M. Alexander Otto

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

[email protected]

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

[email protected]

SAN FRANCISCO – It might be time to add psoriasis to the list of comorbidities bariatric surgery is likely to help.

New York University investigators have found a marked improvement in psoriasis and psoriatic arthritis following bariatric surgery, especially with severe disease. The more weight people lose, the better they do.

In an interview at the annual meeting of the American College of Rheumatology, investigator Dr. Soumya Reddy, codirector of NYU’s Psoriatic Arthritis Center in Manhattan, explained how the findings can be used in the clinic and their potential impact on bariatric surgery authorization.

[email protected]

CHICAGO – Weight loss and comorbidity reduction from Roux-en-Y gastric bypass remain durable at 10 years, according to a reviewof 651 patients at the University of Virginia in Charlottesville.

Investigators checked up on their patients after a decade because “the long-term durability of this operation remains ill-defined in the American population.” Their study, likely the largest American series with 10-year follow-up, helps “to more clearly define long-term outcomes that may be achieved following performance of Roux-en-Y gastric bypass and establish a benchmark for future clinical investigation,” they said.

M. Alex Otto/Frontline Medical News

The study included 335 open and 316 laparoscopic Roux-en-Y gastric bypass (RYGB) patients. Although gastric bypass is preformed laparoscopically at the university now, the team felt comfortable including open cases in the analysis because patients and outcomes were similar in both groups. The mean preoperative body mass index, for instance, was about 53 kg/m² and the mean operative time about 230 minutes. Postoperative incisional hernia and anastomotic stenosis were more likely with open surgery.

As in other studies, weight loss peaked at 24 months, with patients shedding a mean of 74% of their excess weight. Although that had fallen to a mean of 52% at 10 years, “they still kept off half of their excess weight, which is outstanding,” investigator and general surgery resident Dr. Hunter Mehaffey said at the annual clinical congress of the American College of Surgeons.

Surgery also led to persistent reductions in obesity-related comorbidities. Before RYGB, for instance, 38% of patients had gastroesophageal reflux disease, versus 29% after 10 years. Similarly, the prevalence of degenerative joint disease fell from 61% to 32%, diabetes from 41% to 18%, obstructive sleep apnea from 36% to 16%, hypertension from 59% to 47%, pulmonary problems from 28% to 13%, and psychiatric issues from 39% to 29%. About a quarter of patients had cardiac comorbidities before RYGB, versus 16% at 10 years after surgery. The data came from chart reviews and patient interviews, and the findings were statistically significant.

Overall, patients seemed glad to have had the operation, reporting an average satisfaction score of 8.7 out of 10 points, he said, adding, “I would expect these findings to be generalizable to other institutions. This is a good, durable operation.”

Given the scope of the comorbidity reductions, “the savings in health care costs” from RYGB “are likely underestimated,” Dr. Mehaffey said.

There was another lesson from the study, as well. It took a while to track down patients for 10-year follow-up because they were no longer seeing their surgeons. “If we are not going to see these patients much after 2 years, we really have to make sure that their primary care physician knows” how to recognize and manage possible complications, such as nutritional deficiency or hypoglycemia, he said.

Dr. Mehaffey had no disclosures, and there was no outside funding for the work.

[email protected]

CHICAGO – Weight loss and comorbidity reduction from Roux-en-Y gastric bypass remain durable at 10 years, according to a reviewof 651 patients at the University of Virginia in Charlottesville.

Investigators checked up on their patients after a decade because “the long-term durability of this operation remains ill-defined in the American population.” Their study, likely the largest American series with 10-year follow-up, helps “to more clearly define long-term outcomes that may be achieved following performance of Roux-en-Y gastric bypass and establish a benchmark for future clinical investigation,” they said.

M. Alex Otto/Frontline Medical News

The study included 335 open and 316 laparoscopic Roux-en-Y gastric bypass (RYGB) patients. Although gastric bypass is preformed laparoscopically at the university now, the team felt comfortable including open cases in the analysis because patients and outcomes were similar in both groups. The mean preoperative body mass index, for instance, was about 53 kg/m² and the mean operative time about 230 minutes. Postoperative incisional hernia and anastomotic stenosis were more likely with open surgery.

As in other studies, weight loss peaked at 24 months, with patients shedding a mean of 74% of their excess weight. Although that had fallen to a mean of 52% at 10 years, “they still kept off half of their excess weight, which is outstanding,” investigator and general surgery resident Dr. Hunter Mehaffey said at the annual clinical congress of the American College of Surgeons.

Surgery also led to persistent reductions in obesity-related comorbidities. Before RYGB, for instance, 38% of patients had gastroesophageal reflux disease, versus 29% after 10 years. Similarly, the prevalence of degenerative joint disease fell from 61% to 32%, diabetes from 41% to 18%, obstructive sleep apnea from 36% to 16%, hypertension from 59% to 47%, pulmonary problems from 28% to 13%, and psychiatric issues from 39% to 29%. About a quarter of patients had cardiac comorbidities before RYGB, versus 16% at 10 years after surgery. The data came from chart reviews and patient interviews, and the findings were statistically significant.

