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TNF Inhibitors in Takayasu's Arteritis
A large, retrospective, multicenter study demonstrated the efficacy of intravenous infliximab and subcutaneous adalimumab in patients with Takayasu arteritis.
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Guidance on aromatase inhibitor-associated bone loss with hormone-sensitive breast cancer
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EurekAlert!
An updated joint position statement on the management of aromatase inhibitor-associated bone loss (AIBL) addresses the heightened fracture risk in women undergoing endocrine therapy for estrogen-responsive breast cancer, providing practical guidance for both osteoporosis specialists and oncologists.
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JAMA overview of Obstructive sleep apnea (OSA) - affects 1 billion worldwide. Treatment options: Positive Airway Pressure, Oral Appliance, Positional Therapy, Weight Loss, upper airway surgery. https://t.co/imrdsLAocG https://t.co/JEneFvyijN
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FDA Approves 1st new Fibromyalgia drug in 15 yrs - Tonmya (cyclobenzaprine HCl sublingual) as treatment of fibromyalgia in adults. Based on 2 phase 3 trials and 1400+ pts. Dose 2.8 mg tabs 1-2 SL qhs (peak concentration 4.3 hours; t1/2 life = 36 hrs, longer w/ elderly, liver dz) https://t.co/8DVRet5sjU
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The Patient Journey with Rheumatic Disease
Oton and colleagues have reviewed the "patient journey" - from symptoms to specialty referral in those diagnosed with rheumatic and musculoskeletal diseases (RMDs). They identify the eight stages along the way and where improvements https://t.co/VY3kB3Ohmp
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Pain Flares in RA are just pain, not inflammation. Study of 195 RA pts (11+ yrs dz dur), 49-89% experienced at least 1 flare (median 2-4 flares/mo), IQR 2.1-5), lasting median of 2 days. Flares preceded by worsening mood, anxiety, sleepiness - but no change in Accelerometer https://t.co/csbHtiEglp
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Anifrolumab appears effective & safe in refractory Cutaneous LE. OL Study of 15 CLE, on HCQ, topical steroids, failed multiple DMARDs. All Rx w/ ANIF 300 mg IV q4wks. ALL improved, CLASI-A decr from 16 to 1 (p<0.001); CLASI-D decreased from 5 to 4 (p<0.001). DBPCT needed! https://t.co/umEYz0XDyt
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Nailfold videocapillaroscopy (NVC) in Dx of systemic sclerosis - study of 258 NVCs found giant capillaries (specificity 98%) & capillary density to be best at defining a scleroderma pattern (39%). Density ≤8 capillaries/mm best defined dropout (AUC 0.911); having both = 91% https://t.co/zyoe7ofGLR
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Advances in Still's disease Rx:
- using IL-1 or IL-6 inhibitors 1st line
- New FDA approval of emapalumab (IFNg) for MAS
- unclear if biologics can cause lung probs in Stills https://t.co/zSqTcOSVGE https://t.co/8GhoamkV4N
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JAKne? Study of 2183 IBD pts on JAK inhib, 272 developed acne. Crude prevalence: 16% upadacitinib, 4% tofacitinib, 2% filgotinib (dose-dependent w/ UPA & Tofa). JAKne in pts 30–50 yrs; mild-moderate severity; in 1st 3 mos. Higher risk w/ prior hx acne vulgaris (OR 4.9) https://t.co/G29CvZ6aux
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Dermatomyositis Reviewed
Researchers from the University of Pennsylvania have published an open-access review of dermatomyositis (DM) - its manifestations, hallmark cutaneous features, etiopathogenesis and treatment options.
https://t.co/Dm85RL99UU https://t.co/SbaVBWC3Wv
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“A physician is judged by the three A’s: ability, availability, and affability.”
- Paul Reznikoff, MD
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Inefficiencies of ANA Testing
The Journal of Rheumatology has published an analysis of antinuclear antibody (ANA) multiplex testing showing its nonspecific utility and poor rate of return in identifying ANA-associated autoimmune rheumatic disease (ARDs). https://t.co/85B70egGBw
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Wondering what rheumatoid arthritis experts think about the future of treatment?
Dr. Jack Cush moderates a special Tuesday Nite Rheumatology session, live at 7 PM ET on August 26th, where experts will dive into a nationwide survey on the evolution of biologics and DMARDs.
Hear https://t.co/afYRarqjvj
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Biologic Switching in Psoriasis
A systematic review and meta-analysis found that biologic switching was effective in a significant number of psoriasis patients; but there may be a price to pay.
https://t.co/QEv5jx9AIo https://t.co/06keUfXwRT
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There's a transient (1 yr) increase in New Abx Rx among 399 PsA pts after starting a TNF inhibitor. Pre-TNFi, PsA pts were more likely to recv Abx vs controls (1.26 vs. 0.60/yr; p<0.001). Post TNFi Abx use incr to 1.64/yr (p<0.001) but returned to baseline thereafter. https://t.co/LHXn5d7oC9
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Pain Flares in RA are just pain, not inflammation. Study of 195 RA pts (11+ yrs dz dur), 49-89% experienced at least 1 flare (median 2-4 flares/mo), IQR 2.1-5), lasting median of 2 days. Flares preceded by worsening mood, anxiety, sleepiness - but no change in Accelerometer https://t.co/twI6wcxKf7
Dr. John Cush RheumNow ( View Tweet)
Difficult to manage SpA (D2M-axSpA) defined as failure ≥ 2 b/tsDMARDs (diff MOAs). Study of 129 axSpA pts, 8.5% were D2M, & 3% were treatment refractory (more inflammation- TR). D2M had signif higher BASFI (4.2 vs. 2.9), BASDAI (5.1 vs. 3.5), ASDAS (3.7 vs. 2.8). Predictors: https://t.co/4qdHEFxr3J
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Wisdom of Medical Aphorisms
The American Journal of Medicine and Dr. Joseph S. Alpert have curated insightful aphorisms from leading figures in internal medicine, such as Eugene A. Stead, Jr., Francis Peabody, Paul Beeson, and others, including Alpert. These timeless aphorisms https://t.co/IqjPKmlVAk
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Chondrocalcinosis Increases Osteoarthritis Risk
Analysis of data from two large, prospective cohort studies show that knee chondrocalcinosis was associated with an increased risk of incident knee osteoarthritis.
https://t.co/Jd1Wb9lWpT https://t.co/QwXn2ehNie
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