Nearly half of all available vacation days go unused and over 40% of Americans failed to use any vacation days in 2015. Common sense says that taking more time off (not less) is likely to lead to increased work productivity. Your next vacation is essential to building a better you. Here are some tips to insure you get the most from your time off.

It is well known that influenza infection is more common in patients with rheumatologic diseases. Blumentals et al. showed that patients with rheumatoid arthritis are at increased risk for influenza regardless of DMARD/biologic use and may have a 2.75-fold increased incidence of related complications (https://buff.ly/2gYNTSz).

There is much controversy regarding vaccine safety and efficacy in the United States. Prior to COVID19, there were populations who lacked confidence in vaccination for any number of reasons. Dr. Grace Lee presented a great overview of the vaccination recommendation to adoption framework that is worth review in light of the ongoing COVID-19 vaccine trials. 

Stopping methotrexate for 2 weeks after the administration of flu vaccine led to improved immunogenicity without increasing disease activity among patients with rheumatoid arthritis (RA), a prospective Korean study showed.

The current issue of the CDC's MMWR reviews the new seasonal recommendations for vaccination against influenza. This is an update to the previous recommendations of the Advisory Committee on Immunization Practices (ACIP). 

Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Available products for this season include the inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV).

Among 330 million Americans, roughly 32.1 million have been fully vaccinated and 61.1 million have received at least one dose of a COVID-19 vaccine (as of March 8th).

The CDC has issued new guidelines for those who have taken the COVID Vaccine, acknowledging the potential benefits of relaxing some measures (quarantine requirements) and reducing social isolation, while they study the safey of relaxing such measures in those who have been vaccinated.

There is a national shortage of a new shingles vaccine, Shingrix, which is a problem for those who want to start the vaccine and those seeking to receive their second and final injection. 

Since its FDA approval nearly a year ago, sales of the new vaccine have outperformed projections and are expected to approach $1 billion in revenue for 2018. 

However, the growth and use of this two-dose Shingrix vaccine has been hampered by shortage and production delays.

Although both the disease and the treatment for it in rheumatology patients may work at cross-purposes with immunizations, only a very few vaccines are absolutely contraindicated in this population, an infectious disease specialist told rheumatologists here.

Those are certain of the live-virus vaccines, and only one -- rotavirus vaccine for infants born to women receiving immunosuppressants -- is in widespread use with no suitable alternative, said Brian Schwartz, MD, of the University of California, San Francisco.

Numerous guidelines (ACR, ACIP/CDC, ATS, NICE) all call for timely vaccinations in patients with rheumatoid arthritis (RA) and those receiving immunosuppressives or biologics. 

Dixon and colleagues in the UK assessed the level of adherence to these guidelines in the UK, specifically looking at the uptake of influenza and pneumococcal vaccinations in patients with RA.

A retrospective cohort study of adult RA patients (N = 15,724) treated with non-biologic immunosuppressive therapy was drawn from a large primary care database.

The five do's and don'ts when it comes to vaccinating your patients. 

Flu season is upon us. While we try our best to vaccinate as many patients as possible, at times it can be challenging for reasons ranging from patient’s perceptions that the vaccine gives them the flu to others stating they are allergic to vaccine components.

A patient with rheumatoid arthritis told me she has an egg allergy and cannot take the flu shot; what do I tell her?

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.

Streptococcus pneumonia is a leading cause of morbidity and mortality in adults; including patients with autoimmune diseases who are at particular risk.

In 2014, the ACIP recommended routine use of the 13-valent pneumococcal conjugate vaccine (PCV13) in series with the 23-valent pneumococcal polysaccharide vaccine PPSV23 for adults ≥ 65 years, with the goal of providing broader protection by adding the PCV13 recommendation.

Shingrix (GSK), the herpes zoster subunit vaccine (a two-shot series), was approved by the FDA in Fall 2018 and is currently approved for use in adults 50 years and older. Shingrix has replaced the live zoster vaccine, Zostavax (Merck) as the preferred shingles vaccine, however its use in patients with immune-mediated inflammatory diseases (IMIDs) remains a gray area.

