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The RheumNow Week in Review - 6 October 2017

The RheumNow Week in Review discusses the past week's news, journal articles and highlights from In this week's report, Dr. Jack Cush discusses when to hold the biologic, lymphoma risk with tofacitinib, early clues to the diagnosis of RA, biologic use in pregnancy, what's killing psoriasis patients and the 2016 top 5, best selling drugs in rheumatology.

  1. Study of 16207 RA patients >65yrs shows non-serious infection rate of 47.5/100PY; increased 20% by steroid use.Infx common in RA
  2. Rules for Drug Cessation with Infection 
  3. 241 patients with Clinically suspect arthralgia - Positive Serology increases RA risk: CCP HR 8.5; RF 5.1; CarbP Ab 3.9; RF+CCP+ has PPV 67%
  4. Frequence of Secondary Sjogrens is 20% in RA and 14% in SLE - with a >15 to 1 female to male ratio
  5. Lower RA dz activity & remission assoc w/ lower serious infection rates! Inflammation (not drugs) drives infx risk
  6. 107 JIA pts followed for 3 yrs on Biologics- 25% (35) had Serious/Opportunistic infx. range 10.6-14.8/100py
  7. In 19 RCTs, 6194 RA pts received tofacitinib for 19406 pt-Yrs & 19 developed lymphoma (SIR 2.62) or 1:1000 PY risk
  8. 2016 US Top selling drugs: Humira $13.6 billion, Enbrel $7.4 billion, Remicade $5.3 billion, Lyrica $4.4B,RTX $3.9B
  9. Idiopathic arthralgias pts with no US synovitis have negative predictive value 89% for developing inflam arthritis
  10. RA RCT Inclusion of FM or Depression pts or pts on SSRI had 10% less ACR20 & 1/2 LDAS responses, more W/D & AE
  11. In 7-15% PSA precedes Pso;In remainder, median time from PSO dx to PsA is 7-8yrs. <75% get PsA w/in 10-15 yrs of PsO
  12. IBD Associated with Increased risk of Autoimmune and Inflammatory Diseases
  13. Patterns of Biologic Use During Autoimmune Pregnancy 
  14. Alcohol Related Deaths Increased in Psoriasis



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