Monday, 18 Mar 2019

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RheumNow Podcast – You Owe Me a DEXA (3.15.19)

      Dr. Jack Cush reviews this week's news and highlights from
  1. 2,933 adults >50 yrs went to the ER with a new vertebral fracture (2008-2014) but 98% did not have a DXA in 2yrs before and 1 yr after; and only 7% started OP Rx; In the ensuing 2 yrs, 38% developed another Fx
  2. #1 Humira tops list of top selling drugs of 2018 at $19.9 Billion worldwide sales. Other Rheum drugs include #6 Rituxan $6.9 billion and #10 Stelara $5.2 billion
  3. Study of 1021 Scleroderma patients from the EUSTAR cohort shows progressive skin fibrosis (>5 mRSS in 1 yr) was associated with significant lung function decline (FVC worse ≥10% (53.6% vs 34.4%; p<0.001) and all-cause mortality (15.4% vs 7.3%; p=0.003).
  4. Osteoarthritis Initiative shows weight loss (>5% BMI) in obese and overweight persons resulted in a lower risk of knee cartilage loss assessed by MRI after 8 yrs; results only seen in diet only or diet + exercise pts.
  5. 23 year followup of the COBRA trial shows that early aggressive treatment with SSZ or combination + Tapered prednisone yields a long term survival equal to the general population; thereby negating RA potential to incr mortality 
  6. CORRONA Registry - Chronic opioid use doubled 2002-2015, rising from 7.4% to 16.9%. Strongest predictors included severe pain (HR 2.53), antidepressant use (HR 1.79), high Dz activity (HR 1.55) & high disability (HR 1.45). 
  7. Lower TNF Inhibitor Persistence in Spondylitis 
  8.  EULAR Consensus Guidelines for Juvenile Localized Scleroderma   
  9. Tramadol May be Associated with Increased Mortality in Osteoarthritis     


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

Rheumatologists' Comments

In regards to "Lower TNF Inhibitor Persistence in Spondylitis", I suspect the explanation may involve some degree of "overdiagnosis" based on history and imaging and other "ill defined" medical comorbidities associated with SpA. Even if the diagnosis of SpA is well supported, axial symptoms are common and multifactorial (FMS, DDD, DJD, etc), and may be more related to such conditions that do not respond to anti-TNF agents.

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