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Denosumab Protects Against RA Erosions

d RheumNow

Combining denosumab (Prolia) with a conventional disease-modifying antirheumatic drug (DMARD) such as methotrexate showed promise for slowing radiographic damage in rheumatoid arthritis (RA), a manufacturer-sponsored phase III trial called DESIRABLE found.

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CDC: One in Four US Adults have Arthritis

d Jack Cush, MD

MMWR reports that in 2017, one in four US adults have arthritis (range from 22.8% to 34.6%), with higher rates in Appalachia and Lower Mississippi Valley regions. Of those with arthritis, 31% reported to have "severe arthritis".

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RheumNow Podcast – DESIREABLE Results (5.3.19)

d Jack Cush, MD

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

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Nonadherence is Costly for Patients in Pain

d Jack Cush, MD

A comparative cohort study of patients with osteoarthritis (OA), gout, diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM) shows that nonadherence to pain medications is high and leads to greater overall health care resource utilization and costs. 

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Ideal Outcomes are Seldom Achieved in Gout

d Jack Cush, MD

Studies from a cohort of gout patients in Mexico shows that long-term goals of a target serum urate (sUA) 6 mg/dL and remission are rare, especially for those with severe gout.

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Cohort study finds 6/420 (1.4%) of SLE patients had steroid induced pancreatitis is - half of them died. Lit review finds 451 lupus pancreatitis with majority developing pancreatitis w/in 3 days of medium-to-high dose steroids (mortality = 37.5%). https://t.co/QsIHsl44qx

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Dr. John Cush RheumNow ( View Tweet)

“..the only difference between those who have failed and those who have succeeded lies in the difference of their habits —I will form good habits and become their slave. - from The greatest Salesman in the World

Dr. John Cush RheumNow ( View Tweet)

Eight Survival skills (cont) 5) Set a daily goal and track your progress. 6) find a daily "hassle" & reframe it in a more positive light. 7) Do something nice for someone else each day. 8) Practice mindfulness by paying attention to the present moment https://t.co/8uX7Db7QdB

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Dr. John Cush RheumNow ( View Tweet)

Eight Survival skills (from NPR article) to manage stress: 1) identify one positive event each day.2) Tell someone or share that positive event. 3) Start a daily gratitude journal. 4) Whats your personal strength and how have you used it; https://t.co/8uX7Db7QdB

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Dr. John Cush RheumNow ( View Tweet)

Study of 281 Italian pts with temporal artery Bx-proven Giant cell arteritis shows increased mortality w/ large vessel involvement (HR 5.14) at diagnosis, and reduced mortality with PMR onset (HR 0.57) & adventitial inflammation (HR 0.31) on TABx. https://t.co/iF90cqYtqn

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Dr. John Cush RheumNow ( View Tweet)

Recent Methotrexate use lowers Cardivascular risk by 20% finds a Study of 23,994 elderly RA patients. 13.7% had a CVE (28.5 events per 1000 PY; 95% CI 27.6–29.5). https://t.co/yyR5DUTfF8

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Dr. John Cush RheumNow ( View Tweet)

Cush offers drug 'safety rules to live by' for rheumatologists https://t.co/5BKBKZjyNw

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Dr. John Cush RheumNow ( View Tweet)

Invincibility lies in the defence; the possibility of victory in the attack. Sun Tzu https://t.co/jhW2LXrEYv

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Dr. John Cush RheumNow ( View Tweet)

2019 FDA Drug Safety Warnings all pertain to Rheumatology agents 1) boxed warning for sleep meds; 2) harms w/ sudden opioid stops; 3) risk of VTE with high dose tofacitinib; 4) cardiac risks with febuxostat https://t.co/yHYqWJ7pow

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Dr. John Cush RheumNow ( View Tweet)

Analysis of new drug registration trials in RA (1998-2018) shows an increase in placebo responses (significant for ACR50 & ACR70); yet with significant reductions in Disease duration, SJCand DAS28-ESR. Changes in RA? RCTs? expectation bias? https://t.co/at6uesuNvL

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Dr. John Cush RheumNow ( View Tweet)

DESIRABLE study from JAPAN Rx 654 (relatively) early, MTX tx RA pts with PBO, or Prolia given q3 or q6 mos. Denosumab lead to significant reductions in Erosion scores, total Xray (not JSN) and increased BMD (vs PBO); no effect on ACR20/50/70. https://t.co/DQrmXYrhAf

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Dr. John Cush RheumNow ( View Tweet)

Osteoarticular involvement with sarcoidosis is uncommon (<13%); in the hands shows a honeycomb/latticework trabecular pattern in metacarpals https://t.co/bE4VgWaEzN

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Dr. John Cush RheumNow ( View Tweet)

French real-world study of Psoriatic arthritis pts starting apremilast (n 3207) or MTX (n 2736), finds higher discontinuation rates at 1 yr for apremilast (69%) vs MTX (59%) https://t.co/bhPwaPhX23

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Dr. John Cush RheumNow ( View Tweet)

Study of 213 RApatients starting MTX. After mean F/U 4.3 yrs and 6288 ALT tests, 7% had ALT elevation; 21% of these were ALT>1.5×ULN. Strongest predictor was a pre‐treatment elevation of ALT (OR 6). 3% permanently stopped MTX due to ALT elevation. https://t.co/ti4ClypXgQ

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Dr. John Cush RheumNow ( View Tweet)

Study of 14928 Autoimmune/Rheum Dz pts in UK Clinical Practice Research database found the influenza vaccination was not associated with arthritis flare or increase in PCP visits (actually lowered consultas for joint pain in following 90 days) https://t.co/rrwu68g7DM

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Dr. John Cush RheumNow ( View Tweet)

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