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ICYMI: 2021 Rheumatology Year in Review
For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.
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ICYMI: Adalimumab Addition vs. Methotrexate Escalation in Psoriatic Arthritis
An interesting study in Lancet Rheumatology shows that psoriatic arthritis patients not responding to methotrexate alone can respond after adding or escalating adalimumab on top of methotrexate to reach minimal disease activity (MDA) response.
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Proposed investigations (findings) in the diagnosis of Stills disease:
- CRP, ESR, Ferritin (high)
- W/U for infection, cancer (negative)
- Serologies (negative)
- consider Imaging (CXR, CT, US, PET)
https://t.co/l3yqAx6PA0 https://t.co/Sg7okwKHaw
Links:
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Guidelines for MAS complicating Systemic JIA: Dx is based on:
- Fever in sJIA with ^ ferritin > 684, plus
- Any 2 of these: elevated PLTs, AST, Triglycerides or low Fibrinogen
https://t.co/aIEvxRYZca https://t.co/DYpLHxRCzI
Links:
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Cyclic GMP–AMP synthase (cGAS) engages stimulator of interferon genes (STING) to trigger inflammatory cytokines & type I interferons. cGAS–STING activation by genomic or mitochondrial self DNA implicated in autoinflammatory & autoimmune dz https://t.co/7CEFt9wLrl https://t.co/HpHhjJOATd
Dr. John Cush RheumNow ( View Tweet)
Five Mistakes When Diagnosing Still’s Disease
AOSD is likely to be the adult continuum of systemic-onset juvenile arthritis (sJIA) and hence, frequently affects young men and women below the age of 35 years.
https://t.co/C9kUOpFIlc https://t.co/82GIA7hSJl
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Tofacitinib had faster and larger impact on improvement of fatigue compared to placebo in treatment of ankylosing spondylitis pts.
Note 100% fatigue resolution roughly same vs. placebo
@RheumNow #EULAR2022 ABST#POS0305 cc: @doctorRBC : https://t.co/sodp75Nblw
Dr. John Cush RheumNow ( View Tweet)
Li et al. Orelabrutinib in SLE. 60 patient phase 2 RCT. Week 12 SRI(4) 50.0%/61.5%/64.3% in orelabrutinib groups vs 35.7% PBO. @RheumNow #EULAR2022 LB0005 https://t.co/wWJhlY5IYW
cc: @RichardPAConway : https://t.co/2IAURdfAOB
Links:
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#EULAR2022 Prof Schulze-Koops highlighted a mechanistic study that baricitinib therapy ex vivo suppressed autophagy, increased apoptosis, and reduced expression of adhesion molecules in #sjogren salivary glands. Next step should be randomised controlled trial cc: @Yuz6Yusof https://t.co/1tDBNzTuwQ
Dr. John Cush RheumNow ( View Tweet)
In vitro study shows Upadacitinib inhibits enthesis T cell derived TNFa and IL-17A, disrupting the prominent IL-23/IL-17/TNFa axis driving SpA.
@RheumNow #EULAR2022 ABST#POS0331
cc: @doctorRBC https://t.co/M8YYAOBVat
Dr. John Cush RheumNow ( View Tweet)
#OP0004 #EULAR2022 In line with EULAR President’s preech to go Digital, Prof Mosca highlighted a study which showed assessment of joints in RA could be done by taking photos and analysed their dorsal skin folds using convolutional neural network
cc: @Yuz6Yusof : https://t.co/mn48vXtGad
Dr. John Cush RheumNow ( View Tweet)
Bimekizumab: IL-17A and F inhibitor for tx of PsA - BE OPTIMAL trial reached primary endpoint: ACR50 44% vs. placebo
Efficacy as early as 2 weeks
No MACE, uveitis, IBD, deaths
@RheumNow #EULAR2022 ABST#LB0001 cc:@doctorRBC : https://t.co/wgeBsfdQcL
Dr. John Cush RheumNow ( View Tweet)
Prof Hoi @alberta_hoi Anti-Sm in SLE. Present in 17%. Assoc severe disease activity, "classic" SLE manifestations, specific serologic and proteomic profile. Argues for Sm+ SLE being a specific subset (or even a "different" disease?)
#EULAR2022 POS0774. cc: @RichardPAConway https://t.co/cwp6q4kouz
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#Bestinclass Recurrent #PMR RCT of #sarilumab v placebo. Nearly doubles sustained remission but maybe attenuating effect - flare difference over time? N=118. 🤷♀️ Dunno who I would use it in yet. LB0006 @RheumNow @eular_org #EULAR2022
@Janetbirdope
Dr. John Cush RheumNow ( View Tweet)
SELECT-AXIS 1 trial of upadacitinib in active #AS with an inadequate resp to prior biologic - pivotal phase 2/3 RCT of 420 AS pts (Dz dur 7.7 yrs; 83% B27+) showed better ASAS40 at wk 14 w/ UPA vs PBO (45% vs 18%; P<0.0001) #EULAR2022 POS0306 https://t.co/JmreAOqnqh https://t.co/pTFeAzWUYU
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Solving Still’s Disease
Still's disease is the most common rheumatic cause of unknown fever in adults. This series covers the definition, history, epidemiology, key manifestations and labs, diagnostic criteria, and more.
https://t.co/YqpSW6T3El https://t.co/vwehTCm4aN
Links:
Dr. John Cush RheumNow ( View Tweet)
Allopurinol Safety in CKD Patients
A study in the Annals of Internal Medicine reports chronic kidney disease (CKD) patients can be safely treated with allopurinol without an increased risk of mortality.
https://t.co/qUQmuZedJq https://t.co/u2Ntjd1oio
Links:
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QD Clinic - Stills (or Not) MAS off of Tocilizumab
https://t.co/YGEifF5X8K https://t.co/719RjYzbE3
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CDC: Immunocompromised account for 12.2% of all COVID-19 hospitalizations, with an increased risk of ICU (aOR=1.26) and death (aOR = 1.34), even if vaccinated (aOR 1.40; aOR = 1.87). In immunocompromised, death rate was not affected by vaccination. https://t.co/PVRnOPb9gX https://t.co/W2S9eb1cOo
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Here's a reference for the Salmon-pink skin rashes in adult-onset Still's disease; distinctive in color (faint, salmon-pink), distribution (trunk, neck extremities), and evanescence (comes and goes within the same day). These are not static eruptions! https://t.co/BgzyQeiLyW https://t.co/c3aolVfpav
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Dr. John Cush RheumNow ( View Tweet)