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morbidity,covid,heart,lung,brain

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

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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liver,hepaitis,pink,gb

Hepatitis B Reactivation with Rituximab and Abatacept

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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puzzle.RA_.jpg

RETRO - Taper or Not: You Decide

Jack Cush, MD

A prospective, phase 3 trial of rheumatoid arthritis (RA) patients in sustained remission has shown more than half will flare if disease-modifying antirheumatic drugs (DMARD) therapy is tapered or discontinued and that remission is best maintained by continued DMARD therapy.

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obesity.knee_.arthritis.jpg

Prevalence of Arthritis Rising in the USA

MMWR

The latest CDC estimates of the national prevalence of arthritis and arthritis-attributable activity limitations (AAAL) show a continued increase in absolute number: 58.5 million (23.7%) U.S. adults have arthritis, 25.7 million (43.9%) of whom have AAAL. 

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RA,hand,elderly,active

Malnutrition and Quality of Life in Elderly RA Patients

Jack Cush, MD

Rheumatoid arthritis (RA) imparts a significant disabilty and quality of life (QoL) limitations worsened by aging, but also by malnutrition.

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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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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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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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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

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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)
ICYMI: Upadacitinib RA program (5306 pts) the risk of H. zoster by Rx and dose (HZ/100PYs) MTX = 0.8/100PY ADA+MTX= 1.1/100PY UPA 15 mg= 3.0/100PY UPA 30 mg = 5.3/100PY Hence there is a 4-5X risk of HZ w/ JAKinhibitors https://t.co/wo9ih5PJ77 #RheumNow https://t.co/h1GoGzADdv

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Dr. John Cush RheumNow ( View Tweet)
Upadacitinib RA program (5306 pts) the risk of H. zoster by Rx and dose (HZ/100PYs) MTX = 0.8/100PY ADA+MTX= 1.1/100PY UPA 15 mg= 3.0/100PY UPA 30 mg = 5.3/100PY Hence there is a 4-5X risk of HZ w/ JAKinhibitors https://t.co/wo9ih5PJ77 https://t.co/Zv9sSRBSHb

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Dr. John Cush RheumNow ( View Tweet)
2125 RA pts in RCTS w/ baricitinib entered a long term F/U study. baricitinib pts had less XRay damage over 5 yrs; 5 yr No Xray progression was 60% on baricitinib 4 mg; 66% baricitinib 4 mg+MTX; vs 41% on just MTX monotherapy. https://t.co/pLuQCDSf6g https://t.co/wFs3G0DrJ7

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Malnutrition and Quality of Life in Elderly RA Patients https://t.co/4hEFTSaCga https://t.co/OPK3ThWqst

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RA patients had a higher 30-day rehospitalization than OA after TKR (OR 1.11) and THR (OR, 1.39). While infections, postoperative complications, cardiac did not differ, RA TKR had less VTE, but RA THR had higher VTE risk (OR, 2.41) https://t.co/QlOWngcEnJ

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In case you missed it— A longitudinal study from Iceland shows an increasing number of native joint infections (NJI), with iatrogenic, postarthroscopic infections being of particular concern. Read more… https://t.co/n82PpZ7a96 #RheumNow https://t.co/SmOBX0701N

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In case you missed it: Patients with rheumatoid arthritis (RA) who had a history of cancer did NOT have an increased risk of new or recurrent cancers if treated with biologic therapies, a meta-analysis found. #RheumNow https://t.co/jM9oiRin2M https://t.co/RknVHmZK98

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A placebo controlled RCT of canakinumab in 31 Adult Stills pts with arthritis showed responders (by DAS28) had signif reductions in calprotectin, IL-1RA, IL-18, IL-at wk 4. Unfortunately: didnt look at fever, rash, serositis, etc. https://t.co/p4Fohos2iU

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