Overall, patients seemed glad to have had the operation, reporting an average satisfaction score of 8.7 out of 10 points, he said, adding, “I would expect these findings to be generalizable to other institutions. This is a good, durable operation.”

Given the scope of the comorbidity reductions, “the savings in health care costs” from RYGB “are likely underestimated,” Dr. Mehaffey said.

There was another lesson from the study, as well. It took a while to track down patients for 10-year follow-up because they were no longer seeing their surgeons. “If we are not going to see these patients much after 2 years, we really have to make sure that their primary care physician knows” how to recognize and manage possible complications, such as nutritional deficiency or hypoglycemia, he said.

Dr. Mehaffey had no disclosures, and there was no outside funding for the work.

[email protected]

CHICAGO – Weight loss and comorbidity reduction from Roux-en-Y gastric bypass remain durable at 10 years, according to a reviewof 651 patients at the University of Virginia in Charlottesville.

Investigators checked up on their patients after a decade because “the long-term durability of this operation remains ill-defined in the American population.” Their study, likely the largest American series with 10-year follow-up, helps “to more clearly define long-term outcomes that may be achieved following performance of Roux-en-Y gastric bypass and establish a benchmark for future clinical investigation,” they said.

M. Alex Otto/Frontline Medical News

The study included 335 open and 316 laparoscopic Roux-en-Y gastric bypass (RYGB) patients. Although gastric bypass is preformed laparoscopically at the university now, the team felt comfortable including open cases in the analysis because patients and outcomes were similar in both groups. The mean preoperative body mass index, for instance, was about 53 kg/m² and the mean operative time about 230 minutes. Postoperative incisional hernia and anastomotic stenosis were more likely with open surgery.

As in other studies, weight loss peaked at 24 months, with patients shedding a mean of 74% of their excess weight. Although that had fallen to a mean of 52% at 10 years, “they still kept off half of their excess weight, which is outstanding,” investigator and general surgery resident Dr. Hunter Mehaffey said at the annual clinical congress of the American College of Surgeons.

Surgery also led to persistent reductions in obesity-related comorbidities. Before RYGB, for instance, 38% of patients had gastroesophageal reflux disease, versus 29% after 10 years. Similarly, the prevalence of degenerative joint disease fell from 61% to 32%, diabetes from 41% to 18%, obstructive sleep apnea from 36% to 16%, hypertension from 59% to 47%, pulmonary problems from 28% to 13%, and psychiatric issues from 39% to 29%. About a quarter of patients had cardiac comorbidities before RYGB, versus 16% at 10 years after surgery. The data came from chart reviews and patient interviews, and the findings were statistically significant.

Overall, patients seemed glad to have had the operation, reporting an average satisfaction score of 8.7 out of 10 points, he said, adding, “I would expect these findings to be generalizable to other institutions. This is a good, durable operation.”

Given the scope of the comorbidity reductions, “the savings in health care costs” from RYGB “are likely underestimated,” Dr. Mehaffey said.

There was another lesson from the study, as well. It took a while to track down patients for 10-year follow-up because they were no longer seeing their surgeons. “If we are not going to see these patients much after 2 years, we really have to make sure that their primary care physician knows” how to recognize and manage possible complications, such as nutritional deficiency or hypoglycemia, he said.

Dr. Mehaffey had no disclosures, and there was no outside funding for the work.

[email protected]

San Francisco – Treat-to-target should be the goal of every office visit for rheumatoid arthritis, according to a joint European and North American investigation involving more than 500 patients.

That’s because it works, explained study investigator Dr. Sofia Ramiro, a rheumatology fellow at Leiden (the Netherlands) University Medical Center.

The study confirms what has long been suspected but not exactly demonstrated before in a robust, real-world setting, she noted. The findings also suggest that some rheumatoid arthritis patients probably could be pushed harder toward remission.

In an interview at the annual meeting of the American College of Rheumatology, Dr. Ramiro explained the project and why it matters for clinical care.

[email protected]

San Francisco – Treat-to-target should be the goal of every office visit for rheumatoid arthritis, according to a joint European and North American investigation involving more than 500 patients.

That’s because it works, explained study investigator Dr. Sofia Ramiro, a rheumatology fellow at Leiden (the Netherlands) University Medical Center.

The study confirms what has long been suspected but not exactly demonstrated before in a robust, real-world setting, she noted. The findings also suggest that some rheumatoid arthritis patients probably could be pushed harder toward remission.

In an interview at the annual meeting of the American College of Rheumatology, Dr. Ramiro explained the project and why it matters for clinical care.

[email protected]

San Francisco – Treat-to-target should be the goal of every office visit for rheumatoid arthritis, according to a joint European and North American investigation involving more than 500 patients.

