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RheumNow Weekly Podcast – 3 Wiseguy Rheumatologists (11.9.18)

d Jack Cush, MD

Dr Jack Cush reviews the News and Journal reports from the past week on RheumNow.com.  Be sure to check out our upcoming meeting in March 2019 - RheumNow Live.

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Intensive Patient Education Does Not Improve Low Back Pain Care

d Jack Cush, MD

JAMA reports on a randomized clinical trial of 202 adults with acute low back pain showing the addition of intensive patient education failed to improve pain outcomes.

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E/M Guidelines: Right Road, Wrong Direction

d RheumNow

Last July, the Centers for Medicare & Medicaid Services (CMS) proposed new E/M guidelines for office visits with physicians. It issued the final guidelines on November 1, with a few tweaks.

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Should Immunoglobulins be Monitored with Rituximab Use?

d Jack Cush, MD

Boston researchers have found that in a large cohort study of patients receiving rituximab (RTX), most were not being monitored for hypogammaglobulinemia, despite the observed significant increase in severe infections and increased mortality in RTX treated patients.

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Musculoskeletal Events with Statin Use

d Jack Cush, MD

Analysis of the FDA Adverse Event Reporting System data examined the association between statins' musculoskeletal adverse events (MAEs).

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Guidelines for Patellofemoral Pain

d Jack Cush, MD

New recommendations have been published in the Journal of Athletic Training on the management of patellofemoral pain (PFP).

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IgG4-Related Disease: First Draft Criteria Presented at ACR 2018

d Brittany Ahmed, MD

As Dr. John Stone, MD, MPH recounted in his presentation regarding the new ACR/EULAR Classification Criteria for IgG4-Related Disease (IgG4-RD), only 15 years prior, IgG4-related disease was an unknown entity in the medical community.

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Metanalysis of 10 studies and 204 RA patients suggests that during pregnancy disease activity improved in 60% of patients but flared post-partum in nearly half (47%). https://t.co/DHeY4rgKu1

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up - 3 Wiseguy Rheumatologists. Watch it here https://t.co/WudWQPRtXl or listen on iTunes or here https://t.co/OOJ0e2IG0L

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Dr. John Cush RheumNow ( View Tweet)

Frankincense is derived from Boswellia plants. Boswellia serrata is an Ayurvedic purported to be anti-inflammatory; inhibits 5-lipoxygenase & possibly prostaglandins, Pilot studies in OA have shown significant pain relief and improved physical function https://t.co/OPxal73aIF

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BMJ metanalysis of toxicity w/ checkpoint inhibitors shows risks w/ atezolizumab (hypothyroid, N/V) , pembrolizumab (arthralgia, pneumonitis, hepatic tox), ipilimumab (skin/GI/renal), nivolumab (milder, endocrine); Nivolumab (best safety w/ lung CA) https://t.co/qzcehpLe4S

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What works in Dactylitis? Literature review suggests ustekinumab, ixekizumab, adalimumab, and apremilast are efficient. Secukinumab, clazakizumab, abatacept, and tofacitinib were promising. Brodalumab was ineffective https://t.co/SLPcjBaNAv

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Analysis of Natl Inpatient Sample database (1998-2014) compared outcomes in 87605 SLE pregnancies vs matched cohort: found SLE had more C-section, IU fetal death, Pre-eclampsia, VTE, CKD, HTN, longer stays Presented by Dr. Bella Mehta #ACR18 Abst 1852 https://t.co/iYicIbOlxP

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Durkan Test for CTS is when the Examiner presses the thumbs over carpal tunnel and holds pressure for 30 seconds. The onset of pain or paresthesia in the median nerve distribution within 30 seconds is a positive result . https://t.co/1wlJWzX68H
Dr. John Cush RheumNow ( View Tweet)
Do you know who patients perceive to be a "great doctor"? Just listen - its always someone who shows they care and/or someone with a personality. Dispassionate, know-it-all service isnt well received!

Dr. John Cush RheumNow ( View Tweet)

Study of 512 pts shows when testing for Carpal Tunnel syndrome Thenar atrophy & sensory loss were highly specific, but thenar atrophy had lowest sensitivity (22%) & Durkan test highest (96%). Tinel had lowest specificity 40.9% and NPV 59.1%. https://t.co/Wi8qxNSxIg

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Korean claims data analysis shows intestinal Behcets disease is associated with a 24-34 fold increased risk of hematologic malignancy (esp leukemia, myelodysplasia) vs population. BD Women not men) have an overall higher cancer risk (SIR 4.27) https://t.co/Ik6KdEGz7u

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N of 1 trial of On-Demand Sildenafil in Raynauds (multiple crossovers in single patient) shows in 38 pts there was a 90% chance of response w/ sildenafil superior to placebo; but substantial heterogeneity of patient responses limits the clinical relevance. https://t.co/FCllFm1FLR

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JAMA Metanalysis shows there is limited evidence showing the benefit of reduced dietary salt intake in heart failure patients. https://t.co/EsxApEUsbe

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Survey of 686 physicians (Internists, Cardiology, Endo) shows 72% report financial tie to industry. Most common free drug samples (55%), food/beverage (48%), consulting (4%), or scientific advisory board (3%). https://t.co/qV5zAfXaBo

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