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The Great Unknowns (8.5.2022)
Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.
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ACR Updated Guideline on Vaccinations for Rheumatic Patients
The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).
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Gout Flares Up Cardiac Risks
A large case-control study showed that gout patients who experienced a cardiovascular (CV) event were more likely to have had a recent (< 120 days) gout flare compared to those without CV events.
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The Approach to Difficult to Treat Rheumatoid Arthritis
Tan and Buch have reviewed the approach to difficult to treat rheumatoid arthritis (D2T-RA), with a new EULAR definiation of D2T-RA to foster an approach rationale and concideration of treatment options.
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Durkan's Carpal Tunnel Compression Test is more sensitive (0.71) than Tinel's (0.47), Phalen's test (0.50) to detect #carpaltunnelsyndrome. - @rheumnow #RheumGR https://t.co/05U1a0HR2q
UTSWRheum UTSWRheum ( View Tweet)
Oral surveillance - tofacitinib vs TNFi in high risk pts: more infections, serious infection (SIEs) & non-serious infx with Tofa vs TNFi. SIE risk 17%-48% higher; SIE higher w/ high dose Tofa, esp in pts aged≥65. Usual risk factors - age, pred, comorbid. https://t.co/gjD8xqtfgp https://t.co/doMd4E9ClL
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Dr. John Cush RheumNow ( View Tweet)
Private insurance claims data suggests that in the last 5 yrs Lyme disease has increased 19% (urban) to 60% (rural areas). Prevalence highest in June & July. Top 5 states - NJ, Maine, VT, Rhode Island, Conn. https://t.co/QHnhiWLOk3 https://t.co/7fYWQe0nBh https://t.co/GYKekF4Enf
Dr. John Cush RheumNow ( View Tweet)
Biosimilar availability is slow coming in US (only RTX, Inflx), but by 2030 these rheumatologic biologics should be available as biosimilars:
- rituximab
- infliximab
- adalimumab
- etanercept
- golimumab
- abatacept
- tocilizumab
- ustekinumab
- denosumab
https://t.co/Jjy9xrk4PA https://t.co/4Ht7HSngHQ
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Dr. John Cush RheumNow ( View Tweet)
Supplemental Vitamin D Fails to Lower Fracture Risk
NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.
https://t.co/tY1VY3hpM2 https://t.co/22FcdnvAjL
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Dr. John Cush RheumNow ( View Tweet)
Study of Erythrocyte MTX-polyglutamates (MTX-PG1-5) levels in Crohns patients shows that age, lower GFR and subcutaneous #MTX use all significantly increase RBC MTX-polyglutamate levels (all risk factors for MTX toxicity) https://t.co/469eMqbCBC https://t.co/8LoarfIyV4
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Dr. John Cush RheumNow ( View Tweet)
Gout Flares Up Cardiac Risks
A large case-control study showed that gout patients who experienced a cardiovascular (CV) event were more likely to have had a recent (< 120 days) gout flare compared to those without CV events.
https://t.co/HVmHZ0Pi7I https://t.co/XhdLTed5mr
Links:
Dr. John Cush RheumNow ( View Tweet)
The Approach to Difficult to Treat Rheumatoid Arthritis
Tan and Buch have reviewed the approach to D2T-RA), with a new EULAR definiation of D2T-RA to foster an approach rationale and concideration of treatment options.
https://t.co/CfCvgbl3VP https://t.co/OKzyY79shU
Links:
Dr. John Cush RheumNow ( View Tweet)
Study of 57 #RA pts. w/ ILD treated with abatacept. Lung progression in 46% before ABA. After median 27 mos of follow-up, ILD
- 72% improved or stabilized
- 23% worsened
- 5% died.
No significant change in FVC, DLCO
ILD worse assoc w/ DAS28, FVC DLCO https://t.co/7H87cAJRbG https://t.co/D60QFfevpA
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Dr. John Cush RheumNow ( View Tweet)
New Updated GRAPPA Psoriatic Arthritis Recommendations
The GRAPPA treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains."
https://t.co/PkDofio1eh https://t.co/kp6UEgwonV
Dr. John Cush RheumNow ( View Tweet)
JAMA overview of Patient Reported Outcomes (PROs) - how generated, validated, used and limitations.https://t.co/572KxUO59s https://t.co/5c6xQfZqzu
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Dr. John Cush RheumNow ( View Tweet)
Krill Oil Effective in Knee Osteoarthritis
Krill oil supplements in knee OA was shown to be superior to placebo in reducing knee pain, stiffness and function while increasing the omega-3 index.
https://t.co/JkLrz5C0Pk https://t.co/XzZWXJ8zgA
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Dr. John Cush RheumNow ( View Tweet)
Plasmacytoid Dendritic Cell Inhibitor in Cutaneous Lupus
Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells.
https://t.co/qOu2jMa6EK https://t.co/LMaY7gpt05
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Dr. John Cush RheumNow ( View Tweet)
102 #RA patients in low dz activity followed for a year - half usual care vs half using smartphone assisted Pt-initiated care. DAS28 slightly increased in both groups without signif difference; app group had less visits (1.7 v 2.8; p<0.001) https://t.co/txttFjjgla https://t.co/TideQ5tVjJ
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Dr. John Cush RheumNow ( View Tweet)
Upadacitinib in non-radiographic Axial Spondyloarthritis
The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of nr-AxSpA, extending the efficacy of UPA beyond classic ankylosing spondylitis.
https://t.co/BbvOSRxbXU https://t.co/z5QOaFKrxz
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Dr. John Cush RheumNow ( View Tweet)
In the RECOVERY trial - 8156 hospitalized COVID-19 patients; those on baricitinib had significantly fewer deaths (12% vs 14% PBO) but the size of benefit was somewhat smaller than that suggested by previous trials. (adjusted rate ratio 0·87) https://t.co/EW7xLc9TLC https://t.co/Ahr7bwAQmJ
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Dr. John Cush RheumNow ( View Tweet)