Rheumatologist and clinical pharmacologist, world traveller pretences, and even sometimes journal podcast host. All opinions my own
Articles by David Liew
The GLP-1 Opportunity Cost in Rheumatology Save
There is no doubt it is an incredibly exciting time to be tackling obesity-related diseases, like many rheumatic diseases appear to be, to some extent. When I wrote two years ago that “what is for sure, however, is that rheumatology will not be able to close its eyes to the impact of Ozempic (Ozempic Will Change Rheumatology), it was, if anything, an understatement.
The weight is off, the DMARDs are off - now what? Save
Sometimes it’s only when we have effective solutions that we have to think about what to do next. And when that happens, remember why we do things in the first place. In an era when weight loss is happening on scale, now we need to think about the goals after the weight is lost. Weight loss seems more achievable now than it ever has been - partially because it is more achievable, but partially because now we believe that it is achievable.
Current clinical practice trends in giant cell arteritis diagnosis and management: a national survey of Australian rheumatologists and rheumatology trainees
Data availability statement The data that support the findings of this study are available in the supplementary material of this article. Supporting Information Filename Description imj70319-sup-0001-supinfo.pdfPDF document, 169.1 KB Data S1. Supporting Information. References 1, , . Giant cell arteritis. Best Pract Res Clin Rheumatol 2016; 30: 169–188. 2, , . Giant cell arteritis: beyond temporal artery biopsy and steroids. Intern Med J 2017; 47: 1228–1240. 3, , .
Why I love the late breaking abstracts
Every year I love the late breaking abstracts. It’s consistently my favourite part of the meeting program, by some distance. I’m not shy about this, and usually I request that with RheumNow’s EULAR and ACR coverage that I get on the daily recap on the last day so I can tell our full listening audience as much – although this year was the exception, because I foolishly let my flight scheduling back to Australia get in the way.
Why I love the late breaking abstracts
Every year I love the late breaking abstracts. It’s consistently my favourite part of the meeting program, by some distance. I’m not shy about this, and usually I request that with RheumNow’s EULAR and ACR coverage that I get on the daily recap on the last day so I can tell our full listening audience as much – although this year was the exception, because I foolishly let my flight scheduling back to Australia get in the way.
Where are we at with PD-1 agonism?
Promising novel mechanisms of action always create excitement, but the immune checkpoint PD-1 has cemented itself in the news far more than most. This fame is primarily from therapeutic inhibition in cancer and rheumatological inflammatory sequelae that emerge, but invoking the inverse and using PD-1 agonism to treat classical autoimmunity has subsequently been making its own mark.
Stopping therapy in GCA
They say the easiest bit about GCA, like PMR, is the first week after you start steroids. The feeling is a culmination of many good things: the patient can feel the weight of inflammation off their shoulders thanks to you, the fear of the imminent risk of blindness has passed, much of what needs to be done seems to have been done - and yet, none of the complicated path ahead, strewn with glucocorticoid toxicity and relapse (and the sometimes possibility of it) has become evident yet.
Choosing a nonsteroidal anti-inflammatory drug for pain
SUMMARY Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful for many conditions, frequently in preference to other therapies such as opioids. They play an important role in osteoarthritis, headache disorders, acute musculoskeletal injury, dysmenorrhoea and dental pain. In axial spondyloarthritis, they can modify disease and represent first-line therapy. Most NSAIDs have comparable efficacy for most conditions, despite their different pharmacodynamic effects.
What we need in very early arthritis
It's easy to think that in our current world that we've done it all for rheumatoid arthritis, that there's nothing left to be done after b/tsDMARDs have become relatively widespread and accessible. If we aren’t satisfied that we’ve done all we can for our RA patients, how can we make their treatment and their lives better?
What would it take for JAKs to ROCK the boat?
JAK inhibitors have taken a beating over the last three years. The excitement and potential has been tempered by mounting cardiovascular safety concerns, but specifically in at-risk patients, compared to TNF inhibitors. Once the suggestion is made, though, the concern is powerful. I am sure I am not the only one who has had to have difficult conversations navigating nuance in explaining situations where I think the risk is more than manageable. The fear of cardiovascular events can be hard to shake.
Polymyalgia rheumatica: killing them softly
References 1. Crowson, CS ∙ Matteson, EL ∙ Myasoedova, E ∙ et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases Arthritis Rheum. 2011; 63:633-639 2. Spiera, RF ∙ Unizony, S ∙ Warrington, KJ ∙ et al. Sarilumab for relapse of polymyalgia rheumatica during glucocorticoid taper N Engl J Med. 2023; 389:1263-1272 3. Strand, V ∙ Msihid, J ∙ Sloane, J ∙ et al.
