Today’s Top Story
ACR releases guidelines for treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis.
The American College of Rheumatology (ACR) has published a set of guidelines for the treatment of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). In patients with active AS, strong recommendations include use of NSAIDs, use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, no use of systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. The authors state that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. Among patients with active nonradiographic axial SpA despite treatment with NSAIDs, the authors conditionally recommend treatment with TNFi. Read more…(registration may be required)
The complete guidelines are published in the journals Arthritis & Rheumatology and Arthritis Care & Research. Read the abstract in Arthritis & Rheumatology
Read the abstract in Arthritis Care & Research

Other News

Study: Age strongest predictor of compartment syndrome after tibia fracture.
A study published in the October issue of the Journal of Orthopaedic Trauma examines risk factors for development of acute compartment syndrome (ACS) after tibia fracture. The authors conducted a retrospective cohort study of 1,388 patients who sustained an acute tibial diaphyseal fracture. Overall, 160 patients were diagnosed with ACS. The authors found that age was the strongest predictor of ACS, with the highest prevalence between 12–19 years and 20–29 years. After adjusting for age, occupation and implant type were the only factors that remained significant. The authors state that, after further subanalysis, implant type was not predictive when stratified by Tscherne class. Read the abstract…

Study: Some patient falls may be linked to infection.
Data presented at the Infectious Diseases Week conference suggest that infection may be a contributing factor toward falls in some patients. The researchers conducted a retrospective study of 161 patients who presented with a fall and coexisting systemic infection. They found that bacteremia was present in 73 patients (45.3 percent), urinary tract infection in 68 patients (42.2 percent), respiratory tract infection in 42 patients (26.1 percent), and endocarditis in 10 patients (6.2 percent). Of the bacteremic cases, 22 (30.1 percent) were caused by Staphylococcus aureus, 11 (15.1 percent) by Escherichia coli, and 7 (9.6 percent) by Streptococcus pneumoniae. The researchers state that fall as a direct result of infection was suspected in 22 (13.9 percent) of evaluable cases. Read more…

FDA updates labels for certain approved drugs.
The U.S. Food and Drug Administration (FDA) has released its monthly update of labeling changes for approved pharmaceuticals. The list includes drug products with safety labeling changes to the boxed warning, contraindications, warnings, precautions, adverse reactions, or patient package insert/medication guide sections. The following drugs have seen recent label changes:

  • Gabapentin (trade name Neurontin) capsules, tablets, and syrup
  • Ramipril (Altace) capsules
  • Nicotine polacrilex (Nicorette) gum and large lozenges

Read more…

MedPAC submits comments on CMS proposed Physician Fee Schedule.
The U.S. Medicare Payment Advisory Commission (MedPAC) has submitted comments to the U.S. Centers for Medicare & Medicaid Services (CMS) regarding that agency’s proposed revisions to the 2016 Medicare Physician Fee Schedule. Among other things, MedPAC addresses the issue of shared accountability arrangements between providers, and notes three potential barriers to such gainsharing: the physician self-referral law, the anti-kickback statute, and the civil monetary penalty provision in the Social Security Act, which prohibits hospitals from offering physicians financial incentives to reduce services to Medicare patients. MedPAC recommends that Congress grant CMS the authority to allow gainsharing arrangements between physicians and hospitals, with safeguards to ensure that cost-saving measures do not reduce quality or influence physician referrals. MedPAC also offers support for linking individual Physician Compare web pages to Open Payments (Sunshine Act) data, and streamlining and consolidating Medicare quality incentive programs. Read the letter (PDF)…

New Mexico/Texas.
The Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) has voted to join an amicus curiae brief filed before the New Mexico Supreme Court in a case that could have jurisdictional ramifications for medical liability claims. At issue is a case in which a physician working in Texas provided medical care to a resident of New Mexico. In a March 19, 2015 opinion, the New Mexico Court of Appeals held that a physician should be subject to the New Mexico Tort Claims Act and not the equivalent Texas legislation. Some are concerned that the decision may expand New Mexico’s limited liability to Texas physicians in private practice and circumvent Texas’ cap on noneconomic damages. Read more (PDF)…

The Milwaukee Journal-Sentinel reports that a bill being drafted for introduction in the Wisconsin State Senate would, if enacted, allow parents to sue if an adult child up to age 27 dies as the result of medical error. State law currently prohibits parents of adult children from suing for medical liability if their child dies. Read more…

Call for volunteers: Biomedical Engineering Committee.
Oct. 21 is the last day to submit your application for a position on the Biomedical Engineering Committee (one member opening). The Biomedical Engineering Committee monitors and reviews scientific and regulatory developments in the field of biomedical engineering as they relate to orthopaedic surgery. Applicants for this position must be active fellows with experience in standards and guidance document development. A specialization in adult reconstruction or sports medicine is preferred. Learn more and submit your application…(member login required)