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.

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.

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.

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.

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

“Autoimmunity is the Achilles heel of onco-immunotherapy” per Dr. Leonard Calabrese, which leaves a dilemma for rheumatologists.

Onco-immunotherapy induces immune dysregulation to allow patients to develop an immune response to their cancer cells. An unfortunate side effect for patients taking onco-immunotherapy is often autoimmune-like diseases referred to as immune adverse reactions (irAEs). Studies in France and the United States have shown that irAEs can be a good prognostic sign, suggesting these therapies are working. Rheumatology is faced with new problems as onco-immunotherapies may induce new chronic diseases in multiple different forms secondary to the treatment.

"If radiation was a drug that could improve survival in the metastatic setting like that it would be millions and millions of dollars." -- James B. Yu, of Yale Cancer Center, discussing aggressive use of stereotactic body radiation therapy in oligometastatic cancer.

This past week in Chicago gave us a plethora of new and eye-opening research, people, KOLs, exhibits, sessions, guidelines, posters and a never-ending supply of coffee served in small paper cups.  ACR 2018 highlights for me included:

The ACR/ARHP 2018 national meeting in Chicago presented us with opportunities to learn more about inflammatory myositis. A particularly interesting lecture was HOT topics in myositis. There were a few abstracts on MDA-5 related disease and a few on new or repurposed medications for dermatomyositis which will be covered here.

Highlights from Tuesday and Wednesday (days 3 and 4) from the ACR annual meeting include: the important and impactful abstracts covered by the Rheumatology Roundup session; upadacitinib clinical trials; and the baricitinib CV and VTE safety analysis.

As expected, this year’s ACR meeting saw an upswing in the number of abstracts on immune related adverse events from checkpoint inhibitor therapy compared to last year.

A very small study presented at ACR18 looking at tocilizumab monotherapy in patients with a new diagnosis of giant cell arteritis has nevertheless given hope to the tantalising idea that some GCA patients might achieve drug-free remission without steroids, although broader data are requ

A number of abstracts at this year’s ACR in Chicago highlighted issues around pregnancy and contraception advice in routine clinical practice.

Audio Highlights and Interviews from Day 3 at the ACR 2018 meeting  LISTEN HERE

Highlights from Tuesday, day 3 of the ACR Annual meeting in Chicago, included:

The PEXIVAS Study –  2x2 Trial of Plasma Exchange and Reduced Steroids in ANCA-Associated Vasculitis (AAV) - Abstract #2788

There have been a number of interesting posters and presentations covering the field of axial spondyloarthropathy. I’ve picked out a few points that I found particularly relevant.

Classification Criteria

Human NK cells express multiple receptors that interact with HLA class I molecules which, in turn, suppy peptides that bind HLA-E to form CD94/NKG2A NK receptor ligands.

Like most rheumatologists, I retain a deep and abiding love for methotrexate.

There are many avenues for interdisciplinary collaboration within rheumatology, as our specialty encompasses every organ system and diseases with protean manifestations.

Audio Highlights and Interviews from Day 1 at the ACR 2018 meeting - LISTEN HERE