Monday, 18 Jun 2018

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Could Measuring Drug Levels with TNF Treatment Hurt Your Patients?

Our colleagues in gastroenterology measure drug levels with certain biologics used in inflammatory bowel disease in order to increase the dose for optimal benefit if the patient has a low trough level (i.e. targeting drug level).

There have been GI trials with T2T with drug levels but they are not always suggesting that the strategy is superior to usual care. Also, this is really not a common practice in rheumatology.

We Measure What we do in RA, But so What?

We are supposed to treat to a target (T2T) in RA. In other words, measure many components of the disease and its activity and calculate a score and if the patient is not in remission (or a low state if remission is not achievable) we are to make a treatment change.

Does RA kill you? Let me count the ways….and what you can do about it

There were many presentations at EULAR 2018 in Amsterdam about the mortality of RA.

Gout Takeaways

The annual EULAR meeting just came to an end today. Rooms are gradually emptying out. People look both content to have updated their knowledge and relieved that four very busy days have concluded. Time to summarize.

Methotrexate Update

I was delighted to see that investigators presenting work at EULAR 2018 haven’t lost interest in our old friend methotrexate, with a number of abstracts examining issues of safety, dose and route of administration.

Low incidence of methotrexate induced liver abnormalities

EULAR 2018 - Day 3 Report

Day 3 highlights include Behcet’s responds to apremilast and that biologics do not differentially affect TKR/THR post-operative infection rates. Be sure to check out today's podcast as well. 

EULAR 2018 - Podcast from Day 3

This EULAR 2018 Podcast is a compilation of audio clips from EULAR in Amsterdam.

Click HERE to listen.

You can also listen on iTunes, Soundcloud or Stitcher. 

High Biologic Blood Levels Increases the Risk of Infections in RA

A big concern of most is the risk of infection with use of tumour necrosis factor inhibitor (TNFi) and biologic drugs.  While studied in both trials and in post-marketing studies, it is unknown if infection risk is dose-dependent.

In abstract OP0229 UK researchers have shown high biologic blood levels are associates with an increased risk of total infections in RA, but not serious infetions.

The RheumNow Week in Review – EULAR18 Abbreviated (6.15.18)

We're crazy busy at EULAR all week.  Instead of this review, we recommend that you tune into our multiple podcasts from experts and faculty attending EULAR 2018 in Amsterdam.  You can find these on iTunes, SoundCloud or Stitcher.

Tune in next week for the EULAR week in review!

Changing my Mind at EULAR

Each year I attend I hope that I’m going to come across something that changes my practice and this year, I think I may have struck gold at a session on Giant Cell arteritis at EULAR in Amsterdam.

Update on Osteoporosis

This session was an update on the management of osteoporosis given by Professor Christian Roux from France.

He emphasised the use of composite risk score like the FRAX. He highlighted that the risk of vertebral fracture is increased by both the recency and severity of previous vertebral fracture. So it is important that those with vertebral fractures are followed up and treated appropriately to prevent subsequent fractures.

Increased Risk of Infection in Psoriasis and Psoriatic Arthritis

As we gather more knowledge about psoriatic arthritis ( PsA) and psoriasis (PSO) over time, and achieve better outcomes with new therapies, more questions arise about quality of life, survival  and comorbidities in PsA and PSO. Similarly to RA, we learned about increased risk of CVD and malignancy. With more data compiled in cohorts it is possible now to ask the same questions as we asked in RA.