RheumNow Podcast – Delays in Diagnosis (3.8.19) Save

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com

1. Shoulder replacement surgery - low risk of revision in older women (2.7%), highest (23%) in men 55-59 yrs; Revision highest in the 1st 5 yrs. SAE risk <90d was <4.8%; highest in men >85 yrs (21%). Pulm embolism risk Rel Risk = 61fold in women 50-64. https://t.co/NVSzfgZvwS   
2. Systematic review of Paternal DMARD exposure prior to pregnancy shows no firm evidence of harm with TNFi, ABA, RTX, azathioprine, cyclosporine, HCQ, leflunomide, MTX or mycophenolate mofetil. Data from 84 papers, 611 male exposures, 5986 pregnancies https://t.co/yfIYoMqaRs 
3. Study of 6529 Afib pts on warfarin, 37.5% were also on aspirin. Adding aspirin to warfarin yielded significantly more bleeding (26 vs 20%), major bleeding (5.7 vs 3.3%), ER visits (13.3 vs 9.8%) but similar thrombosis rates (2.3 vs 2.7%) at 1 yr. https://t.co/m5XDBEN6jh 
4. Claims analysis from Natl Taiwan Health Database, compared 262 JIA pts w/ controls & showed JIA pts have 30 fold higher risk of an adult autoimmune dz- Hazard Ratio=129.5 for RA; aHR-10.1 SLE, 49.62 AS & 8.2 PsA. Highest risk (46x) for JIA onset 11-15 yrs https://t.co/oL3stNLYvc 
5. The PARA study shows among 249 pregnancies (2002-2008), breastfeading was less in RA - at 4-6, 12 & 26 wks postpartum 43%, 26% and 9% of the RA breastfed (vs 63%, 46% & 41% in controls). Many patients D/C breastfeeding so they could start medication. https://t.co/ONf1jgFJYL   
6. From CreakyJoints- 20 Things pts wish their Rheums Knew: 1 Fix the Vocab, 2 Dont rush me, 3 Dont sugarcoat, 4 Realistic diet, 5 Listen to me, 6 Dont judge me, 7 Flares last longer than you think, 8 Do a mental check up; AND MORE https://t.co/TuKIn86RNv   
7. QD Clinic - Five Leflunomide Pearls | from RheumNow https://buff.ly/2tUI0ww   
8. A study of 2,369 patients with fibromyalgia showed the mean time from initial complaint to diagnosis was 6.42 years. Comorbidity, younger patient, and older physician age were associated with longer time to diagnosis. https://t.co/mHGIR7C4PW
9. Multiple Delays in Referral of New RA Patients   
10. Biologic Agents have Equal Efficacy in Enthesitis and Dactylitis    
11. Lower Mortality Results from Lower Activity in Lupus
12. RheumNow.live