That’s because it works, explained study investigator Dr. Sofia Ramiro, a rheumatology fellow at Leiden (the Netherlands) University Medical Center.

The study confirms what has long been suspected but not exactly demonstrated before in a robust, real-world setting, she noted. The findings also suggest that some rheumatoid arthritis patients probably could be pushed harder toward remission.

In an interview at the annual meeting of the American College of Rheumatology, Dr. Ramiro explained the project and why it matters for clinical care.

[email protected]

If you haven’t dealt with a chikungunya patient yet, you probably will soon.

The mosquito-borne virus, long considered a tropical disease, is on the upswing in the United States, carried back especially by vacationers returning from the Caribbean. It causes an inflammatory arthritis that’s hard to recognize and treat.

“We’ve actually even had some here in Seattle,” said Dr. Gregory Gardner, a rheumatologist at the University of Washington, Seattle.

So a session this year at the annual meeting of the American College of Rheumatology, “Coming to a Joint Near You: Chikungunya” on Sunday, Nov. 8, at 8:30 a.m., is probably one that attendees won’t want to miss, said Dr. Gardner, one of the many planners of this year’s meeting.

The session will cover chikungunya immunopathology, clinical manifestations, and treatment – just about all you need to know to handle a case. The chikungunya session is just one example of the meeting’s timely, on-point clinical information. Another one that’s likely to be popular is “Maintenance Therapy in ANCA-Associated Vasculitis: Evaluation and Treatment of Patients in Remission,” on Monday, Nov. 9, at 7:30 a.m., and “The Great Debate: Long-Term, Low-Dose Corticosteroid Use in the Treatment of Rheumatoid Arthritis” on Sunday at 2:30 p.m. While some worry about the long-term side effects of steroids in rheumatoid arthritis, others think the approach is safe and possibly even disease modifying, Dr. Gardner said.

The clinical sessions will be complimented by a full slate of original science. “We’ve had more abstracts submitted this year than to any other previous meeting,” over 4,000. “There’s great research being presented,” said Dr. Victoria Shanmugam, a Washington, D.C., rheumatologist and also a planner of this year’s meeting.

Getting into the late-breaking abstract session on Tuesday, Nov. 10, at 4:30 p.m. “was incredibly competitive this year,” she said. Just a handful of the 70 submissions made it. Investigators who did will share their latest findings on tocilizumab for giant cell arteritis; baricitinib versus placebo or adalimumab for rheumatoid arthritis; adalimumab with methotrexate for uveitis in juvenile idiopathic arthritis; epratuzumab in moderate to severe systemic lupus; tofacitinib in ankylosing spondylitis; and interleukin-17a inhibition in active ankylosing spondylitis.

There’ll also be a strong show of original research in the plenary sessions at 11 a.m. Sunday, Monday, and Tuesday. Studies in Tuesday’s session, for instance, include investigations into the pharmacogenetics of allopurinol in gout and the role of anakinra in recurrent pericarditis.

Results from the Scleroderma Lung Study II, which pitted oral cyclophosphamide against mycophenolate mofetil for interstitial lung disease in systemic sclerosis, will be revealed Sunday at 4:30 p.m. in the “Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics I” session. Until now, there haven’t been strong prospective data to support the use of mycophenolate in scleroderma lung disease. “There will be a lot of interest in this. People have been waiting for these results to come out,” Dr. Shanmugam said.

Planners have done something new this year by bringing fertility and pregnancy research into its own dedicated abstract session, “Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects,” on Monday at 4:30 p.m.

It’s recognition of the central role those issues play in rheumatology. Fertility and pregnancy are a “major clinical challenge we face in daily practice. Our diseases often present during pregnancy, and we tend to have diseases that affect young women. Patients have a lot of questions,” Dr. Shanmugam said.

The abstract session will be a mix of basic and clinical research across a range of rheumatic conditions. The hope is to break down the silos in rheumatology to foster collaboration and move the field forward, she said.

That session will be complemented by “Reproductive Issues in Rheumatology” on Wednesday at 11:00 a.m. – focusing on biologics in pregnancy and pregnancy outcomes in rheumatoid arthritis – as well as “Pregnancy and Infertility in Rheumatic Disease” on Monday at 2:30 p.m.

Macrophage activation is getting its share of attention, too, especially in adults, for instance during the “Nuts and Bolts of Macrophage Activation Syndrome” session on Monday at 8:30 a.m.

“Historically, it’s mainly been studied in children. We wanted to focus on bringing this into adult rheumatology. I think this is going to be a very good session,” Dr. Shanmugam said.

[email protected]

If you haven’t dealt with a chikungunya patient yet, you probably will soon.

The mosquito-borne virus, long considered a tropical disease, is on the upswing in the United States, carried back especially by vacationers returning from the Caribbean. It causes an inflammatory arthritis that’s hard to recognize and treat.

