In this Therapeutic Update, Drs. Mease, Gibofsky and Cush answer five questions regarding the August 3rd FDA Arthritis Advisory Committee meeting that reviewed the potential approval of tofacitinib (Xeljanz) in patients with active psoriatic arthritis. The panel was nearly unanimous (10-1) in favor of the efficacy and safety profile of of tofacitinib, and similarly voted 10-1 to approve this drug for use in PsA. Final decisions on these recommendations from the AAC panel will be made at a later date by the FDA. 

Dr. Jack Cush reviews highlights and news from the past week on RheumNow.com. 

Hypertension, nephrolithiasis and chronic kidney disease (CKD) commonly associates with gout.  While there is a clear need to dose adjust NSAIDs and colchicine in those with CKD, there is some debate about the need to dose adjust when using allopurinol with CKD.

Serum uric acid (SUA) levels are clearly linked to gout. Researchers from Harvard have systemically reviewed the literature to quantify the risk of onset and flare with varying levels of SUA.

The medical use of cannabis is often extended to management of chronic pain and neuropathic pain.

A metanalysis of 27 chronic pain trials show that there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations.

A prospective Swedish study between 2001–2009 found a higher risk of aortic regurgitation, pacemaker, AV block and atrial fibrillation in SpA, AS, uSpA and PsA patients.

Despite large randomized trials failing to show the efficacy of RTX in SLE (LUNAR, EXPLORER), uncontrolled observational data suggests possible efficacy and safety of RTX in refractory SLE.

A time-series analysis of incident rheumatoid arthritis (RA) patients seen between 1996 and 2011 in the Danish National Patient Register shows that the incidence of hip (THR) and knee replacements (TKR) began to decrease after the introdution of biologic agents for RA in 2002.

Curtis and colleagues have analyzed the certolizumab (CZP) RAPID1 and RAPID2 trials to assess the risk of serious infectious events (SIEs), and shown that steroids combined with an age-adjusted comorbidity index (AACI) yields a 2-3 fold predictable risk for SIE.

Researchers from the Nottingham University Hospitals have analyzed the efficacy and safety of  oral (PO) and intravenous (IV)  cyclophosphamide (CTX) in ANCA-associated vasculitis (AAV) patients and demonstrated a trend for fewer relapses, better 1 year survival and less toxicity w

Dr. Jack Cush reviews the news from the past week on RheumNow.com. Subscribe to the podcast on iTunes and SoundCloud.com. 

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The Cochrane Database has published its review of calcium channel blockers (CCB) in Raynaud's phenomenon, showing CCBs may be useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud's phenomenon, especially with primary Raynaud's.

Early diffuse cutaneous systemic sclerosis (SSc) was associated with high levels of disability and fatigue, according to analysis of data from the European Scleroderma Observational Study cohort.

Dalbeth and colleagues have published a novel report in Arthritis & Rheumatology, novel in that it is a trial of early gout patients that looks at clinical and radiographic outcomes. They showed that febuxostat improves magnetic resonance imaging (MRI) measures of synovitis and reduced gout flares, but failed to alter X-ray progression with 2 years follow-up. 

The Food and Drug Administration (FDA) approved use of Nucala (mepolizumab) for use in treating adults with eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss vasculitis. This is first FDA-approved therapy specifically to treat EGPA. 

Renal dysfunction is common among patients with rheumatoid arthritis (RA), particularly among older patients, women, and those with hypertension, Japanese researchers reported.

Despite a growing body of evidence suggesting that maternal health is more important than maternal medications to fetal and infant outcomes, little is known about the long term oucomes of infants born to mothers with rheumatoid arthritis (RA). Using Danish population data, researchers have shown in utero exposure to maternal RA is associated with an increased risk of thyroid disease, and an increased risk of future RA.

A task force from the American Academy of Sleep Medicine (AASM) performed a systematic review of the scientific literature on obstructive sleep apnea and screening tests.

The NLRP3 inflammasome is a critical component of the innate immune system and activation of NLRP3 inflammasome results in caspase-1–dependent secretion of the proinflammatory cytokines IL-1β and IL-18.