Friday, 20 Jan 2017

Today's Headlines

Who Is At Risk to Lose Insurance if the ACA is Changed or Repealed?

If Congress changes or repeals the Affordable Care Act (ACA), which adults are at risk of losing health insurance? A new research letter published online by JAMA Internal Medicine reports on their socioeconomic characteristics, rates of chronic disease and health care use compared with adults covered by employer-sponsored health care who are unlikely to be affected by changes in subsidies on the exchanges or to Medicaid.

EULAR Revised Recommendations for Fibromyalgia

The European League Against Rheumatism (EULAR) recommendations for fibromyalgia (FM) management were published in 2007 and largely had recommendations based on expert opinion’. These guidelines were updated in May of 2015 after a systematic reviews and meta-analyses of the data.

Consensus Guidelines for Juvenile Dermatomyositis Management

SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) was established in 2012 to optimise the diagnosis and treatment of several pediatric diseases. They have recently published their recommendations regarding the diagnosis and management of juvenile dermatomyositis (JDM).

Dietary Intake Triggers Inflammation

IL-1β, along with pancreatic insulin, helps regulate blood sugar levels, as well as chronic inflammation.

Patient and Provider Education Fails to Improve Osteoarthritis Outcomes

A randomized trial of 537 knee osteoarthritis (OA) patients in the Duke Healthcare system has shown that patient- and provider interventions were no better than the usual standard of care.

Rituximab Effects on ANCA, IgG and Infectious Risk in ANCA-Associated Vasculitis

Rituximab has significantly changed the management of patiehts with ANCA-associated vasculitis (AAV). Yet the longitudinal assessment of such patients needs to be guideded by clinical and laboratory parameters.

A multicenter, retrospective study assessed the effect of rituximab on autoantibodies and immunoglobulin levels, and clinical outcomes in 239 AAV patients.

PPIs Reduce Post-Hip Fracture Mortality

The association between the use of proton pump inhibitors (PPIs), osteoporosis (OP) and OP-related fragility fractures has been a topic of ongoing discussion in rheumatology community.

The RheumNow Week in Review – 13 January 2017

Dr. Jack Cush reviews highlights from this past week on

In the years to come, the availability of numerous new IL-6 inhibitors it will either complicate treatment decisions, alter existing treatment paradigms, or result in an all-out war against TNF inhibitor dominance. Data, differences and time will tell.

Recently, I went to one of my patient’s funeral. It was sad.

I got onto flight #610 from Atlanta to Dallas the other day and was greeted by a flight attendant in first class. After introducing himself, he said, “That’s my name and you can imagine how it’s gone for the past 25 years.”
I’m sitting with a patient discussing moving to an advanced therapeutic (i.e., medication that costs a lot of money). I started thinking about what I would choose and given my busy lifestyle a quick injection or tablet would seem preferable to an intravenous infusion. I assume that my patients are probably like me and would make similar choices. I am a little taken aback when this patient chooses an IV medication. She tells me her rationale in terms of her feelings, ideas, fears, and expectations and it makes complete sense. I may have misjudged her and without asking may have suggested a treatment that would not have been the best for her in terms of her lifestyle or beliefs.
In my last article, I said that coffee, not wine, would be the libation of choice for rheumatologists. Why coffee? you may ask. After all, the language of coffee is not dissimilar to that of wine and writers of coffee (as well as the label descriptions) use the same vocabulary and analogies as does the writing about wine. Often, from the description-with words like spice, cocoa or nuts-it is not clear whether the beverage is a Cotes-de-Rhone or an Americano. Certainly coffee is better hot than cold and appropriate for all meals although some argue that champagne can be quaffed all day long.
In my experience, rheumatologists are very fine people. Since they are cognitive specialists, they are scholarly, thoughtful and prudent. Furthermore, they are sensitive to the vicissitudes of human existence. Rheumatology is probably the first subspecialty to consider the impact of a chronic painful illness on the spirit and soul and emphasize quality of life as an outcome. Seeking wisdom and knowledge from great minds, rheumatologists are also interested in culture, mindful that masters like Renoir and Klee were among their patients.
Following the November elections, there are now 29 states and the District of Columbia that have legalized marijuana (aka cannabis) for medical use. Of these, eight states and the District of Columbia have also approved laws legalizing marijuana for recreational use. Regardless of the stated benefits associated with marijuana use, there are potential health risks. One of these which rheumatologists may see more of in the future is cannabis arteritis. The following is a recent case we saw at the University of Colorado.
Dr. Arthur Lau: ACR's guidelines on management of glucocorticoid-induced OP
Dr. Arthur Lau reviews the recently released ACR guidelines on the management of glucocorticoid-induced osteoporis, and offers his comments, as presented at the 2016 ACR/ARHP Annual Meeting.

Daily Download

DMARDs Under Study for Secondary Prevention of Cardiovascular Events