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RheumNow Podcast – Don’t Take My Advice (7.19.19)

d Jack Cush, MD

Dr. Jack Cush reports the news and new journal articles from the past week on RheumNow.com.

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Fatigue is Driven by Inflammation, Pain, and Chronicity in Psoriatic Arthritis

d Jack Cush, MD

Correlates with fatigue were assessed in psoriatic arthritis (PsA) patients in the DANBIO registry and found to be associated with  clinical inflammatory factors, disease duration, and chronic pain.

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Intraarticular Capsaicin in Knee Osteoarthritis

d Jack Cush, MD

A novel compound, synthetic trans‐capsaicin (CNTX‐4975), has been studied as an intraarticular injection and shown to significantly reduce pain in patients with chronic moderate‐to‐severe osteoarthritis of the knee.

A phase II, multicenter, double‐blind study enrolled 172 knee OA patients between the ages of 45–80 years. Patients were randomized to receive either intraarticular placebo, or a high‐purity synthetic trans‐capsaicin CNTX‐4975 0.5 mg, or CNTX‐4975 1.0 mg.

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Increased Risk of Cardiovascular Death in Hip and Knee Osteoarthritis

d Jack Cush, MD

Hip and knee osteoarthritis patients have been shown to have increased mortality rates from cardiovascular events when compared to the general population.

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A Potential Biomarker for Chronic Fatigue Syndrome Patients

d Jack Cush, MD

Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

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Upadacitinib Superior to Adalimumab in Methotrexate Refractory RA

d Jack Cush, MD

Upadacitinib, a JAK1-selective inhibitor, was studied head to head against adalimumab and placebo in rheumatoid arthritis after an inadequate response to methotrexate, and shown to be superior to ADA and PBO in ACR20 and DAS remission level responses.

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FDA has approved Otezla 30 mg bid for adults with oral ulcers associated with Behcet's Disease; based on the results showing apremilast lowers the number and pain of oral ulcers in a 12-week placebo-controlled Phase 3 study https://t.co/QeIXxsHxtY

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FDA has approved Otezla 30 mg bid for adults with oral ulcers associated with Behcet's Disease; based on the results showing apremilast lowers the number and pain of oral ulcers in a 12-week placebo-controlled Phase 3 study. https://t.co/QeIXxsHxtY

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Canadian study shows the estimated annual cost of inappropriate B12 prescribing was $45.6 million, assuming a 64% inappropriate prescription rate. Only 1.7% of prescribed intramuscular B12 demonstrated any deficiency with a malabsorptive indication https://t.co/yYW9oDjjPZ

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Mayo study comparing 429 Gout patients in 1990 and 2010 shows less 1st time Podagra 74% to 59% (p<0.001) and 24% higher flare rates in 2010. Predictors of future flares were hyperuricemia (HR 1.59) and CKD (HR 1.34) https://t.co/ZCgCzO7dUs

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There was no increaesd risk of cancer in 767 patients with giant cell arteritis in western Norway was compared to matched controls https://t.co/25gf89Ty0f

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anti-MDA5+ amyopathic dermatomyositis (ADM) with ILD is severe and refractory. NEJM letter reports on 18 ADM Rx w/ tofacitinibs who showed better 6 mo survival (100% vs 78%) (P=0.04) and improved ferritin, FVC, DLCO, & CT Chest over time. https://t.co/lsVGPxChoO

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Can Febuxostat be given to Allopurinol Hypersensitivity? Such pts not included in registrations trials; yet many literature reports of no toxicity & rare cross-Rxn; PI says ULORIC indicated w/ intolerant to allopurinol, or when allopurinol Tx not advisable https://t.co/KG36Ls6VsI

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Its been FORTY years since the "House of God" by Samuel Shem changed your medical thinking, if not humor. Check out Dr. Len Calabrese's recollections of the books 40th anniversary & join his summer book club and add some commentary! https://t.co/L8wiGpWk42

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Its been 0 years since the "House of God" by Samuel Shem changed your medical thinking, if not humor. Check out Dr. Len Calabrese's recollections of the books 40th anniversary & join his summer book club and add some commentary! https://t.co/L8wiGpWk42

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Women in the OTIS Pregnancy Project (657 RA, 170 JIA vs 564 without autoimmune dz) - preterm delivery (PTD) was increased in RA & JIA (RR 2.09 & 1.81) vs control; maternal activity was assoc w/ PTD (ARR 1.58 & 1.52), steroids had a 2-5X risk of PTD https://t.co/bWIHz0s1PV

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10 question UK survey on the use of HCQ in 989 patients (71% SLE; 12% UCTD/MCTD, 5.2% skin lupus, 11.5% RA, SS, etc). Results: 56% never had HCQ side effects; 23% had AE that improved; 12% had AE currently & 8.6% stopped HCQ for AE. https://t.co/iqJl0eEPTg

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Its been 30-40 years since the "House of God" by Samuel Shem changed your medical thinking, if not humor. Check out Dr. Len Calabrese's recollections and call to join his summer book club and add some commentary!! https://t.co/L8wiGpWk42

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A review of 376 FDA advisory panels between 2008-15, finds that 22% of FDA’s final actions were discordant with an advisory panels recommendations (moreso w/ safety panels). Of these, 3/4 lead to more restrictive actions and 1/4 less restrictive decisions https://t.co/AK7KbwN2l5

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Analysis of 149 OA and 203 RA pts from Rush Univ Rheum Clinic showed the same disease burden (by RAPID3) betw OA & A at initial visits, but after 6 mos. RAPID3 was more improved in RA patients than OA patients (P < 0.001). https://t.co/fNQ2ncJScI

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