Wednesday, 07 Dec 2016

Today's Headlines

Nonsignificant CV Risk with Actemra vs Enbrel

WASHINGTON -- Rheumatoid arthritis is a recognized risk factor for heart attacks and stroke, but a study comparing two leading biologics found only a non-significant increase in relative risk for patients treated with toclizimab (Actemra) vs etanercept (Enbrel), researchers reported here.

Physicians Still Over-Prescribe Antibiotics, Narcotics and Opioids

A study by the American College of Physicians (ACP) found that physicians continue to prescribe treatments that offer little benefit to patients, despite the advice of clinical guidelines. Overuse of antibiotics, aggressive non-palliative treatment in patients with limited life expectancy, treatment of chronic pain, and dietary supplements may be the most frequently used low value treatment interventions used by doctors.

Key Lessons from the TNF Inhibitor Head-to-Head EXXELERATE Study

The EXXELERATE study is featured prominently in Lancet this week. In some ways, this represents a landmark negative trial that rheumatologists should review and be aware of.

Is ABT-494 the Next JAK Inhibitor?

Tofacitinib may well be joined by a new once daily JAK inhibitor, baricitinib in the next few months.

The RheumNow Week in Review – 2 December 2016

Dr. Cush highlights reports from this week on

CURES Act : House Passes Largest Bill Since Obamacare

The 21st Century Cures Act has become one of the most-lobbied health care bills in recent history, with nearly a half billion dollars being spent on both sides - those for and against the bill.

The bill is supposed to streamline the approval process of prescription drugs and medical devices by the FDA.

Statins for the Treatment of Osteoporosis

Can statins be used to treat osteoporosis?
Osteoporosis is a major health problem worldwide.

ASDAS Activity Correlates with Xray Progression in Spondyloarthritis

Investigators analyzed a prospective study of patients with early axial spondyloarthritis (axSpA) to assess predictors of outcome.

Poddubnyy and coworkers studied 178 patients with definite axSpA and serially assessed disease activity using the Ankylosing Spondylitis Disease Activity Score (ASDAS) and radiographs to detect spinal progression.

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.
Many readers of RheumNow know of my interest in the history of our discipline, and some of the writings and discoveries which have resulted from them. In the past three years, I have had the opportunity to explore the contributions of Max Hirsch, MD to our field.
Is the microbiome influenced by wines "terroir" (“the complete natural environment in which a particular wine is produced, including factors such as the soil, topography, and climate”)? Len Calabrese believes so.
The ACR Annual Meeting (#ACR16) is such a huge event that it’s worth your time to spend an hour or two planning your time at the meeting. Here's my tentative #ACR16 session schedule.
Everything will be alright in the end; and if it’s not alright, then it’s not yet the end. – Suni Kapoor (from the Best Exotic Marigold Hotel)
Dr. Greg Silverman - The Disconnect Between Autoimmunity and Inflammation
Dr. Greg Silveman from NYU discusses his #ACR16 Abstract #585 that examines the number of CCP specific memory B cells and if this correlated with RA disease activity (DAS28)

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When do you primarily use IL-17 inhibitors (secukinumab)?