Wednesday, 19 Feb 2020

TODAY'S HEADLINES

BSR Guidelines for Giant Cell Arteritis

NICE has commissioned an update to the 2010 British Society for Rheumatology guideline for the management of giant cell arteritis, and proposed a total of 19 recommendations for the diagnosis and treatment of GCA.

Primary Care Visits Decline 2008-2016

A national claims-based analysis has shown a consistent decline, by commercially insured adults (18-64 yrs), in primary care physician visits from 2008 to 2016; with nearly one half having no PCP visits in a given year by 2016. 

Efforts to contain costs and improve clinical outcomes often center around coordinated medical care through PCPs.

RheumNow Podcast - RWCS Quick Hits (2.14.20)

Dr. Jack Cush reviews the highlights from the 2020 RWCS meeting in Maui, Hawaii.

PEXIVAS - Plasma Exhange Fails to Boost Outcomes in Severe AAV

The PEXIVAS study showed that plasma exchange did not reduce the incidence of death or ESKD in patients with severe ANCA–associated vasculitis.

Shingles Vaccine Lowers Risk of CVA

Shingles infection has been historically linked to an increased risk of stroke. A new study found that Zoster Vaccine Live, one type of shingles vaccination, may prevent stroke in some older adults.
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While the ACR prepares to publish its new guidelines for the diagnosis and management of vasculit

It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.
The House of God is probably more known of than read, with over 3 million copies sold since its release when I was a Chief Medical Resident in the era of its writing. The book itself, according to the author Samuel Schem (aka Steven Bergman, MD, DPhil), a psychiatrist and currently Professor of Humanities at NYU, is a true account of his internship, albeit laden with some liberties of fiction - and it's been quoted for generations. The House of God is cruelly funny and portrays many uncomfortable and dehumanizing aspects of medicine, including substance abuse, bawdy sex (and lots of it), sleeplessness, depression, and suicide to name a few. Taken at face value, it would seem countercultural to our current aspirations of putting patients first, #MeToo and burnout concerns. Is this book merely a humorous anachronistic rant, or a serious work of reflection meritorious of being read and pondered upon?
It’s hard work wearing a crown. The dermatologists have been dethroned as Medscape’s happiest specialty after years at the top. While studies only detail that we are the most satisfied outside of work, I argue we are the happiest working, too. With an N of 1, here are my 10 observations.
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QD Clinic - Weighty Decisions in RA
Weighing Decisions on Drug D/C, Weaning, Add-ons, etc
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