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Best of 2022: Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines

d Michael Putman, MD, MSCI

In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

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Best of 2022: New Updated GRAPPA Psoriatic Arthritis Recommendations

d Jack Cush, MD

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.

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Best of 2022: EULAR 2022 Top 10 Abstracts

d Jack Cush, MD

Dr. Jack Cush reviews the top abstracts from EULAR 2022  As chosen by me with the aid of the RheumNow EULAR faculty. “Top” is relative and subjective, but my criteria for inclusion are based on impact, water cooler talk potential, innovation and social media buzz.  Speaking of social media…

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TNF inhibitors Dont Increase Cancer Risk! 4592 RA pts:TNFi Rx (2296) vs matched DMARD Rx (2296) pts. TNFi had a lower cancer risk than DMARD Rx (IR 6.5 vs. 15.6 /1000PYs]). TNFi had Lower HR GI CA (0.432), breast CA (0.146), GU CA (0.220) https://t.co/RouhT57Qkx
Dr. John Cush RheumNow ( View Tweet)
Study of 1141 consecutive gouty pts finds 10 (0.9%) with "Shrinking Toes" in those w/ tophaceous gout (usually MTP1,2) - toe shortening mainly due to lytic bone collapse during articular tophus dissolution (esp in severe gout w/ severe erosions) https://t.co/K0DzvAYoAg https://t.co/JhZWtSK7K4

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COPA, a rare syndrome w polyarthritis, ILD, pulmonary hemorrhage, w excessive STING signaling. #RWCS2022 @RWCSmtg https://t.co/EUv8sMK8dx
Dr. John Cush RheumNow ( View Tweet)
Many have quoted and shown this image of Ankylosing Spondylitis in a young military recruit at age 25, 35, 45, 50 & 51yrs. This may be the MOST used slide in rheum! It comes from the work of Toronto's Dr. Hugh Little, who sadly passed away at age 58 yrs. https… https://t.co/G28YlyhX3v
Dr. John Cush RheumNow ( View Tweet)
Retrospective study looked at 47 adults w/ dermatomyositis treated with tofacitinib. While clinically similar, those on TOFA were were younger (53vs 61), shorter Rx duration (24 vs 53 mos);there was signif CDASI improvement. #ACR22 https://t.co/nZ8NgS4cZb

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Challenges in Lupus: -Mortality greatest in 1st yr -Dx Delays 6.4 yrs -Long-term complications increased 50 fold -Steroids worsen long-term outcomes -Health care costs increased 3 to 5 years prior to Dx -Mean delay in drug starts after Dx =177 days https://t.co/NPxzluJJAV https://t.co/J2uLOfeijV

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NEJM Clinical Images: 74-yoF with psoriatic arthritis has swelling of the fifth finger; found to have nontender, subcutaneous nodules in the hypothenar region and over the fifth finger. https://t.co/ugfFGZ0CWh https://t.co/a5q1TWRqMM

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Best of 2022: Undifferentiated Arthritis Does Not Follow an RA Course https://t.co/gKzIPuIbAB https://t.co/SI1RubDi5Y

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Dr. John Cush RheumNow ( View Tweet)
Best of 2022: Acne with JAK Inhibitors https://t.co/ul0CJUTFZE https://t.co/dahLh04k4u

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Infection in lupus is suggested by very high CRP, PMN-lymph ratio (NLR) Plt-lymph ratio(PLR). Study of 104 hospitalized SLE found all very high w/ infx & Combined cutoffs of CRP >20 mg/L, NLR >3.5, PLR >151 had 87 sensitivity & 81% specificity for infx https://t.co/2ycSGhnHeK https://t.co/VZsGAK2hFs

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NEJM has published results of 2 phase 3 trials (BRAVE-AA1, BRAVE-AA2) demonstrating the efficacy of Baricitinib in aduls with severe alopecia areata - BARI was superior to placebo in hair regrowth by week 36 https://t.co/eTP2d107ti https://t.co/BMKrL5NLyg

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New Hope for Hand Osteoarthritis The drug talarozole – which increases retinoic acid – could be a promising new treatment for hand osteoarthritis. https://t.co/jVMLiJLnch https://t.co/0nk8WA2k1S

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Dr. John Cush RheumNow ( View Tweet)
Best of 2022: Methotrexate in PsA Until the publication of the SEAM trial1, evidence in the medical literature for the efficacy of the most commonly used drug for PsA worldwide, MTX, has been lukewarm at best. https://t.co/vl2u9JENpt https://t.co/SHHAfkFX9k

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Dr. John Cush RheumNow ( View Tweet)
anti-IL-23 therapy is not effective in Axial Spondyloarthritis. While ustekinumab, guselkumab and risankizumab are approved in psoriasis (& PsA for GUS, RIZ), studies of Ustekinumab and risankizumab failed to show efficacy in axSpA https://t.co/hjXEopji6r https://t.co/FwzBa2YNzb

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Dr. John Cush RheumNow ( View Tweet)
On Wednesday 12/21 the FDA approved tocilizumab (Actemra; 8 mg/kg, 60-min IV infusion ) for hospitalized COVID-19 on steroids, supplemental O2 & req ventilation, or ECMO; 1st MAb approved for COVID-19; Prev EUA issued in June 2021 https://t.co/BswLu4ZY5O https://t.co/7gpPkeoPZ4

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Dr. John Cush RheumNow ( View Tweet)
Deucravacitinib, TYK2 inhib, studied in phase II trial 203 active PsA pts randomised to PBO, or DEUC 6 mg or 12 mg qd. At wk 16 ACR-20 responses were significantly higher with DEUC 6mg (53%, p=0.0134) and 12 mg (63%, p=0.0004) vs PBO. https://t.co/0zCcYXMQOD #BestOf2022

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213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/rBNDHrb3sh #BestOf2022

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