The Medscape’s Physician Lifestyle & Happiness Report 2019 crowned rheumatologists as the happiest subspecialists. We topped the list with 65% of the respondents indicating that they were happy outside of work.

Dr. Jack Cush presents his favorite abstracts and presentations from Rheumatology Round Up and ACR 2019.

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

A Spanish prospective cohort of active, uncontrolled gout patients were followed and showed that failure to reach a target serum uric acid (sUA) level of 6 mg/dl (0.36 mmol/L) or less was associated with a 2-3 fold increase in mortality.

Physical activity appeared to be protective against the development of cognitive impairments among patients with rheumatoid arthritis (RA), a prospective cohort study found.

A cohort study of 97 patients with psoriatic arthritis (PsA) examined the prescribing practices in PsA, and found biologics are commonly initiated as the primary mode of therapy in outpatients with PsA. However, treatment modifications can be made regarding patients who are managed with apremilast alone.

The European Medicines Agency safety committee (PRAC) has concluded that Xeljanz (tofacitinib - TOFA) could increase the risk of blood clots in the lungs and in deep veins in patients who are already at high risk for venous thromboembolic events. The PRAC is recommending that TOFA should be used with caution in patients at high risk of blood clots (VTE), regardless of dose used.

Major new insights into the treatment of psoriatic arthritis dominated the headlines during the past year, with a head-to-head trial comparing IL-17A inhibition with tumor necrosis factor blockade, another study considering whether methotrexate can improve outcomes with anti-TNF therapy in PsA, and an investigation into the effects of biologic therapy on bone.

An analysis from the Women’s Health Initiative study shows that postmenopausal women who participate in vigorous physical activity have a statistically lower risk of total and site-specific fractures

Novartis has announced the results of the EXCEED trial that pitted its IL-17 inhibitor, Cosentyx (secukinumab - SEC) against Humira (adalimumab - ADA) in patients with active psoriatic arthritis. The trial demonstrated that SEC was not non-inferior to ADA, but failed to meet its primary endpoint of superiority over ADA as far as drug efficacy.

Yesterday, AbbVie reported the top-line study results showing the efficacy of Rinvoq (upadacitinib - UPAD) adult patients with active psoriatic arthritis who previously had an inadequate response to a biologic DMARD.

Dr. Jack Cush reviews recent journal articles and info bits from the past week on RheumNow.com. 

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) from 2017 analyzed the burden of rheumatoid arthritis (RA) for 195 countries between 1990 to 2017 and surmised that RA is a major global public health challenge, with increasing prevalence and incidence rates.

Arthritis Research & Therapy reports on a prospective cohort of children with juvenile idiopathic arthritis (JIA) shows that the incidence has held steady at 12.8/100,000 children, but that the frequency uveitis and the need for orthopedic surgery has decreased in the last 20 years.

A Canadian population-based study shows that pregnant women with rheumatoid arthritis (RA) frequently discontinue their DMARD medications, especially in the first trimester.

Children with inflammatory diseases who were treated with tumor necrosis factor (TNF) inhibitors had a higher rate of incident psoriasis than those not exposed to these biologics, a single-center retrospective study found.

Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.

Researchers from Washington State University have shown that inhibition of tumor growth factor-β (TGF-β)-activated kinase 1 (TAK1) can effectively downregulate inflammatory mediators and suppress inflammation caused by gout.

JAMA has an article this week on the shift from biologic drugs to less expensive therapeutic biosimilar agents. The impact of biosimilars can be easily represented by the shift from adalimuamb - a biologic with nearly $19 billion in sales in 2018 - to any one of the four FDA approved biosimilars for adalimumab (see the daily download for slides on new adalimumab and other biosimilars).

A nice review by Physician Sense and MDLinx discusses potential physician violations of current HIPAA law, largely driven by the digital age and common work flows. Several mistakes you you be aware of and avoid, include: