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Canadian Vaccination Guidelines for the Immunosuppressed
A multidisciplinary Canadian task force has developed guidelines for vaccination in patients receiving immunosuppressive therapies, based on the evidence that immunosuppressive use in immune-mediated disease may be associated with an elevated risk of infections.
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The Risk of Tuberculosis with TNF Inhibitors
A study from Turkey shows that among 2117 patients treated with a TNF inhibitor (TNFi) the risk of developing TB was 6 fold higher in those treated with a TNFi compared to non-users.
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RheumNow Podcast - Death and Surgery (2-22-19)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com:
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Safety Warnings for Higher Dose Tofacitinib
Pfizer has issued a press release regarding the safety of tofacitinib, citing higher rates of pulmonary embolism and death associated with the use of higher dose tofacitinib 10mg bid in rheumatoid arthritis (RA) patients treated in a long-term safety trial.
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Remission Unlikely in RA
Dr. Marwan Bukhari (editor of Rheumatology) has written an editorial wherein he suggests that true remission is hard to achieve. He notes that "remission as a target is a noble objective that we should all aspire to but we should not chastise our practice if we do not achieve it, as more and more evidence suggests that we should consider it the ideal but not the norm."
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TKR - One or Two at a Time?
His would-be surgeon tried mightily to talk him out of a bilateral knee replacement. At 340 pounds, the patient's BMI -- above 43 -- was a significant contraindication.
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Older Men Less Likely to be Assessed and Treated for Osteoporosis
A study from the University of Washington in Seattle find that men with osteoporosis were less likely to be assessed by dual-energy X-ray absorptiometry (DXA); vitamin D measurements and were less like to receive calcium/vitamin D and bisphosphonate prescriptions.
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RheumNow Podcast - MTX vs. Etanercept in Psoriatic Arthritis (2.15.19)
Dr. Jack Cush discusses the news from the past week on RheumNow.com - including the SEAM trial, MRI guided T2T, biologics and infection, contraceptive use, ANA negative lupus, etc.
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No Added Benefit to MRI-Guided Therapy in Rheumatoid Arthritis
A treat-to-target (T2T) strategy to manage rheumatoid arthritis hinges on clinical metrics to optimize therapy. But investigators from Denmark have shown that using magnetic resonance imaging–guided T2T failed to improve disease activity remission rates or reduce radiographic progression.
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Differing Effects of Smoking and HLA-DRB1 in Seropositive Rheumatoids
Analyses from the Swedish EIRA incident rheumatoid arthritis cohort study shows that smoking and HLA-DRB1 exert differential effects on serologically defined RA subsets - but that the strongest influence was seen in double positive (CCP+, RF+) individuals.
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Biologic High Out of Pocket Costs for Medicare Patients
Specialty tier drugs, including biologics, accounts for nearly half of all medication spending by Medicare Part D patients. High out-of-pocket costs for these patients is a major concern.
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Opioid Use in Osteoarthritis Varies by State
A study in Arthritis & Rheumatology shows that there is substantial statewide variation in rates of treatment with long‐term opioid therapy in osteoarthritis - not fully explained by differences in access to healthcare providers, varying case‐mix, or state‐level policies.
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Update on Pregnancy Management in RA
Two recent reports offer good news to rheumatoid arthritis (RA) women who are planning to become pregnant.
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No Difference in Oral or IV Antibiotics for Bone & Joint Infections
Research from the NEJM shows that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first six weeks for complex orthopedic infections.
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Multidisciplinary Recommendations for Rheumatoid Foot Problems
Approximately 90% of patients with rheumatoid arthritis (RA) have foot problems.
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Obesity Needs to be Treated in Psoriatic Arthritis
Obese patients with psoriatic arthritis (PsA) who followed a short-term, very low-energy diet showed improvements in multiple aspects of disease activity, a prospective study found.
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Does Seropositivity Change with Therapy?
A subanalysis of the early rheumatoid arthritis (RA) "IMPROVED" study has shown that changes in RA-autoantibody levels are not associated with disease activity or or long-term drug response, but instead reflect intensity of immunosuppression.
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Smoking Doesn't Influence Rituximab Responses in Rheumatoid Arthritis
Alcohol, smoking and obesity have all been shown to influence the risk and activity of rheumatoid arthritis (RA) and may also influence response to therapy. This study assesssed whether smoking would influence response to rituximab (RTX) in RA.
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RheumNow Podcast – FDA Panels Meet on Gout & OP (1.18.19)
Dr. Jack Cush reviews the news, articles and FDA Panel discussions from the past week.
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Combo RA Treatment May Boost Risk for Serious Adverse Events
A current meta-analysis of safety and efficacy of combination bDMARD treatment in RA patients shows that combination treatments increase serious advese event (SAE) risks, and the risk for serious infections in particular.
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