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The RheumNow Week in Review – 28 October 2016

Dr. Jack Cush reviews highlights, news and journal reports from this week at RheumNow.com

  1. A persistant limp in a child is the most common early sign of juvenile arthritis. http://buff.ly/2eDouyw
  2. Hydroxychloroquine hearing loss/ototoxicity - a rare complication that I did not know about! https://t.co/W4JM6mbTKW
  3. Twos tudies suggest RA is associated with 1.5-2 fold increased risk of hearing loss. https://t.co/qMLNbfFdre https://t.co/Kafe628jUI
  4. Panel of neutrophil genes may be highly predictive of TNFi response in RA pts; CMPK2, IFIT1B, and RNASE3 https://t.co/4jjaHdgGgQ
  5. Comparing TB vs Pyogenic spondylitis:TB spondylitis has more extraspinal findings, Hx TB, +IGRA; also more fever, abscess (psoas,vert) https://t.co/IeKPQDY6M9
  6. In Ireland, Pfizer has cut the price of Enbrel to match the price of Benepali - an ETN biosimilar. https://t.co/AKdp5bhHoc
  7. J&J will compete w/ price of Inflectra through a variety of innovative contracting options, discounts & rebates to payers, providers, & PBMs
  8. Rheumatoid nodules almost never ulcerate; but gout tophi DO! Risk factors age, tophus size & no protective sensation https://t.co/kmsnNlRBF2
  9. Everything will be alright in the end; & if it’s not alright, then it’s not yet the end. Dr. Cush blogs on “Prescribing Hope in Medicine” https://t.co/7CHXGJBuuA
  10. Metanalysis 3 RCTs shows starting allopurinol during acute gout attack does not increase pain or prolong attack. https://t.co/XU6CQxBTNU
  11. RA Blacks usually have less Xray erosions; new study shows PAD4/PAD3 Abs found in African-Americans w/ Xray severity https://t.co/CDpUQDbLfa
  12. 5 big Methotrexate Mistakes: Such as taking MTX : 1) daily (instead of weekly); 2) without Folate daily; 3) with renal failure, 4) without routine labs; abd 5) with HBsAg+
  13. Type I diabetes is often assoc w/ other autoimmune Dz, includying Hashimotos, celiac sprue, Graves, RA, vitiligo https://t.co/CHWK3fuXOK
  14. The POSTURE Study finds that Apremilast Fails in Ankylosing Spondylitis. http://rheumnow.com/content/posture-study-apremilast-fails-ankylosing-sp...
  15. Metanalysis of simultaneous versus staged bilateral total knee arthroplasty http://rheumnow.com/content/simultaneous-versus-staged-bilateral-total-k...
  16. Kawasaki Disease Pathogenesis Hinges on Interleukin-1 . New finding that a polymorphism in the inositol-triphosphate 3-kinase C leads to increased NLRP3 inflammasome activity and excess IL-1 in KD patients.
    http://rheumnow.com/content/kawasaki-disease-pathogenesis-hinges-interle...
Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

I enjoy your website RheumNow and your weekly highlights. Old guys like me need to be "spoon-fed". In regards to mistakes with methotrexate, I have 2 concerns: 1. Many people are being characterized as having CKD based on automated chemistry. Calculated GFR's and CrCls indicate stages 1-4. At what point should I be concerned about methotrexate toxicity? Should I get serum or red cell methotrexate levels or use any of the other testing for methotrexate toxicity available commercially such as 5,10-Methylenetetrahydrofolate reductase (MTHFR) ? Is there a "standard of care" in the setting of CKD? 2. Please note that the likelihood of methotrexate toxicity in greatly increased when a patient is admitted to a SNF or other long term care situation where weekly meds are unusual. The staff may change qweekly to qdaily because they think there is a typo error. David S. Knapp, MD (semi-retired)

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