Steroid Over-Prescribing Persists in RA

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Almost half of patients with rheumatoid arthritis (RA) in the UK receive glucocorticoids from primary care physicians, and of those who are prescribed glucocorticoids, more than half receive more than 10 mg a day.

Prescribing Rules

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If you are responsible for the outcome and welfare of patients – you need prescribing rules.

If you are supervising others or responsible for the training of those learning rheumatology – you need prescribing rules.

Combination or Monotherapy Tocilizumab in Rheumatoid Arthritis

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Several rheumatoid arthritis studies have shown that tocilizumab (TCZ) may be as effective as monotherapy when compared to combination therapy (methotrexate plu

DSB: Managing Methotrexate Toxicity (Best of 2015: #1)

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Methotrexate was first introduced in 1955 for leukemia and in 1986 became FDA approved for the treatment of adults with severe, active, rheumatoid arthritis or children with active polyarticular-course juvenile RA.

2015 ACR RA Guidelines Released– Finally! (Best of 2015: #2)

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ACR 2015 RA treatment guidelines were published yesterday, nearly a year after they were preliminarily presented at the 2014 ACR meeting in Boston. After a year of review and revision these have been posted.

The Nine Lives of Hydroxychloroquine (Best of 2015)

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Hydroxychloroquine is one of many medications frequently used in rheumatology practice.

Alcohol and Methotrexate - What Do You Advise? (Best of 2015: #9)

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What are your rules on methotrexate and alcohol use? How about casual, social or occasional alcohol use? If one alcoholic beverage is ok, what about 2, 3 or six while taking MTX?

Preventing Hepatitis B Reactivation Due to Immunosuppressive Drug Treatments (Best of 2015)

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Reactivation of hepatitis B virus infection can have devastating consequences, especially amongst those patients receiving immunosuppressive therapy.

Chikungunya Spread Continues (Best of 2015)

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The spread of the viral infection Chikungunya continues with the CDC issuing a travel advisory for those traveling to Mexico, where over 7000 cases of the viral infection have been reported.

Should Lupus Patients Receive Influenza and Pneumococcal Vaccines? (Best of 2015)

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Barry Waters, MD*: I have a 21 yr old lupus nephritis patient on mycophenolate, hydroxychloroquine and prednisone 40 mg per day.

When to Taper Patients Off Opioids

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I am often asked the question: When is the right time to taper a patient off opioids?

My view is that a patient should be tapered any time the risks exceed the benefits, or when treatment goals are not being met.

Bariatric Surgery Improves Rheumatoid Arthritis Outcomes

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Obesity is a modest risk factor for rheumatoid arthritis (RA) onset. More importantly, obese patients have significanty lower treatment responses to DMARDs and biologics, making them harder to treat than your average RA patient.

Herpes Zoster Increases the Risk of Stroke and MI

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At the 2015 ACR annual meeting in San Francisco, Len Calabrese, DO, of the Cleveland Clinic, gave a plenary session talk linking "shingles" infection to an increased risk of CVA (

CDC Reports Increases in Tularemia

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The Centers for Disease Control and Prevention (CDC) has reported a sharp rise in tularemia, especially in Colorado, South Dakota, Wyoming, and Nebraska.

RA Guidelines, Methotrexate and Mortal Risks in Gout: November 2015 top social media news

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Here's what you may have missed: in November 2015, RheumNow published 80 tweets on news, research and teaching points that impact the rheumatology community. We had a reach (impressions) of 79,100, 79 mentions, and over 3399 visits to RheumNow.com to check out what we publish.

Two-Fold Increase of Demyelinating Diseases with TNF Inhibition

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Despite the potential contributory role of TNF in the pathogenesis of multiple sclerosis, several trials have shown that TNF inhibitor (TNFi) use may lead to worsening of MS, optic neuritis and other demyelinating disorders.

DRIVE Trial: Denosumab and Methotrexate Prevent Joint Erosions

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Joint erosions in RA result from a complex process with multiple contributing mechanisms. One of those mechanisms involves RANK receptor activation by RANKL leading to osteoclast differentiation, activation and survival.

Changing Patterns of Drug Use in Pregnant Rheumatic Patients: Steroids Down, Biologics Up

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Desai and coworkers analyzed public and private insurance claims data (2001-2012) to assess patterns of drug use in pregnant woment with RA, SLE, PsA and AS. Specifically, they looked at immunosuppressive drug use in the 3 months preceding and during pregnancy.

EULAR 2015 Psoriatic Arthritis Treatment Guidelines

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The management of psoriatic disease, including psoriatic arthritis (PsA) has evolved significantly in the last decade.  Nevertheless, there are still some uncertainties - such as what the role of methotrexate should be, and when to use newer and novel therapies.