Why We Built This Course

About Rheum In Practice

There is a severe and worsening shortage of rheumatologists. New patients can wait months for an appointment, and even established patients are finding follow-ups harder to schedule. When someone with rheumatoid arthritis, lupus, or another rheumatic condition has a flare, specialist care often isn't available fast enough, and too many of those patients end up in the ER or urgent care.

The providers who see these patients first, nurse practitioners, physician assistants, and primary care doctors, are increasingly the ones managing early rheumatic care. Rheum In Practice exists to give those providers the practical knowledge to do it with confidence.

This is not theory. It is the day-to-day clinical reasoning two practicing rheumatologists use to evaluate, manage, and know when to refer.

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Meet the instructors

Dr. Tom Rennie and Dr. Jane Ayala are board-certified rheumatologists with over 40 years of combined experience. They built Rheum In Practice from real consults, the same positive ANA referrals and flare-ups they see in clinic every week, so the training reflects what you will actually encounter with your patients.

Meet Jane B. Ayala, MD

Dr. Jane B. Ayala is a Board-Certified Rheumatologist with over a decade of experience in private practice. She is originally from Brazil, and moved to the US in 2002. She completed six years of advanced training at the University of Texas Health Science Center in San Antonio, TX, where she served as Chief Resident/Clinical Instructor.

Dr. Ayala has been nominated by her peers and recognized as a Super Doctor by Texas Monthly in multiple years from 2015 through 2024, and named a Top Doctor as published in Texas Monthly from 2012 through 2014. Dr. Ayala received the National Institute of Medicine’s Award of Honor for Excellence in Rheumatology in 2013. In 2014, she was honored with the Vitals Patient’s Choice Award, and patients consistently recommend her to friends and family.

She was also named a Top Rheumatologist in San Antonio by the International Association of HealthCare Professionals in 2015. Dr. Ayala is a board member of the Central and South Texas Arthritis Foundation and also serves on the board of the State of Texas Association of Rheumatologists. Passionate about her patients, Dr. Ayala is active in her church and enjoys being a soccer fan and soccer mom. She also enjoys playing Pickleball and together with Dr. Rennie have been organizing a yearly Dink for a Cure Pickleball Tournament benefiting the Arthritis Foundation since 2020.

Meet Thomas A. Rennie, MD

Dr. Thomas A. Rennie, Jr. was born and raised in Ponca City, OK. He attended the University of Oklahoma where he obtained a Bachelor of Science in Zoology. He received his medical degree in 1994 from the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine in Bethesda, MD. He completed his Internal Medicine internship and residency at Fitzsimons Army Medical Center in Aurora, CO and Eisenhower Army Medical Center in Augusta, GA. Dr. Rennie completed his Rheumatology Fellowship in 1999 at Walter Reed Army Medical Center in Washington DC. During this time, he also completed a Research Fellowship at the Walter Reed Army Institute of Research. Dr. Rennie is Board Certified in Internal Medicine and Rheumatology.

In 1999, Dr. Rennie was assigned to Brooke Army Medical Center in San Antonio, TX. During his assignment, he served as the Chief of Performance Improvement and Risk Management for the Department of Medicine, Co-director of the Uveitis Clinic and Chief of the Rheumatology Service. After he completed his 16 years of military service in May 2006, Dr. Rennie became a founding partner of Rheumatology Associates of South Texas in San Antonio, TX where he continues to practice. Dr. Rennie’s interests include spending time with his family, especially his granddaughters Lainie and Addie, pickleball, martial arts and all sports and outdoor activities. Dr. Rennie also is a Board Member on the Central and South Texas Arthritis Foundation Local Leadership Board.

Free guide: How to read the Labs a Rheumatologist Orders

A positive ANA is one of the most common reasons patients get referred, and one of the most misunderstood labs in primary care. A positive ANA on its own is like being told a patient has "a car" with no details about the make, model, or whether it'll cause trouble.

This free guide breaks down the labs that turn a vague positive ANA into a clear clinical picture, including:

The ENA panel and what each antibody points to (Smith, RNP, SSA/Ro, SSB/La, Scl-70, Jo-1)
Anti double-stranded DNA and what its specificity and sensitivity really mean
The supporting labs to order before you refer (complement, CBC with differential, urinalysis)
Other causes of a positive ANA worth ruling out