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The RheumNow Week in Review – 21 April 2017

Dr. Jack Cush reviews highlights from the past week on

  1. Long term followup of RA pts on Norfolk registry demonstrate better SURVIVAL when DMARDs are started early (<6 mos)
  2. How Pfizer makes most of its $52.8 billion in 2016 - Surprisingly most from Prevnar 13 at $5.7 bill/year!
  3. Neutrophil to Lymphocyte ratio useful in assessing SLE w/ lympho/leukopenia from Rx or SLE? High (>2) w/ Dz activity
  4. Acute Arthritis study shows ultrasound gout findings show sensitivity/specificity for 1) double contour 42/92%, 2) Intraarticular aggregates 58/92%, and 3) tophi 40/100.; all with a PPV 88-100%
  5. In animal models, high fat, high carbohydrate diet (junk food) promotes cartilage damage and osteoarthritis.
  6. Corrona study 1,567 PsA shows patients w/ dactylitis or enthesitis had more Dz activity, Pain, Fatigue, low work,HAQ
  7. Osteoarthritis Initiative 4367 pts shows 15% w/ recurrent falls, increased by 22-25% w/ opioid or antidepressant use
  8. Lyme disease hits 2016 record high in Maine; 1464 cases, up by 21% from 2015. Most increased Penobscot Co since 201…
  9. Data from OP/OA mtg in Italy says Knee Osteoarthritis is associated wth a 13% higher risk of developing hypertension (P=.03)
  10. Norway population study shows self-reported dx of RA & AS highly inaccurate, 19% RA, 16% AS verified by hosp records
  11. FDA Delays Baricitinib Decision
  12. The Cost of Not Taking Medicine
  13. Anti-IL-23 Therapy Effective in Crohn's Disease
  14. Paradoxical Toxicities with TNF Inhibitors
The author has received compensation as an advisor or consultant on this subject

Rheumatologists' Comments

I am working in locum in Wisconsin and note that the EHR frequently lists a "problem" (not diagnosis) of Lyme disease. The majority of such patients have poorly documented disease manifestations with non-confirmatory serologies upon repeat or Western Blot. The majority are "diagnosed" and empirically treated in the ER or urgent care setting by a primary care doc based on non-specific complaints (when I started practice in 1978 such patients were labeled "chronic brucellosis", now they are labeled "chronic Lyme disease). Hence I am slow to accept any "reports" regarding the incidence of Lyme disease. More likely its the incidence of mis-dagnosis of Lyme disease. A + PPD does not equate to active TB (only exposure), and +serolgy for Lyme does not equate to active disease, only expoure to B. Bergdorfi.

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