Friday, 16 Aug 2019

TODAY'S HEADLINES

Upadacitinib (RINVOQ) FDA Approved for Rheumatoid Arthritis

The US Food and Drug Administration (FDA) today approved AbbVie JAK1 inhibitor, Rinvoq (upadacitinib) for adults with  rheumatoid arthritis with moderately to severely active disease either not responding to, or intolerant of, methotrexate (MTX). 

The approved once daily dose is 15 mg qd. The drug may be used with MTX or other DMARDs but should not be combined with other JAK inhibitors or biologic agents.

Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease

Serologic testing is the principal means of laboratory diagnosis of Lyme disease. Current recommendations include using a sensitive enzyme immunoassay (EIA) or immunofluorescence assay, followed by a western immunoblot assay for specimens yielding positive or equivocal results. On July 29, 2019, the Food and Drug Administration cleared several Lyme disease serologic assays with new indications for use, allowing for an EIA rather than western immunoblot assay as the second test in a Lyme disease testing algorithm. Thus, serologic assays that utilize a second EIA in place of western immunoblot assay are acceptable alternatives for the serologic diagnosis of Lyme disease.

Rise in Fatty Liver Disease Linked to Obesity and Diabetes

Gut has published population results from NHANES population study showing that the prevalence of fatty liver disease is rising in the US and is driven by obesity and diabetes.

Trends in Inflammatory Arthritis Care in Germany

The German National Database (NDB) has reviewed their experience in the care and quality of life of inflammatory rheumatic disease patients snce 1993, showing improved use of metrics, improved outcomes and a changing profile of biologic and anti-rheumatic drug use.  

With Autoimmunity, Checkpoint Inhibitors Can Be Used

Among patients with pre-existing autoimmune diseases who developed cancer and were treated with immune checkpoint inhibitors (ICI), flares of the underlying disease and other immune-related adverse events were common, a retrospective study conducted in France showed.

BLOG
How do you help your patients who are resistant to your medical recommendations when they are receiving biased information from friends, family, and the internet? I wanted to share with you two cases and my approach.
While often seen as demanding, millennial patients have grown accustomed to having direct access to everything and everyone. They tend to be more involved in the clinical evaluation in the office, more concerned about the social aspects of the disease, and are more frustrated with the varying shades of gray in diagnoses and delayed treatment efficacy. What does this mean for you and your practice?
Knowing the names of the agents in today’s armamentarium should be simple. But, the nomenclature is notoriously confusing. The names of monoclonal antibodies can stretch to five syllables which defy easy pronunciation beyond the “mab” at the end. Who comes up with these names anyway?
The House of God is probably more known of than read, with over 3 million copies sold since its release when I was a Chief Medical Resident in the era of its writing. The book itself, according to the author Samuel Schem (aka Steven Bergman, MD, DPhil), a psychiatrist and currently Professor of Humanities at NYU, is a true account of his internship, albeit laden with some liberties of fiction - and it's been quoted for generations. The House of God is cruelly funny and portrays many uncomfortable and dehumanizing aspects of medicine, including substance abuse, bawdy sex (and lots of it), sleeplessness, depression, and suicide to name a few. Taken at face value, it would seem countercultural to our current aspirations of putting patients first, #MeToo and burnout concerns. Is this book merely a humorous anachronistic rant, or a serious work of reflection meritorious of being read and pondered upon?