Infections in the management of rheumatic diseases: An update

Patients with inflammatory rheumatic conditions have an increased risk of infection. While this could be the  result of the underlying disease, it may also be caused by the use of immunosuppressive therapies, which are  needed to treat these disorders. An increasing number of patients with rheumatoid arthritis or other rheumatic diseases are using biologic therapies (biologics) in addition to the synthetic diseasemodifying anti-rheumatic drugs. The side-effects and complications of these relatively new agents are unknown to many specialists  (outside of rheumatology) and general practitioners. This article highlights updates on the most important  infections encountered in the daily management of patients with rheumatic diseases and discusses how these may be prevented

South African guideline for the use of chronic opioid therapy for chronic non-cancer pain

Chronic pain may have a significant impact on health-related quality of life and can be difficult to manage. In carefully selected patients, and as part of a comprehensive pain management strategy, opioid analgesia may help to achieve long-term pain control with a manageable side-effect profile and a low risk of serious adverse effects. However, appropriate evaluation, including biopsychosocial screening and risk screening is essential before initiating an opioid and during continued therapy. This guideline aims to assist practitioners in screening and selecting appropriate patients with chronic non-cancer pain to initiate, monitor and continue pain management with opioid therapy.The development of this guideline was supported by an unrestricted grant from Mundipharma who did not participate in the development or writing of the guideline. Dr M Raff has received honoraria for consultancies and non-restricted research grants from Mundipharma, Pfizer, Janssen Pharmaceutica, AstraZeneca, MSD, Eli Lilly, Aspen and Abbott Laboratories. Drs J Crosier and S Eppel have received honoraria from Mundipharma. Prof. H Meyer has received honoraria for consultancies and non-restricted research grants from Janssen Pharmaceutica, Eli Lilly, MSD and Mundipharma. Dr B Sarembock has received honoraria for consultancies and non-restricted research grants from MSD, AstraZeneca, Pfizer and Mundipharma. Dr D Webb has received professional fees for services to Abbott Laboratories, Adcock Ingram, Alcon Laboratories, AstraZeneca, Eli Lilly, Janssen Pharmaceutica, Mundipharma, Novartis, and Reckitt Beckiser Pharmaceuticals.http://www.samj.org.zaam201