“We’ve actually even had some here in Seattle,” said Dr. Gregory Gardner, a rheumatologist at the University of Washington, Seattle.

So a session this year at the annual meeting of the American College of Rheumatology, “Coming to a Joint Near You: Chikungunya” on Sunday, Nov. 8, at 8:30 a.m., is probably one that attendees won’t want to miss, said Dr. Gardner, one of the many planners of this year’s meeting.

The session will cover chikungunya immunopathology, clinical manifestations, and treatment – just about all you need to know to handle a case. The chikungunya session is just one example of the meeting’s timely, on-point clinical information. Another one that’s likely to be popular is “Maintenance Therapy in ANCA-Associated Vasculitis: Evaluation and Treatment of Patients in Remission,” on Monday, Nov. 9, at 7:30 a.m., and “The Great Debate: Long-Term, Low-Dose Corticosteroid Use in the Treatment of Rheumatoid Arthritis” on Sunday at 2:30 p.m. While some worry about the long-term side effects of steroids in rheumatoid arthritis, others think the approach is safe and possibly even disease modifying, Dr. Gardner said.

The clinical sessions will be complimented by a full slate of original science. “We’ve had more abstracts submitted this year than to any other previous meeting,” over 4,000. “There’s great research being presented,” said Dr. Victoria Shanmugam, a Washington, D.C., rheumatologist and also a planner of this year’s meeting.

Getting into the late-breaking abstract session on Tuesday, Nov. 10, at 4:30 p.m. “was incredibly competitive this year,” she said. Just a handful of the 70 submissions made it. Investigators who did will share their latest findings on tocilizumab for giant cell arteritis; baricitinib versus placebo or adalimumab for rheumatoid arthritis; adalimumab with methotrexate for uveitis in juvenile idiopathic arthritis; epratuzumab in moderate to severe systemic lupus; tofacitinib in ankylosing spondylitis; and interleukin-17a inhibition in active ankylosing spondylitis.

There’ll also be a strong show of original research in the plenary sessions at 11 a.m. Sunday, Monday, and Tuesday. Studies in Tuesday’s session, for instance, include investigations into the pharmacogenetics of allopurinol in gout and the role of anakinra in recurrent pericarditis.

Results from the Scleroderma Lung Study II, which pitted oral cyclophosphamide against mycophenolate mofetil for interstitial lung disease in systemic sclerosis, will be revealed Sunday at 4:30 p.m. in the “Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics I” session. Until now, there haven’t been strong prospective data to support the use of mycophenolate in scleroderma lung disease. “There will be a lot of interest in this. People have been waiting for these results to come out,” Dr. Shanmugam said.

Planners have done something new this year by bringing fertility and pregnancy research into its own dedicated abstract session, “Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects,” on Monday at 4:30 p.m.

It’s recognition of the central role those issues play in rheumatology. Fertility and pregnancy are a “major clinical challenge we face in daily practice. Our diseases often present during pregnancy, and we tend to have diseases that affect young women. Patients have a lot of questions,” Dr. Shanmugam said.

The abstract session will be a mix of basic and clinical research across a range of rheumatic conditions. The hope is to break down the silos in rheumatology to foster collaboration and move the field forward, she said.

That session will be complemented by “Reproductive Issues in Rheumatology” on Wednesday at 11:00 a.m. – focusing on biologics in pregnancy and pregnancy outcomes in rheumatoid arthritis – as well as “Pregnancy and Infertility in Rheumatic Disease” on Monday at 2:30 p.m.

Macrophage activation is getting its share of attention, too, especially in adults, for instance during the “Nuts and Bolts of Macrophage Activation Syndrome” session on Monday at 8:30 a.m.

“Historically, it’s mainly been studied in children. We wanted to focus on bringing this into adult rheumatology. I think this is going to be a very good session,” Dr. Shanmugam said.

[email protected]

If you haven’t dealt with a chikungunya patient yet, you probably will soon.

The mosquito-borne virus, long considered a tropical disease, is on the upswing in the United States, carried back especially by vacationers returning from the Caribbean. It causes an inflammatory arthritis that’s hard to recognize and treat.

“We’ve actually even had some here in Seattle,” said Dr. Gregory Gardner, a rheumatologist at the University of Washington, Seattle.

So a session this year at the annual meeting of the American College of Rheumatology, “Coming to a Joint Near You: Chikungunya” on Sunday, Nov. 8, at 8:30 a.m., is probably one that attendees won’t want to miss, said Dr. Gardner, one of the many planners of this year’s meeting.

The session will cover chikungunya immunopathology, clinical manifestations, and treatment – just about all you need to know to handle a case. The chikungunya session is just one example of the meeting’s timely, on-point clinical information. Another one that’s likely to be popular is “Maintenance Therapy in ANCA-Associated Vasculitis: Evaluation and Treatment of Patients in Remission,” on Monday, Nov. 9, at 7:30 a.m., and “The Great Debate: Long-Term, Low-Dose Corticosteroid Use in the Treatment of Rheumatoid Arthritis” on Sunday at 2:30 p.m. While some worry about the long-term side effects of steroids in rheumatoid arthritis, others think the approach is safe and possibly even disease modifying, Dr. Gardner said.

