ACR 2017 Highlights: RA, SpA, PsA, OA, Lupus and More

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The quality of the meeting was on par with the host city, with extensive data presented on a range of topics, from social media to drug safety. The organization committee did a great job and I got the feeling that most people felt the congress was user friendly given the magnitude of the event. During this year’s meeting, I had the privilege of working with the RheumNow team, which gave me the opportunity to hone my social media skills and get my Twitter game on. After reviewing plenty of posters and going to numerous presentations, here are my top take home messages as classified by disease state.

Rules for Drug Cessation with Infection

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Everyone gets their education about drug-related infection risk from television ads. Rheumatologists should know what the real risks are and educate their patients that they have a higher than normal rate of nonserious infections. But the infection risk is way more related to inflammation than any specific drug risk.

Q Fever - The Intersection of Rheum and ID

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Today in clinic, I saw a patient with longstanding seropositive, erosive rheumatoid arthritis who had been treated with etanercept for over 10 years. She had undergone valve replacement years ago for regurgitation.

“The Big Sick” Movie Review

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It's Monday morning and my first patient is a newly diagnosed rheumatoid. This is his first visit back after starting methotrexate 6 weeks ago. Despite doing great and in remission with only one active joint, he asks, “Are sure this is RA? Or could this be Still’s disease?” Admittedly, this is a weird second-visit question, but I was impressed.  

Forced, Rational or Glitch-Ridden Prescribing Practices

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A recent analysis of 3 groups of treatment-naïve, early rheumatoid arthritis (ERA) patients looked at the factors that influenced the choice of therapy.

My Approach to Difficult RA

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Patients are labeled as having “difficult RA" when: 1) we are frustrated, 2) it's too late, 3) we've run out of options or 4) the relationship is failing. We see them, but don’t quite know what to do with them.

The IL-6 Wars

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In the years to come, the availability of numerous new IL-6 inhibitors it will either complicate treatment decisions, alter existing treatment paradigms, or result in an all-out war against TNF inhibitor dominance. Data, differences and time will tell.

Food and Wine and the Rheumatologist: The Microbiome and Natural Wine

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Is the microbiome influenced by wines "terroir" (“the complete natural environment in which a particular wine is produced, including factors such as the soil, topography, and climate”)? Len Calabrese believes so.

It's the engine that kills ya’, not the caboose

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This past weekend I was fortunate to lecture at the Harvard Advances in Rheumatology Course, where I reviewed the safety issues surrounding the use of biologic therapies. In discussing infections, cancer, cardiovascular events, etc., it became very clear to me that these problems, while worrisome, are often escalated in their importance – all at the expense of what is most dangerous: RA itself.

MONEYBALL

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The movie Moneyball is a David versus Goliath tale with the A’s (David) struggling to compete with Goliath teams like the Yankees. The movie pits hunch-driven “expertise” (convention) against a mathematic approach to decision making (Moneyball). Would you trust a big Whopper computer printout of next best drug(s) to give to Mrs. Hawking who has psoriatic arthritis and needs to start a DMARD? I believe most of you would huff and scoff at a formulaic or number-driven approach.

Time for a Paradigm Change in Rheumatoid Arthritis

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How many clues are needed for a rheumatologist to know something is wrong with the therapeutic soup he/she is trying to concoct?  One patient's tale leads to rethinking the RA treatment paradigm.

Polymyalgia Rheumatica: An Interval Look at Management Questions

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p dir="ltr"Despite an often fairly characteristic pattern of signs and symptoms, there are significant diagnostic challenges with polymyalgia rheumatica. The reason is that similar clinical features can be also observed in other diseases mimicking PMR, including infectious and malignancies, elderly-onset rheumatoid arthritis, giant cell arteritis, chondrocalcinosis or myositis, to mention some of the most important differential diagnoses. nbsp;/p