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Implementing Smoking Cessation Programs

Jack Cush, MD

Rheumatologists are keen to the effects of smoking (increased arthritis risk, worse outcomes, blunted DMARD responses, added cardiopulmonary risks), but often do not have the resources or plan to encourage or implement smoking cessation from the rheumatology clinic. A new study details the success of a rheumatology staff‐driven protocol, Quit Connect, to increase the rate of electronic referrals to free, state‐run tobacco quit lines.

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Another study suggests poorer outcomes in Rheum pts on Rituximab. French Cohort study of 1090 inflammatory rheumatic MSK pts -13% w/ severe COVID-19 & 8% who died. 63 RTX pts had more severe disease, longer hosp stays & more death (21% vs 7%) https://t.co/5UCvFeVWRS
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Comparison of oral and parenteral MTX shows oral MTX in RA is non inferior to subcutaneous MTX treatment (in 640 RA pts) with regard to disease activity, but oral MTX had fewer adverse events than SC ( 41% vs 52%, p= 0.005). https://t.co/828kcG53iz
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Matched cohort Nurses’ Health Study looked at 283 pre‐RA pts (mean 9.7 years before RA Dx) and and 842 controls; 21% pre‐RA were ACPA+. ACPA+ was associated with increased risk of COPD (HR 3.04) that was not seen in ACPA- pts. https://t.co/HNB11eAiva
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Dr. Olga Petryna ( @drpetryna) weighing the future Rx in RA by Dr. Fleischmann: -CD22, new IL6i & GM-CSF show promises but far form being available -bDMARD or tsDMARD after MTX but work better wMTX -JAKS better choice for mono-therapy but safety is a concern #RNL2021
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From Dr. Petryna ( @DrPetryna ) on Pneumonia & RA #RNL2021 : -PNA most common hospital inf in RA and main cause of hosp mortality -seropositivity assoc w/increase risk of PNA -COPD+RA bad combo: increase PNA & mortality #RheumNow https://t.co/IgXfJTMrcn
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Metanalysis of 32 studies shows most forms of arthritis assoc w/ incr risk of CVA (ischemic stroke: RR=1.53 or hemorrhagic stroke: RR=1.45), esp for RA (RR=1.38), AS (RR=1.49), PsA (RR=1.33), gout (RR=1.4) --risk higher with age <45 years (RR=1.46) https://t.co/YDiebrqtbi
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From @KDAO2011 for #RNL2021 Is it better to taper the steroids or leave it? SEMIRA study. Tapering off low dose steroids cause more flares and more treatment side effects. Dr. Buttgereit says keep your low dose steroids (prednisone 5 mg/day or less) https://t.co/FpQnxUKWwF
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Liver Management in RA - #RNL2021 Highlight by @DrPetryna While RA is not known to affect the liver directly, underlying liver disease and treatment-related effects on the liver can often become an obstacle in the mgmt of many RA patients. https://t.co/OeuloDIXMF
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Claims data analysis (MarketScan, Medicare, Optum) of 87,653 RA patients starting either TNF inhibitor or tofacitinib shows venous thromboembolism (VTE) is rare (<1 per 100) RA Rx with either. VTE risk was same for Tofa and TNFi (HR of 1.13 [0.77-1.65]) https://t.co/UoMQRp12vo
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Dr. Fleischmann vs. Dr. Matsumoto: get rid of MTX vs. get rid of biologic in RA remission. Both argue on sustained remission, risk for anti-drug antibodies, longterm safety. Dr. Buch’s perfect answer… “it depends on patient’s preference, cost.” #RNL2021 https://t.co/FBf2uoDx0B
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