Canary in a Coal Mine (4.19.2024)
Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.
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Autoimmune dz pts have higher risk of macular degeneration. Cleveland Clinic study of 200K AMD vs controls, finds:
- SLE (RR 1.73)
- Scleroderma (1.65)
- Psoriasis (1.48)
- Vasculitis (1.48)
- RA (1.4)
- UC &CD (~1.42)
- Sarcoid (1.42) https://t.co/RrXaaqz3Aw https://t.co/9dGoGRCBYu
Dr. John Cush @RheumNow( View Tweet )
Retrospective cohort compared 6147 new PsA pts vs 23,999 contros PsA. The uveitis risk was significantly higher in PsA (adj HR 2.38). Uveitis risk in PsA higher with prior uveitis (adj OR 136.4) and etanercept Rx (aOR 2.57). 106/107 Rx w/ topical steroids https://t.co/YVzIzSOaiB https://t.co/YORU8cQrAx
Dr. John Cush @RheumNow( View Tweet )
Anti-TNF mAbs, JAKi & anti-IL17 Rx appear protective against anterior Uveitis in AxSpA pts. Network Metanalysis of 44 trials, AU IR -TNF mAb: 4.1, ETN: 5.4, IL17i: 2.8, JAKi: 1.5, & placebo: 10.8. AU risk: TNFi < JAKi < IL-17i < ETN << PBO https://t.co/3zIcvuIaBV https://t.co/UseZ6t00EB
Dr. John Cush @RheumNow( View Tweet )
New Year's Resolutions (1.5.2024)
Dr. Jack Cush imparts his new New Year's Resolutions for 2024 and also reviews the news and journal reports from the past week on RheumNow.com.
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ICYMI: Reduction of AxSpa-Associated Acute Anterior Uveitis with Certolizumab
Acute anterior uveitis is the most common extra-musculoskeletal manifestation in axial spondyloarthritis (axSpA) affecting up to 50% of patients in some age groups. AAU can have a significant impact on quality of life with risk of permanent visual deficits if not adequately treated.
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Rheumatology Roundup - ACR 2023
Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.
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My takeaways from #ACR23 #ReviewCourse session on Inflammatory Eye Disease - Dr. Laura Kopplin:
1. Systemic therapy has better long term outcomes than topical treatments, but many/most ophthalmologists are uncomfortable with prescribing there.
2. FAST Trial: Methotrexate better… https://t.co/eoSeWVHsf0
Paul Sufka, MD @psufka( View Tweet )
Reduction of AxSpa-Associated Acute Anterior Uveitis with Certolizumab
Acute anterior uveitis is the most common extra-musculoskeletal manifestation in axial spondyloarthritis (axSpA) affecting up to 50% of patients in some age groups. AAU can have a significant impact on quality of life with risk of permanent visual deficits if not adequately treated.
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HCQ and risk of retinopathy 👁️
DoD database HCQ 44000+ females & 10000+ males
Risk retinopathy HR 1.5
Variations according to diagnosis SLE higher risk vs. RA, more so in males HR 2, females HR 1.7
No adjustment on HCQ dose
@RheumNow #ACR23 ABST2452 https://t.co/TtTu6ixb45
Aurelie Najm ( View Tweet )
And to continue
B-SAFE Clinical risk score for HCQ retinopathy 👁️ 10 years
4000+ pts, 3% retinopathy over 5yrs
Predictors of HCQ retinopathy
-body weight
-sex
-age
-eGFR
-weight based dose mg/kg
-higher cumulative dose
Risk ranges 1% to >20%
@RheumNow #ACR23 ABST2453 https://t.co/h2tl6vH9M3 https://t.co/8iuRxoVaJ0
Aurelie Najm ( View Tweet )
ABS0524:
⭐️Benefit of Certolizumab (CZP) over standard non-biologic tx in reducing acute anterior uveitis (AAU) flares among high risk pts w/ axSpA
➡️active dz, HLAB27+, 2 or more AAU flares
⭐️CZP reduced AAU flare rate by 87%
#ACR23 @RheumNow
#ACRBest https://t.co/rW0N18agMO
Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )
Abs#0501 @RheumNow #ACR23
Uveitis in SpA, from Greece
AxSpA: 11.7% Uveitis. RF: HLA-B27 (OR 4.15), periperhal arthritis (OR 3.05)
PsA: 2.7% Uveitis. Ass w/ SpA FHx, Axial dis at dx, disease duration
Permanent vision loss in 16% AxSpA, 30% PsA pts, all with recurrent uveitis
Eric Dein ( View Tweet )
C-VIEW study on certolizumab use in preventing anterior uveitis in high risk pts with axSpA.
