Curative direct-acting antiviral therapy (DAAT) for hepatitis-C virus (HCV) infection has been revolutionary, but a novel report shows that nearly one quarter of DAAT treated patients developed new onset or significant worsening of MSK symptoms, despite being negative for hepa

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow: filgotinib rejection, delays in diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX.

JAMA Network Open reports that after adjusting for inflammation, lupus anticoagulant (LA) is significantly increased (positive) in COVID-19 patients and that LA positivity was associated with incidence risk of thrombotic events.

Dr. Jack Cush updates the news and journal articles from the past week on RheumNow.com, with information on enthesitis, nr-Ax-SpA, UAB, Blockbuster Rheum Drugs and use of ACE inhibitors.

Several recent publications have focused on the risk and outcomes of rheumatic disease (RDD) and autoimmune patients who become infected with SARs-CoV-2.

Following are the latest CDC numbers for COVID-19 in the U.S., including total cases and deaths; the states with the highest number of COVID-19 deaths; and COVID-19 healthcare case numbers.

Risk factors for perioperative infections include age, comorbidity, rheumatoid arthritis and steroids to name a few; whether concurrent use of TNF inhibitor (TNFI) therapy adds to this risk has been debated. In a study of elderly patients receiving infliximab infusions, infliximab use prior to surgery did not change the risk of post-operative infections.

An observational study of patients with systemic autoimmune inflammatory rheumatic diseases (AIRD) who also had COVID-19 disease shows that AIRD increased the risk of hospitalization, but that the use of disease-modifying antirheumatic drugs (DMARDs) were not associated with hospitalization.

JAMA Internal Medicine has posted an Editor's note on the use of hydroxychloroquine for COVID-19; noting the sequence of dysfunction since the president promoted its use on March 21, 2020, when he said “What do you have to lose? I’ll say it again: What do you have to lose? Take it.”.

Dr. Jack Cush reviews the news and TOP 13 list of Best Rheumatology Hospitals.

A proof-of-concept study published in Annals of Rheumatic Disease suggests that colchicine significantly improves COVID-19 outcomes.

Efficacy and safety must be determined in controlled clinical trials.he outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties.

In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population. 

According to a small, observational study out of UCLA published as correspondence in the NEJM on July 21, 2020, those with mild COVID-19 symptoms showed an approximate antibody half-life of 73 days.

COVID-19 infection was confirmed by PCR in 30 out of 34 study participants. The remaining four patients developed consistent symptoms and cohabitated with a person who had a known positive test but could not get testing due to availability or mild symptoms.

The number of reporting cases of COVID-19 infection tends to underestimate the true prevalence of infection as only the more severe cases (e.g.,acute respiratory syndrome) get tested or go to the hospital. JAMA Internal Medicine reports that a cross-sectional seroprevalence study from the U.S. shows that COVID-19 is underreported and that actual infection rates can be 6 to 24 times more prevalent than currently reported infections due to SARS-CoV-2.

A recent study from the Netherlands has shown that patients with severe COVID-19-associated cytokine storm syndrome (CSS)  with high dose steroids and tocilizumab had a faster recovery, less need for invasive mechanical ventilation and fewer deaths when compared to CSS patients receiving supportive care only.

They studed COVID-19 patients with CSS, defined as rapid respiratory deterioration plus at least two of the following biomarkers: a) C-reactive protein >100mg/L; b) ferritin >900 µg/L; or c) D-dimer >1500 µg/L.

Inflammatory events following infection with SARS-CoV-2 can often worsen the morbid or mortal outcomes with COVID, yet it has been unclear if glucocorticoids may modulate inflammation-mediated damage and lung injury.  The RECOVERY trial reports that dexamethasone (DEX) use lowered 28-day mortality among COVID-19 patients requiring respiratory support.

The RECOVERY trial was performed in the UK and enrolled hospitalized COVID-19 patients who were randomly assigned patients to usual care alone or the addition of oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days. The primary outcome was 28-day mortality. 

From January 1, 2020–May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19–associated deaths were reported in the United States.

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.