Secukinumab promise in PMR is real
GCA is getting steroid-sparing therapy choices, and PMR doesn’t want to miss out. Most PMR patients with current therapy approaches incur multiple grams of cumulative prednisolone exposure, even though they’re often exactly the kind of patients we would rather keep away from steroids altogether. Yet we only recently got our first steroid-sparing choice in PMR, sarilumab, and conventional registration studies seem hard to run.
Will the Robots Save Ultrasound?
Ultrasound has a lot going for it in rheumatoid arthritis and psoriatic arthritis. It is free of ionizing radiation, yet can deliver helpful insights to the bedside, educating our patients along the way. As we seek to prognosticate more and delineate better, ultrasound should be our friend. That is not news.
Ozempic will change rheumatology
Ozempic is everywhere. Even all the way in Australia, where we have highly constrained supply that makes headlines and substantial limits on direct-to-consumer advertising, somehow I know the jingle from the American ad for Ozempic. I have no special interest or personal gain to be made, but so pervasive is its cultural significance that its ubiquitous brand recognition should come as no surprise. Our rheumatology patients are no different.
JAK inhibitors in GCA?
It’s been eight years, and here we are again. The ACR annual meeting was last in Washington DC in 2016, and there’s probably a lot about ACR 2024 in DC that seems familiar. Maybe for some, it’s the half-smoke hot dogs that DC is famous for, maybe for others it’s something else (as an Australian, who am I to say). Sometimes ACR Convergence can have little overtones of Groundhog Day, living the same story over and over.
The path to new technologies in rheumatology must be beset with caution
Sometimes it feels like we live in an antiquated bubble. We examine from the right side of the patient’s bed and we use Latin abbreviations to give critical instructions about our medicines, for no strong reason apart from the reason that we hav always done it that way. It served our rheumatological forefathers well, and as the rightful torchbearers of the legacy of Osler and Heberden, we look at our whole craft built around this and see no good reason to dispose of this.
Choices in GCA | RheumNow
It has been easy over time to presume that all advanced therapies in a disease area will work as well as each other. We have been so used to the idea that all b/tsDMARDs in rheumatoid arthritis are as effective as each other, given enough time, and that they all modify the disease to prevent the disability that we had become used to. It’s hard to change our thinking to be any different. Similarly, in psoriatic arthritis, the arthritis scores have been hard to separate between the different agents.
The art of talking about risks with our patients
On the first day of EULAR 2024, I am debating Janet Pope. To make it more challenging, it’s about JAK inhibitor safety, and I have been allocated to argue against the regulatory safety warning and the randomised controlled trial that supports it. It’s a challenge, but one that has really given me an opportunity to reflect more broadly. There are many things which are problematic about the regulatory safety warning, a number of which I didn’t put together fluently in my mind prior to this.
Better than bemoaning regulation, we can tackle risk with our words
On the first day of EULAR 2024, I am debating Janet Pope. To make it more challenging, it’s about JAK inhibitor safety, and I have been allocated to argue against the regulatory safety warning and the randomised controlled trial that supports it. It’s a challenge, but one that has really given me an opportunity to reflect more broadly. There are many things which are problematic about the regulatory safety warning, a number of which I didn’t put together fluently in my mind prior to this.
Clinical evaluation is critical for the implementation of artificial intelligence in healthcare: comment on the article by Mickley et al.
Christopher McMaster FRACP, MBBS Department of Rheumatology, Austin Health, Victoria, Melbourne, Australia Department of Clinical Pharmacology and Therapeutic, Austin Health, Victoria, Melbourne, Australia Centre for Digital Transformation of Health and School of Computing and Information Systems, University of Melbourne, Victoria, Melbourne, Australia Search for more papers by this author
Study: Patients with PMR Experience Fatigue, Sleep Disturbance & Mood Disorders
Polymyalgia rheumatica (PMR) is typified by pain and stiffness of the shoulder and hip girdles. Previous qualitative studies have highlighted the importance to patients of additional symptoms, including fatigue and sleep disturbance. These features of PMR are less recognized by clinicians and have not yet been quantified in the literature. Further, the adequacy of the current treatment paradigm in addressing these symptoms is unknown.
When should we be starting therapy in GCA and PMR?
