The current issue of ACP Internist discusses the considerable dissent among the medical community about fibromyalgia (FM), its cause, diagnosis and care. This review addresses many concerns with input from well-known experts in rheumatology.

Rheumatologists may encounter patients with intermediate, posterior and pan-uveitis as part of certain rheumatic diseases such as Behcet’s, but more frequently may be called on to co-manage these patients with steroid sparing agents.

The International Osteoarticular Mycoses Consortitum has publist their review Aspergillus arthritis caused by invasive aspergillosis. Their review identified 31 evaluable cases, 87% of whom were males and adults. More than half (55%) were immunosuppressed by either hematological malignancies (26%), steroids (39%), or transplantation (26%).

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.

There are numerous health hazards associated with obstructive sleep apnea (OSA), including an increased risk of cardiovascular events.Despite efforts to make an early diagnosis and intervene with continuous positive airway pressure (CPAP), it is unknown if CPAP prevents major cardiovascular events (CVE).

Although cardiovascular disease and complications have been well-described in patients with systemic lupus erythematosus (SLE), the association between SLE and heart failure (HF) remains undefined.

Dr. Jack Cush reviews highlights from the past week on RheumNow.com, including IBD/TNFi and cancer risk, fracture nonunion, PMR worse in women, not treating asymptomatic hyperuricemia, and shingles followed by stroke.

Patients with autoimmune inflammatory diseases who develop herpes zoster are at increased risk of stroke for the subsequent 3 months, with risks diminishing thereafter, analysis of Medicare data showed.

Periodontal disease, gingivitis and Porphyromonas gingivalis have been linked to the pathogenesis of rheumatoid arthritis (RA) and the production of anti-citrullinated protein antibodies (ACPA).

Nature reports that the Karolinska Institute and the affiliated Karolinska Hospital are being scrutinized for violations regarding stem cell research in patients without sufficient pre-clinical research, research ethics approval, or approval from regulatory authorities.

The factors that influence the safety of biologic therapy are numerous. Amongst them, increasing age is a potential risk factor, moreso if you also consider the polypharmacy, comorbidities and longer disease duration inherent in an elderly group of rheumatoid arthritis (RA) patients.

A recent JAMA Internal Medicine report on pharmaceutical-sponsored meals disclosed that a $20 meal provided by a drug company could yields 2-5 times more prescriptions.  (Citation source http://buff.ly/2cd58i0) The authors have clarified the current AMA policy on such meals:

Researchers suggest that the burden of EHRs could contribute to physician burnout. The findings of a time and motion study are published in Annals of Internal Medicine.

Dr. Jack Cush reviews highlights from this week in RheumNow:

Disease flares are common in rheumatoid arthritis (RA), often causing patients to seek additional care, if not medication. The frequency of flares varies amongst studies in different populations.  But the consequence of flares has only recently been studied.