Monday, 18 Jun 2018

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RheumNow Week in Review -The Temporal Artery Biopsy Letdown (4.6.2018)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. News on the cost of RA care, infections on planes, CV events and Sacroiliitis in IBD, NXP-2 antibodies and calcinosis and rituximab in myositis ILD patients.

  1. Swiss study of 244 pregnancies finds RA and axSpA have significantly higher risk of pregnancy complications (DM, preeclampsia, infection, small babies, preterm delivery). Active disease predicts preterm delivery in both RA (OR 3.9) & axSpA (OR 13.8) https://t.co/I02unIG499
  2. EMR study of 116 obese/overweight RA clinic pts shows that the 31% lost ≥5 kg during follow-up had 3 fold chance of disease activity improvement (CDA >5). https://t.co/JIanV3FuE8
  3. 2 RA Cohorts from Sweden were compared 1996 (T1) & 2006 (T2). Total cost of care similar from T1 to T2 (EUR 13280 v 12342), Dz activity, sick leave & hospitalization decreased, yet DMARD & drug cost increased. Loss of productivity is the largest part of total costs. https://t.co/OuIyQwGSjv
  4. Study of 114 kids with enthesitis-related JIA shows axial Dz/sacroiliitis rare at onset but after mean of 2.6 yrs found in 63% and 47% respectively. + Familiy Hx of SpA associated w/ sacroiliitis (OR = 3.6) & active disease (OR 3.0) at last FUV https://t.co/xRQhm6iGA6
  5. Of 154 patients with a negative Temp artery Bx 20% were eventually diagnosed with GCA. Predictors of GCA in TAB neg pts were meeting ACR criteria (OR 13.4), clinical dx of PMR (2.8), high platelet counts (1.3). https://t.co/dpsSgqQWn9
  6. Clinic study finds CT scan evidence of sacroiliitis in 15-16.9% of 316 IBD pts vs only 5.6% of controls (no LBP GU pts); but only 5% of IBD SI pts were referred to Rheumatology. http://bit.ly/2EmMTkz
  7. Recent PNAS study shows that there is a low risk of getting infected on an airplane if direct transmission (ie,not seated in close proximity to an infectious passenger) is not possible. https://t.co/a8VOQ0dM7F
  8. 3 million have IBD in USA. New study of 22 million IBD pts shows a 2 fold greater risk of MI (5.9% vs 3.5% without IBD). https://t.co/UACAiTfAAt
  9. Claims analyses from Medicare, IMS PharMetrics & MarketScan (2010-15) looked at CV outcomes in RA pts starting tocilizumab (6,237) or abatacept (14,685) & finds no difference in CV risk (HR 0.82; 0.55–1.22) (TCZ vs ABA) https://t.co/jNnOCDvX2u
  10. 56 myositis patients with anti‐NXP‐2 autoantibodies (18 with and 38 without calcinosis) showed that NXP‐2 Ab levels correlate w/ disease activity, espcially in those without calcinosis; suggesting calcinosis defines 2 phenotypes. https://t.co/1BhJeWTMgv
  11. IL-6 Inhibition Most Effective in Polycyclic Systemic JIA 
  12. Rituximab May Halt ILD in Antisynthetase Syndrome Myositis  
  13. Uveitis in JIA: Screen All, Treat Early  
  14. "Providing medical care is more of a commitment to the patient, than a commitment to science. Empathy, understanding and listening are incredibly hard when you think you have all the answers". - From todays blog on "Least Favored Patient" on RheumNow. https://t.co/9ERyuBjYsr

 

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

Rheumatologists' Comments

Jack-The diagnosis of TA is further complicated when patients have an established Dx of RA which may be flaring. PMR like symptoms and headache complaints as well as elevated ESR are somewhat non-specific and non-diagnostic. A recent TAB on the affected side of my patient was negative. When patients have OP, DM2 or other comorbidities including advanced age, blasting ahead with high dose prednisone can be problematic.
Your Least Favorite Patient piece is excellent advice, often difficult to do, but well worth the effort. Thanks, Jack!

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