Tuesday, 20 Mar 2018

Today's Headlines

Using Synovial Tissue Biopsies to Develop Precision Medicine for Rheumatoid Arthritis

Researchers at Northwestern University have used ultrasound-guided tissue biopsy from the joints to analyze the genes of tissue macrophages with the hope that transcriptional profiling of synovial macrophages may be correlated with clinical parameters or drug responsiveness in rheumatoid arthritis (RA) patients.(Citation source: 

Repeat Malignancy Unlikely with Biologic Therapy

Research from the Danish biologics registry shows that the use of a biologic in patients with a history of a primary cancer does not increase the risk of a second malignant neoplasm (SMN) or mortality in rheumatoid arthritis (RA) patients.

They analyzed 15,286 RA patients in the DANBIO Register between 2000–2011 and found 1678 with a primary cancer.  The majority (1203) did not use biologics after. 

The RheumNow Week in Review - 16 March 2018

Dr. Jack Cush reviews the highlights from the news, journals and major meetings. Bigtime rheumatologic lessons with tales from intestinal crypts, the friendly skies & the hips of hockey players. Also the microbiome and lupus, benefits of ENT findings with GPA and rare risk of opportunistic infections with biologics.

Opportunistic Infections in RA Rare with Biologics

The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis has studied nearly 20,000 patients and observed that there is no substantially different risk of opportunistic infections between different biologics. 

Does Dose Escalation Help in Gout?

Contrary to expectations, dose escalation of allopurinol among patients with gout did not improve survival, a 10-year observational study found.

Bone Marrow Edema Found in SI Joint of Athletes

New research shows that young elite athletes will not commonly manifest bone marrow edema in the SI joint following activity.

A study in Arthritis & Rheumatology  assessed for MRI findings commonly seen in patients with axial spondyloarthropathy (axial Spa). (Citation source: https://buff.ly/2DrlCgB)


A 3rd year medical student started his rotation with me this past week and the rotation was a challenge for us both.

Several years ago, long before promotional lectures, I traveled for a series of lectures. I flew north for 4 days and 4 lectures, 2 at major university programs and 2 dinner lectures to local rheumatologists.

The first lecture went well but the weather turned bad, with a snow storm in the overnight forecast.  Hence my host, a local drug rep, suggested we drive at night to beat the snow and get to the next city for the 10 am University lecture the following morning.

The one-hour drive felt like a week in Cleveland. 

“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle.

What I know and learned is often the subject of blogs on RheumNow. Yet, I’ve always been challenged and irked by what I don’t know.

Angie is my last patient before lunch. I've known her since her RA diagnosis at age 17 years. And for the last 7 years, she’s matured into a fabulous young woman who has adeptly grown her professional life, her dating life and developed her independence, despite her severely active rheumatoid arthritis. But today I see she has a troubled and anxious look as I greet her. 

Almost everyone gets their education about drug-related infection risk from television ads. Rheumatologists should know what the real risks are and educate their patients that they have a higher than normal rate of nonserious infections. But the infection risk is way more related to inflammation than any specific drug risk.

Dr. Alvin Wells: Imaging
Dr. Alvin Wells discusses imaging at the 2018 RWCS meeting in Maui.


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