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CV,risk,MI,heart,cardiac

Heart Failure in RA: Inflammation Matters

d MedPage Today

Patients with rheumatoid arthritis (RA) who had high levels of inflammation at baseline were at increased risk for later heart failure, a large cohort study found.

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COVID Test Antibody

Is It OK to Continue TNF Inhibitors with COVID-19 Infection?

d Jack Cush, MD

Registry level data of patients with immune-mediated inflammatory diseases (IMIDs) diagnosed with COVID-19 should continue their TNF inhibitor (TNFi) therapy as such patients were less likely to experience adverse COVID-19 outcomes (compared to other immunomodulatory treatments).

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Risk of Herpes zoster from upadacitinib RCTs: UPA > ADA > ADA+MTX > MTX. 5306 RA pts, HZ/100 Pt-Yrs was 0.8 MTX mono; 1.1 ADA+MTX; 3.0 UPA 15 mg and 5.3 UPA 30 mg. 71% of UP HZ cases involved a single dermatome. Higher risk w/ prior HZ & Asians https://t.co/0QUvXmFrJ3

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ICYMI: Hepatitis B Reactivation with Rituximab and Abatacept A serologic study of rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without HBsAb positivity. https://t.co/l1qCrWCyZd #RheumNow https://t.co/EUoWt9xGdB

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ICYMI: Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior. https://t.co/F5CGj0w7Bh https://t.co/OuDMgNIKTA

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steroid prednisone lab

Are You a High or Low Glucocorticoid Prescriber?

d Jack Cush, MD

A recent analysis shows thta glucocorticoids (GCs), usually recommended for short-term use in rheumatoid arthritis (RA), are variably used by rheumatologists, and that provider preference is a strong predictors of long-term glucocorticoid use.

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CXCL13 predicts worse Xray status in early #RA. Study of 158 pts, followed 11-years. Baseline CXCL13 correlated with Xray progression (ΔTSS) at 11 years. CXCL13 was superior to CRP, DAS28CRP, SJC28, CCP predicting 11-yr Xray damage https://t.co/1WAdZoYQ1P

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Among 2359 RA & PsA pts (3169 TNFi courses 1778/1391), serious infection (SIE) rates were higher in RA 4.17/100PY vs PsA 2.16/100PY. PsA had 41% lower SIE risk (HR 0.59, p=0.004) - Registry data from the NOR-DMARD study https://t.co/llH07TFHOI

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Retrospective study hospitalized new-onset systemic JIA (2008-19):52 children’s hospitals & 534 sJiAshows 29% rx w/ biologics & 58% steroids. Over time Biologic use increased & MTX decreased. Biologic correlated w/ Hi hospital volume, ICU stay, later years https://t.co/blbOps9zVQ

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast square

RheumNow Podcast – Quackademia (10.15.2021)

d Jack Cush, MD

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

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morbidity,covid,heart,lung,brain

2021 Update to EULAR Points on Immunomodulatory Use in COVID-19

d Jack Cush, MD

EULAR has updated its recommendations (points to consider - PtC) for rheumatologists managing patients during COVID-19; now with 2 overarching principles and 12 PtC.

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Comparative study of 46 AOSD, 9 MAS & 31 adult HLH pts, shows that serum IL-18 was signif higher in AOSD than HLH (closely correlates w/ ferritin, sIL-2R). IL-18, sIL-2R, ‘arthralgia or arthritis’ independently distinguished AOSD from HLH https://t.co/ZW6e78nEkh

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Smoking worsens adult-onset Still’s disease. 185 AOSD pts, found 45 smokers who had higher risk of pericarditis (36 vs 16%), pleuritis (33 vs 14%), abd pain (18% vs 6%), higher systemic score (6.4 vs 5.4 ), More MAS (29% vs 6%), lung disease (18% vs 13%) https://t.co/ZKKhw1EbnD

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Dr. John Cush RheumNow ( View Tweet)

NICE issued a positive final appraisal recommending upadacitinib in previously treated moderate active rheumatoid arthritis (RA). This will expand UPA use to nearly 27,000 RA patients in the UK. Final pub date is Nov 10, 2021 https://t.co/A8OuzNlrAz

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Catastrophic Still's dz occurs early; compares 20 AOSD w/ organ failure vs 40 AOSD without. CAT-AOSD had shorter Dz duration, earlier Rx need; risks: younger; splenomegaly, liver, cardiac,lung involvement; ferritin level, no arthralgia https://t.co/8WIMd0JxZr

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Dr. John Cush RheumNow ( View Tweet)

Costs of #JIA are substantial, total costs up to 44,832 USD annually. Direct costs up to $32,446 USD, accounting for 55-98 % of total. $$$ mostly related to meds; cost go up 3 fold after biologic initiation. (JIA Indirect costs are underrepresented) https://t.co/rukJPWqD0y

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Start #MTX & escalate 5mg q2wk (usual) or 5mg q4wk (fast): open RCT 178 #RA pts - equal EULAR resp (28 v 23%), DAS28-CRP (-1.3 v -1.3) - same at wk8 & 24. No diff in MTX polygluts., cell #s, LFTs, D/C - but more GI sx w/ fast wk8 (40 vs 27%) https://t.co/MbuFoA5HFp

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Dr. John Cush RheumNow ( View Tweet)

liver,hepaitis,pink,gb

Hepatitis B Reactivation with Rituximab and Abatacept

d Jack Cush, MD

Hepatitis B reactivation is an uncommon complication of biologic therapy use. Now, a serologic study of  rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without hepatitis B antibody (HBsAb) positiv

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Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior. https://t.co/F5CGj0w7Bh

Links:

Dr. John Cush RheumNow ( View Tweet)

RETRO - Taper or Not: You Decide A prospective, phase 3 trial of RA patients in sustained remission has shown more than half will flare if DMARD therapy is tapered or discontinued and that remission is best maintained by continued DMARD therapy. https://t.co/KDqGrujGMT https://t.co/8HqSS74PqL

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Dr. John Cush RheumNow ( View Tweet)

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