Wednesday, 24 Apr 2019

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Elevated Fracture Risk in Lupus

A Medicaid study of lupus (SLE) patients finds that fracture risks are elevated in low‐income SLE and lupus nephritis patients compared to those without SLE.

A cohort study matched Medicaid SLE patients and age‐ and sex‐matched non‐SLE comparators to study the primary outcome of fracture of the pelvis, wrist, hip, or humerus.

RheumNow Podcast - Scurvy and Mechanics (2-1-19)

Dr. Jack Cush reviews new journal articles, news reports, and more from the past week on RheumNow.com.

Update on Pregnancy Management in RA

Two recent reports offer good news to rheumatoid arthritis (RA) women who are planning to become pregnant. 

The first studies, RA women experiencing fertility issues who turn to assisted reproductive technology (ART) shows that live births were significantly lower in women with rheumatoid arthritis receiving ART treatment compared to usual rates in women without rheumatoid arthritis.

No Difference in Oral or IV Antibiotics for Bone & Joint Infections

Research from the NEJM shows that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first six weeks for complex orthopedic infections.

There is considerable discussion whether complex bone and joint infections must be managed with prolonged intravenous antibiotics or if oral antibiotic therapy may suffice. 

Low IBD Risk with Secukinumab

The interleukin-23 (IL-23)/IL-17 axis plays an important role in inflammation and infection. Some of these chronic immune-mediated inflammatory disorders include PsO, PsA, AS, and IBD. Patients with PsO, PsA, and AS have up to a four-fold risk of developing IBD versus the general population. One study also supported the role for gut inflammation in spondyloarthropathy.

Ixekizumab and Complete Resolution of Enthesitis and Dactylitis

IL-17 inhibitors have proven to be effective in psoriatic arthritis. Analyses of ixekizumab-treated PsA patients with enthesitis or dactylitis shows this approach to yield significant improvements in enthesitis and dactylitis.

Vertebroplasty and Kyphoplasty Shown to Be Ineffective

There are approximately 750,000 new vertebral compression fractures each year in the United States, with resultant acute and chronic back pain in over one‐third of patients with vertebral fractures (VF).  Both percutaneous vertebroplasty or balloon kyphoplasty have been advocated as useful means of restoring vertebral height and strength capable of reducing pain in symptomatic patients.

Multidisciplinary Recommendations for Rheumatoid Foot Problems

Approximately 90% of patients with rheumatoid arthritis (RA) have foot problems. A multidisciplinary panel (including 2 patients, 22 professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, researchers) in the Netherlands set out to develop recommendations for those who treat RA foot problems. 

Improved Survival with Renal Transplant in SLE

The Annals of Internal Medicine has published a cohort study of lupus nephritis patients with end-stage renal disease showing that renal transplantation is associated with improved survival benefit, and a reduction in death from cardiovascular disease and infection.

RheumNow Podcast – TNFs and the Inflammasome (1.25.19)

Dr Jack Cush reviews the news from the past week at RheumNow.com.

Obesity Needs to be Treated in Psoriatic Arthritis

Obese patients with psoriatic arthritis (PsA) who followed a short-term, very low-energy diet showed improvements in multiple aspects of disease activity, a prospective study found.

Over a period of 6 months, patients on the restrictive diet (640 kcal/day) lost a median of 18.7 kg (41.2 lbs), which represented 18.6% of their weight, according to Eva Klingberg, MD, PhD, of the University of Gothenburg in Sweden, and colleagues.

Does Seropositivity Change with Therapy?

A subanalysis of the early rheumatoid arthritis (RA) "IMPROVED" study has shown that changes in RA-autoantibody levels are not associated with disease activity or or long-term drug response, but instead reflect intensity of immunosuppression. Thus while autoantibody levels may be modifiable by our best therapies, modifying CCP or RF levels appears to have limited clinical relevance.