Tuesday, 25 Sep 2018

News

Methotrexate's Low Efficacy in Cutaneous Psoriasis

In a prospective, double-blind, randomized placebo-controlled study, Warren et al. studied the effect of an intensified methotrexate (MTX) in chronic plaque psoriasis and showed MTX to be effective and superior to placebo.

Usual Allopurinol Doses Insufficient in CKD Patients

Uric acid (sUA) control may be a challenge in patients with chronic kidney disease (CKD). A cohort study shows that conventional dosing recommendations for allopurinol are unlikely to reach target serum sUA goals.

CRA Recommendations for Lupus Assessment and Monitoring

A Canadian Rheumatology Association SLE Working Group was established to develop recommendations for the assessment of people with systemic lupus erythematosus. A panel that included 23 adult rheumatologists, 4 pediatric rheumatologists, 1 immunologist, 4 general internal medicine and rheumatology trainees, and a patient representative, used GRADE methodology to assess the literature and develop guidelines.

Tocilizumab Equals other Biologics in Cardiovascular Risk

An odd side effect of several new agents is the risk of hyperlipidemia. While this has been seen with tocilizumab (TCZ), there does not appear to be a resultant risk of cardiovascular (CV) events. A study of claims data compared CV risk in rheumatoid arthritis (RA) patients receiving TOC (an IL6 receptor antagonists) and other biologics and found no differences with regard to CV outcomes.

Sleep Apnea Raises Gout Risk

Patients with obstructive sleep apnea were at increased risk for incident gout, particularly in the first years after the sleep apnea diagnosis, U.K. researchers reported.

In a large retrospective cohort study, the adjusted hazard ratio for a new gout diagnosis among individuals with sleep apnea was 1.42 (95% CI 1.29-1.56), according to Milica Blagojevic-Bucknall, PhD, of Keele University in Keele, England, and colleagues.

New BSR Guidelines on Biologic Safe Use with Inflammatory Arthritis

The British Society of Rheumatology has produced a set of NICE accredited guidelines for the use of biologic therapies in patients with inflammatory arthritis.

It addresses safety recommendations for all biologic therapies approved by the National Institute for Health and Care Excellence (NICE) up to June 2016, for use in all inflammatory arthritides [RA, PsA and axial SpA (SpA) including AS].

RheumNow Week in Review – Father Knows Best (Paternal Drugs OK) (8.31.18)

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Cool info on paternal exposures to DMARDs/Biologics, Contraceptive let downs, good outcomes in PsA, depression-insomnia-pain triad in OA and how to store your biologic in a hurricane.

No Cancer Risk from Psoriatic Arthritis

Inflammmation is a strong risk factor for malignancy. Yet there are mixed results on whether patients with psoriatic arthritis (PsAg) augments the incidence of cancer and all-cause and cause-mortality.

A study from the national British Society for Rheumatology Biologics Register examined the risk of cancer, assessed by standardized incidence ratios (SIRs)  or standardized mortality ratios (SMRs).

Treatment Preferences in Still’s Disease

In July 2018, RheumNow launched a “Live Vote” survey of US and non-US rheumatologists that asked how they diagnose and treat systemic juvenile idiopathic arthritis (sJIA), also known as “Still’s disease”. It appears that many prefer to start therapy with an IL-1 inhibitor, after a course of steroids and MTX/DMARD. Yet, these findings suggest there are significant unmet needs in the diagnosis and management of sJIA patients.

2018 EULAR Recommendations for Hand Osteoarthritis Care

The uropean League Against Rheumatism (EULAR) has previously put forth recommendations for management of hand osteoarthritis (OA) in 2007. But since then, advances and further evidence have emerged.

An international panel of 19 physicians, healthcare professionals and patients from 10 European countries formulated five overarching principles and 10 new recommendations after a systematic literature review was performed.

Adherence to Gout Therapies Painfully Low

A retrospective study of the large UK Clinical Practice Research Datalink assessed patient compliance in gout and found that adherence to allopurinol is poor, especially among females and younger patients and those with fewer comorbidities.

The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited informatoin about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.