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Opioids, SSRIs and Steroids Increase Fracture Risk in RA

d Jack Cush, MD

Analysis of a large US observational rheumatoid arthritis (RA) patients finds that opioids, SSRIs and glucocorticoids were associated with increased risk of fracture in RA, whereas statins and TNFi had a decreased vertebral fracture risk.

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RheumNow Podcast – Richer or Poorer (5.17.19)

d Jack Cush, MD

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

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Coexistent Gout Increases Risk in Rheumatoid Arthritis

d Jack Cush, MD

It his often said that gout and rheumatoid arthritis (RA) cannot coexist and where confusion exists, a good history and testing for serum urate (SUA) and rheumatoid factor (RF) can usually clarify the dominant disorders. A recent study shows that hyperuricemia and gout are uncommon in RA, but when present shows an increased risk of comorbidities and cardiovascular (CV) mortality.

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Risk Score Predicts Thrombosis Recurrence in APS

d RheumNow

A combination risk score helped predict recurrent thrombosis -- particularly arterial -- among patients with antiphospholipid syndrome (APS), an international study found.

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FDA Final Guidance on Interchangeability with Biosimilars

d Jack Cush, MD

The FDA has published an industry guidance document to define interchangeability as regards to biosimilar use in the United States under section 351(k) of the Public Health Service Act (PHS Act) (42 U.S.C. 262(k)). 

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Less Structural Damage with T2T in Gout

d Jack Cush, MD

A two‐year randomized clinical trial has demonstrated that allopurinol dose escalation to a target serum urate (SU) results in less bone erosion, structural damage and urate crystal deposition in patients with gout.

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Methotrexate Use Not Linked to Interstitial Lung Disease in RA

d Jack Cush, MD

People with rheumatoid arthritis have a significant risk of developing interstitial lung disease (RA-ILD), yet there is often a question as to whether methotrexate (MTX) exposure can cause or worsen ILD.  A controlled cohort study suggests that MTX use is not associated with an increased ris

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Large study from OTIS on PsA and AS shows an increased risk for adverse pregnancy outcomes - including preterm delivery (RR 1.81, 3.82) & Cesarean delivery (RR 1.63, 5.82). Active disease & steroid use may also increase these risks. https://t.co/E10SEq32IO

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DECT is most accurate in diagnosing established gout - review of 10 studies shows a pooled (95% CI) sensitivity of 0.81 (0.77, 0.86) and specificity of 0.91 (0.85, 0.95), respectively. W/ short disease duration (⩽6 wks), sensitivity 0.55 and spec 0.89 https://t.co/DOdejOZGcv

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Review of Factors Contributing to Functional Outcomes after Knee replacement includes: Weight, pain & smoking (increase post-op complications), pain, infection (2% w/in 1st 90days), post-operative range of motion and (severity of) the OTHER knee. https://t.co/mKe8EQnk8q

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Dr. John Cush RheumNow ( View Tweet)

My talk on Infection Prevention and Management with Newer Agents is one of more than 30 talks now available at RheumNow Live On Demand - and registration is free. #rheumed https://t.co/1jGiIQXvua

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Medicare analysis shows Gout patients are twice as likely to have chronic pain (HR 2.02; 95% CI 1.98-2.05) and use of allopurinol or febuxostat was associated with a lower risk of chronic pain (HR 0.72-0.79) https://t.co/xW5rVPyC69

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Dr. John Cush RheumNow ( View Tweet)

Discontinuing TNFi before wk 20 is feasible in RA and JIA pregnancy with well- controlled Dz. OTIS study of 490 women compared 25% who D/C TNFi before wk 20 vs 41% taking TNFi after wk 20. D/C TNF not assoc w/ clinical worsening in the 3rd trimester. https://t.co/J1qE3YZnHi

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Literature review - 23 studies on Natural dietary supplement (NDS) use finds that worldwide 47% of RA pts use NDS, did not differ by geographic region, 47% found NDS to be effective, 13% had adverse side effects, & 30% informed their physicians. https://t.co/N2O16NxuxU

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Study from Rheumatology tries to correlate topic, citations, downloads and Altmetric ratings in rheumatology and finds tweeting about your research does not appear to influence citations. https://t.co/Bez5Infcnf

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Dr. John Cush RheumNow ( View Tweet)

Reactivation of latent CMV infection is rare in Rheum Pts. 14 pts described w/ febrile illness, on steroids (13), with coinfections (8), 4 died during hospitalization, tend to have longer hospitalizations (47 vs. 7 days), more coinfections (67% vs. 17%) https://t.co/pijtFv55Uq

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Dr. John Cush RheumNow ( View Tweet)

Danish study of over 13,600 patients with psoriasis finds that after 5 years of follow-up, 2.6% developed psychiatri (depression, anxiety, bipolar disease, schizophrenia and dementia) problems; 5% after 10 years. https://t.co/wssLSxjbSe

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Adverse childhood experiences (ACEs) were studied in 269 SLE registry (CLUES) pts and compared to California BRFSS controls. 63% had 1+ ACE & 19% had 4+ ACEs. Higher ACE levels assoc w/ worse patient-reported SLE activity, depression, and health status https://t.co/OtvecXh9ow

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overall prevalence of low back pain among US workers is 26.4%, with 5.6% having severe LBP, according to May 14th Annals of Internal Medicine. https://t.co/5sfYFQWHyh

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Public health study from Norway compares the top 1% richest and bottom 1% poorest found significant difference in life expectancy -14 years for men and 8 years for women. Similar USA study finds roughly the same as in Norway. https://t.co/h1QFZmgXaJ

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