Friday, 06 Dec 2019

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RheumNow Podcast – Fight or Switching (DMARDs) (10.18.19)

Dr. Jack Cush reviews the news and journal articles from the past week on

  1. Study of RA complications from National Inpatient Sample data (2005-14) show #RA higher risk for MI (OR 1.03), COPD (1.67), CVA ( 2.2), renal Dz (1.42), EtOH abuse (2.73). Mortality trend increased significantly for CHF (P = 0.025) & AFib (P = 0.042)
  2. UK population study of 6591incident RA patients shows comorbidity increased all-cause mortality (aHR 1.26; 1-1.6). Joint destruction had no effect, but COPD was associated with significantly more mortality (COPD HR 2.84; 1.13-7.12).
  3. Evaluation of ANA testing in sytemic autoimmune dz (AID) finds low titers have low PPV. Highest PPV was for centromere pattern in PSS, w/ a PPV of 29% (1:160), 42% (1:32), 77% (1:640) & 82% (1:1280). Speckled PPV was low unti 1:1280 (PPV 71% for AID)
  4. Single center study of anti-PhosphoLipd Abs in 149 Bx proven lupus nephritis pts 36% had APL Abs (18.8% IgG, 18.1% IgM, 10.7% B2GlyP, 8.1% LAC). F/U of 156 mos - APL+ had lower 10 yr survival (91 vs 99%). lower GFR, more thrombotic events & miscarriage
  5. RISE registry: among 7,274 RA pts w/ serial data [RAPID3 (78.9%) & CDAI (34.2%)]. Amongst those w/ moderate/high disease activity, frequency of DMARD change was low (36%-55%). Less likely to change was elderly, Combo DMARDs or biologics.
  6. Followup of 783 tofacitinib‐treated psoriatic arthritis patients finds increases in LDL and HDL 9% to 14% after 3 and 6 months of therapy with a low risk of HTN or MACE events
  7. Comparison of 69 SLE pts w/ C/S+ infection vs 69 SLE without infx shows that serum procalitonin did not distinguish those w/ infection, BUT C-reactive protein did successfully identify those SLE patients with infection
  8. Taiwanese Claims data study shows the risk of opportunistic infection in ~77K autoimmune pts shows OI highes in PM/DM cases (61.3/1000PY), followed by SLE (43.1/1000PY), SSc (31.6), RA (25), and pSS (24.1). OI risk highest during 1st year
  9. Reminder: Statin induced myopathy is occurs in less than 1%; rhabdomyolysis and necrotizing myositis are very rare. HMGCR Abs against (HMG-CoA) reductase are seen 2- 3 of every 100,000 patients treated with statins.
  10. High Dose Statins Increase Odds of Osteoporosis  
  11. One-Third of Psoriatic Arthritis Patients Will Need Joint Surgery  
  12. Stress and the Risk of Incident Inflammatory Arthritis   
  13. Joint Injections: Are They Worth the Risk?  


The author has received compensation as an advisor or consultant on this subject

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