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The RheumNow Week in Review - 2 February 2018

Dr. Jack Cush reviews highlights, news and recent research published this week on RheumNow.com. This week's report includes rising epidemiologic numbers, vaccine updates for H. Zoster and influenza, narcotics in spondylitis, overuse of OTC NSAIDs, problems with ILD in systemic sclerosis and PM/DM and an inspirational story of the woman who discovered allopurinol.

  1. February 2nd is RHEUMATOID ARTHRITIS AWARENESS DAY - Please Tweet your best advice or good news for those with #RA or send me a message! Good news for big hope and major improvements!
  2. Risk factors for retinal toxicity associated with hydroxychloroquine include longer duration of HCQ use [adj OR 4.71], higher daily dose (3.34), presence of kidney disease (8.56) https://t.co/A6sDsudCRq.
  3. New autoinflammatory disease joins CAPS w/ Cryopyrin point mutation of NLRP3 gene as the cause for keratoendotheliitis fugax hereditaria, only seen in Finland, manifests as episodic few days of eye irritation, beginning in kids/teens and cont thru middle age https://t.co/RQKN9cKRnH
  4. Chemist Gertrude Elion (1918-1999) in 1967 was appointed Head of Dept of Experimental Therapy at Burroughs Welcome & went on to develop mercaptopurine, allopurinol, trimethoprim, acyclovir & AZT. An Amazing Scientist! Her famed career is reviewed in Time https://t.co/oUi2Lmgy4b
  5. Of 1625 Scleroderma pts, 83% presented with Raynauds as 1st symptom (17% did not). Survival was different in RP+ vs RP-, 83 vs. 62% at 20 yrs, 71 vs. 50% at 30 yrs. Mortality highest in older, male, dcSSc subset, ILD, PAH, renal crisis, heart involvement. https://t.co/yJhHjz8UPl
  6. In 116 PM/DM pts with interstitial lung disease (ILD) - 14 died within 6 months. Risk for early death: upper lung lesions (OR 8) & hypocapnia (OR 6.8). Serious infection. in 1/3. Risk factors include high serum KL-6 (OR 3.7), high dose steroid (OR 4.2), combo immunosuppressives(OR 5.5) https://t.co/px6lucIl2K
  7. French registry shows 1278 RA pts initially received full dose RTX (1000 x2) & 14.5% went on to get reduced dose (eg, 500 x2) RTX. Both groups stayed on RTX >5 yrs (~55%), & lower dose grp had 50% fewer serious infx, less total RTX (1.4 vs 2.3 g/year) https://t.co/LOOaaDYbW7 
  8. Between 2008-2014 the US arthritis population rose from 56.1 to 65.1 million. The annual average direct and Out of pocket expenditure went from $584.8 billion and $83.8 billion (2008) to $645.1 billion and $71.5 billion (2014)> Hence, #s drive cost https://t.co/9D87sdmKqR
  9. In the last 25 years the number of patients with gout increased by 30% in the Nordic countries. https://t.co/nZ9ranWdlV
  10. Study shows that annual influenza vaccination 31% effective in preventing hospitalization for Flu, 74% effective at preventing ICU admissin and 70% effective at preventing deaths from the flu. https://t.co/Byeum7gfVd
  11. ACIP Guidelines on H. Zoster Vaccination Updated 
  12. Emergency dept visits for Herpes zoster rose between 2006 and 2013, increasing from 0.13% to 0.14% (8.3% rise). This growth was driven by patients aged 20 to 59 years  https://buff.ly/2DVh8jh
  13. Poor Prognosis of the MDA-5 Antibody in Dermatomyositis 
  14. Opioid Use in Ankylosing Spondylitis 
  15. 15% of Users Exceed Recommended OTC NSAID Dosing 

 

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

Rheumatologists' Comments

Jack-just a "heads-up" on chronic hydroxychloroquine use. While serving as in locums hospital attending at Westchester Medical Center recently I became aware of 3-4 cases of biopsy proven cardiomyopathy due to HCQ. Unlike the rare case of acute cardiac toxicity associated with short-term use of HCQ, these were all long-term treatments for "RA" and the patients presented with cardiac decompensation misattributed to ischemic and/or non-ischemic cardiomyopathy. Also note that HCQ toxicity is now more apparent than in the past.("In early toxicity there are no visible signs, but field, OCT and mfERG changes can be detected"). Have a good meeting in Hawaii-David

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