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Methotrexate Nodulosis (1.19.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. How good (or not) are rheumatologists and what to do about MTX nodulosis?
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Do you check CPK on patients who are on JAK inhibitors? #RNL2024 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
For pts on JAKi needing vaccines; to avoid diminishing vaccine efficacy, Dr. Winthrop noted he treats a JAKi like he would MTX in that he holds the JAKi a week after vaccinating. #RNL2024 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Clinical pearl!
Dr. Winthrop holds JAKi for one week after vaccination.
#RNL2024 @RheumNow https://t.co/BLiKu8xX7t
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Strober's JAKi in dermatology takeaways!
- Consider this for AD
- Dose matters in terms of both efficacy and toxicity
- Consider combination tx
- Topical JAKi option for vitiligo, especially head and neck involvement (harder in hands and other areas)
#RNL2024 @RheumNow https://t.co/ZrPfpUF4Hz
Dr. Rachel Tate uptoTate ( View Tweet)
JAKi are being used in inflammatory skin disease other than psoriasis:
#HydradenitisSuppurativa, #alopecia, #AtopicDermatitis and #vitiligo
- Dr. B Strober #RNL2024 @rheumnow https://t.co/FzPyATPB93
TheDaoIndex KDAO2011 ( View Tweet)
Povorcitinib - JAK1 specific for Hidradenitis Suppurativa
Efficacy at 16 weeks, improvement of disease and draining tunnel count over PBO
Upadacitinib shown with benefit for HS, but not as dramatic JAK response as other derm conditions
#RNL2024 @RheumNow https://t.co/f2cxJbLi1I
Eric Dein ericdeinmd ( View Tweet)
Deucravacitinib takes longer to work for PsO compared to UPA, IL-17i or IL23i; it’s better than apremilast. Side effects w/TYK2i: acne, mild⬆️CK, but zoster & lipid issues aren't seen much, & no CV risk warnings; Dr. Strober doesn't follow labs w/TYK2i. #RNL2024 @rheumnow https://t.co/05jKqL4wdx
TheDaoIndex KDAO2011 ( View Tweet)
Clinical pearl from #RNL2024 @RheumNow
Palmoplantar psoriasis is a great time for first-line JAK inhibitor - Ben Strober, Yale dermatology
JAK for atopic dermatitis - extremely rapid responses https://t.co/hHYdGl51n2
Links:
Eric Dein ericdeinmd ( View Tweet)
"If you are throwing a JAKi at these patients (see below) you are gonna make them better." Dr. Bruce Strober reporting on potential patients/disease states who may respond to JAKi. #RNL2024 @RheumNow https://t.co/bghPuszu5t
Dr. Rachel Tate uptoTate ( View Tweet)
#RNL2024 @RheumNow
Bruce Strober on JAK in skin diseases - diverse benefits:
- PsO
- Atopic dermatitis
- Alopecia areata
- Hidradenitis suppurativa
- Vitiligo
- Lichen planus any many others https://t.co/I9XHVbFpvQ
Eric Dein ericdeinmd ( View Tweet)
“JAKi can be thrown at any inflammatory skin disease and will work!” Dr. B Strober admits he uses many off-label. #RNL2024 @rheumnow https://t.co/nWzW9rMcWL
TheDaoIndex KDAO2011 ( View Tweet)
@RheumNow #RNL2024
Winthrop:
JAKi similar for opportunistic disease, but higher risk for Herpes Zoster than other therapies
Deucravacitinib - lower HZ reported, but younger age. Will see if this holds case in more studies https://t.co/Nd5LitAI3R
Links:
Eric Dein ericdeinmd ( View Tweet)
So why should you consider JAKi?
Multiple reasons provided by @JointMD including efficacy in domains, it's PO, reasonable safety.
#RNL2024 @RheumNow https://t.co/BgFjhb18Ad
Dr. Rachel Tate uptoTate ( View Tweet)
JAKi toxicities of interest:
- Zoster
- Safety: VTE, MACE, Malignancies
- Lab abnormalities including CK, LFT, creatinine, and lipid elevations and cytopenias.
@JointMD #RNL2024
@rheumnow https://t.co/u72yz8uLYB
Dr. Rachel Tate uptoTate ( View Tweet)
@JointMD reviews the pros and cons of JAKi at #RNL2024 @RheumNow https://t.co/z9CSvP5BAZ
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
Many advanced treatments appear to work less well in female patients with PsA, but JAKi seem to not demonstrate this phenomenon. Not sure what to do with this data in clinical practice but it is certainly intriguing @lihi_eder @RheumNow #RNL2024 https://t.co/GDrg715ctg
Richard Conway RichardPAConway ( View Tweet)
Key take home points from @_AprilArmstrong on psoriatic disease @RheumNow #RNL2024 https://t.co/Svx9gNKBuR
Richard Conway RichardPAConway ( View Tweet)
ICYMI: new guidelines published in 2019 for CV prevention. It's important to assess CV risk in our patients because inflammatory diseases is now included as a risk factor (helps when deciding on starting pts on JAKi)- Dr. B Weber #RNL2024 @RheumNow https://t.co/nBQjs49avu https://t.co/apyDjaxudi
Links:
TheDaoIndex KDAO2011 ( View Tweet)
Japanese retrospective study compared RA pts on JAK inhib vs bDMARDs (n=62 ea) having orthopedic surgery; JAKi- pts had more postoperative flares (29% v 12%, P=.01), esp if JAKi held >11d (p.04). No diff in other postop complications https://t.co/NVY1Oajdve https://t.co/fwc9KWYZ9l
Links:
Dr. John Cush RheumNow ( View Tweet)
