The RheumNow Week in Review - 22 December 2017

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

Allopurinol Dose Escalation is Safe with Severe CKD

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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.

Cannibis Weakly Effective in Neuropathic Pain

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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.

Cardiac Disturbances Increased in Spondyloarthritis

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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.

Registry Efficacy of Rituximab in Refractory SLE

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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.

Baseline Risk Score Predicts Serious Infection Risk in TNF-Treated RA Patients

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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.

Advantages of Intravenous Pulse Cyclophosphamide in ANCA-associated Vasculitis

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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

The RheumNow Week in Review - 15 December 2017

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

FDA Approves Xeljanz for Use in Psoriatic Arthritis

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Pfizer Inc.

Cochrane Review: Calcium Channel Blocker Efficacy in Raynaud's

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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.

Febuxostat Works in Early Gout But Fails to Protect from Xray Damage

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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. 

Kidney Dysfunction Frequent in RA

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

Offspring of RA Women Have Higher Risk of RA and Other Diseases

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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.

Why TNF Inhibitors May Work in Some Autoinflammatory Patients

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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.

Infliximab Does Not Increase Perioperative Infection

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Staying on a TNF inhibitor (TNFi) throughout major surgery has generatlly been associated with higher rates of perioperative infection (https://buff.ly/2iBFVjp).  On the other hand, discontinuation of the TNFi prior to surgery is associated with lower ra

Do JAK Inhibitors Increase the Risk of Venous Thromboembolic Events?

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Drug Safety has published a systematic review of the FDA’s Adverse Event Reporting System (FAERS) and finds numerous reports of thromboembolic adverse events (AEs) associated with two currently marketed Janus kinase (JAK) inhibitors, tofacitinib (Xeljanz) and ruxolitinib (Jakafi).

PRECISION Subanalyses Question Aspirin Use

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The PRECISION trial reported last year that celecoxib appears to be safer than the NSAIDs naproxen or ibuprofen in treating osteoarthritis (OA) and rheumatoid arthritis patients who are at increased cardiovascular risk. New data suggests that adding aspirin may nullify this advantage, according to a study presented at the annual American Heart Association meeting and reported by Medscape.

Ixekizumab (Taltz) FDA Approved for Psoriatic Arthritis

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On Friday, December 1st, the FDA approved Lilly's drug Taltz (ixekizumab) for use in adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. 

Taltz, an IL-17 inhibitor, has previously been approved for plaque psoriasis where it has shown high level PASI75 and PASI100 responses.

Pregnancy Outcomes Worse with Myopathies

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Women with the autoimmune inflammatory myopathies dermatomyositis (DM) and polymyositis (PM) are at increased risk for hypertensive disorders in pregnancy, a nationwide retrospective study found.

Opioid Crisis Costs US $500 Billion

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Reuters reports that the opioid crisis has cost the United States as much as $504 billion in 2015,  based on a White House economists report released this week. The White House Council of Economic Advisers (CEA) said the toll from the opioid crisis represented 2.8% of gross dom