Wednesday, 22 May 2019

TODAY'S HEADLINES

Steroids, Not Biologics, Drive Arthroplasty Infections in RA

Medicare and Truven MarketScan administrative data study (2006 through 2015) of rheumatoid arthritis (RA) undergoing arthroplasty found that while that the risks of perioperative infection was similar across biologics, the infection risk with glucocorticoid use, especially at > 10 mg/d, was significantly greater.

EMA Restricts Tofacitinib Dosing

The Pharmacovigilance Risk Assessment Committee of the European Medicines Agency issued recommendations limiting the use of Xeljanz (tofacitinib) 10 mg twice daily in patients with ulcerative colitis in the EU. The new recommendations are temporary while PRAC undertakes a review of all available evidence on the safety and efficacy of tofacitinib. The review follows warnings of an increased risk of pulmonary embolism (PE) and death from the U.S. Food and Drug Administration based on Pfizer's large post-marketing safety study (in high risk rheumatoid arthritis patients with one or more underlying cardiovascular risk factors) wherein those receiving in tofacitinib 10 mg twice daily in study A3921133 had more PE and mortalities than comparator groups (tofacitinib 5 mg bid or adalimumab).

Opioids, SSRIs and Steroids Increase Fracture Risk in RA

Analysis of a large US observational rheumatoid arthritis (RA) patients finds that opioids, SSRIs and glucocorticoids were associated with increased risk of fracture in RA, whereas statins and TNFi had a decreased vertebral fracture risk.

RheumNow Podcast – Richer or Poorer (5.17.19)

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

Coexistent Gout Increases Risk in Rheumatoid Arthritis

It his often said that gout and rheumatoid arthritis (RA) cannot coexist and where confusion exists, a good history and testing for serum urate (SUA) and rheumatoid factor (RF) can usually clarify the dominant disorders. A recent study shows that hyperuricemia and gout are uncommon in RA, but when present shows an increased risk of comorbidities and cardiovascular (CV) mortality.
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“If you don't know what you want, you end up with a lot you don't.” ― Chuck Palahniuk, "Fight

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. Despite the delirium, Pops pleaded he wanted to live to see my 8 year old son graduate high school. My husband, who is an internist, respected the other doctors’ decision and did not want to interfere with his dad’s medical care. With tears in his eyes, he whispered, “I wish we could do more.” My heart was heavy as I did not want to go against my in-law’s wishes to get a second opinion. Trying to make the right decision, I talked to my colleagues, I talked to my patients, and I talked to my own family: what should I do? Go against my in-law’s wishes and transfer him to Dallas for a full evaluation or be complicit in the Do Not Resuscitate Order?
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It’s hard work wearing a crown. The dermatologists have been dethroned as Medscape’s happiest specialty after years at the top. While studies only detail that we are the most satisfied outside of work, I argue we are the happiest working, too. With an N of 1, here are my 10 observations.
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