The clinical sessions will be complimented by a full slate of original science. “We’ve had more abstracts submitted this year than to any other previous meeting,” over 4,000. “There’s great research being presented,” said Dr. Victoria Shanmugam, a Washington, D.C., rheumatologist and also a planner of this year’s meeting.

Getting into the late-breaking abstract session on Tuesday, Nov. 10, at 4:30 p.m. “was incredibly competitive this year,” she said. Just a handful of the 70 submissions made it. Investigators who did will share their latest findings on tocilizumab for giant cell arteritis; baricitinib versus placebo or adalimumab for rheumatoid arthritis; adalimumab with methotrexate for uveitis in juvenile idiopathic arthritis; epratuzumab in moderate to severe systemic lupus; tofacitinib in ankylosing spondylitis; and interleukin-17a inhibition in active ankylosing spondylitis.

There’ll also be a strong show of original research in the plenary sessions at 11 a.m. Sunday, Monday, and Tuesday. Studies in Tuesday’s session, for instance, include investigations into the pharmacogenetics of allopurinol in gout and the role of anakinra in recurrent pericarditis.

Results from the Scleroderma Lung Study II, which pitted oral cyclophosphamide against mycophenolate mofetil for interstitial lung disease in systemic sclerosis, will be revealed Sunday at 4:30 p.m. in the “Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics I” session. Until now, there haven’t been strong prospective data to support the use of mycophenolate in scleroderma lung disease. “There will be a lot of interest in this. People have been waiting for these results to come out,” Dr. Shanmugam said.

Planners have done something new this year by bringing fertility and pregnancy research into its own dedicated abstract session, “Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects,” on Monday at 4:30 p.m.

It’s recognition of the central role those issues play in rheumatology. Fertility and pregnancy are a “major clinical challenge we face in daily practice. Our diseases often present during pregnancy, and we tend to have diseases that affect young women. Patients have a lot of questions,” Dr. Shanmugam said.

The abstract session will be a mix of basic and clinical research across a range of rheumatic conditions. The hope is to break down the silos in rheumatology to foster collaboration and move the field forward, she said.

That session will be complemented by “Reproductive Issues in Rheumatology” on Wednesday at 11:00 a.m. – focusing on biologics in pregnancy and pregnancy outcomes in rheumatoid arthritis – as well as “Pregnancy and Infertility in Rheumatic Disease” on Monday at 2:30 p.m.

Macrophage activation is getting its share of attention, too, especially in adults, for instance during the “Nuts and Bolts of Macrophage Activation Syndrome” session on Monday at 8:30 a.m.

“Historically, it’s mainly been studied in children. We wanted to focus on bringing this into adult rheumatology. I think this is going to be a very good session,” Dr. Shanmugam said.

[email protected]

Biosimilars are coming, and they are going to have an impact on the practice of rheumatology.

But there’s no need to worry. Sessions at this year’s American College of Rheumatology annual meeting will bring attendees up to date about what they need to know to stay ahead of the issue. Biosimilars are just one of a slew of topics to be presented this year to help rheumatologists keep their practices strong with the latest information on regulatory issues, practice management, electronic health records, coding, business models, and other matters.

A major issue with biosimilars is whether pharmacists will be able to substitute them for familiar brand name biologics, and whether they’ll have to notify rheumatologists when they do so. It’s an extension of the generic switch issue, only more fraught because there’s a greater gap between branded biologics and their biosimilar counterparts than between traditional small-molecule drugs and their generics.

States regulate pharmacy practice, and it’s unclear how they’ll come down on the issue. Even so, the biosimilar industry is already at work in statehouses laying the groundwork to allow for easy swaps in the pharmacy.

“Biosimilars in Rheumatology,” a clinical science presentation on Sunday, Nov. 8, at 4:30 p.m., will let rheumatologists know what biosimilar rollouts “might look like in their own states, and what to watch out for. A lot of what will happen is likely to be determined at the state level,” said Dr. Colin Edgerton, a rheumatologist in North Charleston, S.C., and one of the many planners of this year’s meeting.

The session will also go into the experience in Europe, where biosimilar infliximab is one of several biosimilars already on the market, touching upon efficacy, safety, European regulatory solutions, and other matters.

The biosimilar talks dovetail nicely with a Monday, Nov. 9, session at 1:00 p.m. entitled “An Hour Well Spent: Successful Stories of Members Enhancing Patient Care Through State Advocacy.”

There’s a real push in rheumatology “to affect practice management at the state level. The point of this session is to bring together people who have been successful at the state level in forging relationships with decision makers. Those people will educate us on how practicing rheumatologist can impact the state legislature to get things done,” for instance by limiting troublesome insurance company policies such as step therapy and working towards uniform prescription authorization forms. Such issues are better addressed at the state level because things are too much of a patchwork in the United States to be sorted out at the federal level, Dr. Edgerton said.

