You see a patient for the first time to establish care for Sjögren’s disease. She complains of dry eyes, dry mouth and diffuse arthralgias. You do not appreciate any synovitis on physical exam. Of note, you are the fourth rheumatologist she has seen during the past year. Toward the end of the clinic visit, she…
Despite our best efforts and modern interventions, we still have patients in the intensive care unit with organ failure. Although renal failure can be mitigated by dialysis, patients with cardiac or respiratory failure secondary to active autoimmune disease raise difficult clinical and ethical issues. Two recent cases, both with organ failure, led us to examine…
SAN DIEGO—During a session at the ACR/ARHP 2017 Annual Meeting Nov. 3–8, three representatives from the federal government described several of the government’s varied national strategies and agencies that are tackling pain. All of these strategies are affected by the current national epidemic of opioid overdoses and the need for safer analgesic prescribing. But the…
The Case A 58-year-old patient with knee osteoarthritis has been decreasing her physical activity over the past several years due to painful joints, which has resulted in significant weight gain. At her appointment, you encourage her to engage in more physical activity and eat a well-balanced diet. A few weeks later, the patient returns to…
WASHINGTON/SAN FRANCISCO (Reuters)—Puerto Rico, still reeling from Hurricane Maria, is asking the Trump administration and U.S. lawmakers for help in staving off a Medicaid crisis that has put a quarter of the island’s residents at risk of losing medical care. The territory, which has grappled for years with shortfalls in funding of its Medicaid healthcare…
BOSTON (Reuters)—A Rhode Island doctor pleaded guilty on Wednesday to charges he participated in a scheme to obtain kickbacks in exchange for writing prescriptions for an addictive fentanyl-based cancer pain drug produced by Insys Therapeutics Inc. The plea by Jerrold Rosenberg came amid ongoing investigations of Insys related to Subsys, an under-the-tongue spray that contains…
Case Ms. A is an 82-year-old woman who presented to the rheumatology office for evaluation of osteoporosis. She had been diagnosed with postmenopausal osteoporosis at age 62 after sustaining a right wrist fracture. She was started on alendronate 70 mg weekly and reported medication compliance. At age 79, she sustained an atraumatic right femur fracture….
(Reuters Health)—In the rush to approve new medicines, the U.S. Food and Drug Administration often requires drug companies to study possible side effects and alternative doses for medicines once they hit the broader market. A September 20 online analysis in the New England Journal of Medicine concludes that, in many cases, that’s not being done….
CHICAGO (Reuters)—Ohio Attorney General Mike DeWine said on Wednesday his office sued five major drug manufacturers, accusing them of misrepresenting the risks of prescription opioid painkillers and so helping fuel a sky-rocketing drug addiction epidemic. A growing number of state and local governments are suing drugmakers and distributors, seeking to hold them accountable for the…
We teach medical students, residents and fellows evidence-based medicine to lay the groundwork for rational prescribing and good clinical judgment. But should we stop our rheumatology fellows from interacting with pharmaceutical companies as part of this foundation? It is not surprising that pharmaceutical companies can influence physician prescribing through gifts. At least, it should not…