RheumNow Podcast – FDA Hyperactivity (7.26.19)

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Dr. Jack Cush reviews the news, journal reports, and FDA releases and deliberations covered this past week on RheumNow.com

A Potential Biomarker for Chronic Fatigue Syndrome Patients

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Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

Be ‘on point’: Guidelines for rheumatic complications of immunotherapy

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Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. At EULAR 2019, Madrid, several recommendations including RA, SLE, and Sjogren’s syndrome have been developed. Agreement for principles with respect to the treatment of immune mediated adverse events from cancer immunotherapy are lacking.

EULAR 2019 - Day 1 Report

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Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. Here are a few of the highlights from day 1 EULAR in Madrid, including another IL-23 inhibitor, BTK inhibition, abatacept in Sjogren's syndrome, don't repeat the ANA, and drug free remission in systemic JIA.

Borrelia burgdorferi Peptidoglycan Shedding Drives Lyme Arthritis

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Research published in PNAS has shown that long after active Lyme infection in the joint, a peptidoglycan (PG) of the the spirochete Borrelia burgdorferi can be found in the joints of those with late-stage Lyme disease.

EULAR 2019 - Day 1 Report

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Here are a few of the highlights from day 1 EULAR in Madrid. 

Be ‘on point’: Guidelines for rheumatic complications of immunotherapy

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Preview of EULAR 2019 Abstracts

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EULAR 2019 begins today in Madrid and features over 2000 presentations.  After an initial review of titles and abstracts, I’ve compiled a hit list of presentations of interest to me and hopefully other practicing rheumatologists.  

Management of Hemophagocytic Lymphohistiocytosis (HLH) in Adults

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Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by activated macrophages and cytotoxic T cells.  HLH manifests recurrent fever, cytopenia, liver dysfunction, and a sepsis-like syndrome that may complicated by multiple organ failure.

Proinflammatory Diets May Increase CRP and RA Onset

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Despite the lack of good evidence, there has been great speculation about the role of diet in causing or alleviating inflammation. Now there's new research suggesting that proinflammatory diets can increase serum C-reactive protein levels and also the risk of rheumatoid arthritis onset.

Might IL-17 Inhibition Be Effective in RA?

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Interleukin 17 (IL-17) inhibitors are highly effective and FDA approved for use in psoriasis, psoriatic arthritis and ankylosing spondylitis. However, many of the initial trials were done in rheumatoid arthritis (RA) where it was projected to be effective, but was not. A recent metanalysis examines how effective IL-17 inhibition was in two RA populations: biologic-naïve or tumor necrosis factor inhibitor inadequate responders (TNF-IR).

RheumNow Podcast – Rituximab Monitoring (5.31.19)

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Dr. Jack Cush presents the news and best of rheumatology and medicine from the past week on RheumNow.com

2019 EULAR Guidelines on Antiphospholipid Syndrome Management

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A EULAR task force has reviewed the medical literature and developed evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. They note that a high-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS.

Predictors of Serious Infections with Rituximab

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The risk of serious infectious events (SIE) with rituximab (RTX) is similar to that seen in other biologics (e.g., RA: 2% or 4.3/100PY), but with prolonged use the risk may change. Recent research says that low IgG levels, RTX induced neutropenia, prior SIE and comorbidities can significantly augment this risk.

A retrospective longitudinal single center study of 700 rheumatic and musculoskeletal diseases (RMDs) treated monitored serum immunoglobulins (at baseline and 4–6 months after each cycle), clinical outcomes and SIE over time.

Nintedanib May Benefit Systemic Sclerosis Related Interstitial Lung Disease

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The NEJM reports a randomized placebo controlled trial of nintedanib, a tyrosine kinase inhibitor, in systemic sclerosis patients with interstitial lung disease (ILD) resulted in less pulmonary decline, but had no effect on other features of systemic sclerosis. 

Risk Score Predicts Thrombosis Recurrence in APS

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A combination risk score helped predict recurrent thrombosis -- particularly arterial -- among patients with antiphospholipid syndrome (APS), an international study found.

FDA Final Guidance on Interchangeability with Biosimilars

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The FDA has published an industry guidance document to define interchangeability as regards to biosimilar use in the United States under section 351(k) of the Public Health Service Act (PHS Act) (42 U.S.C. 262(k)). 

Methotrexate Use Not Linked to Interstitial Lung Disease in RA

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People with rheumatoid arthritis have a significant risk of developing interstitial lung disease (RA-ILD), yet there is often a question as to whether methotrexate (MTX) exposure can cause or worsen ILD.  A controlled cohort study suggests that MTX use is not associated with an increased ris

Calcineurin Inhibitors in Anti-Synthetase Dermatomyositis ILD

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A pilot treatment study of patients with anti-aminoacyl-tRNA synthetase antibody–positive polymyositis/dermatomyositis-associated interstitial lung disease (anti-ARS-PM/DM-ILD) shows therapy with glucocorticoids and calcineurin inhibitors (CNI) to be highly effective. 

Biomarkers Predict Thrombosis in Lupus

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A composite risk score that included three biomarkers predicted thrombotic events among patients with systemic lupus erythematosus (SLE), a cross-sectional study found.