Meanwhile, “Practice Without Walls,” a Monday session at 4:30 p.m., will explain how independent rheumatology practices can pool resources to improve quality of care and reduce costs, even across town or state divides. It’s one way to stay independent at a time of increasing consolidation.

The goal is to “allow integration without necessarily selling your practice to an established hospital group that has no particular interest in rheumatology. There are a lot of details to doing that; this will be an opportunity to learn from people who have done it successfully, so you don’t have to reinvent the wheel,” said Dr. Edgerton, one of the moderators for the session.

[email protected]

Biosimilars are coming, and they are going to have an impact on the practice of rheumatology.

But there’s no need to worry. Sessions at this year’s American College of Rheumatology annual meeting will bring attendees up to date about what they need to know to stay ahead of the issue. Biosimilars are just one of a slew of topics to be presented this year to help rheumatologists keep their practices strong with the latest information on regulatory issues, practice management, electronic health records, coding, business models, and other matters.

A major issue with biosimilars is whether pharmacists will be able to substitute them for familiar brand name biologics, and whether they’ll have to notify rheumatologists when they do so. It’s an extension of the generic switch issue, only more fraught because there’s a greater gap between branded biologics and their biosimilar counterparts than between traditional small-molecule drugs and their generics.

States regulate pharmacy practice, and it’s unclear how they’ll come down on the issue. Even so, the biosimilar industry is already at work in statehouses laying the groundwork to allow for easy swaps in the pharmacy.

“Biosimilars in Rheumatology,” a clinical science presentation on Sunday, Nov. 8, at 4:30 p.m., will let rheumatologists know what biosimilar rollouts “might look like in their own states, and what to watch out for. A lot of what will happen is likely to be determined at the state level,” said Dr. Colin Edgerton, a rheumatologist in North Charleston, S.C., and one of the many planners of this year’s meeting.

The session will also go into the experience in Europe, where biosimilar infliximab is one of several biosimilars already on the market, touching upon efficacy, safety, European regulatory solutions, and other matters.

The biosimilar talks dovetail nicely with a Monday, Nov. 9, session at 1:00 p.m. entitled “An Hour Well Spent: Successful Stories of Members Enhancing Patient Care Through State Advocacy.”

There’s a real push in rheumatology “to affect practice management at the state level. The point of this session is to bring together people who have been successful at the state level in forging relationships with decision makers. Those people will educate us on how practicing rheumatologist can impact the state legislature to get things done,” for instance by limiting troublesome insurance company policies such as step therapy and working towards uniform prescription authorization forms. Such issues are better addressed at the state level because things are too much of a patchwork in the United States to be sorted out at the federal level, Dr. Edgerton said.

Meanwhile, “Practice Without Walls,” a Monday session at 4:30 p.m., will explain how independent rheumatology practices can pool resources to improve quality of care and reduce costs, even across town or state divides. It’s one way to stay independent at a time of increasing consolidation.

The goal is to “allow integration without necessarily selling your practice to an established hospital group that has no particular interest in rheumatology. There are a lot of details to doing that; this will be an opportunity to learn from people who have done it successfully, so you don’t have to reinvent the wheel,” said Dr. Edgerton, one of the moderators for the session.

[email protected]

Biosimilars are coming, and they are going to have an impact on the practice of rheumatology.

But there’s no need to worry. Sessions at this year’s American College of Rheumatology annual meeting will bring attendees up to date about what they need to know to stay ahead of the issue. Biosimilars are just one of a slew of topics to be presented this year to help rheumatologists keep their practices strong with the latest information on regulatory issues, practice management, electronic health records, coding, business models, and other matters.

A major issue with biosimilars is whether pharmacists will be able to substitute them for familiar brand name biologics, and whether they’ll have to notify rheumatologists when they do so. It’s an extension of the generic switch issue, only more fraught because there’s a greater gap between branded biologics and their biosimilar counterparts than between traditional small-molecule drugs and their generics.

States regulate pharmacy practice, and it’s unclear how they’ll come down on the issue. Even so, the biosimilar industry is already at work in statehouses laying the groundwork to allow for easy swaps in the pharmacy.

“Biosimilars in Rheumatology,” a clinical science presentation on Sunday, Nov. 8, at 4:30 p.m., will let rheumatologists know what biosimilar rollouts “might look like in their own states, and what to watch out for. A lot of what will happen is likely to be determined at the state level,” said Dr. Colin Edgerton, a rheumatologist in North Charleston, S.C., and one of the many planners of this year’s meeting.

The session will also go into the experience in Europe, where biosimilar infliximab is one of several biosimilars already on the market, touching upon efficacy, safety, European regulatory solutions, and other matters.

