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RheumNow Podcast – LTF – Listen to Fauci (7.17.20)
Dr. Jack Cush reviews the news, tweets and journal articles from the past week on RheumNow. Let's dig into this week's 14 highlights.
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PRIME Cells Predicting Rheumatoid Arthritis Flares
The current issue of NEJM reports a novel cell type that may be used to identify rheumatoid arthritis (RA) patients who may flare.
Investigators prospectively collected blood samples from 4 patients for longitudinal RNA sequencing (RNA-seq) for discovery of moleculartranscripts that were differentially expressed before flares.
Anti-Rheumatic Therapies for COVID-19 Infection
Since the onset of the COVID-19 pandemic numerous anti-rheumatic therapies have been proposed as being potentially beneficial. The mechanistic effects of these agents, either presumed antiviral, anti-inflammatory and anti-thrombotic effects, may benefit mitigate the damage seen with COVID-19 infection.
This review will examine the potential benefits and existing evidence for treating suspected or proven COVID-19 infection with antimalarials, inhibitors of interleukin-6 (IL-6) or interleukin-1 (IL-1) Janus kinase (JAK) inhibitors, TNF inhibitors or colchicine. There are many other antirheumatic and immunosuppressive therapies that are in clinical trials that will not be reviewed here including IVIG, rituximab, calcineurin inhibitors (sirolimus, etc.), apremilast, emapalumab (anti-IFN gamma), etc.
COVID's Multisystem Inflammatory Syndrome in Children
Two recent reports further characterize the newly described, Kawasaki-like, syndrome affecting children with COVID-19 infections.
The NEJM describes the childhood syndrome as having Kawasaki’s disease, fever, toxic shock syndrome, acute abdominal conditions, and encephalopathy; hence the label Childhood Multisystem Inflammatory Syndrome. The disorder emerged in late April 2020, first in the U.K., and then similar cases were reported from many other countries. The CDC named this multisystem inflammatory syndrome in children (MIS-C).
Methotrexate May Enhance Pegloticase Response in Gout
For patients with gout exacerbations while on pegloticase (Krystexxa), adding methotrexate may help reduce uric acid levels, researchers suggested at the European League Against Rheumatism (EULAR) virtual meeting.
In a small open-label study of 14 patients experiencing acute gout attacks, use of the pegloticase/methotrexate combination reduced uric acid levels to near undetectable levels in 11 patients, reported John Botson, MD, medical director of Orthopedic Physicians Alaska in Anchorage. He noted that this was far below the 5 mg/dL level recognized as the threshold for development of inflammation that causes gout attacks.
Day 3 - Top 5 from EULAR 2020
These were my top abstracts from Thursday, 4th of June at EULAR 2020:
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FDA Approves Taltz for Non-Radiographic Axial Spondyloarthritis
Today Eli Lilly announced that Taltz (ixekizumab) has received FDA approval for the treatment of adults with active non-radiographic axial spondyloarthritis (nr-axSpA).
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First Look at COVID-19 Global Rheumatology Alliance Registry
Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.
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RheumNow Podcast - Rheumatic Patients with COVID (5.29.20)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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TNR Grand Rounds - Cytokine Storm Syndromes
This week's Tuesday Nite Rheumatology featured Dr Randy Cron from the University of Alabama - Birmingham as he spoke and took questions on the immunology, immunopathogenesis and treatment of Cytokine Storm Syndrome, especially as they relate to COVID-19 and rheumatic disease patients. The program was moderated by Dr. Jack Cush.
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Boston and Wuhan Report Rheum COVID Patients at Risk for Respiratory Failure
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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TNR - COVID-Rheumatology Registry & COVID in OZ
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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High Dose Anakinra Effective in COVID-19
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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RheumNow Podcast - COVID Kids and Men (5.15.20)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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CDC on Pediatric Multi-System Inflammatory Syndrome
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.
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Kids' COVID-Linked Ailment Is Not Your Typical Kawasaki Disease
As data continue to emerge about a multi-system inflammatory disorder in children apparently connected to COVID-19, evidence is growing that this is not your typical Kawasaki disease.
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TNR Grand Rounds - What does COVID-19 have to do with Lupus?
Last night's Tuesday Nite Rheumatology featured Dr. Joan Merrill (OMRF). In her lecture, "What does COVID-19 have to do with lupus?", she discusses the pathogenesis of lupus, and specifically thrombotic microangiopathy, complementopathies, catastrophic lupus syndrome and the potential overlap with the vascular pathology seen with COVID-19 infection.
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