All pts were B27+ w/ at least one episode of anterior uveitis
Uveitis flares lower in certolizumab group compared to non-bDMARD use
@RheumNow #ACR23 Abs#0524 https://t.co/CfnhzStBMv
Robert B Chao, MD ( View Tweet )
Bummed to miss sunny San Diego but still excited to join #ACR23 @RheumNow
Time to get some learnin' on!
Informative review on the role of systemic treatments and the rheumatologists role in ocular inflammation. https://t.co/0nFDEZHfGW
Robert B Chao, MD ( View Tweet )
Did you know about Tubulointerstitial nephritis uveitis (TINU) syndrome? Usually younger pts; uveitis may not be concurrent with the TIN. Risks: NSAID/abx, infx, genetics. Nice systematic review of this entity (link below). #boardquestion @rheumnow #ACR23 https://t.co/HDqLDHyGM6
TheDaoIndex @KDAO2011( View Tweet )
Systemic inflammatory conditions related to scleritis #ACR23 @RheumNow https://t.co/qc6szUnOUl
Dr. Antoni Chan ( View Tweet )
Keeping the eyes 👀 on the target. Early start to the day with the ACR review course on the eye 👁️ in rheumatic disease. Causes of uveitis #ACR23 @RheumNow https://t.co/g5y5Vs01RX
Dr. Antoni Chan ( View Tweet )
ID testing for pts with inflammatory eye disease: syphilis, TB, Lyme (where appropriate). Low yield is toxoplasma, toxocara and viral dz - Dr L Kopplin #ACRReview
@RheumNow #ACR23 https://t.co/UyQ8Bc2cEy
TheDaoIndex @KDAO2011( View Tweet )
ICYMI: Hydroxychloroquine Dose and Risk for Incident Retinopathy
A cohort study in Annals of Internal Medicine shows that higher hydroxychloroquine doses was associated with progressively greater risk for incident retinopathy. The study aimed to assess the long-term risk for incident hydroxychloroquine retinopathy and examine the degree to which average
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Excessive alcohol intake associated with higher risks of 61 diseases in men, including liver cirrhosis, stroke, and several gastrointestinal cancers, gout, cataracts, some fractures, and gastric ulcer. https://t.co/WqMuHQ3Unn https://t.co/IU0SaRcswZ
Dr. John Cush @RheumNow( View Tweet )
Any dose more than 1500 is associated with retinopathy ? So what to do. @Lupusreference #RNL2023 @RheumNow https://t.co/2zdjpcuvKa
Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )
Overview of Juvenile idiopathic arthritis (JIA) assoc uveitis (JIA-U) seen in 10–15% ofJIA pts, higher risk w/ ANA+, oligo-JIA, f& onset ≤6 yrs age. Rx options: topical steroids, MTX, ADA, INFLX, RTX and TCZ (review of TCZ in JIA-U) https://t.co/fqQ8ZhSLCM https://t.co/1GkUpCqJoE
Links:
Dr. John Cush @RheumNow( View Tweet )
Vision Loss with ANCA-Associated Vasculitis
Shelley K. Dhillon, MD, presents her poster at RWCS 2023.
https://t.co/e25SFDXk7O https://t.co/J1AsdE3b0Y
Links:
Dr. John Cush @RheumNow( View Tweet )
Hydroxychloroquine Dose and Risk for Incident Retinopathy
A cohort study in Annals of Internal Medicine shows that higher hydroxychloroquine doses was associated with progressively greater risk for incident retinopathy.
The study aimed to assess the long-term risk for incident hydroxychloroquine retinopathy and examine the
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We review the available literature, with a particular focus on the recent findings in the Hopkins Lupus Cohort, regarding the clinical utility of hydroxychloroquine blood levels in helping to clarify some of the issues regarding retinopathy, how best to dose this medication, and medication adherence.
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