The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it. GCA and PMR are at the stage in the growth of their therapeutic development where this problem is moving to the front of mind, and it made for a fitting topic in the ACR Convergence Great Debate. Drs.
Why are older RA patients getting mistreated?
Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. This core tenet of modern rheumatology is surely not just canon, but has been intuitive for decades, no matter the age of the patient.
How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard. We know that we need to communicate well with the patient and her whole team, so that details are not lost, but often that has been time-consuming at best and fraught at the worst.
JAKi for PMR: Safe, or a Concern for Older Adults?
Hi, David Liew here from Melbourne, Australia as part of the RheumNow PMR month campaign that is Make Rheum for PMR. I just want to talk to you a little bit today about JAK inhibitors in polymyalgia rheumatica. Now, JAK inhibitors obviously have dominated a lot of the discussion in our therapeutic landscape over the last couple of years.
Clinically suspect arthralgias: justified or artefact?
Some subjects in rheumatology seem to create contention the more they get explored, and one of those areas is a traditional crowd favourite for discussion at EULAR - clinically suspect arthralgias. At EULAR 2023 in Milan, the perfect platform was provided for an airing of grievances, in a debate entitled ‘Clinically suspect arthralgias: fact or myth’.
EULAR 2023 | RheumNow
The Importance of Knowing Which Entheses are Involved in PsA
Better at Predicting RA from MRI: Humans or Computers?
An artificial intelligence model to assess pre-RA hand MRIs has confirmed what human readers have known before: that bone marrow edema and tenosynovitis are objectively the best predictors of future RA development in patients with clinically suspect arthralgias or undifferentiated arthritis. The computer cannot outperform human readers yet though, according to data presented in the opening abstract plenary at EULAR 2023 in Milan, Italy.
We asked ChatGPT to write us an article
Our rheumatology editor gave ChatGPT a run at a story to test the hype and doesn't think reporters have much to worry about. There’s been an awful lot of talk about ChatGPT. Depending on who you are, large language models (LLM) will either (a) replace us, (b) plagiarise us, or (c) annoy us. To paraphrase the kid in the Old El Paso ads from the 90s: porque no los tres? (Why not all three?) That kid is now a low-ranking Instagram influencer (@lil_missimia), so what would she know anyway?
We asked ChatGPT to write us an article
There’s been an awful lot of talk about ChatGPT. Depending on who you are, large language models (LLM) will either (a) replace us, (b) plagiarise us, or (c) annoy us. To paraphrase the kid in the Old El Paso ads from the 90s: porque no los tres? (Why not all three?). That kid is now a low-ranking Instagram influencer (@lil_missimia), so what would she know anyway?
Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review
DISCUSSION To our knowledge, this is the first systematic review to examine published cases of myelosuppression in colchicine use in the context of rheumatic conditions. We identified 30 reports of 47 patients with myelosuppression. Across the 47 studies, there were 15 patients taking CYP3A4 inhibitors and 13 patients taking P-gp inhibitors, suggesting that drug interactions contributed to myelosuppression.
Celebrating the life of Philip C. Robinson, MBChB, PhD, FRACP
We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. The rheumatology community recently lost physician and educator Philip Robinson, MBChB, PhD, FRACP, associate professor in the faculty of medicine at the Royal Brisbane Clinical Unit at the University of Queensland, in Australia. He was born in Wellington, New Zealand, on June 9, 1979.
Q&A: ‘Large, structural issues’ working against preventive care in rheumatology
Source/Disclosures Source: Healio Interviews Disclosures: Liew and Robinson report no relevant financial disclosures. Source/Disclosures Source: Healio Interviews Disclosures: Liew and Robinson report no relevant financial disclosures. We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Editor’s Note: This interview between Healio and Drs. Philip Robinson and David Liew occurred in September.
EULAR 2022 | RheumNow
Can We Get Rid of RA?
Activated osteoarthritis following immune checkpoint inhibitor treatment: an observational study
Clinical/translational cancer immunotherapy Activated osteoarthritis following immune checkpoint inhibitor treatment: an observational study http://orcid.org/0000-0002-7645-0919Pankti Reid1, http://orcid.org/0000-0001-8451-8883David FL Liew2,3, Rajshi Akruwala4, Anne R Bass5 and Karmela K Chan5 1Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA 2Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia 3Division of Rheumatology and...
