Wednesday, 15 Aug 2018

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The RheumNow Week in Review – No Good Gout (8.10.18)

Dr. Jack Cush reviews the news and latest journal articles from the past week on  Info on Surgery and Hip Fractures, Gout drugs abandoned, Allopurinol escalation, hydroxychloroquine drug levels, how to treat scleroderma in India and exactly who gets back pain. 

  1. Myositis and scleroderma specific autoantibodies, including anti-TIF1, anti-NXP2 and anti-RNA polymerase, are very rare in patients with lung cancer without an autoimmune disease.
  2. MAINRITSAN2 compared fixed dose (q 6 mos) RTX to "tailored" RTX (to CD19, ANCA titers) in 162 AAV (GPA, MPA) pts - BVAS/relapse rates similar betw fixed (17%) vs tailored (10%) (p=0.22) w/ less infusions in the latter (248 vs 381).
  3. Open label study from India - 60 pts w/ diffuse systemic sclerosis Rx with open label monthly IV CYC 500 mg/m2 or RTX 1000 mg × 2 doses. At 6 months, the FVC and Rodnan skin score improved in RTX, but not CYC, pts. CYC had more toxicity. UNCONTROLLED. 
  4. Matched cohort study shows that exposure to NSAIDs, Cox-2, acetaminophen, narcotics or glucosamine (in 3 yrs prior) does not increase the rate of knee replacement in Knee #OA patients 
  5. Using HCQ levels and patient Surveys to define adherence, an International study of 305 SLE pts shows 18.4% of SLE patients to be “severely nonadherent” & 23.4% of patients as nonadherent. There was moderate agreement between questionnaires, drug level, and physician assessment. 
  6. 204 Swedish Ank Spondylitis Men and women studied over 5 yrs. Men had more disease (mSASSS) and progression then women. Progression predicted by AS Xray findings and obesity; CRP was a risk factor for men; BASMI & bisphosphonates in women 
  7. 11 yr study in Finland shows risk factors for low back pain and radicular pain to be higher in women, and with obesity, smoking, and strenuous physical work. Vibrating tools increased lumbar radicular pain risk. LBP was less with walking or cycling to work.
  8. Ironwood goes bust on Rheumatology! Ironwood has dropped its licensing deal for AstraZeneca's lesinurad franchise, which includes Duzallo and Zurampic, saying that "test markets did not meet expectations."
  9. 10 yr study of ~13k US VA gout pts who did/didnt increase allopurinol shows dose escalation seldom achieved target SUA <6.0, but was associated with increased mortality (HR 1.08; 95%CI 1.01–1.17). Escalation more a marker of severity, not T2T
  10. Selective Use of HLA-B*5801 Testing in Gout
  11. In Slovenia the #RA annual incidence 16.1/100,000 adults & the time from Sx onset to Rheumatology referral is 12.9 (4.4–26) wks; 36% were started on DMARD Tx within 12 wks of Sxs! I WISH THESE STATS WERE ACHIEVABLE IN USA !
  12. Switching to biosimilars (and generics) saved the UK National Health Service NHS England saved £324 million in 2017/2018. 
  13. Fractures Augment 10 Year Mortality Risk 
  14. Early Hip Fracture Surgery Reduces Mortality  
  15. Dr. Roland Moskowitz (1929 - 2018)  
The author has received compensation as an advisor or consultant on this subject

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