Non-Tuberculous Mycobacterial Infections - Diagnosis and Management for the Rheumatologist

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Non-Tuberculous Mycobacterial infections are among the most frequently reported opportunistic infections in the setting of biologic therapy. While there are hundreds of NTM species, only a minority are clinically relevant. In this review, I'll address important NTM diagnosis and management issues relevant to patients receiving biologic therapy.

The Unregulated $37 Billion Supplement Industry

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In 1994 there were 600 supplement companies, producing 4,000 OTC supplement products for a total revenue of about $4 billion. Today we have close to 6,000 companies, producting nearly 75,000 supplement products, bringing in $37 billion annually.

How Much Testing is Enough?

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I saw a patient this past week with new onset polyarthralgia, which led me to ponder how my fellow rheumatologists would utilize laboratory testing in such a patient.

The RheumNow Week in Review – 11 August 2017

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The RheumNow Week in Review caps the week's news every Friday. Dr Jack Cush reviews the news, journal reports and important events from the past week in rheumatology.

Joint Pain Linked to Increasing Temperature, Not Rainfall

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Every rheumatologist knows and every rheumatic patient woes about the havoc weather inflicts on joint pains. Yet, research on this issue has seldom confirmed these impressions.

Criteria for Early Referrals from Primary Care

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Early diagnosis and early intervention has been the mantra of all who manage musculoskeletal (MSK) diseases for decades. While the rules for referral may be clear to some, the lack of uniformity and promotion amongst primary care providers is less certain.

Curbside Consults - July 2017

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Curbside Consults are cases submitted by our rheumatology colleagues as challenging therapeutic or safety issues. Answers are based on experience, with added evidence from the medical literature and published guidelines. Here are four new cases. 

The RheumNow Week in Review – How to ACR/EULAR 23 June 2017

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Dr. Jack Cush reviews his approach to attending and getting the most out of ACR or EULAR Congress meetings.

Debate over Alcohol and Methotrexate Precautions

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Drs. Kremer and Weinblatt have responded to a recent Annals of Rheumatic Disease article regarding the hepatic risks of alcohol use with methotrexate (MTX) therapy authored by Humphries et al. (Citation source: http://buff.ly/2r70uuz)

The RheumNow Week in Review – 2 June 2017

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Dr. Jack Cush reviews highlights from the past week on RheumNow.com. 

New BSR 2017 Gout Guidelines

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The British Society for Rheumatology/British Health Professionals in Rheumatology first published a guideline for the management of gout in 2007. They have just updated and published their new guideline, largely because of new therapies, an increasing incidence of gout, low penetrance of urate lowering therapies, and the inability to achieve a target serum uric acid level.

The RheumNow Week in Review - 26 May 2017

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Dr. Jack Cush Reviews highlights from the past week on RheumNow.com:

Educational Intervention Facilitates Treat-to-Target Management in Rheumatoid Arthritis

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Treat-to-target education through group-based quality improvement sessions can result in wider use of treat-to-target in practice, according to researchers.

Above-Label Dosing and Noncompliance with Biologics in Psoriatic Arthritis

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Claims data analysis of 4245 psoriatic arthritis patients on TNF inhibitors showed both higher than expected durations of noncompliance and higher than label dosing - all at an increased cost.

Smoking and Worse Outcomes in Spondylitis

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BIRMINGHAM, England -- Smoking was a strong predictor of more severe disease in patients with axial spondyloarthritis (AxSpA), with people who had ever smoked having worse disease activity and worse quality of life than those who had never smoked, researchers reported here.

Lipstick Rheumatology

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A 25 year-old female recently diagnosed with seronegative rheumatoid arthritis was started on a TNF inhibitor. She came in for a follow-up visit and noted that her toenails were brittle and discolored when she removed her nail polish recently.  She is concerned that she may have psoriasis or that this may be a side effect of the TNF inhibitor.

What is your next step?

Best to Rehab at Home Following Joint Replacement

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A New York Times article sheds light on recent evidence suggesting that those undergoing hip or knee replacement will do just as well with home therapy compared to inpatient rehabilitation following surgery.

Paradoxical Toxicities with TNF Inhibitors

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Something is curiously wrong when a drug induces the disease it is intended to treat. Yet this phenomenon has been described with all five FDA-approved TNF inhibitors.

Mortality in Gout Increased

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Two current articles in the Journal of Rheumatology address issues surrounding mortality risk among those with new and established gout.

ACR Says the New AHCA is Insufficient for Arthritis Patients

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Dr. Sharad Lakhanpal, MBBS, MD, President of the American College of Rheumatology (ACR) has issued a press release condeming the insufficiencies of the newly proposed American Health Care Act (AHCA).