Monday, 25 Mar 2019

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RheumNow Podcast – To Needle or Not to Needle (11.30.18)

Dr. Jack Cush updates the news and reports from the past week at

  1. The Next Best Meeting in Rheumatology is coming - RHEUMNOW LIVE - March 22-24 2019 in beautiful downtown Fort Worth. Short Lectures, interactive sessions, Q&A panels, TED (like) Talks, digital, streaming and much more. You dont want to miss this meeting!
  2. Study of 2053 RA patients from VA medical centers found 27% with chronic lung disease that confered a 51% increased mortality risk that was not altered by MTX or biologic therapy.
  3. Amongst 192 patients w/ ANCA Assoc. vasculitis there were 95 severe infections (25%; 26/100PYs). TMP/SMX prophylaxis lowered risk of severe infections by 70% (HR 0.30). Risk was higher w/ age, bronchiectasis, endobronchial dz, COPD.
  4. Could routine use of hydroxychloroquine reduce the rate of serious infections in immunosuppressed patients? A modest to moderate risk reduction noted in two large SLE cohort studies.
  5. A systematic literature review shows that triple positivity for ACPAs, RF, and anti‐CarP antibodies yields a higher specificity for RA (98–100%), accompanied by a lower sensitivity (11–39%).
  6. Bisphosphonate safety review - risk of Atypical Femoral Fracture is 1/1000 and risk of osteonecrosis of the jaw is 1/10,000. One-third of IV zolendronic acid pts will have arthralgia/myalgias or flu like sxs.
  7. TB Testing 2 - Note: <10% of pts initially PPD/IGRA neg may be positive later (either they were anergic or have a new TB infx). I Recommend repeat TB testing 3 mos after starting or changing from 1st to 2nd biologic - Repeat testing indicated if newly EXPOSED or when Risk Changes
  8. TB Testing - Do PPD or IGRA before TNFi or biologic - If negative, start therapy - If Positive, Eval for active TB (Sxs, CXR, C/S); if neg --> LTBI Rx BEFORE biologic - If "Indeterminate", repeat or change test. If same or neg--> start biologic - Do not do annual TST or IGRA
  9. Metanalysis shows DMARDs (6 studies) and biologics (5 studies) offer NO clinically significant benefit compared with placebo in Osteoarthritis.
  10. 2018 NRMP report shows Rheumatology as one of the most competitive fellowships with 313 applicants for 221 positions - 147 filled by US grads and 69 by FMGs.
  11. There are SIX FDA approved TNF inhibitor biosimilars in the USA - 3 infliximab (Ixifi, Renflexis, Inflectra), 2 of adalimumab (Amjevita, Cyltezo) and 1 etanercept biosimilar (Erelzi).
  12. 80 overweight & obese pts w/ mild to moderate Knee OA Rx in RDBPCT showing garlic 1000 mg/D significantly lowers pain scores, resistin levels (but not TNF). Garlic may work by effects on MMPs, cytokines? shown to lower CRP levels     
  13. Steroid Injection Superior to Splinting in Carpal Tunnel Syndrome  
  14. AURA-LV Trial - Voclosporin Effective in Lupus Nephritis   


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

Rheumatologists' Comments

Hi Jack and all, On item #10, I have an idea that can help the manpower, now that rheumatology is more competitive (which means that many qualified applicants are not matched): How about having funding from community rheumatologists? We can have sort of an extra matching program involving interested community practice, program directors, IM residents to work it out, so we don't have to wait or depend on federal funding only. Also, maybe we can have more training programs outside traditional medical schools, like Scripps Clinic, Geisinger Health,... Thuan Vu, MD

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