Last week I received a request to let my readers know about AbbVie’s Rheumatology Scholarship.  To be honest, I’ve struggled with this.  My daughter was already working on the application.  She has a better shot at a scholarship that has few applicants than if there are zillions of applicants.  Do I really want everyone to know about this opportunity?  Since you’re reading this post, you realize that I decided to go ahead and help spread the news.

There are fifteen $15,000 scholarships available to students seeking degrees from either college or trade school.  To be eligible, the student’s doctor must confirm diagnosis of either RA, JIA, PsA, or AS.  More details can be found in the message AbbVie sent:


Did you know students living with a rheumatologic disease like rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) face unique challenges as they pursue their higher education goals? These students have a higher prevalence of short-term school absences when experiencing symptoms. According to one study, over 90% of students with rheumatologic disease seeking treatment at a rheumatology center reported missing school an average of 3.9 days during a two month period compared to the national average of 1.1 days.1

AbbVie recently launched the AbbVie Rheumatology Scholarship, which is designed to provide financial support for exceptional students living with RA, JIA, psoriatic arthritis (PsA) or ankylosing spondylitis (AS), as they pursue their higher education goals. Our hope is that this scholarship will further empower patients to reach their educational goals.

Below is a brief overview of the scholarship for your reference.

AbbVie Rheumatology Scholarship Overview

  • The scholarship is available to students living with RA, JIA, PsA or AS, who are seeking an undergraduate or graduate degree from an accredited United States (U.S.) university/college or trade school, and who plan to enroll for the 2016-2017 school year.
  • Fifteen Rheumatology Scholars will be selected. The award value will be $15,000 for each recipient.
  • Applicants will be judged based on academic excellence, community involvement, written response to an essay question and ability to serve as a positive role model for the rheumatology community.
  • Key dates and deadlines include:
    • Applications are available on
    • Applications must be submitted by April 4, 2016.
    • Winners will be notified by April 29, 2016.
  • More information on the AbbVie Rheumatology Scholarship, the application process and eligibility criteria can be found at


RA is a Risk Factor for Osteoporosis

Osteoporosis is silent. People’s bones can gradually become weaker and weaker with no outward hints that there is a problem — until suddenly bones break.  Spontaneous compression fractures of the spine can be quite painful and lead to deformity, chronic pain, and premature death.  Broken hips are another risk factor for early death — approximately 20% of people with a broken hip die within one year of the fracture.

In an ideal world, osteoporosis would not occur.  In theory, osteoporosis is entirely preventable.  Since we don’t live in an ideal world, it is crucial that osteoporosis be identified early and treated aggressively.

DEXA is the gold-standard in osteoporosis testing.  DEXA scanners (Dual-Energy X-ray Absorptiometry) (also called DXA) use two separate very low-radiation x-ray beams – about 1/10th the radiation of standard x-rays — to image the hips and spine to measure bone mineral density.  As we would expect from the “dual energy” portion of the name, these two x-ray beams have different energy levels.  Bone mineral density is calculated by measuring the difference between what is absorbed from the first beam and the second.

Test results will provide a variety of numbers.

  • Bone Mineral Density
  • T-Score
  • Z-Score

Bone Mineral Density (BMD) is a raw number indicating the average concentration of minerals in your bones. The higher the number, the higher the bone mineral density and the stronger the bones.  Lower numbers indicate weaker bones.

T-score and Z-score are based on statistics.  Compiling the results from many people has allowed scientists to determine what is normal bone mineral density, and what constitutes strong or weak bones.  Graphing the data forms a picture shaped somewhat like a bell.

A brief aside about statistics:  in statistics, the mean is the average — it tells us what is normal. The standard deviation tells us how far away something is from what is normal. 68% of all data will only deviate slightly from the average (will be within one standard deviation of the mean) — this makes sense because obviously most things should be close to what is normal. On a bell curve (pictured below), the mean does not deviate at all from what is normal, thus the center of the curve deviates zero (labeled 0), and most of the data clusters close to the middle — one standard deviation is labeled +1 (above zero) and -1 (below zero).  95% of the data will be within two standard deviations of the mean (labeled +2 and -2), and 99.7% of the data will be within three standard deviations of the mean. It is very rare for something to deviate significantly from what is normal.

T-score and Z-score numbers indicate standard deviations from the mean on a bell curve.  A T-score compares your BMD with healthy young adults who have good bone mineral density.  A Z-score compares your BMD with others of your age and ethnicity.  Doctors are most concerned with the T-score.


A bone mineral density scan T-score that is more than one standard deviation below the mean is bad. Between one and 2.4 standard deviations below normal is osteopenia, while a T-score of 2.5 or more standard deviations below the mean is osteoporosis.

Who should get a bone density scan? The general rule is women at age 65 or men at age 70.  Before age 65, the test is only considered if you have risk factors, and if treatment would occur based on test results.  If you wouldn’t be treated, there’s no point in having the test done.  Bone density scans are rarely done on premenopausal women; until menopause, high estrogen levels seem to provide protection against broken bones even in people with low bone mineral density.  The question is, what are the risk factors?

