Methotrexate is a mainstay drug in the treatment of rheumatoid arthritis (RA).  Yet, we may not be using it long enough or optimizing its use.   Dr. Jim O'Dell presented his findings this week during a plenary session at the ACR meeting in San Francisco. Using a claims database of over 274 million US patients, the treatment of 35,640 RA patients was examined between 2009 and 2014.

The American College of Physicians released a position paper exploring factors driving the growth of “concierge” and other “direct patient contracting practices” (DPCPs) and the “limited” evidence on their impact on patient care.

What do you tell your patients who are considering augmentation mammoplasty? Or who question the safety of prior implants? The Annals of Internal Medicine have published a systematic analysis at 32 studies conducted from the 1990s onward. (Citation source http://buff.ly/1O2ALp7) 

Furie and coworkers presented the results of a 52-week phase II trial of anifrolumab (ANIFR), a type I interfernon (IFN) receptor antagonist in patients with lupus (SLE).

Clements et al presented the results of their Scleroderma Lung Study II wherein PSS patients with interstitial lung disease were randomized to receive either 3 grams daily of mycopheonolate or 2mg/kg/day of cyclophosphamide. (Citation source: http://buff.ly/1HsOUMH) 142 patients were randomized; 106 completed the 2-year evaluation (more MMF than CYC).

Liu and coworkers from Boston presented abstract #1213, with data from the NHS II Survey. They examined 93,859 women (without RA) and their dietary data from 1991 to 2011.

 Myasoedova and colleagues from the Mayo Clinic have reported their new data that demonstrates improving cardiovascular (CV) mortality rates in current RA patients treated with modern drugs.

TNF blocker Induced Psoriasis: Take Home Messages

A study of 194 knee OA patients received either 1200 mg chondroitin sulfate or celecoxib 200 mg daily, and clinical and MRI outcomes were assessed at 1 and 2 years. In addition to clinical measures, MRI was done to to detect loss of cartilage, changes in bone marrow legions, and thickening of the synovial membrane in the knee.

ACR 2015 RA treatment guidelines were published yesterday, nearly a year after they were preliminarily presented at the 2014 ACR meeting in Boston. After a year of review and revision these have been posted.

In September, the FDA issued warnings that the dipeptidyl peptidase-4 (DPP4) inihibitor Invokana may cause a dose-dependant increased risk of bone fractures. This was based on a review of nine clinical trials. Such fractures could occur as early as 12 weeks after initiation and with minor traumatic provocation.

An FDA Advisory Panel reviewed the safety of fluoroquinolones and their use to treat sinus infections, urinary-tract infections and bronchitis. The panel unanimously voted in favor for revision of the product label to more adequately portray the changing safety profile of this class, that includes Cipro and Aveloz.

While decades of drug development have improved treatment options, some of our older drugs are harder to improve upon. The same can be said for old movies and new movies, or classic literature and current best sellers. Which do you prefer or rely on?

As risk of hip fracture increases with advanced age, our knowledge of risk factors for hip fracture among very old people remains limited. A population-based study from Sweden was designed to investigate risk factors for hip fracture among very old people, including individuals with dementia and persons living in residential care facilities.

"Doc....the pain is killing me." This oft heard patient complaint may be truer than you think.