A national claims-based analysis has shown a consistent decline, by commercially insured adults (18-64 yrs), in primary care physician visits from 2008 to 2016; with nearly one half having no PCP visits in a given year by 2016. 

Recent research from the Lown Institute reports that 750 older Americans are hospitalized daily because of serious side effects from and the core problem is that of polypharmacy, especially in the elderly. 

A registry study of metric use (primarily RAPID3 and CDAI) in the treatment of rheumatoid arthritis (RA) patients shows that, even in the face of moderate or high disease activity, treatment changes by rheumatologists were relatively low (35.6–54.6%).

The VEDERA study sought to confirm whether the very early introduction of first-line etanercept+methotrexate (ETN+MTX) was superior to treat-to-target MTX (MTX-TT) in patients with early RA.

The BMJ reports that while most US providers are cautious in their prescribing, half of opioid prescriptions are written by 1% of providers.

Between 2003 and 2017, there was an annual average of 669495 providers prescribing 8.9 million opioid prescriptions.

UK registry reports that greater than 80% of total knee replacements can last for 25 years.

The outcomes regarding the duration and durability of knee arthroplasties is sketchy, with many orthopedists projecting a 15 to 20 year survivial. Hence the need for an appraisal of the data.

The US healthcare market has evolved into an incredibly expensive system that often does not deliver good medical outcomes. While most of us know these problems exist, we rarely have up-to-date data or can offer alternatives to the way we manage care, especially to the chronically ill who consume much of our health care dollars. In their book, authors Tim Harrington, MD and Andrew Johnson, MS, MBA offer insights, evidence and experience on how we may do our part to improve the management of chronic rheumatic/orthopedic issues.

The availability of biologic biosimilars has thus far had negligible impact on prescribing practices in the United States, in stark contrast to what has been observed in some European countries, researchers reported.

QD Clinic - Lessons from the clinic. Today’s clinic topic: Dealing with Non-Adherence in the Clinic.

Medscape has reported the results of its 2020 annual physician survey, This year rheumatologists (60%), general surgeons (60%), public health and preventive medicine physicians, and allergists/immunologists are the "happiest" outside of work compared to other specialists, according to Medscap

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. The podcast covers: best therapies for dactylitis and enthesitis; we have a new knockout for knee pain in OA; and are you on the naughty or nice list when it comes to the new ACR-AF guidelines for arthritis? This and more. Tune in.

A group of Western Australian clinicians have set out to assess current practices and proved guidance recommendations for high-quality care for the most common musculoskeletal (MSK) pain scenarios encountered by clinicians in emergency and primary care.

It’s a great time to be a rheumatologist and to manage RA. But, if you keep doing what you’re doing, you’re going to keep getting what you’ve got.

We have options that are endless – we have 28 biologics in rheumatology; 19 approved for RA in the last 20 years, but 15 of these are me-too copies or biosimilars. We currently have 2 JAK inhibitors and may have 3 or 4 by year end. But what we really need is the right drug, at the right time, in the right patient – but how will we know.

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).

The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) have jointly developed new classification criteria for systemic lupus erythematosus (SLE); prompted by the need for criteria that were both highly sensitive and specific. The net result is improved sensitivity and specificity, but the use of positive ANA requirement along with a longer list of weighted criteria ensures its utility in SLE research (including early or latent SLE), but not clinical practice.

Gilead has submitted a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for filgotinib, an investigational, oral, selective JAK1 inhibitor for the treatment of adults who are living with moderate-to-severe rheumatoid arthritis (RA).

Domestic violence was found to predispose to a higher risk of fibromyalgia and those developing chronic fatigue syndrome.

A Canadian analysis shows that rheumatoid arthritis (RA) patients are more likely to receive biologic DMARDs earlier if they are younger, female, and living in urban areas closer to prescribers.

Bristol-Myers Squibb (BMS) has completed its $74 billion acquisition of Celgene. With the acquisition complete, Celgene is now a wholly-owned subsidiary of BMS. The combined companies have nine products with more than $1 billion in annual sales.