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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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Omega-3 Rich Fish Lowers Gout Flares

d Jack Cush, MD

Boston researchers have shown that consumption of fish rich in omega‐3 polyunsaturated fatty acids (n‐3 PUFA) leads to a lower risk of recurrent gout flares.

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FDA Adds Boxed Warning to Sleep Drugs

d Jack Cush, MD

The Food and Drug Administration (FDA) added a Boxed Warning to several sleep medications (e.g., eszopiclone, zaleplon, and zolpidem), warning rare but serious injuries may occur as a result of abnormal sleep behaviors (sleepwalking, sleep driving, and engaging in other activities while not

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High GPA Hospital Readmission Rates

d Jack Cush, MD

A national database reveals that patients with granulomatosis with polyangiitis (GPA) have 22.3% risk of hospital readmissions within 30 days of discharge. 



From a total of 9749 hospital admissions with GPA, there were 2173 readmissions within 30 days of discharge.

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

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

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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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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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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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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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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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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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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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8/171 ANCA-Assoc Vasculitis pts had Uncommon manifestations - often seen in PR3+, very young or very old w/ delay in Dx (~12 mos); includes Pancreatitis, unusual pulmonary dz (cystic lung disease; usual interstitial pneumonia) or splenic infarcts https://t.co/UFONWMTYYi

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Top 5 non-clinical jobs for physicians: 1 Hospital administrator; 2 Healthcare Organization Director; 3 Senior medical writer; 4 Healthcare Organization Director; 5 Health Educator https://t.co/EINNxdwdRk

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Have you registered for free online access to RheumNow Live? More than 30 speakers delivered exceptional talks last month in Fort Worth, Texas - check them out here: https://t.co/1jGiIQXvua #rheum https://t.co/wyFkFvX8dY

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Rheumatic disorder with hepatic origins/involvement include primary biliary cholangitis, autoimmune hepatitis, primary sclerosing cholangitis, SLE/overlap, AOSD, Hemophagocytic syndrome. https://t.co/N61uq1AioZ

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Physicans are answerable to (their bosses): 1) the patient; 2) God (or whomever guides you); 3) your mother (she may be watching). No one else matters.

Dr. John Cush RheumNow ( View Tweet)

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