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JAK Inhibitors in Difficult Still’s Disease
A small retrospective study suggests that patients with difficult to treat adult-onset Still's disease (AOSD) or sytemic juvenile idiopathic arthritis (sJIA) may respond well to JAK inhibitor (JAKi) agents - presumable by blocking pro-inflammatory cytokines, notably IL-6 and IFN.
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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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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/Tx4UnDf5m3 https://t.co/bsh2DQYGc9
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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/nmadPUhlyH https://t.co/4UbNPMtxIh
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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/IqKdvRkcgZ https://t.co/cieXqJABTL
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Approach to ILD in Myositis Syndromes
Mehta et al have published a full read review of managing ILD in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.
https://t.co/av6fVqASme https://t.co/utHJ9oiyRq
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The FDA has extended its indications for ustekinumab (Stelara) for use in pediatric psoriatic arthritis aged 6 years and older. Pediatric PsA makes up 6% of all pediatric inflammatory arthritis pts. https://t.co/7bGJ0ZCJJl https://t.co/GtuXdHj3Og
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FDA has approved a topical PDE4 inhibitor Roflumilast (Zoryve) a 0.3% cream for use in Plaque Psoriasis (Age 12 and Older) https://t.co/UwDf3UkuZI https://t.co/5l4xE1LaxA https://t.co/PpwiKYUpdN
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#RA disease activity drives risk of hospitalized infections (SIE). Study of 3,254 RA pts w/ 529 hospitalized infx. SIE seen 3.8/100 person Yrs in remission, 6.6/100PY w/ low Dz activity & 8/100PY w/ moderate Dz activity. HR was 1.60 w/ LDA and 1.83 w/ MDA https://t.co/i4bSsnRiHk https://t.co/kcN9ZvpSOn
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PsA Females: more likely to have Peripheral arthritis, have more pain, fatigue, poor function, lower QOL and less likely to have xray damage (than men)
Males: more axial dz & severe psoriasis
PsA Women may need more psychosocial support & pain management https://t.co/ZYWYu1K3jW https://t.co/xZX913vGdX
Dr. John Cush RheumNow ( View Tweet)
QD Clinic - Still's (or Not): an FUO Evaluation
A young man with fever up to 104F, has a complex history.
Is this Still's disease or not?
https://t.co/k47Kz3onCn https://t.co/UVMaaU1uPO
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521 clinically suspect arthralgia (CSA) pts were assessed - Low educational attainment was associated with increased risk of developing inflammatory arthritis (HR = 2.35), independent of BMI & smoking https://t.co/h1bXDfxaQk https://t.co/g2ign0HDmj
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Evusheld works & reduces COVID-19 by 77%; yet only 25% of available Rx has been used. Its FREE to the ~7000 immunocompromised pts who might benefit from it. Repeat doses (300 mg) every 6 mos! Time to jump on this! https://t.co/BSi7EtJytf https://t.co/GafjXXZ2ny
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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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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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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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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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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
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