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RheumNow Podcast - Top 13 Rheumatology Centers (7-31-20)

Jack Cush, MD

Dr. Jack Cush reviews the news and TOP 13 list of Best Rheumatology Hospitals.

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Serial DEXA May Not Be Advisable

Jack Cush, MD

Does repeat bone mineral density (BMD) measurement predict subsequent fracture risk in postmenopausal women?

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SEMIRA Study: Best to Continue Low Dose Steroids in RA

Jack Cush, MD

The SEMIRA trial studied the  tapering vs continuing oral glucocorticoids in rheumatoid arthritis (RA) patients who achieved a low disease activity state (with tocilizumab) were more likely to show safety and better disease control with continuing steroids - even though two-thirds of patients were able to safely taper their glucocorticoid dose.

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Low Risk of COVID in Biologic Treated Rheum Patients

Jack Cush, MD

In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population. 

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For TNF Response in RA, Weight Matters

RheumNow

Patients with rheumatoid arthritis (RA) who were obese were significantly less likely to remain on treatment with tumor necrosis factor (TNF) inhibitors -- but so were those who were underweight, a large, long-term study determined.

Compared with patients with normal weight, patients in obesity class II, whose body mass index (BMI) was 35 to 39.9, had a hazard ratio for shorter drug survival (i.e., the drug's effectiveness, safety, and tolerability) of 1.28 (95% CI 1.06-1.54), while those in obesity class III, whose BMI exceeded 40, had a hazard ratio of 1.67 (95% CI 1.29-2.18), according to Sytske Anne Bergstra, PhD, of Leiden University Medical Center in the Netherlands, and colleagues.

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The RheumNow Podcast is up - Top 13 Rheumatology Centers in the US; anakinra & colchicine in COVID, unload the loading dose, CB2 in Scleroderma. Watch it here>> https://t.co/5LIIi7Pwg1 or listen to the podcast here>> https://t.co/5LIIi7Pwg1

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Based on a small number of studies (n = 5), there is little evidence to support the superiority (efficacy & safety) of Loading dose regimens when starting biologic (abatacept, certolizumab and secukinumab) therapy. https://t.co/0lNUzTFIOK

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Safety & efficacy of rituximab in Older RA (>65; n=97) vs younger (<65yrs; n=276) showed no difference in drug survival over 2 yrs (72% vs 74%)or SDAI activity. BUT.. there were more SIE (14.2 vs 6.6/100 PY) & pneumonia (10.7 vs 5.1/100 PY) in older pts https://t.co/dxqPg2fOlV

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FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Naloxone can be administered(+/- medical training) to help reduce opioid overdose deaths https://t.co/9B0hPhOm57

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Metanalysis of 10 studies ( p534 patients) shows that exercise in ankylosing spondylitis improves pain, function and disease activity. Statistically signif improvement in pain (P<0.0001), BASDAI (P <0.00001), and BASFI (P<0.00001), but not CRP and ESR. https://t.co/fKo9kNOrmO

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Analysis of administrative health data (1984‐2016) on 12984 #RA pts shows RA w/ psychiatric comorbidities (depression, anxiety, bipolar, schizophrenia) had more additive visits (10.9), hospitalizations, hospital days (3.6), more drugs (7.3) & FP visits https://t.co/5py0i2tWqL

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CHMP of the EMA (European Medicines Agency) has recommended approval of filgotinib (Jyseleca) for moderate to severe active rheumatoid arthritis (RA) in adults not responding to DMARDs. The daily drug has been studied at 100mg and 200 mg doses. https://t.co/pEybIZALFq

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Down syndrome-associated arthritis (DA) presents as a seronegative erosive polyarthritis. Besides an Avg 19-month delay in Dx, most are treated same as JIA but JIA agents are often poorly tolerated & less effective in DA. Prevalence=8.7/1000 Downs kids https://t.co/hEtAbo2tY6

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Dannish registry study of 2.6 million pregnancies, finds spontaneous abortion risk was increased in women <35 yrs with RA Dx <5 yrs before pregnancy (OR = 1.25; 1.07, 1.48), but not in RA women >35 or w/ preclinical RA (compared w/ non-RA) https://t.co/fAxvfYOQcJ

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French cohort analysis of 104 kids taking Tocilizumab (mostly for Stills dz or polyJIA) shows 25% with serious AE (15.3/100 PY), mostly seriou infections or infusion reactions. at TCZ initiation. Most occured in systemic JIA or another autoinflammatory Dz https://t.co/oFSxQlZEwx?

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CORRONA Registry shows no difference in 1 year outcomes when RA patients are given 1st line TNF inhibitors compared to 1st line non-TNF biologics (ABA, TCZ, RTX, anakinra, TOFA: thus supporting current RA guidelines, recommending individualised care https://t.co/YWJicBMAAK

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Metanalysis of 7 RCTs looked at melanoma risk comparing 34 029 biologic Tx vs 135 370 non-biologic conventional systemic Tx pts, showing no signif. increased risk in IBD (RR 1.20; 0.60-2.40), RA (pRR 1.20; 0.83-1.74), or psoriasis (HR 1.57; 0.61-4.09) https://t.co/PCOddiwKv0

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FDA has issued draft guidance on Cannibis research: “Cannabis & Cannabis-Derived Compounds: Quality Considerations for Clinical Research, Draft Guidance for Industry,” outlines FDA’s current thinking on clinical research related cannabis-derived compounds https://t.co/ppvisN1oxU

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Systematic review of 100 pts with statin-associated myopathy showed mean age 65 yrs, presenting w/ symmetric prox. muscle weakness, mean CK=6853 IU/l, all were HMG-CoA reductase Ab+ & >80% had necrotizing myopathy & required immunosuppressants https://t.co/BoNmOHPkGH

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Retrospective cohort of 147 Adult-Onset Stills Dz pts finds 18 (12.3%) with lung dz (LD) at the diagnosis of AOSD. AOSD-LD were older, w/ more myalgia, LN, pleuritis, ab,dominal pain, more systemic Dz, higher ferritin and more mortality (%39 vs 10%). https://t.co/2phEFwi6n2

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