Rheumatoid arthritis is just one of many risk factors for development of osteoporosis.  Other risk factors include:

  • history of taking 5mg or more of corticosteroids for more than three months
  • taking methotrexate (other meds, too)
  • family history of osteoporosis
  • history of an immediate family member with a fragility fracture
  • history of bone fracture as an adult
  • loss of height
  • weight of less than 127 pounds
  • being a smoker
  • menopause
  • eating a diet low in calcium
  • avoiding sunlight (indicative of low vitamin D production)

Given these risk factors, it is no surprise than rheumatologists refer patients for bone density scans.

Everything published about DEXA says that it is painless.  This information is obviously prepared by people who have never had the test.  Although it is technically true that the x-rays themselves do not inflict pain, before the scan is taken you’re strapped to a table in an uncomfortable position and required to stay tied down for the duration of the 15-20 minutes of the test. Although the average person might not be physically injured by the scan, it is inaccurate to say that the test is painless.  More accurately, the test is uncomfortable, but not unbearable.

After the test is complete, the referring doctor will receive a report showing your Bone Mineral Density, your T-score, and your Z-score.  Your report might also include use of the World Health Organization’s Fracture Risk Assessment Tool (FRAX) . This attempts to calculate a person’s probability of fracture within the next ten years with the goal of frightening patients into taking osteoporosis seriously.  A 28% risk of fracture within ten years is about 2.8% per year.  2.8 doesn’t sound nearly as scary as 28%, though, thus the use of ten-year risk estimates.  If you click on the link, select “calculation tool” and then select your continent/country and complete the questionnaire.  The calculation can be made either with or without results of a bone density scan.

Avoiding Holiday Flare

Flare — dramatic worsening of RA symptoms — seems to occur at the worst possible times. That’s because triggers include stress and overwork.  We have two weeks until Thanksgiving, so unless our goal is to flare badly and miss out on all the festivities, a bit of advance planning is needed. Don’t wait until the last minute; start the work now.

Menu Planning

Write out your menu.  A few years ago, I realized that our menu was way more food than what we really needed.  I have no idea why it took me so long to recognize that we were serving two full feasts. My pared-down menu requires about half the work. Nobody feels deprived (that’s why there are still rolls on the menu) and it’s way less work to clean up.  Do whatever works for your situation.


Next list all the ingredients that will be needed to prepare your menu.  This should eliminate running out of ingredients and needing to make an emergency run to the store.  Here is my list; you’ll generate your own based on your specific menu.

Click to enlarge

Click to enlarge

Make things easy for next year!  Type your list and save it in your computer; you’ll be able to find it next year. You can even slip a holiday notebook onto your cookbook shelves so that the same menu and grocery list can be used every Thanksgiving (and Christmas, if you’re like me).

Check this required-ingredient list against your pantry to determine what you need to get at the grocery store. Don’t wait until next week.  Now is a good time to take care of getting your menu planned and your grocery list made.  Obviously you won’t want to buy vegetables this soon, but everything else can be done now.  Spreading out the work a little-bit-at-a-time helps to minimize RA flares.

Menu Prep

Delegate!  Just because you’re hosting an event does not mean you have to provide all the food and do all the work.  My mom is diabetic, so she is in charge of bringing the cranberry relish that she loves and wants instead of my cranberry sauce.  The person who’s celiac is in charge of the GF dinner rolls so that she knows they are safe for her to eat.  Another person is asked to bring drinks.  Green salad is another thing that’s easy to delegate.

Copy your menu, then work out a schedule of when those things should be prepared.  Mine is provided below as an example.  How much can be done in advance? The turkey needs to be roasted on Thanksgiving day, but almost everything else can be done ahead.



Everyone’s standards of cleanliness are different. Mine are generally, “clean enough to be healthy; messy enough to be happy,” so I do a little extra right before the holidays. No matter what your personal standards are, if you try to clean your entire house the day before company comes, you’re going to flare and miss out on the fun of having people over.  Spread the work out over the next two weeks so that everything gets done without you wearing yourself out. I do a scaled-down spring-cleaning in the fall to get ready for holiday company.


Getting it All Done

Choosing a couple jobs a day makes all the cleaning and meal prep realistic instead of flare-inducing.  Make yourself a little calendar and spread the jobs out over the weeks leading up to Thanksgiving.  Here’s my plan:


Click to enlarge

This lets me do just a few jobs each day so that I’m not too tired, and it gets things done Thursday morning with minimal effort. I’m able to sit and visit with family and friends instead of rushing around, stressed about getting everything done.

Serving the Meal

Gone are the days of multiple serving dishes so that both tables are set completely.  Gone are the days of taking forever to fill everyone’s glasses.  Gone are the days of taking two hours to clean up after dinner.  Life is so much easier now!  I serve Thanksgiving dinner buffet-style.  The plates go in a pile on the counter. People get their own drinks. The food is arranged so that everyone can walk through the kitchen to fill their plates, then head to a table to sit and eat.  The table isn’t too crowded; there isn’t a side-board set up to hold the salad and dressings that won’t fit on the table.  Cleanup goes much faster with half the serving dishes.  It’s much less work this way and everyone still enjoys a nice meal together.

Thanksgiving, like the rest of life with RA, goes much more smoothly when we learn to pace ourselves.