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GRAPPA,PsA,guideline

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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acne

Best of 2022: Acne with JAK Inhibitors

d Jack Cush, MD

JAK inhibitors have become enormously popular and while their side effect profile has been delineated and reviewed, little mention is made of acne – an adverse event that may affect up to one-quarter of patients taking JAK inhibitors (JAKi). Dermatologists often refer to this side effect as "JAKne".

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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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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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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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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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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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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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Lit review of MDA5 antibody-positive clinically amyopathic dermatomyositis w/ ILD - shows limited data from 15 studies, 388 pts, 1 RCT: ? best survival with high-dose steroids + immunosuppressive (CTX or CyA/tacrolimus). Refractory dz Rx w/PLEX, Tofa, RTX https://t.co/8yE4B3SfRg

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Allopurinol Use Does Not Increase Mortality in Gout w/ Chronic Kidney Disease A trial has shown that allopurinol use dose escalation and achieving target uric acid levels, was not associated w/ increased mortality in patients with gout and concurrent CKD. https… https://t.co/IIBo3aOLio
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Lumbar spinal stenosis affects 103 million worldwide (11% of older adults in US). 1st line Rx is activity modification, analgesia, PT. Benefits of epidural steroids havent been established. Decompressive surgery only for selected pts w/ pain & limitation https://t.co/zye3p5j2Hn https://t.co/HzVGLT8Qgl

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Hyperuricemia as a biomarker of severe #PsA? Study of 242 PsA pts 30% had hyperuricemia & 6% had gout. Hyperuricemia was significantly associated with age, comorbidity, perph polyarthritis, Jt destruction, less response to treatment. https://t.co/6uUWYPyFKf https://t.co/9nVj0lYwMO

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Study of 119 SLE pts (30 w CKD) shows urinary galectin-3 binding protein as a biomarker, increased w/ active LN, significantly (p<0.001)correlating w/ SLEDAI, SLICC RAS, histologic activity; higher in proliferative vs membranous LN (p=0.04) https://t.co/DlJzREdj0h https://t.co/peqZzpQrWk

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JAKi not yet safe in pregnancy - theyre fetotoxic at high doses (animals). JAKi do cross placenta. ACR Guidelines: no position due to no data. 47 tofa Rheum & 15 UC maternal exposures - no signif probs. Paternal use of JAKi is ok. https://t.co/o4zqwwHwU9 https://t.co/NfFu3rb3gD https://t.co/72bJgfC6zx

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