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Paucity of Effectiveness Research on Telemedicine in RA

Jack Cush, MD

A systematic review of telehealth in delivering equivalent care in RA patients demonstrates there is limited evidence that virtual RA care is equivalent to conventional face-to-face care. Despite current widespread use, there is a great need for credible well-designed research that will address comparable patient outcomes, implementation strategies and long‐term health system consequences. 

Article

Measureable Benefits to Treat-to-Target Management in RA

Jack Cush, MD

Desai and colleagues have published that when a learning collaborative group focused on a treat‐to‐target approach was compared to usual care, a modest but significant impact on implementation, treatment changes and patient outcomes in RA patients managed with a treat‐to‐target approach was seen.

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Listen to last weeks QD Clinics Podcasts (Mar 12)-Ms. RA, Notalgia & Anti-Intraarticular QD147 - Combination Biologics QD146 - Anti-Intraarticular QD145 - Notalgia? QD144 - Ms. RA QD143 - Blinded by Noncompliance https://t.co/UgE54RqFHQ
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Population claims based study of RA patients shows improvement in the 10-year risk of acute myocardial infarction over time (same as the general population). Nevertheless, RA pts have a 21 % higher risk of AMI than the matched general population https://t.co/zfsJftR9ZA
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Analysis of US National Inpatient Sample (2000‐2014). In #RA pts, there was a signif decline in annual rate of hospitalizations (76per million in 2000 to 30 per million 2014) & Hosp mortality (0.70% to 0.41%); but a signif incr in hosp for arthroplasty https://t.co/kkpmdKzEhQ
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75 RA pts on MTX >3 yrs had FIBROSCANS done to assess their value. 12 pts (16%) had Fibroscan ≥ 7.1 kPa, 3 patients w/ severe liver stiffness (9.5 to 12.5 kPa) & 1 w/ cirrhosis range scores (> 12.5 kPa). No Bx were done; LFTs were not predictive https://t.co/Pi1h1nF0Uq
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#RA associated interstifial lung dz has incidence of 1-5 per 1,000 PYs and prevalence as high as 67%; risk factors; age, male sex, Dz duration, CCP Abs; w/ age as best predictor of mortality. There is no clear drug interventions that helps RA-ILD https://t.co/zJvWqt0w6L
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While RA incurrs a 2 fold risk of CHF; the use of HCQ does not add to a CHF risk. Mayo nested case-control study, compared RA w/ CHF vs nonCHF RA pts, showing HCQ use, nor duration of use, failed to increase CHF (OR: 0.96).https://t.co/Tx9jr07C7i
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620 RA patients from Nordic biologics registers started a non-TNFi as 1steverr bDMARD but later switched to a 2nd bDMARD (ABA 86, RTX 40, TCZ 67 TNFi 427). Retention was 70% @ 6 mos & 50% @12 mos. 30-40% on 2nd bDMARD reached LDAS or remission https://t.co/u8BQn0rYca
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Compared with no statin use; statin use in RA pts is assoc w/ 28% lower mortality risk. Population study of 19,614 RA pts w/ incident statin use, compared 1,883 statin users vs 1,883 nonusers. All-cause mortality was lower (HR 0.72;0.56-0.91) w/ statins https://t.co/onMlWoVdPL
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