Curbside Consults - February 2016

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The following is a collection of cases presented to me by rheumatology colleagues. Each has a challenging therapeutic or safety issue. Answers are based on experience with references from literature and guidelines.

Challenges of Dermatomyositis Progress

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In the current issue of Lancet, Pierre Miossec discusses the challenges of studying and managing juvenile dermatomyositis and, specifically, the

Transdermal NSAID Touted as an Advance

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Reuters reports that researchers at the University of Warwick have devised a new transdermal drug delivery patch that may change the future of pain management. 

Febuxostat Safe in Gout with Moderate-Severe Renal Impairment

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Renal impairment is a risk factor for gout and a barrier to optimal gout management. Many of the drugs used to treat gout require adjustment in those with renal disease.

Pulmonary Hypertension Earlier and More Severe in Men with Scleroderma

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Pulmonary hypertension is an uncommon complication of systemic sclerosis (SSc) and historically thought to slowly evolve in those with limited scleroderma over many years. 

Only Two-Thirds of US Adults Get Adequate Sleep

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Optimal sleep duration for adults is suppose to be 7 or more hours of sleep each night. Shorter sleep duration (7 hours per night) is associated with greater likelihoods of obesity, high blood pressure, diabetes, coronary heart disease, stroke, frequent mental distress, and death.

RA Flares Common After Anti-TNF Withdrawal

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The risk of a flare increased by more than three-fold over 1 year when patients with longstanding rheumatoid arthritis (RA) in remission, or with stable low disease activity, stopped their anti-tumor necrosis factor (TNF) treatment, Dutch researchers reported.

CBC Hidden Pearls

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CBC…it’s easy as 123! The complete blood count (aka, CBC) is the most routine, but indispensable, of all medical assessments.

ASAS: MRI Definition of Active Sacroiliitis

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Increased use of MRI for diagnosis of spondyloarthritis (SpA) in the last two decades has led to earlier diagnoses and gradual incorporation of MRI into the SpA assessment toolset.

Hidradenitis Suppurativa Increases Cardiovascular Event Risk

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting exocrine glands with painful abscesses in intertriginous areas.

Ultrasound Training Escalates in the United States

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A recent report cites the frequency of musculoskeletal (MSK) ultrasound (US) education in US residency and fellowship training programs.

RWCS 2016 – Periodic Fever and Macrophage Activation Syndrome + Pregnancy in IBD

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Pregnancy and Immune Modulating Therapies

Lupus Flares After Renal Transplant

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Whether lupus activity is ameliorated by end-stage renal disease (ESRD) or transplantation has been debated.

Patient's Out-of-Pocket Costs for New Drugs Sky-Rocketing

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The good news: in 2015 the FDA approved a record number of new drugs (n=45).

The bad news: most new drugs entering the market today have an exorbitantly high price tag.

RWCS 2016 - Updates in AS, PsA and Lupus

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Update on Ankylosing Spondylitis and Spondyloarthritis

Smoking and Age Linked to Development of Inflammatory Arthritis

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A prospective cohort of RA first-degree relatives were prospectively studied for genetic and environmental factors (smoking, body mass index, education, and parity) and RA-related autoantibodies that may influence future development of inflammatory joint symptoms over a 2 year&nbsp

Prescribers More Likely to Escalate to Biologics than Triple DMARD Therapy

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The paradigm for DMARD use in rheumatoid arthritis (RA) begins with DMARD monotherapy and then escalates to combination therapy with either DMARDs or a combination of conventional DMARD plus a biologic DMARD (bDMARD).

RWCS 2016 – OA/OP, Gout, Sarcoid & JIA Reviewed

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Recent Developments in Osteoarthritis, Osteoporosis and Gout

Relapse Common in ANCA-Associated Vasculitis

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Overall survival and survival free of end-stage renal disease (ESRD) have both improved significantly over time in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but the risk of relapse has not.

RWCS 2016 – Rheumatoid Review, Psoriatic Arthritis and Medical Marijuana

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The Rheumatology Winter Clinical Symposia launched its 9th annual conference yesterday in Maui. Highlights of this meeting will be covered by RheumNow from Wednesday 2/10 till Saturday 2/13.

Rheumatoid Arthritis Year in Review