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Ides of March (3.15.2024)
Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children
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CDC
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement. The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.
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US Trends in RA DMARD Use 2017-2021
A trend analysis of DMARDs shows that only half of rheumatoid arthritis (RA) patients are taking DMARDs, and that the COVID-19 pandemic substantially affected DMARD use. Despite numerous DMARD advances and evolving treatment guidelines since 1990, older therapies are still commonly used and the latest agents make up a small percentage of overall DMARD use.
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Again, a High Mortality with Depression and RA
Last week we reported on a Korean study showing a 66% elevated mortality risk in RA patients (n=38,487) with depression.
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Again, a High Mortality with Depression and RA
Last week we reported on a Korean study showing a 66% elevated mortality risk in RA patients with depression. This week, a new report shows depression in RA increases the mortality risk by more than 5 fold.
https://t.co/C7Z7djny4S https://t.co/J9B6DUqcIC
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Study 1189 males athletes sanctioned for doping with Androgenic anabolic steroids compared to 59 450 controls. Anabolic steroids signifi. increased the mortality risk (HR 2.81) from both unnatural (accidents) & natural causes (CVD, etc) https://t.co/XJr1oUw1gM https://t.co/YIQhdCXd2y
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9 Facts about Leflunomide
Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui.
https://t.co/M0wtGTYkdO https://t.co/dvYqz4WEH2
Dr. John Cush RheumNow ( View Tweet)
HS-Related Autoinflammatory Syndromes
HS is an autoinflammatory skin disorder of the terminal hair follicle, manifesting with painful nodules, abscesses, draining tunnels, and hypertrophic scarring, typically occurring in apocrine gland bearing skin.
https://t.co/02Svwj99Bm https://t.co/9oy1UngII7
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SLE & remission on hemodyalysis (HD)? Cohort of 137 pts starting HD & the # off SLE Rx increased w/ time: 67% (HD start), 76.0% (1st Yr), 83% at 3 yrs (less w/ younger). Lupes flares most in 1st yr of HD; @12 mos 52% minor and 12% had severe flares. https://t.co/8N7CJWkIUY https://t.co/48eOclzrJH
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Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/cLqt3FSzBk https://t.co/eD84WPZyuq
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Long-term safety of Ixekizumab (IXE) - 26 RCTs (22k PYs) in PSO, PsA, AS & nr-axSpA
- nasopharyngitis most common AE; AEs did not incr over time
- D/C from AE 3-5/100Pys
- ISRs: 5.9-11.6/100PYs
- Candida 1.2-2/100PYs
- IBD: 0.1 PsO - 0.8/100PY for axSpA
https://t.co/nOoCE3VOxD https://t.co/F4gP1yR1Je
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Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory tract infections were most frequent with recurrence rate that remained stable over time https://t.co/zwELL2yevG https://t.co/GLbidGvjp3
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DANBIO #RA registry study: in 21,982 Rx starts (96K PtYrs) saw 1423 cancers w/ no overall increase in cancer risk with tocilizumab, sarilumab, abatacept, or rituximab (HRs from 0.7–1.1). No diff betw ABA vs TNFi (HR 1.41) nor HEME CA RTX vs TNFi (HR 0.09) https://t.co/mIEqALnnwI https://t.co/N1v3TzuBGm
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Chinese SLE registry study of 350 SLE-TP (low plts) pts - 55% were aPL Ab+ (who had lower Plts @baseline (61K vs 76k). aPL+ SLE-TP pts w/ higher relapse rate (58% vs. 44%, P=0.009) & lower complete response rate. > more aPLs--> increased relapse rates https://t.co/Mb2YhsniVJ https://t.co/92QRWICcB4
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JAMA Review of DMARD Use in Rheumatoid Arthritis
JAMA has reviewed the "2022 EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs".
https://t.co/pJLriraWqq https://t.co/JElMzDyeMs
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COX-2 (on the left) have lower ulcer risk than COX-1 (to the right) NSAIDs. @BCryer https://t.co/Xfm7xJkvzd
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High risk pts on NSAIDs need prophylaxis!! @bcryer https://t.co/NAnHtkTNvL
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Endoscopy and Worry are indicated in the face of DYSPEPSIA and any of these: @BCryer https://t.co/6TabKhiLPO
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Testing for H. Pylori. Serologic tests are OK but after Rx eradication, 25% of pts will remain positive for H. Pylori. @BCryer
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Multiple Rx options to treat H. Pylori - Dr. Cryer recs regimens of 14ds; top line w/ bismuth is most recommended. (most effective is the one the patient will actualy take!) @BCryer https://t.co/f6836Ga1Fz
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