Dubai Rheumatologist

28/07/2025

23/07/2025

One day I will write a book titled:
"The Closing of the Doctors' Minds: How the Misuse of 'Classification Criteria' as 'Diagnostic Criteria' in Clinical Practice Contributed to the Suffering of Thousands of Patients."

In clinical practice, we've witnessed a growing misuse of classification criteria — tools originally designed to create homogenous study populations — as if they were meant for diagnosis. This misunderstanding has closed many physicians’ minds, leading to delayed diagnoses and unnecessary suffering for countless patients.

One of my mentors in Wisconsin used to say something so simple, yet so wise:
"If it looks like a duck, swims like a duck, and quacks like a duck, then it's probably a freaking duck."

Yet, somehow, many of us have forgotten this basic clinical intuition.

Just recently, I saw a patient with recurrent neurological symptoms and progressive disability. I told him, "I'm not a neurologist, but you strike me as a textbook case of MS (Multiple Sclerosis)." He nodded — and said that two neurologists had already told him the same.
But both refused to make the diagnosis.
Why?
Because he didn’t meet the criteria.

That is insane.

We see this all the time in rheumatology, too — patients suffering for years because they don't "fit the criteria," even when the clinical picture is obvious.

Let’s be clear: classification criteria were never meant for clinical diagnosis. They were developed to ensure consistent inclusion in research studies. Using them as diagnostic tools in practice leads to both under-diagnosis and over-diagnosis.

It’s time to stop the madness.
We must reclaim clinical reasoning, trust our judgment, and remember that patients don’t always read the criteria before they show up in our clinics.

07/08/2022

Important notice for those who may be suffering from an autoimmune lung disease.

Some of these diseases can be treated with Nintedanib (which can be life saving)

The original brand cost is $4250 per month (and should be taken for several years)

An Indian generic exists for around $50 per month.

Check with your doctor if this medicine suits you.

18/07/2022

We continue to see from time to time, significant kidney damage in some patients, due to "supplements" and "nutritional support" like "protein shakes", most likely due to tainting with melamine like in the infamous milk scandal that resulted in kidney injury in thousands of children, and even death in some.

STOP these "poisons".

The 2008 Chinese milk scandal was a significant food safety incident in China. The scandal involved Sanlu Group's milk and infant formula along with other food materials and components being adulterated with the chemical melamine, which resulted in kidney stones and other kidney damage in infants. T...

20/04/2022

One of the common problems we have in rheumatology is that a significant number of patients who have inflammatory arthritis will present with COMPLETELY normal blood tests and X-rays, and sometimes will ALWAYS have normal blood tests, so they are told “all labs and X-rays are normal so no disease exists” resulting in a long delay of the diagnosis, causing a lot of suffering for patients, and resulting many times in serious damage to their joints.

So the message is “Inflammatory arthritis CAN be present even with COMPLETELY normal blood tests and X-rays"

28/01/2022

If you have joint pain that is worse and/or associated with stiffness after rest or in the morning, and if you have swelling of any of the joints, you most likely have inflammatory arthritis, EVEN if ALL the labs are normal.

This misunderstanding by some doctors (that labs should always show something in inflammatory arthritis) is resulting in unnecessary suffering and damage to the joints of a lot of patients.

22/01/2022

This Omicron is spreading like a wild fire, and it WILL infect at least HALF of the world population in a few months, including even a high percentage of the "properly" vaccinated (though their disease will be less severe, and the chance of death much less), so the question is: would Omicron be the "mild" fire that extinguishes the "bad" fire, by creating a "useful" level of "herd immunity", that may never be achieved by the vaccine alone due to low vaccination rates in most of the world.

Fingers crossed.🤞

16/01/2022

Why do some apparently "completely healthy" people die of COVID-19.

Research has shown that some people have rare genetic abnormalities causing deficiency of interferon alfa (alpha) activity, which is a significant factor in fighting the virus.

Others have "acquired" auto-immune conditions, where their body produces antibodies against interferon alfa that stop it from working against the virus, so their body is preventing their body from fighting the virus. (Like some patients who received interferon as a treatment for hepatitis then their body started producing antibodies against it)

There are undoubtedly other factors that the research will show in the future, but the above is something that we already know.

Still, the BEST way to reduce the risk of COVID-19 disease, is to stay up to date on vaccination with a good vaccine and with boosters.

15/01/2022

The vast majority of "supplements," "herbals," and "naturals" are nonsense, with no beneficial effect or just minimal impact, and in many cases, they are harmful.

There are, however, few exceptions; one of these exceptions is fish 🐠 oil, which is one of the best treatments for high triglycerides (but with mixed but limited effect on cholesterol), and it also most likely has some benefit for the heart and maybe for some inflammatory conditions.

Also, one of the possible benefits is that it may act as a mild anticoagulant, like aspirin. (Actually, some experts warn that taking too much may predispose to bleeding)

Taking one capsule (1000 mg total every day) is a good idea unless there is an allergy or other contraindications.

12/01/2022

Quick tip for “rheumatism” patients:

If you have one of inflammatory arthritis diseases (inflammatory rheumatism) and the disease is not controlled enough on the “old” non-expensive medicines and you were told you need one of the “EXPENSIVE” medicines, but you cannot afford it; check with your doctor if Tofacitinib is appropriate for your case, since the generic in India cost 3% (3 percent) of cost of the original. (and many of the “original” medicines actually get their active ingredients from India and China.)

30/12/2021

Omicron is actually acting like a "new" pandemic, that is more contagious but less severe (mild to moderate symptoms in those who received 2 doses of a good vaccine), but a BOOSTER is a must to avoid the low but real possibility of hospitalization or death, in addition to all the usual precautions.

Act now, get your BOOSTER ASAP.

02/12/2021

Quick tip.

COVID-19 booster side effects:

When my patients were getting the initial vaccination, I advised them to take paracetamol/acetaminophen 500 mg, 2 tablets 3 times a day, to be started 1 day before the shot, and to continue for 1 week after, to minimize side effects, since few patients (and my son) reported fever and body ache following the second shot (in a sense these were signs of the immune system response)

I would say it applies more after the booster, since I am feeling slightly feverish, and having some body ache even with paracetamol. (A small price for the huge benefit)