The biosimilar talks dovetail nicely with a Monday, Nov. 9, session at 1:00 p.m. entitled “An Hour Well Spent: Successful Stories of Members Enhancing Patient Care Through State Advocacy.”

There’s a real push in rheumatology “to affect practice management at the state level. The point of this session is to bring together people who have been successful at the state level in forging relationships with decision makers. Those people will educate us on how practicing rheumatologist can impact the state legislature to get things done,” for instance by limiting troublesome insurance company policies such as step therapy and working towards uniform prescription authorization forms. Such issues are better addressed at the state level because things are too much of a patchwork in the United States to be sorted out at the federal level, Dr. Edgerton said.

Meanwhile, “Practice Without Walls,” a Monday session at 4:30 p.m., will explain how independent rheumatology practices can pool resources to improve quality of care and reduce costs, even across town or state divides. It’s one way to stay independent at a time of increasing consolidation.

The goal is to “allow integration without necessarily selling your practice to an established hospital group that has no particular interest in rheumatology. There are a lot of details to doing that; this will be an opportunity to learn from people who have done it successfully, so you don’t have to reinvent the wheel,” said Dr. Edgerton, one of the moderators for the session.

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CHICAGO – A few simple baseline variables predict if heart surgery patients will need early nutritional support after their operations, based on a review of more than 1,000 cardiac surgery patients from Johns Hopkins Hospital in Baltimore.

Nonelective surgery and a cardiopulmonary bypass time of 100 minutes or more, plus five preop variables – previous cardiac interventions; total albumin below 4 g/dL; total bilirubin at or above 1.2 mg/dL; white blood cell counts at or above 11,000/mcL; and hematocrit below 27% – predict the need for nutrition in the first few days after cardiac surgery, they found (J Am Coll Surg. 2015 Oct: 221[4];e70).

The Hopkins team has combined those factors into a risk score, with 4 points assigned for low albumin, 6 points for nonelective surgery, 6 points for low hematocrit, and 5 points for the other four variables, yielding a maximum score of 36 points.

The researchers developed the system after discovering that it sometimes took more than a week for cardiac patients who needed postop nutrition to get it. About 40% of patients with scores of 20 or higher will need early nutritional support, and those heart patients are now the ones at Hopkins who get a nutrition consult as soon as they return from the operating room, said Dr. Rika Ohkuma, a general surgery research fellow at Johns Hopkins. “The score can be used for risk stratification and has potential quality improvement implications related to early initiation of nutritional support in high-risk patients.”

Just 2% of patients who score 10 points or below need early nutrition, so consults are less pressing. About 9% of patients who score from 10-20 points will require nutrition, so consults are at the discretion of the physician, the investigators concluded.

Those insights came from a review of 1,056 adult heart cases in 2012. Just 87 patients (8%) had a postop consult for nutritional support. Most wound up with enteral feedings, but they started an average of 5 days after surgery. The handful that needed both parenteral and enteric feedings started them an average of 7 days after surgery.

Meanwhile, those 87 patients had significantly higher hospital mortality (29% vs. 3%), ventilator time (278 vs. 20 hours), and gastrointestinal complications (32% vs. 5%), and fewer discharges to home (49% vs. 84%) than did other patients.

The team thought that the delay in feeding might have had something to do with the poor outcomes, so “we tried to improve our behavior. We know that nutrition is beneficial for critically ill patients and that we need to start early, but there was no gold standard for when to start,” Dr. Ohkuma said.

The investigators came up with the risk score after figuring out how patients who needed nutrition differed from those who did not. They found, for example, that patients who have emergent surgery were more than three times as likely to have a nutrition consult than were those who had elective procedures.

Now when patients are admitted to the ICU after cardiac surgery, “we all know their [nutrition] score; if they are likely to need support, we immediately call the nutritional support service for a consult.” Patients no longer have to wait, Dr. Ohkuma said.

The researchers launched a prospective study in January 2015. Nutritional needs were addressed sooner, at about postop day 4, for the 70 patients who have needed, and mortality seems to be dropping.

The investigators have no relevant disclosures.

[email protected]

CHICAGO – A few simple baseline variables predict if heart surgery patients will need early nutritional support after their operations, based on a review of more than 1,000 cardiac surgery patients from Johns Hopkins Hospital in Baltimore.

Nonelective surgery and a cardiopulmonary bypass time of 100 minutes or more, plus five preop variables – previous cardiac interventions; total albumin below 4 g/dL; total bilirubin at or above 1.2 mg/dL; white blood cell counts at or above 11,000/mcL; and hematocrit below 27% – predict the need for nutrition in the first few days after cardiac surgery, they found (J Am Coll Surg. 2015 Oct: 221[4];e70).

The Hopkins team has combined those factors into a risk score, with 4 points assigned for low albumin, 6 points for nonelective surgery, 6 points for low hematocrit, and 5 points for the other four variables, yielding a maximum score of 36 points.

