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MTX Fails Knee OA (6.6.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com
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Denosumab and Osteoporosis - A JAMA Review
An overview of denosumab use in osteoporosis (OP) by Bauer and Ensrud was published in JAMA
https://t.co/3d7Q61nVKM https://t.co/i3DjtcsuWo
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Rules on Mycophenolate Use in SLE
Dr. Diane Kamen. a rheumatologist and lupologist from the Medical University of South Carolina in Charleston, South Carolina, discusses the use of mychophenolate in the management of systemic lupus.
https://t.co/ieiUNYQbsB https://t.co/KlC0dO06tc
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Let the young know they will never find a more interesting, more instructive book than the patient himself." – Giorgio Baglivi
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Do SGLT2 and GLP-1 therapies have a role in Lupus?
Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP1-RA), initially developed to lower glucose in Type 2 Diabetes, also provide cardiovascular and renal protection for patients https://t.co/JxnbgeqgOp
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SLE Treatment Landscape: Abundance or Overload?
Imagine a world where the multiple drugs in Phase 2 and 3 trials actually get approved, and we get access to them? I know you may be thinking that I am overly optimistic, but there are so many drugs in development in lupus that we https://t.co/xLgSU4ZLgP
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Metanalysis of 12 trials, 12 902 adults hospitalized w/ COVID betw May, 2020 & March, 2022 (7 Bari, 3 Tofa, 2 Ruxo). Fewer deaths in those on JAKi (11·7% vs 13·2%; aOR 0·67 [95% CI 0·55–0·82]; high-certainty evidence); 39 fewer deaths/1000. JAKs had less mechanical ventilation https://t.co/QSMRo3RcRr
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Systematic review of JAK inhibitor use in systemic sclerosis - 18 articles/87 SSc pts (80%F; ages 13–78 yrs). JAKi (83% tofa) mostly used for ILD & Skin Dz (45%) or GI+Skin Dz (39%). 87.5% improved, w/ 6% relapsed. Adverse events in 50% (20% infx). We need RCTs! This could be a https://t.co/lNFEX08Vn3
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Blau syndrome -a rare autoinflammatory Dz w/ triad of granulomatous dermatitis, arthritis, & uveitis (may cause blindness); from a NOD2 gain-of-function mutations. Onset age 2-4 yrs. Early biologics (esp TNFi) may prevent joint complications; but metanalysis shows no preferred https://t.co/wYTNv50tqM
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IL-40 is elevated in systemic sclerosis (SSc). Study of serum (90 SSc vs controls/HCs), Skin Bx (5 SSc v 5 HCs). IL-40 signific. upregulated in the skin & correl. w/ ESSG (r = 0.37), GI dz; also w/ serum IL-8, TGF-β1. IL-40 functionally linked to activated B cells, PMNs, T https://t.co/XsSFXgBxuD
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PETRI-isms: "The patient is always right (even when they are wrong)." - Dr. Michelle Petri
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Methotrexate Fails in Knee Osteoarthritis
We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.
https://t.co/Y9elFXTkhN https://t.co/oqDDVPGbh7
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135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/HbwYDVrIAt
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In 2019 there was an estimated 273,000 coccidioidomycosis cases in the USA; 23,000 hospitalizations and 900 coccidioidomycosis-associated deaths. Mostly from endemic states California & Arizona. https://t.co/JXPs8B4Dwb https://t.co/90e1TYxGoW
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Positive results from Phase 2b RENOIR RCT of Rosnilimab, an agonist targeting PD-1+ T cells. 432 RA pts on MTX or csDMARDs, Rx w/ 6 mos of PBO vs ROS (100 or 200 mg q4wk or 600 mg q2wk). All 3 doses of rosnilimab achieved significant reductions DAS-28 CRP at Wk 12 https://t.co/6nF8KPRK2f
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Systematic review of fibromyalgia & sleep quality - 47 RCTs, 11094 pts showed CBT for insomnia had a significant improvement in sleep quality; but CBT for pain had no impact. Only moderate improvement w/ pregabalin, sodium oxybate; but no effect w/ amitriptyline, milnacipran, https://t.co/AEqbShRh6e
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UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/ObssKGcomq
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Single-centre retrospec study of 39 Juvenile Dermatomyositis pts Rx w/ JAKi. Partial/complete Clin inactive Dz achieved in 32/39 w/in 6 months w/ steroid reduction and W/D of other DMARDs. Only TIF1γ) Ab (+) was assoc w/ nonresponse to JAKi (P < 0.001). 5 w/ H. Zoster
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Psychological Bulletin has published that invalidating (gaslighting) pts Sxs can have harmful consequences. Includes pts dx w/ Ehlers-Danlos, endometriosis, fibromyalgia, ME/CFS, POTS, Gulf War, IBS, long Covid, multiple chemical sensitivity, SLE, and vulvodynia.
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Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
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