New BSR 2017 Gout Guidelines (Best of 2017)

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The British Society for Rheumatology/British Health Professionals in Rheumatology first published a guideline for the management of gout in 2007. They have just updated and published their new guideline, largely because of new therapies, an increasing incidence of gout, low penetrance of urate lowering therapies, and the inability to achieve a target serum uric acid level.

Therapeutic Update: 5 Questions on FDA Hearing for Tofacitinib in PsA (Best of 2017)

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In this Therapeutic Update, Drs. Mease, Gibofsky and Cush answer five questions regarding the August 3rd FDA Arthritis Advisory Committee meeting that reviewed the potential approval of tofacitinib (Xeljanz) in patients with active psoriatic arthritis. The panel was nearly unanimous (10-1) in favor of the efficacy and safety profile of of tofacitinib, and similarly voted 10-1 to approve this drug for use in PsA. Final decisions on these recommendations from the AAC panel will be made at a later date by the FDA. 

Stroke Risk Highest in the First Year of Lupus (Best of 2017)

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Arkema et al has published in Annals of Rheumatic Disease a study showing that ischaemic and haemorrhagic stroke (CVA) is elevated in systemic lupus erythematosus (SLE) compared with the general population, especially in the first year. 

Death Rates from Lupus Remain Disproportionately High (Best of 2017)

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The Annals of Internal Medicine reports that despite improving trends in mortality, death rates from systematic lupus erythematosus (lupus) remain high compared to those in the general population, and disparities persist between subpopulations and geographic regions.

The RheumNow Week in Review - 22 December 2017

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

Allopurinol Dose Escalation is Safe with Severe CKD

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Hypertension, nephrolithiasis and chronic kidney disease (CKD) commonly associates with gout.  While there is a clear need to dose adjust NSAIDs and colchicine in those with CKD, there is some debate about the need to dose adjust when using allopurinol with CKD.

Risk of Gout Onset and Flare Linked to Urate Levels

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Serum uric acid (SUA) levels are clearly linked to gout. Researchers from Harvard have systemically reviewed the literature to quantify the risk of onset and flare with varying levels of SUA.

Cannibis Weakly Effective in Neuropathic Pain

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The medical use of cannabis is often extended to management of chronic pain and neuropathic pain.

A metanalysis of 27 chronic pain trials show that there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations.

Cardiac Disturbances Increased in Spondyloarthritis

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A prospective Swedish study between 2001–2009 found a higher risk of aortic regurgitation, pacemaker, AV block and atrial fibrillation in SpA, AS, uSpA and PsA patients.

Registry Efficacy of Rituximab in Refractory SLE

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Despite large randomized trials failing to show the efficacy of RTX in SLE (LUNAR, EXPLORER), uncontrolled observational data suggests possible efficacy and safety of RTX in refractory SLE.

Worldwide Trends in BMI in Children, Adolescents and Adults

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Lancet reports on the analysis of 2416 studies, involving 128.9 million persons over 5 years of age shows previously rising trends in children's and adolescents' BMI have plateaued in many high-income countries, but still at high levels. 

Frequency of Rheumatoid Knee Replacements Down in the Biologic Era

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A time-series analysis of incident rheumatoid arthritis (RA) patients seen between 1996 and 2011 in the Danish National Patient Register shows that the incidence of hip (THR) and knee replacements (TKR) began to decrease after the introdution of biologic agents for RA in 2002.

Baseline Risk Score Predicts Serious Infection Risk in TNF-Treated RA Patients

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Curtis and colleagues have analyzed the certolizumab (CZP) RAPID1 and RAPID2 trials to assess the risk of serious infectious events (SIEs), and shown that steroids combined with an age-adjusted comorbidity index (AACI) yields a 2-3 fold predictable risk for SIE.

Advantages of Intravenous Pulse Cyclophosphamide in ANCA-associated Vasculitis

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Researchers from the Nottingham University Hospitals have analyzed the efficacy and safety of  oral (PO) and intravenous (IV)  cyclophosphamide (CTX) in ANCA-associated vasculitis (AAV) patients and demonstrated a trend for fewer relapses, better 1 year survival and less toxicity w

The RheumNow Week in Review - 15 December 2017

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Dr. Jack Cush reviews the news from the past week on RheumNow.com. Subscribe to the podcast on iTunes and SoundCloud.com. 

FDA Approves Xeljanz for Use in Psoriatic Arthritis

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Pfizer Inc.

Cochrane Review: Calcium Channel Blocker Efficacy in Raynaud's

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The Cochrane Database has published its review of calcium channel blockers (CCB) in Raynaud's phenomenon, showing CCBs may be useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud's phenomenon, especially with primary Raynaud's.

Fatigue, HAQ and Hand Disability Correlated in Early Systemic Sclerosis

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Early diffuse cutaneous systemic sclerosis (SSc) was associated with high levels of disability and fatigue, according to analysis of data from the European Scleroderma Observational Study cohort.

Febuxostat Works in Early Gout But Fails to Protect from Xray Damage

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Dalbeth and colleagues have published a novel report in Arthritis & Rheumatology, novel in that it is a trial of early gout patients that looks at clinical and radiographic outcomes. They showed that febuxostat improves magnetic resonance imaging (MRI) measures of synovitis and reduced gout flares, but failed to alter X-ray progression with 2 years follow-up. 

FDA Approves Mepolizumab for Churg-Strauss (EGPA)

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The Food and Drug Administration (FDA) approved use of Nucala (mepolizumab) for use in treating adults with eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss vasculitis. This is first FDA-approved therapy specifically to treat EGPA.