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Canary in a Coal Mine (4.19.2024)
Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.
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SGLT2 Inhibitors Lowers Gout Risks in Type 2 Diabetes
A population-based cohort has demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in gout patients is superior to sulfonylurea therapy in lowering the risk of incident gout and recurrent flares among patients with type 2 diabetes (T2D).
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TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR:
- TNF mAbs: 4.1
- etanercept 5.4
- IL-17i: 2.8
- JAKi: 1.5
- placebo: 10.8 https://t.co/qN9UL16YPO https://t.co/5WOjAq9ty6
Dr. John Cush RheumNow ( View Tweet)
ILD Onset in MDA-5 Dermatomyositis
MDA5 antibody-positive DM is a rare, aggressive and progressive subtype of DM. Its' severity is dependent on the development of progressive ILD, manifesting as either RPILD and CILD.
https://t.co/9OPddNCLKr https://t.co/7KNCLnC3BA
Dr. John Cush RheumNow ( View Tweet)
Next up! Spondyloarthritis Spectrum
Tuesday, April 23, 2024 | 6:30PM ET
Nonradiographic Axial Spondyloarthritis - Eric Ruderman, MD
Enthesitis in Spondyloarthritis - Lihi Eder, MD
Future Therapy of Axial Spondyloarthritis - Lianne Gensler, MD
https://t.co/XvA0cPsC1E https://t.co/FZ3GfHpTFm
Links:
Dr. John Cush RheumNow ( View Tweet)
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Dr. John Cush RheumNow ( View Tweet)
#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease
Dr. John Cush RheumNow ( View Tweet)
High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
Dr. John Cush RheumNow ( View Tweet)
#RNL2024 @anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx
Dr. John Cush RheumNow ( View Tweet)
Chikungunya arthritis Metanalysis & good full-read review - 8 studies showing chronic arthritis (CCA) in minority of infected;, polyarticular, looks like RA, few seropositive, few w/ erosions on imaging. CCA may be progressive w/ irreversible damage https://t.co/8NdBCGTfxF https://t.co/SLt5COmKVf
Dr. John Cush RheumNow ( View Tweet)
Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://t.co/UX8hnwJjhs https://t.co/xU9RWCcr9C
Dr. John Cush RheumNow ( View Tweet)
RA-ILD at Higher Risk for Serious Infection and Death
A prospective, multicenter study from Spain has demonstrated higher rates of mortality and serious infection in rheumatoid arthritis–associated interstitial lung disease (RA-ILD) patients.
https://t.co/cjmcNi0ZqL https://t.co/wUXNWNeyOa
Dr. John Cush RheumNow ( View Tweet)
Lupus Accelerating Breakthroughs Consortium Partners with FDA
https://t.co/GW7Zy72oIZ https://t.co/AGYY8WDKcK
Dr. John Cush RheumNow ( View Tweet)
Retrospective study of hand/feet Xrays in early/suspected #RA due to low prevalence of erosions (4.4%) seldom leading to change in Dx (2pts; 0.3%) or prognosis change (0.4%). Seronegative had less erosions; Longer Sxs not assoc w/ erosions https://t.co/YCj04ZlQJq https://t.co/fHf6EvGOyc
Dr. John Cush RheumNow ( View Tweet)
BSR Guideline on Management of Sjogren’s Syndrome
Sjögren disease (SD) is the most common of all autoimmune disease, yet little is know of its etiology and there are insufficent interventions for those affected with mucosal or systemic manifestations.
https://t.co/Y8hNoBmBn3 https://t.co/up5motCwkp
Dr. John Cush RheumNow ( View Tweet)
The lateral foot/ankle anatomy 🥰 https://t.co/yuGt1seUd4
Faraz Sethi farazzledphysio ( View Tweet)
Did you know the first clinical controlled trials were done on sailors with scurvy? They were randomized to: a quart of cider, HCl, 2 spoons of vinegar, pint of sea water, spicy nutmeg paste w/ water vs. 2 oranges and a lemon. Guess which sailors fared best? #RheumGR @UTSWRheum https://t.co/fAeCeIxZ9e
TheDaoIndex KDAO2011 ( View Tweet)
AbbVie announced preliminary positive results from phase 3 SELECT-GCA study showing remission in 46% of #GCA pts Rx w/ upadacitinib for 52wks (vs 29% PBO); RCT included a 26-wk steroid taper regimen https://t.co/lqGVHKw3XF https://t.co/EyLuf8QLZA
Dr. John Cush RheumNow ( View Tweet)
PJP PPx in AAV
@anisha_dua #RNL2024 @RheumNow
919 GPA pts on RTX - only 31% on TMP/SMX
13 pts devel PJP, not on PPx
Overall decreased serious infections (HR 0.5), outpt infections HR 0.7
Adverse effects on TMP/SMX 29.6 vs 13.4
For every serious ifn avoided, 2-3 pts will have AE
Dr. John Cush RheumNow ( View Tweet)
Metrics Used by Rheumatologists in RA https://t.co/Pu40jbqhHR https://t.co/jtMm5odrxU
Dr. John Cush RheumNow ( View Tweet)