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Osteoarthritis Risky Business (4.18.2025)
Dr. Jack Cush reviews the news and Journal reports from this week on RheumNow.com. Osteoarthritis patients have unique risks and synovial fluid WBC numbers can tell you when to worry about septic arthritis in gout and pseudogout patients.
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Genetic Sequencing in Rheumatology
Genetic sequencing as a research and diagnostic tool has expanded in medicine and rheumatology. An interesting review in Arthritis and Rheumatology suggests that despite currently modest use, there will be an expanded role for genetic sequencing in the field of rheumatology.
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The Increasing Cost of First-Line Biologics for Plaque Psoriasis
A national commercial claims analysis of first-line use of biologics in biologic−naive plaque psoriasis patients found a near doubling of net treatment costs from 2007 to 2021 ($21 236 to $47 125).
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An emulation trial shows that Humira biosimilars (Amjevita & Imraldi) were equivalent to Humira in psoriasis & achieving PASI <=2, both for new biologic starts and for biologic switchers. https://t.co/zLnPbtXKie https://t.co/ispbmxd8dv
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CDC's Committee on Immunization (ACIP) met and recommended:
1. Expand strains for meningococcal vax
2. Lower age for RSV vax > 50y
3. Rec. chikungunya vax for certain travelers
- Flu & Covid Vax to be up next mtg 6/25 https://t.co/jInnR5JSxS https://t.co/PXg0HDLgnL https://t.co/4pfZSRrEzi
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Genetic Analysis of Asymptomatic Antinuclear Antibody Positive Patients
A large scale genomic population study found antinuclear antibodies (ANA) in up to 14% of the population; most with ANA are asymptomatic, and ANA production is not associated with significant genetic risk. https://t.co/Ltqf1yaaoy
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Genomics and Future Drug Targets for Osteoarthritis
A Nature article details the results of an osteoarthritis, genome-wide association study meta-analyses across up to 489,975 cases and 1,472,094 controls, establishing 962 independent associations, 513 of which have not been https://t.co/OYyePkAeAM
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2001–2015 Danish national health registry study of 1.8 million adults, including 290,781 w/ knee or hip #OA & 1.5 million age-, sex-, education-matched controls. Women w/ knee or hip OA had 44% higher risk of CV Dz (HR 1.44), while men w/ HOA/KOA lesser incr (HR 1.24) CV risk https://t.co/P9V7m9rqAa
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In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/uAfInA5MAq https://t.co/3AjMRQnmts
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Systematic review of >90 studies on Pregnancy and RA risk indicates that parity, gravidity, infertility, pregnancy loss do not adversely affect RA development. But low birthweight was assoc w/ RA Dx/severity, and pre-eclampsia incr risk of subsequent RA Dx. https://t.co/nw8FfWyM8A
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Recent Medscape Physician Compensation Report 2025, MD Salaries dropped by:
Dermatology: -11%
Neurology: -6%
Urology: -6%
Plastic surgery: -4%
Cardiology: -4%
Ophthalmology: -4%
Gastroenterology: -3%
Rheumatology: -3% https://t.co/kNKuBwbL8J https://t.co/fA7d5A3wJp
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Distinguishing Septic and Gouty Arthritis
A single center, retrospective review of patients undergoing knee joint fluid aspirations for presumed crystalline arthritis (CA) showed that synovial WBC may provide a useful diagnostic marker for SA with an optimal threshold of 50,000 https://t.co/00kNogjRdr
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Predictors of Developing RA
A prospective cohort study of seropositive arthralgia patients demonstrated that baseline characteristics and labs can be used to predict which arthralgia patients are at highest risk of developing RA. These studies underscore the influence of https://t.co/WAohoaiBwY
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Enzyme Porcupine inhibition of Wnt signaling is a promising treatment forsclerosteosis - rare Dz caused by SOST mutations & loss of functional sclerostin. Results in high bone mass & skeletal overgrowth (Sxs of facial paralysis, hearing loss, incr intracranial pressure https://t.co/9DYO82quiC
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JAMA Pt Education handout - Scleroderma https://t.co/UpK24WfyNF
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Ultrasound lesions of dactylitis associ w/short-term development of PsA. Study of 64 PsO +arthralgia pts. IUS PD synovitis & B mode enthesitis predicted PsA Dx (p < .001) w/ an accuracy of 89.1 %, a sensitivity of 86.7 % and a specificity of 89.8 %. https://t.co/Ij6oYP1TuK https://t.co/55sO4uFXNI
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Phase 2, DBRPCT of nanobody anti-IL-17, izokibep in 172 Psoriatic arthritis pts, showed higher ACR50 rates for izokibep 80mg vs PBO at wk 16 (52% vs 13%; p=0.0006) w/ 40mg=48%. Other arthritis, psoriasis, enthesitis, dactylitis, QOL outcomes also improved.https://t.co/CQn9EVjr9g https://t.co/vVnTo2FPV6
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AutoAbs & protein signatures evolve as pts go from Preclinical to established RA. Pts vs controls distinguished w/in 5 yrs of Dx best by iCCP3, RFIgA, RFIgM; and 104 proteins differentially expressed & gene analyses showed 21 pathways enriched ≤5 years of Dx. https://t.co/u8abvqNtnX
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Daily purposeful walking assoc w/ lower risk of Knee OA (KOA). UK Biobank study of 89,969 persons, F/U 6.8 yrs - 2711 developed KOA. HRs for incident KOA were 0.84 (0.76-0.92), 0.81 (0.71-0.90), and 0.74 (0.64-0.85) if walking ~5000, ~7000, & ≥8000 steps/d, respectively https://t.co/St9QLuOy9R
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Phase 3 trial shows inebilizumab reduces flares in IgG4-related disease (10% vs 60% in placebo; HR 0.13, p<0.001) and boosts remission rates without background immunosuppressants. CD19+ B-cell depletion shows promise as a new treatment. #Rheum @RheumNow https://t.co/7iSyPfnMV0 https://t.co/M51b0dipMs
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Natasha Salman, DO DrNatashaSalman ( View Tweet)