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.

Infection is a major cause of morbidity and mortality in RA patients and thus vaccinating against preventable infections is a top priority for rheumatologists. Numerous studies have looked at efficacy and immunogenicity of various vaccines in this population and it is known that RA treatments may reduce efficacy.

Dr. Cush reviews highlights from the past week on RheumNow.com. CHMP sends a positive recommendation for tofacitinib to the EMA. This would be for the 5 mg bid dose mod-severe RA https://t.co/O2XfkDF6XB  (NOTE: video error says tocilizumab, when tofacitinib (Xeljanz) was intended!)

A JAMA article presents the US Public Health Task Force review of OSA testing. The task force points out that “the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults (based on lack or poor quality evidence) and that screening for OSA in asymptomatic patients is likely to lead to unnecessary diagnostic testing and higher health care costs without evidence of benefit.

Neuropsychiatric lupus (NPSLE) is a diagnostic challenge as its clinical manifestations are protean and the pathophysiology is poorly understood. A study published in the current issue of Rheumatology uses unique methodology to compare brain histopathology and ex vivo imaging in lupus patients with and without NPSLE and controls.

RheumNow will periodically report safety issues as Drug Safety Bulletins. These will update you with safety issues, label changes and reports of new, ongoing and resolved drug shortages that affect rheumatology. If you have suggestions or information about specific drug shortages or drug safety issues, please email us at info@rheumnow.com.

Researchers from the Massachusetts General Hospital (MGH) have studied the initial steps in an animal model of inflammatory arthritis and found that complement C5a is critical to neutrophils migration into joints. The findings of these early events in the inflammatory cascade were published in Science Immunology. (Citation source: http://buff.ly/2kpeR5D)

A study published in The BMJ shows that financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results; thereby questioning the bias in these objective trials. (Citation source: http://buff.ly/2jUnA3q)

Interchangeability, or the substitution of a biosimilar for its innovator biologic, is on the horizon. Will the prescriber chose the biosimilar in place of the originator? Or will this allow pharmacists or healthcare plans to substitute a biosimilar, without intervention from a healthcare provider?

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

If Congress changes or repeals the Affordable Care Act (ACA), which adults are at risk of losing health insurance? A new research letter published online by JAMA Internal Medicine reports on their socioeconomic characteristics, rates of chronic disease and health care use compared with adults covered by employer-sponsored health care who are unlikely to be affected by changes in subsidies on the exchanges or to Medicaid.

The European League Against Rheumatism (EULAR) recommendations for fibromyalgia (FM) management were published in 2007 and largely had recommendations based on expert opinion’. These guidelines were updated in May of 2015 after a systematic reviews and meta-analyses of the data.