In ILD, a step-up diagnostic strategy vs. immediate surgical biopsy reduced need for unexpected chest tube drainage.

SOURCE CITATION: Kalverda KA, Ninaber MK, Wijmans L, et al. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. Lancet Respir Med. 2024;12:513-522. 38640934.

In RA, use of systemic glucocorticoids ≥5 mg/d (prednisolone-equivalent) was linked to MACE at 8.7 y.

SOURCE CITATION: So H, Lam TO, Meng H, et al. Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with rheumatoid arthritis: a population-based study. Ann Rheum Dis. 2023;82:1387-1393.37487608.

In adults with active dermatomyositis, IV immune globulin improved treatment response at 16 wk vs. placebo.

SOURCE CITATION: Aggarwal R, Charles-Schoeman C, Schessl J, et al. Trial of intravenous immune globulin in dermatomyositis. N Engl J Med. 2022;387:1264-78. 36198179.

In RA, new use of JAK inhibitors was associated with nonmelanoma skin cancer vs. TNF inhibitors at 2 y.

SOURCE CITATION: Huss V, Bower H, Hellgren K, et al; ARTIS group. Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: a national real-world cohort study. Ann Rheum Dis. 2023;82:911-919. 36868796.

Six attitudes to promote personal, patient-centred care in an era of addictive technology.

In contrast with the rapid advances in medical knowledge and technology, the clinical encounter may often appear as perfunctory, impersonal, and unworthy to both patient and practitioner who is often immersed in the computer screen rather than the patient, stressed by improbable time constraints, and often finds deceptive relief in inappropriate test-ordering, prescriptions, and referrals. We suggest routinely adopting six attitudes to achieve a more balanced, personal, and patient-centred encounter: conducting a curiosity-driven encounter; emphasizing humanistic values; performing a complete physical examination; increasing patients' face time; addressing the patient's health as a whole; and rational test-ordering and judicious prescribing.

In older adults discharged from hospital, home-based exercise programs improve some outcomes.

SOURCE CITATION: Lin I, Glinsky J, Dean C, et al. Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: a systematic review and meta-analysis. Clin Rehabil. 2022;36:1170-85. 35522200.

Hemoptysis in a cannabis user.

A healthy young man presented to the emergency department with mild hemoptysis associated with cannabis abuse. He was on no medications and cocaine abuse was ruled out by both history and negative toxicology screens. There were neither signs of an infection, nor of a systemic or cardiac disease. Imaging studies were consistent with diffuse alveolar hemorrhage, a reported, albeit rare adverse drug reaction of tetrahydrocannabinol (Naranjo score 6). The patient improved spontaneously within a few days, hemoptysis stopped and repeat imaging was entirely normal. With the increase in cannabis abuse and enhanced cannabis potency worldwide clinicians may increasingly encounter even unusual cannabis-associated adverse drug reactions, including associated diffuse alveolar hemorrhage.

Mind the caretaker: ED referrals of community-dwelling older adult patients by their primary caregivers are accurate.

BACKGROUND: ED referral of older adults on the initiative of their family or paid live-in caregiver is common but not previously studied. METHODS: ED-presenting community-dwelling patients ≥65 years were studied, emphasizing the referring agent, and correct (admitted or discharged +changed diagnosis/treatment) vs. incorrect referral (discharged, no change made). RESULTS: Of 448 consecutive patients (median age 83 years), 231 were referred by their primary physician (PCP) (73% admitted, 17% discharged +change). 117 ED referrals were initiated by their family (78% admitted, 6% discharged +change), and 100 by their paid caregiver (66% admitted, 21% discharged +change). Differences were non-significant, as was the distribution of main diagnoses. CONCLUSIONS: ED referral of older adults from the community by laymen who know the patient well (family or caregiver) is non-inferior to a referral by their PCP. ED physicians should regard non-physician ED presentations as seriously as a referral by a physician, pending confirmation in future studies.

Diagnostic errors: Under-appreciated, under-reported and under-researched.

Diagnostic errors, were given relatively little attention, compared with the effort invested in treatment errors. However, erroneous diagnoses continue to be quite prevalent (10%-15% in every setting investigated), and are often associated with substantial patient harm including increased mortality and frequent permanent disability. Physicians may not be aware of the fact that despite the wide availability of sophisticated diagnostic imaging and new and sensitive tests, diagnosis remains far from infallible, because of a complex interplay of physician, patient and illness factors. Research devoted to misdiagnosis remains difficult to perform and insufficient in scope, but the search for the optimal means to improve diagnostic accuracy continues. Newly achieved insights regarding diagnostic errors are presented, and essential system and individual approaches to improve diagnostic accuracy are proposed.

In older adults, new use of allopurinol or febuxostat was linked to hypersensitivity reactions versus colchicine.

SOURCE CITATION: Singh JA, Cleveland JD. Hypersensitivity reactions with allopurinol and febuxostat: a study using the Medicare claims data. Ann Rheum Dis. 2020;79:529-35. 32024648.

Guselkumab safely improved clinical outcomes in biologic-naive patients with psoriatic arthritis.

SOURCE CITATION: Mease PJ, Rahman P, Gottlieb AB, et al. Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet. 2020;395:1126-36. 32178766.