Wednesday, 24 Apr 2019

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RheumNow Podcast - Death and Surgery (2-22-19)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com:

Lupus Microbiome May Drive Disease Activity

Silverman and colleagues have published their study of the fecal microbiome of systemic lupus erythematosus (SLE) patients and found roughly five times more gut bacteria known as Ruminococcus gnavus, and that these abnormalities in microbiota can correlate with measures of disease severity in SLE.

Impressive Survival of Interleukin-1 Inhibitors in Systemic Juvenile Idiopathic Arthritis

The drug retention rate of interleukin-1 inhibitors (IL-1) used to treat systemic juvenile idiopathic arthritis (JIA) appears to be quite high according to a new study. 

Safety Warnings for Higher Dose Tofacitinib

Pfizer has issued a press release regarding the safety of tofacitinib, citing higher rates of pulmonary embolism and death associated with the use of higher dose tofacitinib 10mg bid in rheumatoid arthritis (RA) patients treated in a long-term safety trial.  

Remission Unlikely in RA

Dr. Marwan Bukhari (editor of Rheumatology) has written an editorial wherein he suggests that true remission is hard to achieve. He notes that "remission as a target is a noble objective that we should all aspire to but we should not chastise our practice if we do not achieve it, as more and more evidence suggests that we should consider it the ideal but not the norm."

TKR - One or Two at a Time?

His would-be surgeon tried mightily to talk him out of a bilateral knee replacement. At 340 pounds, the patient's BMI -- above 43 -- was a significant contraindication. 

But the patient -- Nick Yphantides, MD, chief medical officer for California's San Diego County -- told MedPage Today he "aggressively" insisted, threatening to find another surgeon if he had to.

Older Men Less Likely to be Assessed and Treated for Osteoporosis

A study from the University of Washington in Seattle find that men with osteoporosis were less likely to be assessed by dual-energy X-ray absorptiometry (DXA); vitamin D measurements and were less like to receive calcium/vitamin D and bisphosphonate prescriptions. 

Hip Replacements Lasting 25 Years

Lancet reports that, based on a literature review and metanalysis, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

In the USA, there is an estimated 400,000 total hip arthroplasties (THA) annually. UK invesigators set out to answer the question: how long does a hip replacement last?

RheumNow Podcast - MTX vs. Etanercept in Psoriatic Arthritis (2.15.19)

Dr. Jack Cush discusses the news from the past week on RheumNow.com - including the SEAM trial, MRI guided T2T, biologics and infection, contraceptive use, ANA negative lupus, etc.

Stopping Biologics Before Joint Surgery: Is Earlier Better?

Withholding intravenous abatacept (Orencia) for longer than a month before hip or knee arthroplasty among patients with rheumatoid arthritis (RA) did not lower the risk for postoperative infection, a retrospective claims-based analysis found.

Mortality and Hospitalization with Pulmonary Hypertension in Systemic Sclerosis

PHAROS is a prospective cohort studying the natural history of pulmonary hypertension (PH) in systemic sclerosis (SSc). They have shown that risk factors for poor outcomes in this cohort included male sex, DLCO < 50%, exercise oxygen desaturation, and pericardial effusions. 

Noninfectious Proximal Aortitis Needs Serial Follow-ups

A Cleveland Clinic review of patients undergoing thoracic aortic surgery (1996‐2012) identified 196 patients with histopathology‐proven non‐infectious aortitis. The majority of these patients had a recognized systemic disorder, and serial assessments and imaging is crucial to an accurate diagnosis.