis” - 12 pages (about 120 articles)

  • “Sjogren’s or Sjogren’s syndrome” - 2 pages (13 total articles)

The 13 Sjogren’s articles include the one I wrote and a “Fact Sheet” from 2012 that gives the misleading impression of Sjogren’s as mostly a dryness disease, the same outdated message that persists on the ACR website.

ONLINE CME PROGRAMS

There are many online CME resources. This one is devoted to rheumatology topics:

https://www.mdedge.com/rheumatology

The dropdown menu of diseases and conditions does not list Sjogren’s as a separate topic. The few articles about Sjogren’s are buried in the section: “Lupus and other CTDs."


SUMMARY

It is no wonder that many rheumatologists pay little attention to Sjogren’s. The implicit and explicit message from formal medical education, the ACR, and various CME resources is that Sjogren’s is not important.


One would hope that research and medical education would be commensurate with the numbers of people impacted by the disease and the seriousness of that disease. In Sjogren’s, this is clearly not the case. Ultimately, rheumatology leadership needs to step up to the plate and see that Sjogren’s gets appropriate attention at all levels of education.




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