Wednesday, 15 Aug 2018

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The RheumNow Week in Review – Cocoon Therapy? (7.20.18)

Dr. Jack Cush reviews highlights from the news and social media on in the past week. 

  1. Prevalence of Lupus has increased over last 16 yrs; Canadian adminstrative claims data shows lupus 6x more common in women than men. From 2000–2015 incidence 4.43 per 100,000 population. The prevalence rose from 48 (2000) to 90 per 100,000 in 2015
  2. In gastroenterology, rheumatology, and dermatology the cost of nonmedical switching estimated to be $214/per pt (>$770k for 3609 pts w/ swtich rate of 16.6%). If Switch rates rise to 25-50% this could cost $1.2-2.4 million. 
  3. Retrospective study of 142 SLE pts with 173 hospitalizations; SLE infection rate = 50.7% (mostly lung). Independent risk factors include Hi/Low WBC, High CRP, low C4, and length of hospitalization
  4. Study of 132 Systemic Sclerosis pts shows a significant minority with arthralgia, synovitis, contractures and erosions. RF+ in 15.7% of limited, 9% diffuse & 20% of overlapt pts. Double RF/CCP + assoc w/ arthralgia and erosions
  5. RA Adherence to1st bDMARD was suboptimal even in effectively treated pts. Study of 10374 pts, 1 yrs adherence rates = 46%; 2nd Yr = 34%; lowest for golimumab and highest for infliximab. Among 30% who were effectively Treated pts, 2yr adherence =59%
  6. Population study 8 Latin American countries finds among indigenous people the prevalence of MSK/Rheum disorders is 35%: back pain 13%, OA 10%, regional pain 6%, RA 1.3%,and SpA 0.1%.
  7. Senolytics: Can removal of senescent cells improve physical function? Mayo researchers treated aging mice with quercetin & dasatinib (JAK inhibitor) reduces senescent cells & improves physical function and survival!
  8. Australian Safety update 28 cases of MTX mis-dosing - most taking weekly MTX dose as DAILY dose! AE: pancytopenia, thrombocytopenia, neutropenia, stomatitis, mucosal ulcers, GI effects. @Risk: nonEnglish, confusion w/ Folate, mistakes by MDs or pharmacists.       
  9. Great Suggestions from Janet Pope - reduce MTX Rx errors by only prescribing MTX on their (Pts) preferred day of the week!
  10. Predictors of Methotrexate Non-Response    
  11. Unsafe Practices with Ambien Use    
  12. Regional ARTHROS Rheumatology Reviews – Great Lakes 7/28;  Capitol City 8/11; Music city 8/18


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

Rheumatologists' Comments

I believe the non-adherence to biologics is related to two factors: 1.Diagnostic labeling to met EHR demands takes on a life of its own over time resulting in treatment of patient's phenotypic presentations especially with the dumbing down of diagnostic criteria for RA, SpA and even seronegative Primary Sjogrens Syndrome.,Your comments on SNRA have been noted. 2. Unstated pressure to satisfy the customer with an explanation and treatment plan so you can get on to the next patient and EHR to treat. It takes too much time to be uncertain about things. Intellectual honesty and critical thinking slow down the marketplace of healthcare!

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