The RheumNow Week in Review – We’re Number One! (8.17.18)

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Dr. Cush reviews the articles and news from the last week on RheumNow.com. Information on comorbidities, the downside of steroids, unmet need in psoriatic arthritis, and the top 10 rheumatology programs.

Managing Comorbidity and Poor Drug Responses

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Comorbidity is pervasive and complicates medical care in general. It can be a by-product of aging. It may result from drug therapy or an inciting disease process and may be part of the constellation that defines the primary disorder. A growing body of evidence that suggests that comorbidity has a significant dampening effect on drug responsiveness and, adds to poorer outcomes in patients with inflammatory arthritis.

Tumor Necrosis Factor Inhibitors Do Not Increase the Risk of Cancer Recurrence

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There is a large body of data that shows tumor necrosis factor inhibitors (TNFi) use in rheumatoid arthritis (RA) confers the same risk as that seen in RA - meaning there is no increase over and above that incurred by inflammation and RA itself.  There are fewer studies about whether it is s

Success of Stopping Depends on the Biologic

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The type of biologic disease-modifying anti-rheumatic drug (DMARD) being used and remission duration were important factors predicting whether remission was maintained among patients with rheumatoid arthritis after cessation of the biologic, a Japanese study found.

Cardiovascular Benefits of Maintaining Biologic Therapy

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An Australian prospective study of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) has shown that sustained use of tumour necrosis factor (TNFi) inhibitors or biologics can reduce the risks of cardiovascular events (CVEs).

The RheumNow Week in Review – No Good Gout (8.10.18)

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Dr. Jack Cush reviews the news and latest journal articles from the past week on RheumNow.com. Info on Surgery and Hip Fractures, Gout drugs abandoned, Allopurinol escalation, hydroxychloroquine drug levels, how to treat scleroderma in India and exactly who gets back pain.

Fractures Augment 10 Year Mortality Risks

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This nationwide study of adults (50+ yrs) from Denmark has shown that following a fragility fracture, the 10-years mortality risk was increased, especially in the first year following the fracture. 

Early Hip Fracture Surgery Reduces Mortality

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CMAJ reports that seniors are more likely to survive a hip fracture if the surgery is done as soon as they’re admitted to the hospital - suggesting hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.

Selective Use of HLA-B*5801 Testing in Gout

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The current edition of JAMA Internal Medicine describes an Asian gout patient who presents with an allopurinol hypersensitivity reaction that could have been diagnosed by testing for HLA-B*5801.

Febuxostat (IR or XR) Effective in Gout with Renal Impairment

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Saag and colleagues report the results of a 3 month phase III trial demonstrating equal efficacy between febuxostat extended release (XR) and immediate release (IR) formulations in patients with gout.  and normal or impaired renal function.

Big Advances for Two Osteoporosis Drugs

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New developments with the FDA and new scientific findings are adding momentum to two drugs experts believe are game-changers in osteoporosis treatment.

Back Pain in Psoriatic Arthritis

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A single center study of psoriatic arthritis patients has shown that rheumatologist-judged inflammatory back pain (IBP) and criteria defining IBP may not perform well when ascertaining axial involvement in PsA patients. 

Higher Infection Rates for Infliximab in Psoriasis

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A prospective study of psoriasis patients from the British Association of Dermatologists Biologic Interventions Register demonstrated that infliximab therapy yielded 2-3 times more serious infection than seen in those treated with non-biologic DMARDs or methotrexate (MTX).

Opioid Aversion is Augmenting Spinal Steroid Injections

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As physicians turn away from opioids, are they resorting to options that may also be unsafe?

The New York Times reports that some physicians are using the anti-inflammatory drug, Depo-Medrol, for intraspinal injections to manage painful spinal and perispinal disorders.

IL-1 Suppression May Improve Dilated Cardiomyopathy

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Interleukin-1 (IL-1) suppression helped reverse symptoms of dilated cardiomyopathy (DCM) for one patient in a case study that may implicate inflammation in the development of the condition.

Company Payments to Rheumatologists, Specialists Linked to Increased ACTH Prescriptions

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Despite its exorbitant price tag and paucity of supportive clinical evidence, ACTH (corticotropin) sales have increased in the United States. A recent JAMA article examined its use by specialists and found that those who prescribe ACTH (including rheumatologists, nephrologists, neurologists) received corticotropin-related payments from the products sole manufacturer, Mallinckrod.

Statin Associated with an Increase in Inflammatory Myopathy

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JAMA Internal Medicine reports that exposure to statin medications may be linked to histologically confirmed idiopathic inflammatory myositis.

Veterans Administration Shuns Marijuana as an Option

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Cannabis therapy is legal in 30 states in the US, and soon to be legal in Canada and Great Britian, but the US Veterans Administration continues to reject medical marijuana as a therapeutic option - even in states where it is approved.

The Fate of Palindromic Rheumatism

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Palindromic rheumatism (PR) is an intermittent inflammatory arthropathy with episodes of arthritis and/or periarticular inflammation that wax and wane over time. It is thought that up to one-third of such patients may go on to develop rheumatoid arthritis (RA).