Friday, 03 Apr 2020

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RheumNow Podcast - Monitoring Methotrexate Safety (12-6-19)

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

  1. Data from 5 RCTs of 733 pts with systemic necrotizing vasculitis examined risks for serious infection (SIE), finds that 20.2% had SIEs and 2/3 these occured within the first 2 yrs. Age, Lung involvement & 5 Factor Score were independent predictors of SIE
  2. Propensity Score–Matched Cohort claims study compared 11,248 matched pairs RA pts starting either abatacept or TNF inhibitor. ABA had a signficiantly lower risk of hospitalized infx compared to infliximab (HR 0.63), but equal SIE risk vs ETN or ADA.
  3. Palmoplantar pustulosis has very low prevalence rates (<0.1%), qualifying as an orphan disease, Registry data from US, Denmark, Germany identified 1,435, 751 and German PPP patients, respectively; 14-61% also have Psoriasis, with higher risk of PsA
  4. Ultrasound study of 980 #gout pts finds Bone erosions were seen in 44%, with 78.4% of these found in the first metatarsophalangeal (MTP) joint. Independent predictors include age, duration of gout, tophi, US synovitis and and joint effusion.
  5. Metanalysis shows that although MTX may blunt some vaccine responses (eg Pneumococcal), the use of MTX, TNF inhibitors and other biologics should not deter vaccination as most vaccine responses are preserved despite therapy.
  6. Study of two dietary patterns and the risk of SLE from the Nurses' Health Study (NHS, 1984–2014) and Nurses' Health Study II (NHSII, 1991–2015) shows no association between incident lupus and (healthier) prudent or (less healthy) Western diet.
  7. Spinal/SI MRI in the gen. population finds a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA. MRI done in 793 volunteers < 45 yrs (49% males, 8.4% B27+). SI tJ Bone marrow edema in 17%, Vertebra BME 27% & fatty lesions in 81%
  8. Norways HUNT study shows NO fracture risk with PPI use in 15,017 women and 13,241 men aged 50–85 years. PPIs were not associated with an increased risk of fracture age-adjusted HR 0.82 (0.67–1.01) for women; 1.05 (0.72–1.52) for men.
  9. ESPOIR cohort with 172 early seronegative #RA patients finds that early csDMARD use (within 3 mos of Sx) was more likely to predict better outcomes that other prognostic risk (clinical lab or imaging) factors
  10. ACR MTX monitoring guidelines from 1994 (Alarcon et al) -pts should be screened for HBV, HCV, Alb. At AST, ALT should be checked at intervals of every 4-8 weeks. MTX should be stopped/adjusted or liver Bx if AST abnl in 5 of 9 (or 6/12) in 12 mos.
  11. Secukinumab Improves Enthesitis    
  12. Smoking Cessation Lowers RA Disease Activity and CV Risks  
The author has received compensation as an advisor or consultant on this subject

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