Wednesday, 22 Jan 2020

TODAY'S HEADLINES

Low Risk of Inflammatory Arthritis in Hidradenitis Suppurativa Patients

JAMA Dermatology reports that after the onset and diagnosis of hidradenitis suppurativa (HS), such patients have a higher risk of certain forms inflammatory arthritis.

QD Clinic - "I Don't Know Why I'm Here" Consult

QD Clinic - Lessons from the clinic The Consult that shows up without a cause - and what to do?

Biosimilars for Rheum Disease: Failure to Launch

The availability of biologic biosimilars has thus far had negligible impact on prescribing practices in the United States, in stark contrast to what has been observed in some European countries, researchers reported.

QD Clinic - Dealing with Non-adherence

QD Clinic - Lessons from the clinic. Today’s clinic topic: Dealing with Non-Adherence in the Clinic.

Steroid-Sparing Effect of Tocilizumab in Refractory Takayasu Arteritis

A controlled clinical trial has shown that giving the IL-6 receptor antibody, tocilizumab (TCZ), to  patients with Takayasu arteritis (TAK) results in clinical efficacy and has a steroid sparing efffect.

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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.
Millennial physicians comprise a wider, diverse population compared to prior generations, including an ever-increasing female physician community. It is estimated that by 2025, 75% of the work force will be millennials.1 This generation grew up in an era of participation trophies and structured childhood schedules, all while watching their predecessors sacrifice work/life balance due to persistent slashing of reimbursement. All of this sets the tone for change.
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Myosin Regulation May Contribute to Anti-TNF Therapy Response: Dr. Elaine Husni
Dr. Husni highlights abstract #1769 as presented at the 2019 ACR/ARP Annual Meeting in Atlanta.
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ISRs are common with biologic use