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Two current reports from Boston and Wuhan describe cohorts of COVID-19 (+) rheumatic disease patients who generally do well but appear to have a higher risk of pulmonary involvement.
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Hydroxychloroquine (HCQ) has dominated the news in recent weeks, because of poor outcomes reported when used in COVID patients. Yet, a recent report reaffirms what rheumatologists have known for years - that HCQ use is associated with better outcomes in systemic lupus erythematosus, including survival.
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A current letter in the Annals of Rheumatic Disease details the rheumatic disease patient cohort outcomes from the University of Siena, Italy showing only 2 cases of COVID-19 among 859 patients treated with tsDMARDs and bDMARDs.
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A review of available data fails to show an increased risk of melanoma in IMID (inflammatory bowel disease, rheumatoid arthritis, and psoriasis) patients treated with systemic biologic therapies.
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This week's Tuesday Nite Rheumatology features presentations and interviews with Drs. Peter Nash and Philip Robinson. Dr. Robinson presents latest data on the Rheum-Covid.org Registry, that he helped establish under the Global Rheumatology Alliance. Dr. Nash presents the impact of COVID in Australia and pragmatic COVID management.
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Anakinra was studied in 29 COVID(+) patients with respiratory distress and high inflammatory markers (CRP or ferritin) and compared to non-anakinra patients, those on anakinra had better survival (90% vs. 56% ;p=0·009) and greater improvements in CRP and pulmonary function (72% vs 50%) compared to controls at day 21.
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Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.
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Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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The latest hazardous spinoff to the coronavirus infection is an inflammatory, Kawasaki-like syndrome unique to children or adolescents with COVID-19. Sporadic reports from around the globe of this severe pediatric COVID syndrome have littered the news with brief mentions and little detail.
Dr. John Cush
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14 pts refractory AOSD pts (Yamaguchi+) showed a good response to usual doses of tofacitinib. 7/14 complete remission, 6/14 partial remission & 1 relapse w/ pred reduction. May work by reducing reducing IL-6, IL-10, IFN-γ, IFN-α, GM-CSF, neutrophils. https://t.co/rUNoxJdDi5
Dr. John Cush
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Genetic study of 57 systemic JIA children finds presence of MEFV variant p.M694V/I was a risk factor for sJIA (OR: 7.13) https://t.co/TL6WisMQo8 Other studies have shown ~31% of Still's patients at lease 1 genetic variant for periodic fever syndromes. https://t.co/8ppovEw2kt
Dr. John Cush
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Metformin reduces RA risk in Women - Population study of 2.3 million, found 113749 starting metformin (1998-2014); 558 developed new RA. Adherence (PDC 40–59%) predicted lower adjusted hazard ratio = 0.62, moreso in women on 2550+ qd https://t.co/z6AWWlBpa2
Dr. John Cush
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Review of Rheumatic Sxs with Immune checkpoint inhibitors - Common are inflammatory arthritis, PMR & myositis. Non-MSK Sxs include sicca, vasculitides and sarcoidosis. SLE and scleroderma are extremely rare. Majority can be Rx w/ steroids. https://t.co/hku5L7hypo
Dr. John Cush
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A patient service Video - How to Manage your Arthritis Medications (in the time of COVID) - View the video here: https://t.co/hWW0h8wCZn or listen to the podcast on iTunes or here>> https://t.co/8wV4V2pYY5 https://t.co/SldbyCBDeI
Dr. John Cush
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JAK inhibr safety review - Meta-analysis shows a significant 57% increase in risk of H. zoster with JAKi (RR 1.57; 1.04-2.37). Data from 82 studies, 66,159 pts w/ RA, IBD, Pso, PsA, AS. Rates of SIE=2.81/100PY and HZ=2.67/100 PY. No increase in mortality https://t.co/Tyb0VDlJOT
Dr. John Cush
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RA is associated with increased risk of heart failure (HF). Vanderbilt Univ EHR study compared 9889 RA pts vs 9889 matched non-autoimmune pts - RA had 21% greater risk of HF. HF assoc w/ higher CRP, Artemin and MTX assoc w/ 25% lower risk (P=0.021) https://t.co/cm5qZXZAdO
Dr. John Cush
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Secukinumab shown to work in 9/15 (67%) of refractory Behçet’s patients (mucosal and articular dz) by 3 mos - Retrospective study looked a complete or partial responders. #s increased to 86.7% at 6 months. Doses: either 150 or 300 mg qmonth https://t.co/a3Fp3qdbkG
Dr. John Cush
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Metanalysis shows Type 2 DM associated with >2-fold increased risk (aHR 2.25) of severe liver disease (NAFLD); a more modest risk w/ obesity (HR 1.20); other risk variables - low HDL, high triglycerides & hypertension were independently associated https://t.co/uUdARZYkqG
Dr. John Cush
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Subanalyses of Mobility and Monarch studies show that #RA patients with highest tertiles of IL-6 (and CRP) had more disease activity, more Xray damage and better responses (less Xray change) to Sarilumab (vs Adalimumab or MTX). https://t.co/5mTePETFAQ
Dr. John Cush
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The RheumNow Podcast is up - The Beat Goes On.... anakinra, nr-AxSpA, Smoking & GPA, PSS guidelines, IFNa, COVID and IL-6, HCQ,QTc, and Thromboses https://t.co/BsaALcHclv