The Food and Drug Administration (FDA) approved use of Nucala (mepolizumab) for use in treating adults with eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss vasculitis. This is first FDA-approved therapy specifically to treat EGPA. 

EGPA is rare with an stimated incidence of 0.11 to 2.66 cases per 1 million per year and an overall prevalence of 10.7 to 14 per 1,000,000 adults.

There are many avenues for interdisciplinary collaboration within rheumatology, as our specialty encompasses every organ system and diseases with protean manifestations. The intersection of rheumatology and immunology is well known and has become increasingly important, given the association of autoimmune conditions with many of the primary immunodeficiency syndromes. This intersection was highlighted today at ACR by two excellent abstracts.

An 8-week course of prednisone plus rituximab (Rituxin) offered good outcomes in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), including complete remission, researchers reported.

The pilot study in 20 adult patients yielded a 70% complete remission rate at 6 months. This remission rate was virtually identical to that observed in 29 historical controls taken from the Rituximab in AAV (RAVE) trial, which involved 5.5 months of steroid therapy, according to Eli M. Miloslavsky, MD, of Massachusetts General Hospital in Boston.

A national database reveals that patients with granulomatosis with polyangiitis (GPA) have 22.3% risk of hospital readmissions within 30 days of discharge. 

From a total of 9749 hospital admissions with GPA, there were 2173 readmissions within 30 days of discharge.

The top 5 reasons for readmissions were:

The French Vasculitis Study Group has published that patients with systemic necrotizing vasculitis do not have an increased risk of malignancy; in fact they have a risk that is similar to the general population.

Previous reports have suggested either no risk or a declining risk in the era of better therapies for vasculitis. 

Janssen Biotech, Inc. has announced that the U.S. Food and Drug Administration (FDA) has approved SIMPONI ARIA® (golimumab) the treatment of adults with active psoriatic arthritis (PsA) or active ankylosing spondylitis (AS).

These approvals are based on the GO-VIBRANT (in PsA) and GO-ALIVE (in AS) clinical trials previously reported. Simponi Aria was also approved in 2013 for the treatment of moderately to severely active rheumatoid arthritis (RA).

UK researchers set out to study medically significant infections (MSI) in juvenile idiopathic arthritis patients enrolled in the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN).  They compared the rates of MSI in those receiving ETN alone versus MTX alone versus ETN plus methotrexate (MTX).

A number of studies have shown that the treat-to-target approach is effective in achieving clinical remission - the ultimate therapeutic goal in patients with early RA.

The OPERA study was a 2-year investigator-initiated, double-blinded, randomized, controlled trial to evaluate the clinical and radiographic outcomes in DMARD naïve, early RA patients who are begun on methotrexate, with or without adalimumab induction therapy.

A retrospective study of elderly rheumatoid arthritis (RA) patients on Medicare was conducted by a group of researchers from the University of Alabama. They aimed to compare the coronary heart disease risk among RA patients initiating biologic disease-modifying anti-rheumatic drugs of different mechanisms between 2006-1012. (Citation source http://buff.ly/1PJDemH)

Researchers from the University of Birmingham have shown that while Vitamin D may be effective at preventing the onset of inflammation, it is less effective once inflammatory disease is established - largely because, once established, rheumatoid arthritis leads to vitamin D insensitivity. (Citation source https://buff.ly/2iGHYmI)

The current edition of Lancet Diabetes & Endocrinology suggests that neither vitamin D supplementation, nor dose, will improve bone density or prevent fractures in adults. (Citation source: https://buff.ly/2O9tqxI)

A metanalysis of 81 randomized controlled trials included 53,537 subjects and varied in length ( 4 weeks to 5 years); most included women over age 65 years. 

The current edition of Lancet Diabetes & Endocrinology suggests that neither vitamin D supplementation, nor dose, will improve bone density or prevent fractures in adults. (Citation source: https://buff.ly/2O9tqxI)

A metanalysis of 81 randomized controlled trials included 53,537 subjects and varied in length ( 4 weeks to 5 years); most included women over age 65 years.