Friday, 26 Aug 2016

Today's Headlines

Adalimumab Controls Non-Infectious Uveitis in VISUAL II Study

It has long been observed that patients receiving monoclonal antibody based anti-TNF (TNFi) therapies for spondylitis or psoriatic disease have less inflammatory eye complications, such as uveitis. These agents have become common interventions based on these observational results. But now we have randomized controlled trials to prove the efficacy of TNF blockade in non-infectious uveitis.

Drug Use Compounds Risk - Before and After Fragility Fractures

Is the occurrence of a fragility fracture a missed opportunity to reduce exposure to prescription drugs associated with fracture risk?

Patients who experience a fragility fracture are at increased risk of experiencing another one and may require more meds that may compound the fracture risk.

Risk of Sepsis or Death Lower with Biologics in Rheumatoid Arthritis

Researchers from Germany have analyzed their large prospective rheumatoid arthritis (RA) registry to address whether being on biologic therapies leads to poorer outcomes - namely sepsis or death, following a serious infection (SIE).

Knuckle Cracking Good News

Researchers from the radiology department at University of California, Davis Health System have studied the phenomenon of knuckle cracking by simultaneously recording audio and ultrasound imaging from 17 women and 23 men. The group included 30 habitual knuckle crackers and 10 who were not.

Some individuals cracked their knuckles up to 20 times per day for the past 40 years.

RheumNow Week in Review – 19 August 2016

Dr. Cush reviews the highlights in rheumatology for the week ending 19 August 2016.

ARCTIC Study Shows No Benefit to Ultrasound Remission in RA

The goal in rheumatoid arthritis (RA) treatment is remission. But what level or method of remission is best? Using clinical parameters, there are numerous definitions of remission to choose from (ACR boolean, CDAI, SDAI, etc.) and not all measures perform equally when applied to the same patients.  

Remicade Patent Infringements Denied: Opens Door for New Biosimilars

A U.S. court has affirmed its decision that the patent for Johnson & Johnson's drug Remicade is invalid. This new ruling favors the intent of Celltrion and Pfizer, who are seeking to bring their biosimilar versions of infliximab to market in the near future.

Remicade has been Centocor's (J&J's) best selling product, with $6.6 billion in sales last year. The drug's patent will lapse in September 2018.

When I was just a lad in the 1950s, I used to enjoy a television quiz show called “Name that Tune.” This popular show, which was hosted by an amiable singer and comedian named George DeWitt, had a premise that was simple but appealing. The studio orchestra would start playing the notes of a song and the two contestants would compete to see who could identify the song first, running across the stage “to ring a bell and name that tune.”
You write the prescription, hand it to the patient and explain why it’s needed, how to take it and what the most common or most dangerous side effects might be. Comprehensive, reasonable, and professional. Certainly the patient should fill the prescription and start the drug.

Surely you've heard the phrase “eat the frog first”.

My NP is not only a great nurse, counselor, rheumatologist, complex disease manager, joint injector, diabetes expert, clinic leader, mother, wife, and friend – she’s the go to person if you’re a patient, coworker, colleague, cousin or neighbor. She is one of few great partnerships in my entire career. To go to battle with a NP at my side gives me a tremendous daily advantage.
Should you assess your patients' “purse-onality? The purse exam is an important part of the physical that can help make the diagnosis and improve patient outcomes. I often wonder if downsizing the purse should be part of the T2T (treat to target) initiative.
You are in good company if you find the alphabet soup of rules and regulations impacting your practice a bit overwhelming. MU, ICD10, MOC, VBM, MIPS, APM, PQRS, ACO,’s enough to trigger fantasies of early retirement among even young rheumatologists. But don’t despair!
The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.