AS/Spondyloarthritis-EULAR 2021 | RheumNow
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Israel provides COVID vaccine answers for rheumatic disease patients
The question as to how autoimmune rheumatic disease patients fare with the COVID vaccine is one being asked in rheumatologists’ offices everywhere this year, and at the EULAR 2021 Virtual Congress, data presented from Israel, one of the first countries to vaccinate on a broad scale, has provided much-needed reassuring answers.
Artificial intelligence brings clarity to early bony changes in inflammatory arthritis
Subtle early bony changes in inflammatory arthritis can be hard even for experienced rheumatologists to interpret, even though they have traditionally been considered to become disease-defining as they progress. As computational techniques have become more sophisticated and more accessible, questions have been asked as to whether such technology can be harnessed to identify inflammatory arthritis more rapidly.
Blindness with Tocilizumab in GCA: Is it a Worry? Dr. David Liew
Dr. David Liew discusses abstract OP0065, "Tocilizumab in Visual Involvement of Giant Cell Arteritis. Multicenter Study of 312 Patients of Clinical Practice", presented at the virtual EULAR 2021 meeting.
Brief Communication Adam Rischin, Corresponding Author a.rischin@alfred.org.au orcid.org/0000-0003-2849-7680 Department of Rheumatology, The Alfred Hospital, Melbourne, Victoria, Australia Correspondence Adam Rischin, Department of Rheumatology, The Alfred, PO Box 315, Prahran, Vic. 3181, Australia.
New targeted therapies for rheumatoid arthritis
Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, affecting around 1.9% of Australians.1 RA is characterised by polyarthritis, causing pain, irreversible joint damage and disability if left untreated. Treatment aims not just to improve symptoms but to induce remission or control inflammation to prevent joint injury and disability.
COVID vaccine guidelines: glad that ain't me
OPINION | Try writing some guidelines for everyone, in every situation, under intense scrutiny, with no direct evidence, that fits into all governance structures, and do it yesterday, s'il vous plaît. Well, it was always going to come to this – COVID vaccine talk is everywhere you look.
COVID vaccine guidelines: glad that ain't me
3 March 2021 ACR COVID-19 Opinion Well, it was always going to come to this – COVID vaccine talk is everywhere you look. If you happen to have read Jeremy Knibbs’s editorial for The Medical Republic a few weeks ago, you’ll know Australia needs to hit a furious pace of 200,000 vaccinations/day to make the self-imposed October deadline (which the economy is hanging on), and every day we fall behind the required run rate goes up.
It’s time to bring the conversation back
18 February 2021 ACR COVID-19 EULAR public health Posted byDr David Liew The greatest cliché of COVID is that it has taught us a lot of things, but few speak to the times quite like the way we’ve changed our human interactions in a short space of time. We just don’t seem to have the conversations we used to.
Erosions on X-ray: can we delegate this to the computers?
The prospect of automating hand x-ray scoring reliably has always been an enticing one, and data presented at the American College of Rheumatology (ACR) Convergence 2020 suggest this might be in reach in the near future – opening up the prospect of automatic x-ray scoring in real-word practice, without the need for routine involvement of a specialized radiologist.
Hydroxychloroquine for COVID-19: a cautionary tale - InSight+
HYDROXYCHLOROQUINE has never had more scrutiny than during the coronavirus disease 2019 (COVID-19) pandemic. As COVID-19 case numbers grew, the promise of a pharmacotherapeutic panacea to the world’s problems led to exponential growth in interest in a drug not used to attention. While enthusiasm has now been slightly curbed, the real negative impacts have raised questions as how to encourage appropriate prescribing.
Musculotendinous Inflammation: The Defining Pathology of Polymyalgia Rheumatica?
Despite being the most common inflammatory rheumatic disease of the elderly, and despite significant scientific breakthroughs in the related condition giant cell arteritis (GCA), the paradigm of polymyalgia rheumatica (PMR) has failed to progress beyond its earliest descriptions as a glucocorticoid-responsive syndrome of shoulder and pelvic girdle pain and stiffness.
Letter to the editor: Comments on ‘A case of pembrolizumab-induced autoimmune haemolytic anaemia with polymyalgia rheumatica’
Publication History Published online: February 28, 2019Accepted: November 11, 2018; Received: October 30, 2018;
Rheumatic immune-related adverse events secondary to anti-programmed death-1 antibodies and preliminary analysis on the impact of corticosteroids on anti-tumour response: A case series - European Journal of Cancer
Publication History Published online: November 13, 2018Accepted: September 25, 2018; Received in revised form: August 22, 2018; Received: June 7, 2018;
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