RheumNow Podcast – Uppers and Downers

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

ACR Updates COVID-19 Vaccine Guidance- April 2021

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The ACR COVID-19 Vaccine Clinical Guidance was originally published on February 8, 2021 and updated on March 4, 2021. On April 28, 2021, new recommendations were added regarding mycophenolate, methotrexate, acetaminophen, and NSAID timing considerations,  

Predictors of Methotrexate Toxicity

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A metanalysis showed that while adverse events (AEs) are common when methotrexate is used in rheumatoid arthritis or inflammatory arthritis patients, serious AEs ranged from 2.1 to 9.5% and drug discontinuations ranged from 6.7% to 15.5%, mostly due to gastrointestinal events. 

Tofacitinib in Ankylosing Spondylitis

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A phase III trial assessing the efficacy and safety of tofacitinib in adults with with active ankylosing spondylitis (AS) shows that JAK inhibitiion was superior to placebo in a 48 week study.

Psoriatic Pregnancies Pose Risks to the Mother, Not Child

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A metanalysis of pregnancy outcomes in women with psoriasis and psoriatic arthritis finds an excess risk of adverse maternal events, but not adverse neonatal events.

This systematic review included 16 studies meeting inclusion criteria. 

Dual IL-17 Targeting is Effective but has More Candidiasis

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Bimekizumab (BIM) is a monoclonal antibody that targets both interleukin-17A and interleukin-17F, which as a biologic target has worked well in the management of psoriatic disease. The current issue of the NEJM has two reports wherein BIM was shown to be more effective than secukinumab and adalimumab in treating patients with moderate-to-severe plaque psoriasis; however, safety concerns arise. 

Little Effect with Multimodal Treatment of CMC1 Osteoarthritis

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A randomized clinical trial of patients with CMC1 osteoarthritis shows modest benefits when a combination of conservative treatments (education, splinting, hand exercises, 1% diclofenac sodium gel) was used compared to education alone. While there were small to medium benefits with regard to hand function, there was no benefit in pain outcomes. 

Golimumab Effective in non-radiographic Axial Spondyloarthritis

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The GO-AHEAD study was designed to assess the long-term efficacy and safety of golimumab (GLM) in non-radiographic axial spondyloarthritis (nr-axSpA).  After the 16-week, placebo [PBO]-controlled double-blind phase, 189/198 (95.5%) entered the long-term extension (OLE) for 36 weeks wherein G

RheumNow Podcast – Coconspirators: RA and Lung Disease

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Dr. Jack Cush reviews and discusses more than a dozen news and journal articles from the past week on RheumNow.com.

Increased Methotrexate Liver Disease in Psoriasis

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A Danish cohort study examined the risk of methotrexate related liver disease risk in patients with psoriasis (PsO)and psoriatic arthritis (PsA), and found that compared to rheumatoid arthritis (RA), psoriatic patients had up to a 3 fold higher risk of liver disease. 

BSRBR: Demyelinating Disease Following Anti-TNFα Therapy

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Analysis of patients receiving anti–tumor necrosis factor α (TNFi) therapy in the British Society for Rheumatology Biologics Register (BSRBR) shows that the risk of demyelination is rare but is marginally increased by taking TNFi therapy. 

Increased Risk of COPD in ACPA+ Pre-RA Patients

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The lung and its pathology is uniquely tied to rheumatoid arthritis (RA) and its pathogenesis.  A new study shows that elevation of anti–citrullinated protein antibodies (ACPAs) before diagnosis of RA increases the risk of developing chronic obstructive pulmonary disease (COPD

New Side Effect From mRNA COVID Vaccines?

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Herpes zoster reactivation -- a.k.a. shingles -- following COVID-19 vaccination in six patients with comorbid autoimmune/inflammatory diseases may be a new adverse event associated with the Pfizer/BioNTech mRNA vaccine, suggested a new report.

Raynaud and Microvascular Complications with New Migraine Meds

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A new study of calcitonin gene-related peptide (CGRP) antagonists for migraine headaches found that a small subset manifested Raynaud phenomenon and other had microvascular complications, suggesting that CGRP antagonists should be used in caution in patients with Raynauds. 

Broadalumab Efficacy in Axial Spondyloarthritis

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Broadalumab (Siliq), an anti-interleukin-17 receptor A monoclonal antibody, is currently FDA- approved for use in adults with plaque psoriasis; but a recent trial shows it to be effective in patients with axial spondyloarthritis (axSpA).