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RheumNow Podcast – Rheum Lives Matter (8.28.20)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week. Of mice and men in cartilage, the efficacy of JAK inhibitors in patients who are having skin problems, nrAxSpa has its own diagnostic code, metformin, talking about Back Talk, plus so much more.

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TSR Shoulder replacement

Durability of Total Shoulder Arthoplasty

Jack Cush, MD

A systematic review of the outcomes of total shoulder replacements (TSR), humeral hemiarthroplasties, and reverse total shoulder replacements finds that approximately 90% of shoulder replacements last for longer than 10 years with good patient-reported outcomes.

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Treatments Differ Across Centers in Systemic JIA

RheumNow

Significant variations were seen across hospitals in the treatment of children admitted with new-onset systemic juvenile idiopathic arthritis (JIA), despite increasing evidence of the efficacy of biologics and the hazards of extended glucocorticoid exposure, a retrospective cohort study found.

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Selective Biologic Responses in Seropositive RA

Jack Cush, MD

The Journal of Rheuatology reports a pooled analysis of patients from 16 observational RA registries that examined the association between seropositivity (RF or ACPA) with biologic DMARDs responses; they showed better clinical responses when seropositive RA patients receive abatacept (ABA) o

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RheumNow Podcast – The Bad News That’s Fit to Print (8.21.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow: filgotinib rejection, delays in diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX.

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Canakinumab Tapering in Still's Disease

Jack Cush, MD

You can reduce - but not stop - canakinumab therapy in patients who are in complete clinical remission in children with systemic juvenile idiopathic arthritis.

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Filgotinib Decision Delayed by FDA

Jack Cush, MD

On August 18th, Gilead and Galapagos received a complete response letter from the FDA, which will delay consideration of filgotinib for the treatment of moderate-to-severe RA.

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Study of 4 refractory juvenile dermatomyositis (6-20yrs) treated with baricitinib (4–8 mg/day) Significant improvement noted by week 4 in global activity, skin scores, weakness but little change in muscle enzymes or calcinosis. Steroids/other meds lowered https://t.co/GKGBXrogEm

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Metformin as cotherapy in RA? It lowers RA risk in animal models. >2500mg/d lowers risk incident RA in women. Japanese study shows it suppresses osteoclastogenesis and upregulation of inflammatory cytokines, protease and growth factor genes. https://t.co/UEDMgtqLZG

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Dr. John Cush RheumNow ( View Tweet)

Study of 1,631 incident RA & 3283 controls shows respiratory disease assoc with risk of RA, irrespective of RF & CCP and mostly in nonsmokers. aOR increased for chronic upper (1.4), acute lower (2.4) & chronic lower (1.6) Resp Dz, stronger for ACPA/RF+ https://t.co/C1hA631PIW

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Telemedicine: What's Changed and What Needs to be Addressed? An update on legislative changes, uncertainties, and the care gap post COVID https://t.co/HRAsEP7IL6 https://t.co/X6PL0W4tI7

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Dr. John Cush RheumNow ( View Tweet)
Gilead/Galapagos gets a setback for filgotinib, its JAK1 inhib, that was poised to be the next approved RA drug by FDA. Instead the FDA issued a complete response letter; citing concerns over sperm studies (MANTA, MANTA-RAy) & 200 mg dose. Delay till 2021? https://t.co/H0rLjOMXq8 https://t.co/vb4FDUUVoS

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Dr. John Cush RheumNow ( View Tweet)
RheumNow Podcast - The Bad News That's Fit to Print (8.21.20) Dr Jack Cush reviews this week highlights filgotinib rejection, delays in Diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX https://t.co/1oZtU14VOB https://t.co/rcWlbYVKYn

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Dr. John Cush RheumNow ( View Tweet)
ATS Abstract: n=616 survey contrasts rheums (57%) & pulmonologists (43%) beliefs on RA associated ILD. Both preferred to use steroids, MMF, RTX for RA-ILD, but Rheums tend avoid ADA & LEF. Rheums (17%) & Pulms (24%) think MTX a risk factor https://t.co/W5gbu84FBv

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of total elbow arthroplasty in RA - 38 studies, 2,118 TEAs w/ mean F/U of 819 mos - the implant failure & complication rates were 16% & 24%. Aseptic loosening was most common failure (9.5%). Higher failures in younger pts & unlinked design https://t.co/Pq2N1Kku60

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Dr. John Cush RheumNow ( View Tweet)

@RheumNow its time we stopped “seroneg RA” which are many diseases, like ANCA pos Vasculitis we should have ACPA pos RA and others - how many viral arthritides in our country “doing great” on SZP, PLAQ, or low dose MTX and reluctant to stop? #RA #Seronegative

Peter Nash drpnash ( View Tweet)

Mayo clinic: Theres a delay in diagnosing Seronegative RA - 1st joint swelling to diagnosis of RA was 187 days for seroneg vs 11 days for seropositive patients (P<.001). Seronegative RA less likely to achieve remission (28% vs 50% at 5 years) (P=.007) https://t.co/Hgewjmt1CL

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Dr. John Cush RheumNow ( View Tweet)

Are there delays in Dx-ing RA? 2019 UK NHS study shows median delays from 1st Sx to seeing a rheumatologist was 27 weeks, with 20% seen w/in 1st 3 mos. Includes a patient delay (5.4 wks), GP delay (6.9 wks) & hospital delay (4.7 wks) https://t.co/vwNALZKkiR

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Dr. John Cush RheumNow ( View Tweet)

Filgotinib Decision Delayed by FDA. Instead of being the next approved RA drug, the FDA issued a complete response letter; citing concerns over sperm studies and the risk/benefit behind the 200 mg dose. Delay till 2021? 2022? https://t.co/6MHiGtOxCM

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Dr. John Cush RheumNow ( View Tweet)

Forward study of 18,754 RA patients who experienced 1,801 CVD events and found CVD risk reduction with TNFi (HR 0.82 [95% CI 0.72-0.94]) and abatacept (HR 0.50 [95% CI 0.30-0.83]) compared to csDMARDs over & above MTX alone (use vs. non-use: HR 0.82) https://t.co/YVfKWjkvxU

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