Subacromial pain iacounts for up to 70% of shoulder pain. Patients may be diagnosed with subacromial pain syndrome (SAPS), shoulder impingement, or rotator cuff disease and often end up in surgery. 

He would have died. About 4 weeks ago, my 74 year old father-in-law, “Pops” was admitted to a small community hospital for delirium and worsening congestive heart failure. He was seen by a caring hospitalist and a local cardiologist who was deemed good by all the locals, but they could not get him better.

Specialty tier drugs, including biologics, accounts for nearly half of all medication spending by Medicare Part D patients. High out-of-pocket costs for these patients is a major concern. 

Biologic therapy for severe psoriasis was associated with better plaque morphology and less non-calcified coronary plaque, according to a prospective, observational study.

A report from the University of Michigan examined state-wide medical marijuana showing most of it is used for chronic pain. The authors include Kevin Boehnke, Ph.D., Daniel J. Clauw, M.D., Rebecca L. Haffajee, Ph.D., and Saurav Gangopadhyay, M.P.H. undertook this investigation to to assess why people are using cannabis medically. 

The Annals of Internal Medicine reports that the growth and use of compounded pain creams is unwarranted as they were no better than placebo in a randomized controlled trial, suggesting their higher costs are unjustifiable compared to other topical commercially available agents (lidocaine, diclofenac, capsaicin, etc.). (Citation source: https://buff.ly/2BkTj58)

A study in Arthritis & Rheumatology shows that there is substantial statewide variation in rates of treatment with long‐term opioid therapy in osteoarthritis - not fully explained by differences in access to healthcare providers, varying case‐mix, or state‐level policies.

A Medicaid study of lupus (SLE) patients finds that fracture risks are elevated in low‐income SLE and lupus nephritis patients compared to those without SLE. A cohort study matched Medicaid SLE patients and age‐ and sex‐matched non‐SLE comparators to study the primary outcome of fracture of the pelvis, wrist, hip, or humerus.

Dr. Jack Cush reviews new journal articles, news reports, and more from the past week on RheumNow.com.

Two recent reports offer good news to rheumatoid arthritis (RA) women who are planning to become pregnant.  The first studies, RA women experiencing fertility issues who turn to assisted reproductive technology (ART) shows that live births were significantly lower in women with rheumatoid arthritis receiving ART treatment compared to usual rates in women without rheumatoid arthritis.

Research from the NEJM shows that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first six weeks for complex orthopedic infections.There is considerable discussion whether complex bone and joint infections must be managed with prolonged intravenous antibiotics or if oral antibiotic therapy may suffice. 

The interleukin-23 (IL-23)/IL-17 axis plays an important role in inflammation and infection. Some of these chronic immune-mediated inflammatory disorders include PsO, PsA, AS, and IBD. Patients with PsO, PsA, and AS have up to a four-fold risk of developing IBD versus the general population. One study also supported the role for gut inflammation in spondyloarthropathy.

IL-17 inhibitors have proven to be effective in psoriatic arthritis. Analyses of ixekizumab-treated PsA patients with enthesitis or dactylitis shows this approach to yield significant improvements in enthesitis and dactylitis.

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There are approximately 750,000 new vertebral compression fractures each year in the United States, with resultant acute and chronic back pain in over one‐third of patients with vertebral fractures (VF).  Both percutaneous vertebroplasty or balloon kyphoplasty have been advocated as useful means of restoring vertebral height and strength capable of reducing pain in symptomatic patients.