News in brief: First guidelines for AAV; Procedural specialists are overpaid; Inpatient rehab encourages opioid use after TKA

First guidelines for AAV released by ACR

The American College of Rheumatology has released the first guidance in conjunction with the Vasculitis Foundation for the management of Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis (AAV);

Published in Arthritis and Rheumatology, the guidelines on AAV include 26 recommendations and five ungraded position statements for granulomatosis with polyangiitis (GPA and microscopic polyangiitis (MPA), and 15 recommendations and 5 ungraded position statements for eosinophilic granulomatosis with polyangiitis (EGPA). The recommendations cover the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in non-severe EGPA.

In the same issue, the ACR also releases guidelines on Giant Cell Arteritis (GCA) and Takayasu Arteritis, and Polyarteritis Nodosa.

Inpatient rehab encourages opioid use after TKA

Opioid use is twice as high among patients who undergo inpatient rehabilitation following total knee arthroplasty (TKA) compared to those discharged directly home, an Australian study has found.

A study of 158 patients who underwent TKA found that 10 weeks after the procedure  60% of those who had inpatient rehabilitation reported the purchase of opioid-based medications after discharge compared with 34% in the home discharge group (χ2 = 7.4; P = 0.007).

No significant or meaningful between-group differences in index joint pain, function, or mobility were observed, according to study investigators from Liverpool Hospital and the Ingham Institute, Sydney.

“The greater risk [of opioid use] in the inpatient rehabilitation group may be because rehabilitation specialists provide repeat scripts at discharge (~14 days after surgery),” they suggested.

Inpatient rehabilitation patients may also have had more prolonged exposure to opioids compared with those discharged directly home owing to daily opioid prescription prior to therapy for those in the IR program, leading to greater medication reliance and seeking more prescriptions once home, they added.

More details: ACR Open Rheumatology

Call for Medicare to review procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.

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