RheumNow Podcast – ACR 2019 Round Up (11.15.19)

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Dr. Jack Cush presents his favorite abstracts and presentations from Rheumatology Round Up and ACR 2019.

Methotrexate and the Risk of Lung Disease

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Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.

Patients Prefer Nurse Led Care for their Gout

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Despite the well known, well publicized treat-to-target (T2T) goal of a serum uric acid (SUA) level 6 mg/dl, this goal is seldom achieved ( 40%) in clinical practice and patient adherence has been unacceptably low. A recent study shows that nurse-led care led to better outcomes in gout including patient acceptability, long-term adherence, and less flares.

Joint Injections: Are They Worth the Risk?

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Intra-articular injections of corticosteroids for relief of the pain of hip or knee osteoarthritis (OA) may have adverse long-term consequences, researchers suggested.

ACR 2018 - Day 1 Report

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Highlights from Tuesday and Wednesday (days 3 and 4) from the ACR annual meeting include: the important and impactful abstracts covered by the Rheumatology Roundup session; upadacitinib clinical trials; and the baricitinib CV and VTE safety analysis.

Declining Trends in Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis Mortality in the USA

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Annals of Internal Medicine reports that age-adjusted mortality rates for antineutrophil cytoplasmic autoantibody–associated vasculitides (AAV) have improved over time - with a decline of nearly 2 percent per year in the United States from 1999 to 2017. Nevertheless, long-term outcomes continue to lag behind mortality rates of the general population.

RheumNow Podcast – Women Take Over Rheumatology (10.4.19)

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Dr. Jack Cush reviews the News and Journal Reports from this week on RheumNow.com.

FDA Approves Rituximab for Children with GPA

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The U.S. Food and Drug Administration has approved Rituxan (rituximab) for the treatment of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) in children 2 years of age and older in combination with glucocorticoids.

This is the first approved treatment for children with vasculitis.

Sensitivity of Temporal Artery Biopsy

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Metanalysis shows that temporal artery biopsy (TAB) for the diagnosis of giant cell arteritis (GCA) has a sensitivity of 77%, similar to results seen with temporal artery imaging. These data suggest clinicians may be willing to accept a GCA diagnosis without proof by TAB.

Nintedanib FDA Approved for Scleroderma Lung Disease

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Last Friday, the US Food and Drug Administration approved Ofev (nintedanib) to slow the rate of decline in pulmonary function in adults with interstitial lung disease associated with systemic sclerosis or scleroderma, called SSc-ILD.

ILD as a complication of SSc may lead to progressive loss of lung function and may be associated with a significant mortality risk. Prior to the approval of Olev, there were no FDA approved drugs for SSc-ILD.

Tocilizumab Shows No Increase in Cardiovascular Risk

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The ENTRACTE trial examined the risk for major adverse cardiovascular events (MACE) in RA patients and found no increased risk of MACE in patients treated with tocilizumab (TCZ) versus etanercept (ETN).

Checkpoint Inhibitors: Who Gets Myocarditis?

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The usual risk factors for myocarditis may not apply to who gets it while on immune checkpoint inhibiting cancer drugs, an FDA adverse event database suggested.

RheumNow Podcast – Antibiotics Increase RA Risk (8.16.19)

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Dr. Jack Cush reports the news and important journal articles from the past week on RheumNow.com.

War on RA - Part 3: Useless Drugs

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We have options that are endless – we have 28 biologics in rheumatology; 19 approved for RA in the last 20 years, but 15 of these are me-too copies or biosimilars. We currently have 2 JAK inhibitors and may have 3 or 4 by year end. But what we really need is the right drug, at the right time, in the right patient – but how will we know.

EULAR Recommendations on Large Vessel Vasculitis

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Th European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) was originally published in 2009. Since then there have been new randomised clinical trials and cohort analyses leading to an update the original recommendations.

FDA Approves Apremilast for Behcet's Oral Ulcers

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The US Food and Drug Administration (FDA) has approved apremilast (Otezla) for the treatment of oral ulcers associated with Behçet’s Disease, a rare chronic multisystem inflammatory disease that affects about 5 in 100,000 persons in the USA.

RheumNow Podcast – EULAR 2019 Streamin' - (6.14.19)

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Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. Dr. Jack Cush reports from Madrid on several novel presentations from EULAR 2019, including low-dose steroids in hand OA, ABA vs. ADA in double positive RA patients, psoriasis predictors of PsA, tildrakizumab and more.

Steroids in GCA and PMR Increase Infectious Risk

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A large study of UK family practice patients shows that polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) patients treated with glucocorticoids are at an increased risk of bacterial, viral, parasitic and fungal infection, even at daily doses of less than 5 mg prednisolone.

RheumNow Podcast – EULAR 2019 Streamin' - (6.14.19)

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Dr. Jack Cush reports from Madrid on several novel presentations from EULAR 2019.

1. Genovese Vagal nerve stimulator in RA

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.