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The RheumNow Week in Review – 5 May 2017

Dr Jack Cush reviews highlights from the news last week on 

  1. Japan Study shows 8mg IV Actemra can be escalated to q3 wks IV or reduced to q5 wks IV according to q4wk response
  2. Risk Factors for RA-ILD RA-ILD are age, male, Hi Dz, RF+, CCP+, Smoking (esp w/HLA-DRB1), occurs w/in 10yrs RA onset
  3. FDA approved oral MTX soln(Xatmet) 2.5mg/ml for poly JIA. Much cheaper to drink parenteral MTX (2.5mg/ml) @same dose
  4. ACPA positive Non-RA pts w/ ST elevation MI greater mortality (HR 3.1), re-infarction & death (HR 2.4) than ACPA neg
  5. Study of 94 pts shows magnesium oxide not significantly better than placebo in treating nocturnal leg cramps.
  6. PRAISE patients for: 1) Weight loss 2) stop Smoking 3) achieving numeric Remission 4) Birthdays (recent, upcoming) 5) big career/life events
  7. 99FM pts had MRI sacroiliitis 8% & met AxSpA criteria 10%. But no control group comparison? Can AS masquerade as FM?
  8. FDA has accepted Sanofi/Regenerons resubmitted BLA for Sarilumab (IL-6 inhib) for RA w/ PFUFA action date 5/22/17
  9. Early Arthritis study, 14% got RA; MRI tenosynovitis predictive (OR7.5) w/ NPV 95%, PPV 25%,moreso w/ oligoarthritis
  10. Enthesitis-Related Arthritis in Children 
  11. Venous Thromboembolism Risk Factors in ANCA-Associated Vasculitis 
  12. FDA Approves Abaloparatide (Tymlos) for High Risk Patients  
The author has received compensation as an advisor or consultant on this subject

Rheumatologists' Comments

I think the new treatment abalopeptide may have the same limitations as Forteo as neither agent has been shown to reduce hip fractures as far as I know. Comment of early RA and MRI studies, the "poor man"s" MRI is a definite dose related response to a modest dose prednisone taper. That's enough reason to start Plaquenil, if not methotrexate. Sadly, nothing is dirt cheap anymore including methotrexate sol'n which has been in short supply in the past. The cost of Plaquenil is sad testimony to this (not to mention colcrys). Finally, the presence of COPD (attributed to tobacco use or not) in RA patients on methotrexate should trigger testing for alpha-1-anti-trypsin deficiency as I know of a patient on long term methotrexate for RA who died of liver failure due to cirrhosis that was clinically silent, including regular testing of liver enzymes. Just a thought as it may not be cost effective for all RA patients on MTX.

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