The researchers developed the system after discovering that it sometimes took more than a week for cardiac patients who needed postop nutrition to get it. About 40% of patients with scores of 20 or higher will need early nutritional support, and those heart patients are now the ones at Hopkins who get a nutrition consult as soon as they return from the operating room, said Dr. Rika Ohkuma, a general surgery research fellow at Johns Hopkins. “The score can be used for risk stratification and has potential quality improvement implications related to early initiation of nutritional support in high-risk patients.”

Just 2% of patients who score 10 points or below need early nutrition, so consults are less pressing. About 9% of patients who score from 10-20 points will require nutrition, so consults are at the discretion of the physician, the investigators concluded.

Those insights came from a review of 1,056 adult heart cases in 2012. Just 87 patients (8%) had a postop consult for nutritional support. Most wound up with enteral feedings, but they started an average of 5 days after surgery. The handful that needed both parenteral and enteric feedings started them an average of 7 days after surgery.

Meanwhile, those 87 patients had significantly higher hospital mortality (29% vs. 3%), ventilator time (278 vs. 20 hours), and gastrointestinal complications (32% vs. 5%), and fewer discharges to home (49% vs. 84%) than did other patients.

The team thought that the delay in feeding might have had something to do with the poor outcomes, so “we tried to improve our behavior. We know that nutrition is beneficial for critically ill patients and that we need to start early, but there was no gold standard for when to start,” Dr. Ohkuma said.

The investigators came up with the risk score after figuring out how patients who needed nutrition differed from those who did not. They found, for example, that patients who have emergent surgery were more than three times as likely to have a nutrition consult than were those who had elective procedures.

Now when patients are admitted to the ICU after cardiac surgery, “we all know their [nutrition] score; if they are likely to need support, we immediately call the nutritional support service for a consult.” Patients no longer have to wait, Dr. Ohkuma said.

The researchers launched a prospective study in January 2015. Nutritional needs were addressed sooner, at about postop day 4, for the 70 patients who have needed, and mortality seems to be dropping.

The investigators have no relevant disclosures.

[email protected]

CHICAGO – A few simple baseline variables predict if heart surgery patients will need early nutritional support after their operations, based on a review of more than 1,000 cardiac surgery patients from Johns Hopkins Hospital in Baltimore.

Nonelective surgery and a cardiopulmonary bypass time of 100 minutes or more, plus five preop variables – previous cardiac interventions; total albumin below 4 g/dL; total bilirubin at or above 1.2 mg/dL; white blood cell counts at or above 11,000/mcL; and hematocrit below 27% – predict the need for nutrition in the first few days after cardiac surgery, they found (J Am Coll Surg. 2015 Oct: 221[4];e70).

The Hopkins team has combined those factors into a risk score, with 4 points assigned for low albumin, 6 points for nonelective surgery, 6 points for low hematocrit, and 5 points for the other four variables, yielding a maximum score of 36 points.

The researchers developed the system after discovering that it sometimes took more than a week for cardiac patients who needed postop nutrition to get it. About 40% of patients with scores of 20 or higher will need early nutritional support, and those heart patients are now the ones at Hopkins who get a nutrition consult as soon as they return from the operating room, said Dr. Rika Ohkuma, a general surgery research fellow at Johns Hopkins. “The score can be used for risk stratification and has potential quality improvement implications related to early initiation of nutritional support in high-risk patients.”

Just 2% of patients who score 10 points or below need early nutrition, so consults are less pressing. About 9% of patients who score from 10-20 points will require nutrition, so consults are at the discretion of the physician, the investigators concluded.

Those insights came from a review of 1,056 adult heart cases in 2012. Just 87 patients (8%) had a postop consult for nutritional support. Most wound up with enteral feedings, but they started an average of 5 days after surgery. The handful that needed both parenteral and enteric feedings started them an average of 7 days after surgery.

Meanwhile, those 87 patients had significantly higher hospital mortality (29% vs. 3%), ventilator time (278 vs. 20 hours), and gastrointestinal complications (32% vs. 5%), and fewer discharges to home (49% vs. 84%) than did other patients.

The team thought that the delay in feeding might have had something to do with the poor outcomes, so “we tried to improve our behavior. We know that nutrition is beneficial for critically ill patients and that we need to start early, but there was no gold standard for when to start,” Dr. Ohkuma said.

The investigators came up with the risk score after figuring out how patients who needed nutrition differed from those who did not. They found, for example, that patients who have emergent surgery were more than three times as likely to have a nutrition consult than were those who had elective procedures.

Now when patients are admitted to the ICU after cardiac surgery, “we all know their [nutrition] score; if they are likely to need support, we immediately call the nutritional support service for a consult.” Patients no longer have to wait, Dr. Ohkuma said.

The researchers launched a prospective study in January 2015. Nutritional needs were addressed sooner, at about postop day 4, for the 70 patients who have needed, and mortality seems to be dropping.

The investigators have no relevant disclosures.

[email protected]