Thursday, 23 Jan 2020

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RheumNow Podcast – When You’re Hot You’re Hot (10.11.19)

Dr. Jack Cush delivers select commentary on select news and journal articles from the past week on

  1. Just Dx Pigmented Villonodular synovitis in older male w/ CPPD, new myeloma but chronic monarthritis of knee - Dx by MRI. PVNS is benign, localized synovitis (tenosynovitis) of knee, hip, ankle, elbow, even TMJ! Rx is largely excision.
  2. ASBMR meeting presented a study of patients w/ CKD showing that 12 mos romosuzumab improved BMD in lumbar spine, hip, and femoral neck in pts with mild to moderate renal impairment - not enough pts w/ severe CKD to conclude its effects.
  3. Osteoarthritis Initiative studied 4344 knee OA looking at bulge sign (12.7%) & patellar tap (2%); 3.3% had both. Bulge sign increased risk of freq knee pain (OR 1.31) & TKR [OR 1.47); developing a bulge sign had incr risk of same & Xray worsening (OR 1.67) 
  4. 225 very early RA in abatacept AVERT study - 44% had high baseline MRI inflammation. With High MRI inflammation, combo ABA+MTX was better than MTX at 12 mos remission by SDAI (45% vs 16%). Pts w/ low baseline MRI inflammation, remission rates did the same 
  5. Take the Good with the Bad? Study of 179 RA pts achieving remission on TCZ- SC 162 mg qwk randomized to continue qWk or space out to q2Wk -- Weekly Actemra better maintained remission (90% versus 73%; P = 0.004), but then again 73% did well w/ spacing EOW. 
  6. Why do we take such crapy care of patients with #gout ? Is it because we have such divergent guidelines? Or we are just overwhelmed?  Your take please..- Sacrilegious but true. Every MD thinks they are great-they learned it in med school & as a PGY*. A) most dont treat enuf to be good at it; b) "guidelines are for suckers"; c) colichicine+allopurinol=Voila! Evidence of bad Rx? no monitoring, underRx, colchicine, 300mg allopur. only
  7. T2T in Lupus Nephritis aims for less proteinuria, Study of 87 pts with class III/IV LN compared goal of urine protein/creat ratio(UPCR) < 0.5 to stringent < 0.15, Latter assoc w/ lower renal flares (HR  0.16), less CKD (HR 0.19), more MMF use (HR = 7.26)   
  8. N. Zealand study shows their cost of knee OA was $200 million in 2013; and without any changes in the standards of care, this isprojected to increase to $370 million by 2038. (includes an additional 4,000 TKRs per year by 2038).   
  9. Bisphosphonates and the Risk of Osteonecrosis of the Jaw  
  10. Long Delays for Inflammatory Arthritis Patients   
  11. Antibiotics Increase Rheumatoid Risk - Again  
The author has received compensation as an advisor or consultant on this subject

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