Pregnancy outcomes may be affected by psoriatic arthritis or antirheumatic treatment; registry cohort study shows that preterm birth and cesarean delivery were mostly increased by antirheumatic treatment, especially biologics.

Today I have a few questions: Is tramadol really a weak narcotic? Should we really still be doing placebo-controlled trials? What are we going to do about our patients who are smokers? This and more, in this week's review of the news and journal articles.

The Journal of Rheumatology reports that current smoking significantly reduces the clinical efficacy of methotrexate (MTX)-based therapy, as studied in an early rheumatoid arthritis (RA) cohort. Using data from the CAMERA-II trial (which included early RA patients) they studied MTX treated patients who were randomized to concomitant prednisone (MTX + pred) or placebo (MTX + PBO) for 24 months.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most severe drug reactions, as they come with substantial mortality and morbidity.  A review of European centers dealing with SJS and TEN shows that despite best treatment practices, the 6-week mortality rate was 21%.

It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential.